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147 thoughts on “Why We Get Fat

  1. Fifi says:

    These kinds of eating habits are related to wealth, obviously, in poorer nations people are much more likely to be using the whole animals and a wider diversity of fruit and veg (ie. anything available).

    Industrialization of food has also had a big impact upon regional foods and cuisines, not to mention learning to cook in and of itself. If processed, packaged foods are cheaper and more readily available, people simply don’t learn how to cook (the skills aren’t passed down through the generations). They may be a far inferior quality – and ultimately more expensive in the longterm – but for the working poor (who tend to work much harder than the working wealthy, particularly if we’re talking single parent families) the appeal is obvious. The very wealthy often don’t cook for themselves either but they tend to have an actual cook.

    Our relationship to both cooking and eating has changed a lot. Cooking has in some ways become a hobby or craft rather than a basic life skill. Not only do less people know how to cook, despite all the cooking shows on TV (another signifier of cooking as a hobby), but we also tend to approach eating as less of a communal and shared experience. (As a gros generalization, obviously individual families and certain cultural/social groups fall outside of this generalization.)

  2. “People’s desire for steak and cake was driven by class/luxury more than anything else really.”

    Actually, they are driven by desirablility. We desire things that are hard to get to make sure that we get them.

    We like sweet things — even newborns who have never been exposed to candy marketing. Ripe fruit is sweeter and more calorie-dense than unripe fruit and than vegetables. Starchy, high-calorie vegetables are sweeter than low-calorie vegetables.

    We like fat. We like salt. We like umami. Meat is hard to get — it often runs away, may be dangerous, may be guarded by another carnivore or scavenger, and needs processing. We wouldn’t bother if we didn’t really like it.

    We don’t stop really liking these things just because industrial agriculture and food processing and distribution have made them easy to get. We still really like them.

    Of course there are wealth and class signifiers associated with food. Plenty of them. But we like meat and fat and sugar because we’re omnivorous animals. (Dogs find these things extremely desirable too, and it’s not because they signify wealth.)

  3. “But we like meat and fat and sugar because we’re omnivorous animals. (Dogs find these things extremely desirable too, and it’s not because they signify wealth.)”

    When I was a kid, my mom (I think) used to say that if you crave something, like liver, then that means your body is sending you a signals that it is low in that nutrient, like iron.

    To a certain extent I don’t believe this. From what I’ve read, evolutionarily, we are inclined to crave scarcity, fat, high calories foods, to protect against times of famine.

    But, when I was in Kazakhstan in the winter, when most of the diet was meat, bread, pasta, very cooked potatoes, onions and the occasional cooked vegetable, and candy (As a visitor, it’s difficult to eat fresh greens, veggies some fruits, due to contamination issues). I was really craving a salad or other green veggy. And oddly, after a few weeks, I looked like I needed a salad. My skin was dull. Of course this could have been my imagination or just that a change of diet is hard on your body, like it is for dogs, but since then, I’ve always wondered if there was some truth to the food craving/ low nutrient belief.

    Just speculation

  4. Fifi says:

    Alison – Certainly we enjoy fat, sugar, salt and caffeine (and cocaine, etc) for biological reasons. I didn’t mean to imply the only reason why we enjoy them is because of the status they convey, my main point (which I obviously wasn’t clear about so my bad) was that one reason why steak, sugar and refined flour is so ubiquitous is because they were historically viewed as a luxury item in the US and UK, which is part of what has led to them being marketed (often poorer quality versions with less of the obvious appeal).

    Obviously there are a confluence of factors that range from biology and psychology to industrial farming (which gives us the ability to grow/raise larger quantities) and marketing but economic/social attitudes/beliefs do play a role in regards to what is considered desirable and what isn’t (this goes for other items too, for instance, Burberry stopped making a certain item because it had become to popular with Chavs in the UK). In other cultures the coveted foods are different because of different social beliefs and we quite often find these foods quite disgusting or boring (shark fins in China, sheeps eyes in some Arabic cultures, etc).

    As for the fatty argument, there are plenty of fatty cuts of meat that are considered less desirable than a lean steak so it’s not just about fat. In fact, the trend has been towards leaner cuts of meat being the most desirable and expensive (though obviously they don’t taste as good so you’re going to find less of this in the top restaurants).

  5. Jan Willem Nienhuys says:

    I don’t much about food, but I think that once one is too fat, one needs a lot of energy to haul around that extra weight. For example a person of 1.70 meters (that is 5 foot 7 inches in prehistoric units) having a BMI of 24 weighs just over 69 kilogram (152 prehistoric pounds). If the same person is obese (BMI 31), s/he carries 24/7 the weight of a standard suitcase of the maximum weight you can take with you on an airplane.

    That takes extra energy so makes you want more food. If such a person want to lose weight she’ll have to get used to feeling hungry all the time.

  6. SarahAnn says:

    @tmac

    “SarahAnn- You seem very disdainful and dismissive of what mainstream nutrition science recommends,yet you seem all too willing to buy in to Taubes’s work. Why is that? Are his references the ‘good’ science?”

    I’m not dismissive of all ‘mainstream’ nutrition science (whatever that is) I agree with a lot of the current recommendations (avoid trans fats, eat oily fish, low refined sugar), don’t try to make me out as some alternative kook.

    I don’t ‘buy’ into Taubes work either. I stated in my first comments that his carbohydrate hypothesis is most likely false and that there is plenty of better critiques of his work than this one. But on the saturated fat front and how the current recommendations were formulated I see a well referenced position that has since been backed by high-quality systematic reviews of the current science:

    http://www.ajcn.org/content/early/2010/01/13/ajcn.2009.27725.abstract

    http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7930322&fulltextType=RV&fileId=S0007114510004010

    The McGovern report in 1977 is largely credited with forming the current guidelines wrt restricting fat in the diet. They stated that dietary cholesterol needed to be restricted in order to reduce blood cholesterol. Every single controlled trials since then has been shown this to be untrue, dietary cholesterol has no influence on blood cholesterol, and yet the AHA still recommendations to restrict eggs to 3-4 yolks per week. Why?

  7. Fifi says:

    The problem with pushing the Mediterranean diet as a being “scientifically proven” (as opposed to just a diet high in fruit and veg) is that uncritically doing so actually ignores a whole slew of factors. This isn’t saying that rigorously adhering to the diet isn’t going to be good for your health, it’s just to point out that rigorously adhering to any diet high in fruit and veg, when combined with exercise, has this effect. There’s a somewhat faddish focus on calling it a “Mediterranean diet”(and, of course, there was a populist book accompanying it) and lots of guesswork around why it’s protective (ye olde correlation isn’t causation issue, as well as the effect of carefully monitoring diets on how people eat combined with a switch from a high fat, high sugar diet with no exercise to a diet high in fruit and veg and starting to exercise). The Mediterranean Diet has it’s own faddish “miracle food” aspect too (in this case olive oil). This is not to say it’s not a healthy diet, it’s just to say that any diet high in fruit and veg, when combined with regular exercise, seems to be a healthy diet. Particularly if you live in a nice sunny country, eat fresh local produce and walk everywhere.

    “Mireille Guiliano credits the health effects of the Mediterranean diet to factors such as small portions, daily exercise, and the emphasis on freshness, balance, and pleasure in food.[21]

    Dietary factors are only part of the reason for the health benefits enjoyed by certain Mediterranean cultures. A healthy lifestyle (notably a physically active lifestyle or labour) is also beneficial.[22] [23] Environment may also be involved. However, on the population level, i.e. for the population of a whole country or a region, the influence of genetics is rather minimal, because it was shown that the slowly changing habits of Mediterranean populations, from a healthy active lifestyle and Mediterranean diet to a not so healthy, less physically active lifestyle and a diet influenced by the Western pattern diet, significantly increases risk of heart disease.[24] [25] [26] There is an inverse association between adherence to the Mediterranean diet and the incidence of fatal and non fatal heart disease in initially healthy middle aged adults in the Mediterranean region.[27]

    A 10-year study published in the Journal of American Medical Association (JAMA) found that adherence to a Mediterranean diet and healthful lifestyle was associated with more than a 50% lowering of early death rates.[28]

    The putative benefits of the Mediterranean diet for cardiovascular health are primarily correlative in nature; while they reflect a very real disparity in the geographic incidence of heart disease, identifying the causal determinant of this disparity has proven difficult. The most popular dietary candidate, olive oil, has been undermined by a body of experimental evidence that diets enriched in monounsaturated fats such as olive oil are not atheroprotective when compared to diets enriched in either polyunsaturated or even saturated fats.[29][30] A recently emerging alternative hypothesis to the Mediterranean diet is that differential exposure to solar ultraviolet radiation accounts for the disparity in cardiovascular health between residents of Mediterranean and more northerly countries. The proposed mechanism is solar UVB-induced synthesis of Vitamin D in the oils of the skin, which has been observed to reduce the incidence of coronary heart disease, and which rapidly diminishes with increasing latitude.[31] Interestingly, residents of the Mediterranean are also observed to have very low rates of skin cancer (which is widely believed to be caused by over-exposure to solar UV radiation); incidence of melanomas in the Mediterranean countries is lower than in Northern Europe and significantly lower than in other hot countries such as Australia and New Zealand. Its been hypothesized that some components of the Mediterranean diet may provide protection against skin cancer.”

    http://en.wikipedia.org/wiki/Mediterranean_diet

    Just to say, if we’re going to blast other faddish “brand name” diets for things such as being easier to adhere to under observation, mainly being effective because the person switches from an unhealthy diet and no exercise to more fruit and veg and exercise, and your basic correlation isn’t causation miranda warning, the same needs to be applied to the Mediterranean diet.

    We’re still really in the infancy of both nutritional and exercise science, which is one reason why there’s so much quackery around both diet and exercise. I don’t really see a huge difference between someone getting healthy and losing weight on a Mediterranean Diet 9which is high in salt so not for everyone), a low carb one or Michael Pollan’s very sensible but hardly scientific “eat food, not too much, mostly plants” (Pollan, incidentally, also writes “the whiter the bread, the sooner you’ll be dead.”) In the real world, cutting out white bread can be a very effective way to lose weight. In the real world, it seems like a diversity of approaches for a diversity of people is what’s needed and is the most practical.

    http://en.wikipedia.org/wiki/Michael_Pollan

  8. “This is not to say it’s not a healthy diet, it’s just to say that any diet high in fruit and veg, when combined with regular exercise, seems to be a healthy diet. Particularly if you live in a nice sunny country, eat fresh local produce and walk everywhere.”

    I would just add that another additional aspect of the Mediterranean cooking (I can’t speech to the diet, I haven’t read up much on that.) is the use of different beans as protein. You see this quite a bit in Italian and Mediterranean/Middle Eastern food. If one is cutting back on meat or just wants to add more variety to their cooking, beans are a nice way to go.

    Also soup, lots of soup in Italy. Which I think is quite healthy, a filling way to limit portion size.

    Also, I find Mediterranean foods (more of the Italian variety) and or rustic french (well that’s what the cookbook I have calls it) easier to prepare than french cuisine (which is apparently only healthy to the french and will kill anybody else on sight :) , but also most Asian recipes I’ve come across, which are complex. This is, of course, if you can steer away from the recipes calling for boar and squids ink…which are a little difficult to obtain in the States.

    So, nothing glaring wrong with the content, lots of fruits and veggies, good meat alternative using easy to moderate preparation. Those are the reason’s that I think Mediterranean cooking may be a healthy approach for a typical American. But, I really think it depends on the individual and their taste preferences.

  9. Ben Kavoussi says:

    The whole fat debate in the US is suffering from “navel-gazing,” meaning “self-absorption.”

    One has to go other countries to realize it. By traveling outside of US, you will realize that it is not WHAT we eat, but HOW MUCH eat that determines if we can fat or not.

    Gluttony was once considered a sin. We now think it is OK, and being fat is also socially acceptable. It is embedded in our culture.

  10. Fifi says:

    Ben – Maybe it’s a case of just being very, very occupied with trying to actually find their navel to gaze at….

  11. Ben Kavoussi
    “Gluttony was once considered a sin. We now think it is OK, and being fat is also socially acceptable. It is embedded in our culture.”

    Well lots of things were once considered a sin… sex*, loaning money, homosexuality, and now to a certain extent they are all embedded in our culture. I would point out that we no longer put adulterers in the stocks anymore.

    I’m curious though, if being fat is so socially acceptable, what’s up with bulimia and anorexia? Also why are all the models size 00 these days?

    *The Shakers didn’t have much luck with forming a religion that preached complete abstinence from sex…but they did make some lovely furniture.

  12. tmac57 says:

    micheleinmichigan-You can talk about bulimia,anorexia,and fashion models all you want,but one trip to Wal-Mart,will tell you who is winning the battle of what is socially acceptable when it comes to weight is the U.S.A.

  13. Mandos says:

    That’s absurdly naive. It merely means that the outgroup is growing in number, not that they’re becoming more socially acceptable to the dominant culture.

  14. tmac57 says:

    Mandos-What you are referring to as an ‘out group’, is a majority of U.S. citizens. The numbers range from about 55%-67% as overweight with about 20%-30% of those falling into the obese category. I personally find overweight people to be socially acceptable.Most people that I know are overweight.I don’t think that they are making the best health choice,but that is not the same thing as condemning them socially,and they seem to be functioning quite well in society.They have good jobs,spouses,friends,family,pets,etc. Where is the social stigma?In short,they ARE us.

  15. Mandos says:

    You do realize that outgroups and underclasses can be majorities, right? That they live among one another, etc, etc. And that they appear on TV less often, except in negative contexts.

  16. tmac57 “Most people that I know are overweight.I don’t think that they are making the best health choice,but that is not the same thing as condemning them socially,and they seem to be functioning quite well in society.They have good jobs,spouses,friends,family,pets,etc. Where is the social stigma?In short,they ARE us.”

    Ask them how they feel about their weight. Most people don’t shed tears of shame, have surgery or spend lots of money to get rid of something they feel fine about.

    But true, I see very little social stigma over people being unhealthy…it’s just being unfashionably fat. Athletes who are basically wrecking their body (and setting themselves up for chronic lifelong pain) to become competitive in their sport are admired by the general public.

    Ahh, I’ll just blame the media. It’s so much easier to sell stuff when you can set the bar at an unattainable level…people who feel like sh*# about themselves buy more sh*# in the attempt to make themselves feel better.

  17. tmac57 “You can talk about bulimia,anorexia,and fashion models all you want,but one trip to Wal-Mart,will tell you who is winning the battle” etc

    Also, I’m not buying the logic. Just because a particular trait is on the upswing, does not mean that it is considered good, acceptable, admirable, etc. You are making a leap in reasoning without supporting you point with actual evidence.

  18. FiFi – “Pollan, incidentally, also writes “the whiter the bread, the sooner you’ll be dead.”

    HeHe, I missed this line before. My BIL sometimes says “Cotton Kills”, somehow they have the same ring to them. Of course the “Cotton Kills” is actually supported by a lot of evidence (in the mountain climbing context).

  19. Dacks says:

    @Mandos – outgroup as majority – that is a powerful concept. You’ve just changed my whole understanding of American culture.

    I stopped thinking about which foods to include or avoid in my diet years ago when I realized that people around the world survive on an incredible range of foods – some eating only meat, some eating none, many vegetables, few veggies – and most consume much less than I do. My Western lifestyle is quite sedentary in any historical context; so I try to balance my desire for nutrient dense foods with a high percentage of low calorie foods – fresh veggies and fruits.

    If people in Asia can live on three meals a day of rice and a few occasional vegetables, I think I’ll do all right on the most widely varied diet in human history, as long as I don’t eat too much.

  20. Fifi says:

    An article on an interesting look at a healthy and sustainable diet as proposed by UK academics that also mentions how beef is a status commodity in China …

    http://www.guardian.co.uk/environment/2011/jan/30/livewell-plate-diet-nutrition

    Considering that the current UK government has turned to industry instead of academics and scientists to create nutritional guidelines and to guide policy for the UK, it’s nice to see that researchers are producing their own guidelines (and considering the health of the planet/environment as a factor in general human health)…it’s naive to think that the food industry has no influence on government created guidelines in any country where corporations and lobbyists have more power and are considered more important than citizens (or where a government sees the people as consumers not citizens).

    http://blogs.plos.org/speakingofmedicine/2010/07/08/uk-government-and-food-industry-in-bizarre-alliance/

  21. echinopsis says:

    People need to read the book to understand his points. Taubes studied physics, he understands the importance of the first law of thermodynamics. He states in the book that for someone to lose weight they need to consume less calories than they expend.

    His point however, is that our approach to dietary advice shouldn’t rest on that fact. He points out that that fact says nothing about *why* someone is gaining weight/eating more and only says what is absolutely necessary to happen *when* someone does.
    He argues that (for example) a tiger doesn’t get fat, even with excess environmental food, so why would a human? He is then arguing that it is the presence of (mostly high-gi) carbs in the diet that leads to the weight gain, and due to the effect on insulin of carbs, more of that energy is stored in the adipose tissue, unavailable to the muscles for energy so appetite rises, more calories are consumed.

    The reason why people spontaneously eat fewer calories on a low-carb diet *isn’t* because they avoid the bread but because their body for once can actually regulate it’s own energy intake. Our appetite and our adipose tissue is being hijacked by carbs.

    He also points out that some people eat lots of carbs and are fine. It seems very apparent that the environment of the genetic heritage plays a large part. Cultures that spent 1000s of years living on pacific islands eating fish and coconuts (high fat low carbs) tolerate carbs extremely poorly and not surprisingly are over-represented in obesity statistics in the west, while populations that spent 1000s of years eating carb rich diets are not affected to the same degree.

    If the claims that animal fats are not the cause of heart disease, and knowing that fat does not induce an insulin response, we should not be afraid of fat in the diet. Instead I read magazines where a pizza is made “healthy” by changing the meat from a fatty meat to a lean one and reducing cheese, so overall reducing calories and lowering fat.. No mention whatsoever that a serving of the pizza is half a cup of white flour!

    Challenge all your preconceptions! His primary claims are that refined carbs, sugar and starches are the primary evils. If someone wants to lose weight drop these and the rest will follow.

  22. echinopsis says:

    It’s also worth noting that here http://www.garytaubes.com/2010/12/calories-fat-or-carbohydrates/ Gary argues that any dietary regime that can induce weight loss is based entirely on carbohydrate restriction. I’m not going to repeat the argument but it seems clear that the single most important factor in weight gain/loss is to do with how much insulin is secreted. This may change due to genetics or diet/amount or both.

    The point is that for a intake of calories (say 2000) either a lot can be stored as fat (making a person tired/lazy/hungry) or burnt (making a person energetic, not hungry) and the energy expenditure in a large way depends on the insulin effects of the food. 2000 calories is 2000 calories but 2000 white carb calories will leave someone tired hungry and slightly fatter while 2000 fatty meat calories will not leave someone tired and hungry. Out of those two extremes it’s easy to see why carb restriction facilitates all the other aspects of weight loss (energy expenditure and not hungry) and a carb rich diet (may) leads to lazy and hungry people.

  23. FiFi – I like the ideas behind of your livingwell link, but I will note that the recommendations have been developed using foods that are typical to the UK.

    We’d definitely need a different menu selection in the U.S., seeing as how items like baked potato with baked beans are probably not going to fly here. :)

  24. echinopsis,

    Your explanation makes a lot of sense. Thank you.

    Trials comparing high-protein and high-carb diets show little or no difference for weight loss. This suggests that Taubes’ thesis is an interesting hypothesis but not borne out by facts.

  25. echinopsis says:

    Alison, I’m glad I could help make it clearer.

    But, I think you need to increase your critical understanding of those kinds of studies. Have you read Taubes book? People bring up issues about his hypothesis that he addresses in the book. And he freely admits all along that this is what the science points to currently and his general argument is that nutrition has been stuck in a confounding mindset that has a lot of trouble looking at itself objectively.

    It’s doubly difficult because unlike most modern health treatments the result really affects the public. The public believe that fat is an evil, and that a diet high in omega-6 polyunstaturates and “moderate” with refined carbohydrates and replacing fat with them. The public don’t follow nutritional regimes like studies test for. Why is still so much bread sold white? Not that I really think wholegrain bread is much better

  26. echinopsis says:

    * sorry
    The public believe that fat is an evil, and that a diet high in omega-6 polyunstaturates and “moderate” with refined carbohydrates is ok despite how terrible we know it is for someone

  27. echinopsis says:

    I missed the “how bad” sorry again..

  28. takoyaki says:

    Based on Dr Hall’s excellent book review, it sounds like Taubes has lifted much of his material directly from Atkins. Wonder if anyone at Retraction Watch might be interested, or if Atkins’ widow will sue for plagiarism?

    Disclosure: Tried the Atkins diet many years ago, found I lost some weight because the allowed foods got boring quickly, and I missed fruit, vegetables, and bread far too much.

  29. Jay Wortman MD says:

    The thing that strikes me about this thread is that the fact that people benefit tremendously from a low-carb diet has been lost in the argument over whether Gary thinks the First Law of Thermodynamics applies to humans or not (he does) or whether he has accurately reflected the science (he has), etc etc. In my experience, if you have someone with insulin resistance, this is the first line therapy, end of story. I have seen amazing reversals of metabolic syndrome and type 2 diabetes. I have one case where the fellow had type 2 and MetS, had been on insulin for 17 years, poorly controlled, hypertension, dyslipidemia, Hx of stroke, obese, and after 2 weeks was recording normal sugars on no insulin and at 18 weeks was metabolically normal on no meds with a weight loss of 50 lbs. That was 6 years ago. Since then he has maintained those benefits as long as he stays on the diet. When he goes on a “carb binge”, which he has a few times, all the problems come back. His is not the only case like this. My quest over this period has been to understand why this works so darn well and why it isn’t the accepted first line therapy. The rest of it is just the same as arguing over the number of angels on the head of a pin, IMHO.

  30. Scott says:

    @ Jay:

    I think you’re missing part of the point. Everybody knows that diet and exercise are the best ways to deal with such issues. Gary is making a far more specific claim, that a low-carb diet is the most effective kind of diet, as opposed to any more general calorie restriction diet. The current evidence does not seem to demonstrate that this is the case.

    Also, as an MD you should know that what you personally have seen means very little; it’s just a collection of anecdotes. The only robust way to answer the question of whether low-carb is better than any other calorie-restricted diet is with well-designed clinical trials.

  31. tmac57 says:

    What’s that old saying about a physician who proclaims “In my experience…”?

  32. Jay Wortman MD says:

    Scott,

    I do read the literature and am familiar with the clinical trials in this area (and have been involved in some, too). The studies that people reference to make the claim that it isn’t about carbs, it’s about calories are, without exception, effectiveness studies. You have to be very careful in drawing conclusions about efficacy from effectiveness data. This distinction is routinely ignored, often by the authors themselves, and then by others who propagate this argument. To appreciate the efficacy of this diet, you can look at case studies and you can look at trials where compliance was high. The recent trials, like Sachs et al and Foster et al, had major compliance issues, yet they concluded anyway that low-carb was no more beneficial than calorie restriction for weight loss. These researchers and many others do not know how to properly administer a low-carb diet. In Foster’s case, subjects were told to restrict salt and drink lots of water. He apparently didn’t know that when you restrict carbs you experience natriuresis. This advice would exacerbate sodium depletion and lead to the typical adverse effects reported in these kinds of studies: headache, constipation, weakness, fatigue, etc. with attendant high drop-out rates (I suspect Sachs used this approach, too, given his role in DASH). In Sacks case, he gave me a severe public tongue-lashing at a meeting when I suggested there was some merit in low-carb dieting at a time when he would have been doing the trial where he discovered carb restriction was not effective. My point is that you can find lots of poor quality evidence out there to argue your point in the RCTs. There are some good quality RCTs like the ones done by Volek et al at UConn where the compliance rates are high. In these studies, the low-carb arms outperform the “prudent diet” in every measure. And, I will continue to maintain that, in terms of understanding the efficacy of this therapy, witnessing what happens to a compliant patient is also valid evidence.

    Jay

  33. Scott says:

    @ Jay:

    If you’re familiar with the literature and want to argue your point on that basis, fine. But you should have started there, not by essentially saying “I’ve seen some success stories in my practice therefore this is true.”

    I also would point out that compliance shouldn’t necessarily be labelled as a problem with the trial. If we know one thing for sure, it’s that compliance with ANY restrictive diet is extremely hard. How easy a diet is to comply with therefore an extremely important characteristic.

  34. Jay Wortman MD says:

    @ Scott:

    Compliance is a big part of what an effectiveness trial looks at and that is a valuable thing to study. However, if you want to know about efficacy, compliance is essential. You learn nothing about efficacy if subjects are not compliant. My point is that in the absence of good efficacy trials, one must fall back on case studies to understand the efficacy of this approach. In my experience, and in sharing with colleagues who use this approach, I find there is a tremendous benefit for people with any degree of insulin resistance if they use this diet. Of course there are compliance issues but I compare it to smoking cessation. We know it is the most efficacious way to avoid the harm of tobacco use but it is not highly effective because of poor compliance. Does this stop us from using this approach. No, of course not, because we understand the efficacy, we push on and try to address the compliance issues. With ketogenic diets and insulin resistance, we have a similar set of circumstances except that there are a bunch of nay-sayers out there who use effectiveness data to question the efficacy and who argue that the diet has no merit because nobody can comply. To make matters worse, some of them do their own studies in which the diet is administered poorly to provide more fodder for the argument. Meanwhile, in the clinical setting, where competent practitioners apply the diet, people lose excess weight, normalize their cardiometabolic markers and get off their meds. What’s wrong with this picture?

    1. Harriet Hall says:

      @ Jay Wortman,
      What’s wrong with this picture? There’s nothing wrong with the outcome for patients. What is wrong is using “in my experience” arguments to claim that one diet is superior to others. How do you know that “where competent practitioners apply OTHER diets, people don’t ALSO lose excess weight, normalize their cardiometabolic markers and get off their meds.”?

  35. echinopsis says:

    @Scott
    If you read the book you’ll see that Gary points out that the only way to lose weight is to reduce the insulin secreting effects of food. Restricted calories may achieve this, because they will reduce carbs and most diets like that also try to improve what kinds of carbs.
    One thing to remember is the shocking real world efficacy of restricted calorie diets, if people are consistently hungry the diet will fail sooner or later.

    Have you read the book, or GCBC?

  36. Scott says:

    No, nor is that relevant. I was responding specifically to Dr. Jay’s inappropriate use of personal experience to attempt to prove the point.

  37. Jay Wortman MD says:

    @ Scott and Harriett

    I guess we are just going to have to disagree on whether clinical experience has any merit in assessing the efficacy of a therapy.

    I also lecture to physician audiences about this and “in my experience” doing that, there is quite an appetite for this approach because the “OTHER diets” you refer to don’t seem to be doing the trick.

  38. Jay Wortman MD says:

    @ Scott and Harriett

    I would also suggest that you read “Good Calories, Bad Calories”. Gary does a better job of reviewing the nutritional literature in that book (I believe there are over 1200 citations). He wrote “Why We Get Fat” because GCBC was too hard to read for most people, including a lot of our colleagues. I think it is a little unfair to harshly criticize him for WWGF, which was purposely dumbed down for a wider audience when his opus is really GCBC.

  39. Harriet Hall says:

    @ Jay Wortman,

    I read GCBC before I read WWGF.

    In his book, Taubes himself calls for proper studies to test his ideas.

    Clinical experience is very valuable in guiding research, but it can never be a substitute for actually doing the research. As Mark Crislip says, the 3 most dangerous words in medicine are “In my experience.”

    Throughout history, there have been sincere clinicians whose experience convinced them a certain therapy worked; many of them were subsequently proven wrong. Our experience frequently misleads us: that’s why we do science.

  40. Jay Wortman MD says:

    @ Harriett

    No argument. However, I would venture to say that I have learned about as much from the shared experience of colleagues as I have from the literature. There is merit in both. In my own case, what I observed clinically with this diet led me to the literature and then to getting involved in the research myself. The case I mentioned was not a patient of mine, he was someone who heard me speak on this topic and then proceeded to implement the diet with no particular help from his physician. I was an arms-length observer and was so impressed with what he did that I have been compelled to pursue this. Full disclosure – I corrected my own type 2 and MetS this way, too, and have adhered to a very low-carb ketogenic diet for over 8 years now and I have no intention of going back.

    Yes, Gary calls for studies. I actually discussed this with him last week over dinner. He would like a non-weight loss eucaloric feeding study comparing a low-carb diet to a prudent diet. It would not be that hard to do and it would put to rest the debate about his ideas. He reckons it would cost about $1.5 million. This level of funding would have to come from NIH or a similar source. Why is it, do you suppose, that it has not been done?

  41. “He reckons it would cost about $1.5 million. This level of funding would have to come from NIH or a similar source. Why is it, do you suppose, that it has not been done?”

    Am I missing something here? On the basis of Gary Taubes’ books, some personal anecdotes and your criticisms of studies that have failed to show superior effectiveness of this diet, you want to ask for $1.5M? Or rather, you want some other, real scientist out there to ask for it?

    I dunno. On this basis I might think of giving you $15k, if I had a lot of money and there weren’t too much competition.

    Isn’t the usual procedure to start with small trials, demonstrate that it’s possible to get positive results, and then scale up to progressively larger trials? Because from what I’m understanding, the first step has not yet been achieved.

    I’m not sure I understand what you’re proposing.

  42. Jay Wortman MD says:

    @ Allison Cummings

    I’m not proposing anything. Gary is proposing that a trial should be done. I agree to the extent that if it were done properly it might influence people who have so far been able to ignore the existing evidence.

    The small trials you suggest have already been done. There are a number of RCTs out there, most of which did a poor job of administering the low-carb arm and virtually all which still demonstrated better results for low-carb when compared to low-GI, low-fat, low-cal, etc. Better weight loss, better cardiometabolic improvements and better compliance in most cases. The worst thing that anyone has been able to conclude from these trials is that the low-carb diet was no less effective than the control diets. Among these are a couple of well executed studies that give us a glimpse of the true potential of this approach. If you are interested in reading them, find the recent papers by Jeff Volek or his grad student, Cassandra Forsythe in Lipids.

    The low-carb approach represents a major paradigm shift. This kind of tectonic change is never welcomed. Researchers who work in this area, unless they are card-carrying defenders of the current paradigm, find it very difficult to get funded. People like Sacks and Foster, whose support of the calories in/calories out paradigm is well established, get funded to do low-carb trials, do them badly and produce equivocal results that don’t challenge the paradigm. Researchers like Volek et al, who know how to do a proper low-carb trial get amazing results but can’t get them into high-impact journals and are discounted because of small size, short time-frames, etc etc. all of which are functions of a lack of funding. This is how the paradigm is defended.

    Consider Chris Gardner at Stanford. Nice guy, vegetarian, very bright, believed that low-carb was harmful and did the A to Z trial looking at four diets with varying amounts of carb and fat. After he published his findings in JAMA which showed better performance by the Atkins arm he did some subsequent analysis of his data which showed that the subjects who had insulin resistance did exceptionally well on a low-carb diet and may actually get worse on a low-fat diet. He was unable to get funding to pursue this further and, as far as I know, he hasn’t been able to get those findings published, either.

    Throughout medical history we have defended our cherished paradigms, even in the face of compelling evidence they are wrong. Have a look at the Wikipedia biography of Semmelweis for a classic example. I think this is human nature and I don’t think it has changed in the intervening 150 years.

  43. sandra says:

    Silly, really, to argue with people who haven’t read the book and don’t understand what (who) drives food production.

    The latter certainly isn’t (aren’t) scientific scepticism (sceptics).

  44. frankjspencejr says:

    Dr Novella asked for evidence that eating low fat was the emphasis in the last 30 years. According to NHANES surveys (at least between 1974 and 2000 when obesity rates doubled), the extra 500 calories a day that Americans were eating on average compared to before we started preaching low fat in the late 70s was all carb calories. Fat consumption actually stayed the same or decreased a bit. I know as a physician that the medical community demonized low carb diets. A JAMA editorial labelled them “bizarre concepts of nutrition and dieting”.

  45. frankjspencejr says:

    …here is the reference:
    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm

    Excerpt:
    “During 1971–2000, a statistically significant increase in average energy intake occurred… For men [and women] the percentage of kcals from carbohydrate increased between 1971–1974 and 1999—2000.
    The percentage of kcals from total fat decreased .. for men and for women. In addition, the percentage of kcals from saturated fat decreased for men and for women. A slight decrease was observed in the percentage of kcals from protein,
    The decrease in the percentage of kcals from fat during 1971–1991 is attributed to an increase in total kcals consumed; absolute fat intake in grams increased. USDA food consumption survey data from 1989–1991 and 1994–1996 indicated that the increased energy intake was caused primarily by higher carbohydrate intake (6). Data from NHANES for 1971–2000 indicate similar trends. The increase in energy intake is attributable primarily to an increase in carbohydrate intake…Total fat intake in grams increased among women by 6.5 g (p<0.01) and decreased among men by 5.3 g (p<0.01).

    The latest national dietary data available indicate that the previously reported increase in energy intake has continued, reflecting primarily increased carbohydrate intake."

  46. Amy Alkon says:

    I have to laugh at all this Gary Taubes bashing because the guy is, if anything, panic-stricken about putting out evidence-based science, and “Good Calories, Bad Calories” is so dense with evidence that it’s hard for anyone without a science background to read.

    I’ve known Taubes since around 2000, and it’s a lucky thing, because I have been following his work since we met — and changing the lives of my readers because of it. (I’m a syndicated columnist and blogger — and usually a fan of this site and Harriet. This is a big miss from her — and I’m not going to repeat what’s already been said above about where she’s gone wrong.)

    I get about five letters a week from readers who got so bored with my frequent mentions of Gary Taubes and the (too few) others who recommend a diet based in science rather than the “science” reccomended by government and many or most doctors. These readers finally bought Taubes’ book and checked out the other sources I recommend, and ate accordingly, and dropped pounds like stones falling off a truck.

    Yeah, I know…the plural of anecdote is not data. But, will you take a photo?

    http://www.advicegoddess.com/archives/2010/06/28/la_press_club_a_4.html

    I used to diet — to eat this ascetic diet (fruits, vegetables, high-carb, low-fat…just like the doctor ordered — based on Ancel “Selection Bias” Keys’ crap research). I used to run seven miles a few times a week — wasting time I could’ve spent reading and killing my knees. Ridiculous.

    I am now EFFORTLESSLY THIN thanks to Gary Taubes’ work — laying out what evidence-free science the government and doctors and media have been promoting for decades. I now eat bacon, eggs, butter, greens, steak, steak, steak, chicken, pork chops, green beans drenched in butter, and sauteed Italian parsley. And cheese and salami.

    I’m never hungry, I now need very little sleep, and I sit at a keyboard all day and barely exercise (I do 100 lifts with weights every other day and try to remember to do an hour on the bike every week…which I haven’t been doing lately). I weigh what I did in high school — and I was slim then — without dieting. All I did was cut out carbs — flour, sugar, starchy vegetables like potatoes, and fruit.

    Pssst to the person above mentioning George McGovern: Taubes notes in “Good Calories, Bad Calories” that the food pyramid was created by an aide to McGovern with ZERO science experience.

    Oh, and P.S. I know a lot of writers, and a number of science writers and researchers, and simply knowing somebody doesn’t make me respect their work. The level of evidence behind it does. Which is why I respect the hell out of Gary Taubes, and see it as my mission to put the word out about his work.

    Here’s just one of the numerous e-mails I’ve gotten about how he’s changed the lives of my readers:

    “Dear Ms. Alkon,
    I know your time is precious, so I will keep this e-mail short and to the point. I would like to thank you for using your blog as a forum to talk about low carbohydrate diets and introducing me to the work of Dr. Eades and Gary Taubes. After two pregnancies I was seriously overweight and struggling with losing the excess pounds with no success. After reading your blog posts about low carbohydrate diets, I listened to the YouTube lecture about sugar that you linked to and did some extensive literature searches about the science behind the effects of carbohydrates and sugar on metabolism. Much to my surprise (since this is not my field of research) these studies were more scientifically sound and made much more rational sense than any of the nutritional studies that we are normally told about through the media. After this research, it was not a hard decision to cut out all sugar, grains, and processed food from my diet. The results were spectacular. In a period of a little over three months, with very little effort (for example, I never went to the gym during this time), I was able to lose over 45 pounds and am now actually below my pre-pregnancy weight. Of course, this was all without ever
    going hungry and being able to eat delicious meals filled with meat and buttered vegetables.

    Once again thank you. The information that you provided on you blog has truly changed my life.
    Sincerely, Name Withheld”

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