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Book Review: Good Calories, Bad Calories [Jan. 6th, 2013|03:28 am]
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[Epistemic Status | Okay, listen up. People seem to think that because I am a doctor, I must know something about this field. This is totally false. I got maybe three hours worth of lectures on nutrition in medical school, which were around the sophistication level of "Eat less and exercise more, okay?" So I am as new to all of this as anyone else. I am giving my opinions on some of the things I read, but they are NOT MEDICAL ADVICE and you should NOT TRUST ME and if you do you will GET A HEART ATTACK AND DIE.]

I said I would write a review of Good Calories, Bad Calories, but I don't have the book in front of me so I'm going to have to work from memory. So here goes.

Eating less cholesterol won't actually decrease blood cholesterol or heart attack risk in most people. Lowering blood cholesterol actually leads to higher death rates in the elderly populations at greatest risk of heart attack. The amount of fat you eat has no effect on your risk of heart disease. Dietary fat has no particular ability to make you obese beyond any other form of food.

These are not the revolutionary contrarian claims of Good Calories, Bad Calories. These are the things that most people in the medical establishment paying attention already agree upon. That I had never heard any of them after four years of medical school suggests that a lot of the medical establishment isn't paying attention, and if they're not paying attention what hope for the average person trying to start a diet?

The contrarian claims are more interesting still. Let me start three that, are in retrospect, blindingly obvious.

1) "Primitive" cultures have extremely varied diets, yet practically none of them ever suffer obesity. This includes the Eskimo, who eat obscene amounts of meat and blubber (basically solid fat) and almost nothing else while staying perfectly lean and free from cardiovascular disease. When the start to adopt the ways of "the white man", immediately obesity and cardiovascular disease go through the roof. This suggests that it's not fat or meat or whatever the latest bogeyman is that's causing the problems, but something about processed "civilized" foods. Taubes sticks the blame on refined carbohydrates - white flour and sugar. These are things primitive people would have little access to, but which are staples of food in modern societies.

2) The obesity epidemic started, most people agree, around 1980. The average American now eats less fat than the average American in 1980 - probably because of all the low-fat foods around and "eat less fat" diet advice. That alone pretty much ends any believability of the idea that the obesity epidemic is due to dietary fat.

There are three "macronutrients" - things that food calories can be made of - protein, carbohydrate, and fat. If you eat the same amount of calories, then cutting down fat means you have to raise one of the other two macronutrients. We have mostly made up for our low-fat diets by increasing carbohydrates - hence the infamous decision of the Food Pyramid to place bread at the bottom as the healthiest and most important food. If Taubes is right that refined carbohydrates are the problem, we would expect this decrease in fat and increase in carbohydrates to correspond with the obesity epidemic getting worse, rather than better - as indeed happened.

3) The idea that weight change is based on how much you eat minus how much you exercise, compounded over time, assumes an astounding level of lifestyle stability. I've been at about seventy kilos, give or take, for the past five years. This stability suggests I'm consistently taking in the same amount of calories as I'm burning.

But imagine that tomorrow, before going to bed, I eat a single French fry, and I repeat this each night for the next decade. Now I'm taking in one French fry's worth of calories more than I'm burning. Each day this adds a little more fat to me, until by the end of the decade I weigh a thousand pounds. This jars pretty wildly with our experience. First, it seems unlikely that without any particular effort I've kept my calorie level perfectly stable, to within a margin of error of one French fry, for the past five years. Second, it seems unlikely that a healthy person who eats okay and exercises but also eats one extra French fry a day would end out at a thousand pounds.

[EDIT: Wrong. See http://squid314.livejournal.com/350821.html?thread=3854949#t3854949]

Obesity Set Points

The failure of small dietary changes to produce major changes in weight suggests something more complicated is going on.

Nutritionists tend to scoff at the idea that weight is anything beyond a simple calories in - calories out balance, and for understandable reason. The First Law of Thermodynamics, that mass/energy can neither be created nor destroyed, means that food mass/energy has to go somewhere. If you put it in your body, either you burn it for exercise or it stays in your body and becomes fat. This is why smug people sometimes say that they're following "the physics diet" of eating less and exercising more as opposed to thinking diet pills or fad diets can do much good. Fancy biochemistry stuff has nothing to do with it, mere sophistry on the part of people who claim to have "bad metabolisms" in the same way people used to say they were "big boned".

But even my limited amount of medical knowledge is enough to know this isn't true. There are a bunch of diseases - Prader-Willi Syndrome, hypothyroidism, hypothalamic lesions - that cause obesity. There are even drugs you can take that cause obesity - some of the antipsychotics are famous for this. And by playing around with mice genes, you can get anything from disgusting spherical mice to mice that look like they just got out of a concentration camp, even if they're all feeding out of the same bowl of Mouse Chow.

The book's solution - which I think is pretty standard now - is to say that yes, fat has to follow the laws of thermodynamics, but thermodynamics doesn't specify what is controlling the equation. It could be that your diet and exercise are controlling the weight gain. Or it could be that some innate tendency to weight gain is controlling the amount you diet and exercise.

And it seems to be some combination of the two. Realistically, I know not everything is determined by some mysterious inner process - sometimes I just see a cupcake, and want it, and eat it, and I know my having eaten it is determined completely by the fact that I happened to come across it at that moment and no one was watching (obviously a mysterious inner process could have prevented me from eating it by making me feel really full, but that's different). On the other hand, I accept that a lot of the time I eat things it's because my body is telling me I'm hungry, and a lot of the time I don't eat things it's because my body is telling me I'm full, and a lot of the time I exercise it's because my body is telling me I'm antsy, and so on.

So the idea is of an obesity set point. If you get fatter than your body's hidden set point, it makes you a little less hungry and more willing to exercise until you get back down. If you get leaner than your body's hidden set point, it makes you a little hungrier and more tired until you get back up. It is subtle, complicated, and more than enough to sabotage the diet plans of nearly everyone.

Taubes' work supporting the concept of an obesity set point is really spectacular. He talked about both terrible-sounding studies where scientists forced people to subsist on starvation diets, and fun-sounding studies where scientists forced people to eat as many sundaes as they could stuff into their faces. In both cases, people went to desperate lengths to return to their previous weight, and felt absolutely miserable when denied the opportunity (these studies disproportionately came from the military - in every other setting, people just gave the scientists the finger and broke the study rules after a few days). And this happened whether or not the subjects were fat or thin - it wasn't like being fat provided a "buffer" where you were okay with a semi-starvation diet while your fat burned, you were just as desperate to return to your (high) set point as your thin friend was to return to her (lower) one.

This was accompanied by fascinating animal experiments where they would try to trick rats. Suppose a rat usually ate a 10 calorie diet. They would try to trick the rat by giving it a food that looked and tasted exactly like its old food, but was ten times as calorically dense; the rat would eat a tenth as much food and maintain its weight. If they gave it a food that was only a tenth as calorically dense, the rat would eat ten times as much - and maintain its weight. If they surgically stuck food into the rat's stomach, the rat would eat exactly as much additional food as was necessary to maintain its accustomed caloric input and its weight.

So people (and rats) are really good at maintaining their obesity set point. How come some people have higher set points than others, and why does this change over time?

Low Carb Dieting

Taubes' theory is that it has to do with insulin. Best known as the hormone that goes wrong in diabetes, insulin controls a wide range of bodily processes relating to energy balance. He says that refined carbohydrates (especially sugar) produce so much insulin that the body eventually becomes accustomed to it ("insulin resistant"). Then it is unable to respond to insulin's role in keeping the obesity set point, the set point inches up, and you end up with a vicious cycle of getting fatter and fatter. If you stop eating carbohydrates, your insulin gradually returns to normal and you get thinner.

This is a big part of the principle behind the Atkins Diet, and I think Taubes does a good job in demonstrating that the Atkins Diet, and similar low-carbohydrate high-fat diets, do better than traditional diets in weight loss as well as being pretty safe. Mainstream studies are starting to agree with him, even though for years they were hurling invective against it and declaring it was unsafe for reasons which I still have never heard adequately defended.

How Doomed Are We?

I mentioned on Thursday that I do not trust myself to be able to evaluate every controversial issue, and that I believe a brilliant and compelling crackpot will usually be able to convince me of false ideas in domains where I lack expertise. One obvious solution is to default to trusting the establishment. If the establishment is trustworthy, this is okay. If establishments are consistently untrustworthy, this means I am doomed, and for all I know any random crackpot could be correct and I have no way to be sure and I basically fall into total Cartesian doubt about everything.

Taubes brought me pretty close to the edge of that abyss. If all nutrition guideline makers were so wrong for so long, how can I trust the next group of scientists who say they know something? Climatologists who say global warming exists? Biologists who say Darwinian evolution acting alone can create complex organisms? The arguments on both these topics would take more than a lifetime to wade through entirely and there are extremely clever people making extremely sophisticated statistical arguments on both sides.

I am no longer quite at the edge of the abyss for a few reasons.

The first reason is that it seems Taubes is wrong. That is, a lot of his criticisms of the establishment are correct, but his own pet theory of carbohydrates and insulin seems to seriously fail to hold water. In fact, it seems so bad that it's hard to rule out deliberate dishonesty, which makes me skeptical of some of the rest of his points as well.

(or this could just be the "I am too quick to believe rebuttals and in fact to believe the last thing I read" problem I mentioned on Thursday)

Even though that doesn't make the establishment right, for me it goes a long way to redeeming them. Part of Taubes' point was "When I put it together like this it seems so obvious, and yet everyone missed it for decades." But it only seems obvious because he leaves out the important experimental results that contradict his point. The establishment did not miss those results, and so never settled upon his theory as the Solution To Everything.

So I no longer blame the establishment for missing the One True Theory. Flailing about wildly is a perfectly acceptable tactic in a field as complicated as nutrition. I do blame them for presenting the science as settled instead of honestly stating "Yes, we're flailing about wildly here."

Taubes discusses some of their motivations. The main one, and one I can respect, is that politics works different from science. In science, it is virtuous to say "You know, we think we've found a link between fat and disease, but really we're just flailing about here. Come back in fifty years and we'll tell you some more." In politics, you have to be able to tell people "Eat less fat!" or else they won't do it and maybe they'll die of disease. Since we were just coming out of the fiasco with smoking, when people waited years and years to say for sure that smoking caused lung cancer and goodness knows how many people died of preventable lung cancer in the interim, it is at least easy to see why erring in the opposite direction would be tempting.

Reassuringly, there seem to be some trustworthy smart people in the establishment. The critique I linked to above is by Dr. Stephan Guyenet, who seems like the smartest and most reasonable nutrition blogger I've found so far (Steve Rayhawk's brother, who is an amateur expert in the area, has recommended a different guy I need to listen to at some point, but he seems to broadly agree). He has published research in the field and no one seems to be burning him as a witch.

He paints a picture of the current state of the research which looks like an establishment which has accepted the same facts Taubes points out (even if they haven't quite permeated to the public yet) and is now doing research in what looks like a promising direction - leptin resistance. This new paradigm explains some of the carbohydrate results as well as some of the conventional results. When I did med school, one of the smartest surgeons I studied under was also doing work in leptin resistance and said it was eventually going to explain obesity, it was just fiendishly complicated to work out.

So it looks like the system was never as bad as Taubes thought it was, didn't miss an obvious idea the way Taubes accused it of doing, and eventually righted itself and started limping in the right direction.

It just probably killed a few million people with diets that didn't work in the process. And actively mocked and condemned the ones that did. Oops.

[EDIT: Or here's a claim that older research shows low-carb diets just really don't work that well. But see here for some more recent research showing they might.]

I find it interesting that although the contrarians' biochemical claims were mostly wrong, their solution - low-carb diet - seems to be sort of in the right direction. It would not surprise me if this were a pattern. Skilled amateurs are unlikely to beat the experts at disentangling complicated scientific problems, but they might be better at noticing the way empirical evidence is going. In fact, given that they're less bogged down in theory, that might even be a strong point for them.

Last thoughts

I would highly recommend Good Calories, Bad Calories.

Its negative claims - the ones demolishing those of the standard nutritionists - seem broadly correct, and form a really good survey of the current state of nutrition science.

Its positive claims - the carbohydrate/insulin theory of obesity - seem probably wrong, as far as I can tell. But everyone who responded to my post a few days ago with "Oh, I would never be fooled by convincing-sounding contrarian claims" - well, your challenge is to read GCBC without having read the criticism above and tell me whether you avoided being fooled by it.

It also just provides a really good snapshot of a scientific field and how exactly consensus opinions form. That's something most science books don't go into, and it's sort of scary.

As for diet? I'm trying to cut carbs. I will never be any good at it, because bread is my favorite food and my previous diet relied on it almost exclusively, but I'm trying to be at least a little better. I just discovered low-carb tortillas, which I would have thought unlikely, but they're very good and have only a few calories from carbs each. I'm paying less attention to fat and cholesterol, and more to carbs and (especially) raw number of calories.

But I have to admit I'm not convinced it will do much good. Nutrition science is slightly beyond the voodoo stage, but not by much, and it seems likely there's enough genetic variability that any universal prescription will be useless.
linkReply

Comments:
[User Picture]From: tremensdelirium
2013-01-06 12:36 pm (UTC)

(Link)

But everyone who responded to my post a few days ago with "Oh, I would never be fooled by convincing-sounding contrarian claims" - well, your challenge is to read GCBC without having read the criticism above and tell me whether you avoided being fooled by it.

Oops, too late! To be effective this should go at the top of the post.
[User Picture]From: avva
2013-01-06 12:44 pm (UTC)

(Link)

I read the same post by Guyenet that you did and thought it made a strong counterpoint to Taubes' message. But I don't know how seriously I should take its claim that the mainstream science now recognizes the efficacy of low-carb diets for many overweight patients. If this has been true over the last decade (and the number of studies with results backing up low-carb seems to have been rising) is true, it doesn't seem to have percolated into any official bodies' recommendations, as far as I'm aware. In general, dietary recommendations are still stuck on the same message they had in the 80s - see e.g. http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf that among other things strongly recommends not reducing carbs below 45-65% on weight-reducing diets, and compare with
http://www.health.gov/dietaryguidelines/1985thin.pdf, that says, for example, "Carbohydrates are especially helpful in weight-reduction diets because, ounce for ounce, they contain about half as many calories as fats do".

I wanted to add in this comment that even if mainstream nutritionists are paying attention to low-carb in 2000s, it seems fair to criticize them for ignoring this diet since the early 1970s, when Atkins' book first climbed on the best-seller lists. But having looked a little deeper into it, I'm no longer sure this is true. Here's a thorough-looking review article from 2001 that summarizes a huge number of studies on all three of low-carb, low-calorie and low-fat approaches. They dedicate a lot of attention to low-carb diets and conclude, to recap very concisely:

- that they work, but so do the other two categories
- that they only work due to caloric deficit
- that the reason the deficit arises is uncertain
- and claims of appetite suppression are not definitive and the data is contradictory
- the overall balance is in favor of low-calorie diets and these must the diets recommended to everyone, not low-carb or low-fat ones.

I'm not at all qualified to judge the quality or thoroughness of their review, but it doesn't seem like nutrition researchers had been ignoring low-carb diets, it seems they had been rejecting them based on what seemed to them solid experimental data. The question is - if Guyenet says that now, 10 years later, usefulness of low-carb is established in the mainstream, then -

- what changed to induce such a shift?
- where are the recommendations?
From: deiseach
2013-01-06 03:16 pm (UTC)

(Link)

I wonder if nutritionists liked carbohydrates because they make you feel full; if you're trying to reduce your calorie intake by reducing the amounts you eat, something that fills you up sounds like what you need.

Fibre works as well, but eating high-fibre foods is like chewing your way through a bale of hay. A plate of pasta, say, with a vegetable sauce and no meat is much more interesting to eat and seems like it would help on cutting down on fats and too much animal protein and would be easier for people to stick to such meals.

However, if a majority-carbohydrate diet really doesn't help in long-term weight loss, then for years we've been getting the wrong official advice (apart from 'eat less, exercise more' and 'cut down/out the junkfood').
dk - (Anonymous) Expand
From: deiseach
2013-01-06 02:53 pm (UTC)

(Link)

"I am giving my opinions on some of the things I read, but they are NOT MEDICAL ADVICE and you should NOT TRUST ME and if you do you will GET A HEART ATTACK AND DIE."

Oh, now, you can't be as bad as the advice I got two years ago from a cardiologist, when he had given me the usual advice about losing weight and I'd told him that yes, I've done the yo-yo dieting thing but I have trouble losing weight - "Did you ever see a fat hunger striker?"

Weight loss advice from a CONSULTANT in an Irish REGIONAL HOSPITAL (i.e. the main hospital for the region which takes in patients from a thirty mile radius for all kinds of outpatient clinics, specialist services, emergency treatment, etc.) - Eat absolutely nothing until you are in danger of death by starvation!

Such sage counsel is worth every penny of the health service budget over-run, is it not? Nice to be confirmed that the reason I'm fat is because I'm a lazy, spineless, weak-willed glutton - really encourages me to get out there and start in on that next fad diet craze!

As for reducing carbohydrates - you've lived in Ireland, you know the importance of the potato in the national diet :-)
[User Picture]From: Julia Wise
2013-01-08 04:04 am (UTC)

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>"Did you ever see a fat hunger striker?"
Yes.
[User Picture]From: drdoug
2013-01-06 02:56 pm (UTC)

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It's complex.

In my final year as an undergraduate - back in the early 90s - I did a lit review on the biochemistry of prolonged starvation. After I'd been thoroughly shocked by the horrible things they did to people in the 60s to find some of this out (e.g. strapping very obese people to hospital beds, running umpteen tubes in to them, and giving them only water, electrolytes and a multivitamin), and the things they did to animals in the 70s and 80s (all sorts of ghastly things that read like accounts of the more gruesomely inventive forms of torture), the thing that really struck me was just how hard the body works to maintain homeostasis - and caloric balance is one aspect of that.

One way the body does this - touched on in some but not all of your linked articles (not read GCBC and don't plan to) - is by varying the basal metabolic rate. In essence, almost all of your metabolic pathways can run in both directions, and cells can run these futile cycles back-and-forth more or less rapidly to generate more or less heat. For ages people have suspected that these have a role in metabolic regulation - and hence obesity.

More research required!

(Something of an aside: my lit reviewing also pointed up how enormously expensive the brain is. Not only does it take up a ridiculously disproportionate fraction of the body's total energy budget, it requires glucose and nothing but glucose to run on. The rest of the body can get by in a pinch by burning just about anything energetic - fatty acids, lactate, amino acids - but the brain can't. A lot of the astonishing complexity of the regulation of the body during prolonged starvation is making sure there's glucose in the blood for the brain to use without the rest of the body swiping it. Brains must be good for something or evolution would've optimised those suckers away generations ago.)

((Final aside: The other thing my biochemistry left me with is a huge sense of awe at its complexity. For a short moment 20 years ago, following much intensive study of the distilled wisdom of decades or even centuries of research, I nearly understood some of the basic features of metabolism - which is just one small corner of the body's biochemistry. As I told anyone who would listen at the time, it's a bloody good job I only had to learn that stuff for an exam, not to actually do it, because if I had to understand it all to make it work I'd be dead in minutes.))
[User Picture]From: st_rev
2013-01-07 01:01 am (UTC)

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The brain can also metabolize ketones. The brain of a dieter who's been in mild ketosis for any length of time is drawing about 70% of its calories from ketones.
From: (Anonymous)
2013-01-06 03:02 pm (UTC)

(Link)

I have to split this reply, because apparently it won't fit in one comment.

This includes the Eskimo, who eat obscene amounts of meat and blubber (basically solid fat) and almost nothing else while staying perfectly lean and free from cardiovascular disease.


Their life is unusual in other respects, too -- I wouldn't necessarily assume that someone eating like that in a warm country would be as healthy. Instinctively, the colder it is, the more animal fat I usually feel like eating, and there must be some kind of reason for that. (Conversely, I'm not completely confident that the traditional Okinawan diet would also be that healthy in Siberia.)

Taubes sticks the blame on refined carbohydrates - white flour and sugar. These are things primitive people would have little access to, but which are staples of food in modern societies.


Does he address Mediterranean diet? Italians eat lots of pasta and bread and (especially before WWII) relatively little meat, and the prevalence of obesity is lower here than in the US. (It's not obvious to me that it makes sense to lump “refined carbohydrates” together; intuitively I'd expect sugar to be much worse than starch.)

If you eat the same amount of calories, then cutting down fat means you have to raise one of the other two macronutrients.


You know, I had always taken “eat less fat” to mean “...while keeping carbs and proteins, thereby reducing total calories”. But in hindsight it doesn't surprise me that other people have interpreted it differently.

The Second Law of Thermodynamics


That's “total entropy can increase but not decrease”. “Total energy can neither increase nor decrease” is the first law.

There are a bunch of diseases - Prader-Willi Syndrome, hypothyroidism, hypothalamic lesions - that cause obesity.


But certain people use those as excuses to do nothing about obesity. My grandma is 1.68 m, about 120 kg, and says “but I'm fat because my thyroid doesn't work right!” while eating obscene amounts of food (e.g. 100 g of chocolate every day) and doing pretty much no physical activity whatsoever and not appearing to give a damn about that.

And it seems to be some combination of the two. Realistically, I know not everything is determined by some mysterious inner process - sometimes I just see a cupcake, and want it, and eat it, and I know my having eaten it is determined completely by the fact that I happened to come across it at that moment and no one was watching (obviously a mysterious inner process could have prevented me from eating it by making me feel really full, but that's different). On the other hand, I accept that a lot of the time I eat things it's because my body is telling me I'm hungry, and a lot of the time I don't eat things it's because my body is telling me I'm full, and a lot of the time I exercise it's because my body is telling me I'm antsy, and so on.


There also exist precommitment techniques. I can't eat any cupcakes if there are none in my apartment. I'm pretty sure that when I gain weight, I do because I eat lots of calories from food I eat not because I'm hungry, but because I'm nervous or bored or like the way it tastes. When I'm trying to lose weight, I resolve to almost exclusively buy food that needs cooking before eating (except for bulky low-cal food such as apples), so that there's a trivial inconvenience between me and eating the food that I will only overcome when I'm actually hungry.

(to be continued)

--
Army1987
[User Picture]From: squid314
2013-01-06 08:44 pm (UTC)

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Thanks for pointing out that thermodynamics error; now I feel really dumb.
(no subject) - (Anonymous) Expand
From: (Anonymous)
2013-01-06 03:02 pm (UTC)

(Link)

Here's the second part of my reply:

So the idea is of an obesity set point.


John Walker in The Hacker's Diet hypothesizes that each person might have several distinct set points, and from my experience I think he may be onto something. (Also, IME the set points seems to be based on amounts of fat, not total body weight: exercising more thereby increasing muscle mass seems to also increase my set point.)

They would try to trick the rat by giving it a food that looked and tasted exactly like its old food, but was ten times as calorically dense; the rat would eat a tenth as much food and maintain its weight. If they gave it a food that was only a tenth as calorically dense, the rat would eat ten times as much - and maintain its weight.


I'm not sure it's also that simple in humans (well, in me, at least). Eating more bulky food (while keeping total calories constant) does make me feel less hungry; even pulling my trouser belt tighter does. I guess there are two different mechanisms that can make me feel full: having eaten enough calories (though ISTM that for some reason calories from sugar don't count toward this: regular Coke doesn't make me feel full any more than Coke Zero does), or physically filling my stomach. And the fact that bariatric surgery works suggests that I'm probably not terribly unusual in this respect.

--
Army1987
From: vilhelm_s
2013-01-06 06:43 pm (UTC)

(Link)

The original hypothesis motivating bariatric surgery was that a smaller stomach would make you feel more full. But nowadays it is believed that the main mechanism of action is through the endocrine system. The stomach and gut supposedly releases various kind of signals when in contact with food, although the details are still mysterious.
From: vilhelm_s
2013-01-06 03:23 pm (UTC)

(Link)

While I agree that there is evidence that people regulate their energy intake to maintain their weight, I think the "just one more french fry" argument is wrong, because it ignores the concept of "weight maintenance calories".

If you search for that, you will find a million dieting websites which offer to calculate how many calories per day you need to maintain your current weight. The idea seems to be that for every pound of body weight, you need to eat an extra 10 calories to maintain that weight. I'm not sure what the mechanism is, but maybe it's just that everyday activities (like walking up a stair) requires more energy if you weigh more?

If that's the case, then you don't need to postulate an insulin- or brain-based system for maintaining body weight. Just from the physics your body weight would be naturally stable. E.g. if you start eating an additional french fry (10 calories) per day, your body weight would start to climb until you have gained one pound and the additional daily expenditure matches the daily intake. You would never gain a thousand pounds.
[User Picture]From: Christian Stucchio
2013-01-06 03:34 pm (UTC)

An incorrect claim

(Link)

But imagine that tomorrow, before going to bed, I eat a single French fry, and I repeat this each night for the next decade. Now I'm taking in one French fry's worth of calories more than I'm burning. Each day this adds a little more fat to me, until by the end of the decade I weigh a thousand pounds.

This is simply an incorrect understanding of the calories in/calories out model.

(Admittedly, it's an incorrect idea which Gary Taubes spends a lot of time arguing against, probably because it's an easy straw man and most of his readers can't solve the differential equation needed to debunk it.)

According to the calories in/calories out model, your bodyweight should be stable at a level proportional to your average daily consumption. If you increase your consumption by one french fry/day, your bodyweight will stabilize at a slightly higher level.

I wrote a blog post where I do the math, which you can view here:

http://www.chrisstucchio.com/blog/2011/weight_stability.html

[User Picture]From: gwillen
2013-01-06 06:28 pm (UTC)

Re: An incorrect claim

(Link)

It's worse than that, isn't it?

If a french fry is 10 calories, and a pound of fat is about 3500 calories, then 1 fry per day for 10 years is 10 pounds, not 1000. So even the naive math is wrong.
[User Picture]From: kittles
2013-01-06 04:19 pm (UTC)

(Link)

Disclaimer: I have an Animal Science degree and DID get a lot of nutrition education in college, however it was all on what cheapest things to feed animals to make them grow and get fat as quickly as possible (which followed the MOAR CALORIEZ PLZ model). :p

I haven't read GCBC but I'm familiar with Taubes. The kinds of things he discusses play into the other currently popular diet trend: paleo/primal. They cut out refined sugar and all grains. The first time I did this for 30 days (as part of a nutrition challenge at my gym) I lost 20 pounds. In 30 days. Crazy. But I can't say whether that was because of WHAT I was eating or caloric change - because I had been consuming 400-600 calories a day from Mountain Dew, which I did not replace. And a nice hallmark of paleo/primal is that you don't count calories. So who knows for sure, but maybe I replaced those calories with delicious steak fat. I will say that nutrition plan made me stronger (I hit several new personal records on my weight lifting) less stressed (no mood swings related to food), and I slept better than I ever did before.

That said, I know other folks who have tried it who saw minimal change for themselves, which makes me fascinated by that obesity set point.

You might enjoy this video by Dr. Lustig called Sugar: The Bitter Truth. He goes into some pretty deep biochem on how the liver processes sugars in the absence of fiber and it seemed to make sense. Lustig's take was interesting because he primarily studied obese children as young as 6 months old, who presumably don't "choose" to be fat as folks say adults do based on diet/exercise.
[User Picture]From: st_rev
2013-01-07 01:11 am (UTC)

(Link)

Serious low-carb diets (which may or may not have been what you were on) often lead to huge weight loss in the first few weeks by depleting glycogen and water from the liver--which is a lot less calorie-dense than fat, obviously. And that's a kind of weight that comes back pretty much immediately, of course. Whatever's going on with long-term low-carb dieting is different, though.
[User Picture]From: celandine13
2013-01-06 05:19 pm (UTC)

(Link)

I remain confused by insulin/metabolism stuff and it's going to take me a while to understand Guyenet's article.

But. I seem to remember (from memoirs and so on) that insulin used to be a therapy that they gave in mental hospitals. They'd give you enough insulin to pass out and supposedly that was a cure for depression. And everybody gained weight on insulin. Sylvia Plath wrote about how gross and fat she was after a couple months of insulin.

What's going on there? I can't figure out from Guyenet's article what he thinks would happen if you gave a non-diabetic, non-obese person a bunch of insulin every day for months. Is this just an issue of anecdotal evidence being worthless?
From: jimrandomh
2013-01-07 05:32 am (UTC)

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Insulin signals cells (fat, muscle, liver) to take up glucose from the blood. If those cells don't want the glucose, they express less of the relevant receptors and you have "insulin resistance". This is a problem since it means you can't clear excess glucose from the blood, and excess glucose in the blood damages things.

If you give someone insulin they don't need, they'll get hypoglycemia - low blood sugar - which is potentially lethal. You're hijacking the body's internal energy distribution mechanism, creating a surplus in one place and a shortage in another. To restore their blood sugar concentration, they must eat sugar (or else possibly die), and they will crave it. Hypoglycemic sugar craving is distinct from ordinary hunger, and isn't something willpower can plausibly override. So one of two things will happen to the person you're giving insulin: either their cells become just insulin resistant enough to compensate for the excess, or else they eat extra sugar to compensate and that sugar ends up in places where it isn't needed and causes obesity.

(As a treatment for depression, giving insulin makes about as much sense to me as giving blows to the head.)
[User Picture]From: gwern branwen
2013-01-06 05:24 pm (UTC)

(Link)

> But even my limited amount of medical knowledge is enough to know this isn't true. There are a bunch of diseases - Prader-Willi Syndrome, hypothyroidism, hypothalamic lesions - that cause obesity. There are even drugs you can take that cause obesity - some of the antipsychotics are famous for this. And by playing around with mice genes, you can get anything from disgusting spherical mice to mice that look like they just got out of a concentration camp, even if they're all feeding out of the same bowl of Mouse Chow.

One fascinating example: the drug http://en.wikipedia.org/wiki/2,4-Dinitrophenol It was a weight loss drug that operated by reducing the efficiency of mitochondria; however, the laws of thermodynamics still apply, so where is the excess energy going? As heat - so you can literally overheat yourself to death by using this drug, and that is why it was banned.
[User Picture]From: Randy Miller
2013-01-06 05:25 pm (UTC)

(Link)

"So it looks like the system was never as bad as Taubes thought it was, didn't miss an obvious idea the way Taubes accused it of doing, and eventually righted itself and started limping in the right direction.

It just probably killed a few million people with diets that didn't work in the process. And actively mocked and condemned the ones that did. Oops.

I find it interesting that although the contrarians' biochemical claims were mostly wrong, their solution - low-carb diet - seems to be right."

I haven't read the book yet, but it seems to me the establishment should be damned slightly more than you are willing to do based on that conclusion. Isn't it more important to get the practical advice right than the theory? Especially given how far the mainstream advice is spread--via schools, marketing, doctors, etc. If [most traditional sources of] fat is as good as Taubes, paleo people, Weston Price, etc. maintain, yet the default assumption for health concerned consumers is to shun it as much as possible, I don't think the establishment is excused simply because the magic bullet isn't obvious.

It's like a trial--just because no suspect has confessed, don't go easy on the jury that convicts a suspect with an air-tight alibi.

One of my coworkers has gone more or less vegetarian for health reasons--fear of fat leading to deadly cholesterol levels. Which reminds me, you may be interested, as a (forgive me) statistics geek, in the critique of the China Study by Denise Minger (rawfoodsos.com).
From: (Anonymous)
2013-01-06 06:38 pm (UTC)

dk

(Link)

These are the things that everyone in the medical establishment paying attention already agrees upon.


Maybe the main point is that you're distinguishing "revolutionary contrarian" claims that he alone holds from vanilla "contrarian" claims that have a foothold in the establishment, but talking about people "paying attention" is a cop-out and I think a dangerous choice of words.

How do you identify the people paying attention? What good does it do to divide the establishment into the good part and the bad part? If the medical school curriculum contradicts them, they are contrarian.

Maybe you can identify the groups "paying attention." In particular, if you mean specialists, that's a useful category and you should say it. Maybe it is accurate to describe specialists as paying attention, but I think it is much better to describe them as specialists. Alternatively, specialists may be divided into well-delineated schools and all the specialists at least know of the existence of the other school. But in that case, it seems unreasonable to describe the one group as "not paying attention." They know this other school exists; do you know why they reject it?
[User Picture]From: celandine13
2013-01-06 07:37 pm (UTC)

Re: dk

(Link)

A lot of the mileage in "contrarian" views seems to be *being aware* of claims that are mainstream in a different scientific field, or mainstream among experts but not laymen, etc. Stuff that's well-established beyond a shadow of a doubt to tribe A but unknown to tribe B.
dk - (Anonymous) Expand
dk - (Anonymous) Expand
Re: dk - (Anonymous) Expand
[User Picture]From: gwillen
2013-01-06 06:46 pm (UTC)

(Link)

The amount of fat you eat has no effect on your risk of heart disease.

In your two links I see one meta-analysis concluding that reducing saturated fat intake reduces cardiovascular events, and one that says it doesn't. That doesn't seem quite as straightforward as you state it.

[User Picture]From: squid314
2013-01-06 08:49 pm (UTC)

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Total amount of fat has no effect, changes in type of fats/fat ratio has a small effect.
[User Picture]From: mindstalk
2013-01-06 08:38 pm (UTC)

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There's also the type of fat/meat issue, e.g. wild or pastured grass fed game or cattle vs. corn fed livestock. Our meat may not be their meat. (And milk.)

I can't help noting the the longest lived people eat rice, veggies, and fish, and the Mediterraneans do too, while the Danish are among the few Europeans with life expectancy comparable to the US -- too much dairy?
[User Picture]From: Randy Miller
2013-01-06 08:52 pm (UTC)

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So much for my planned all danish diet.
[User Picture]From: drethelin
2013-01-06 10:14 pm (UTC)

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I'm a little annoyed that you came to basically the same conclusion about that book as me. At least you found better rebuttals than when I looked!

My view on Taubes is a lot like my view on Moldbug. They both point to very concrete writings or studies that undermine the popular notions, but their efforts to build up a counter-narrative are basically castles in the sky. Maybe you can't try to undermine the mainstream without having a crackpot theory of your own but it would be nice if crackpots weren't the main ones skeptical of dogma.
From: michaelvassar
2013-01-08 03:15 am (UTC)

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I'm sad about this requirement that one offer one's own crackpot theory as well. Conscious ignorance is much less respected than it was in Socrates' time.
[User Picture]From: naath
2013-01-07 12:53 pm (UTC)

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Oh grief the thermodynamics-diet people piss me off no end.

There are all sorts of complex arguments about what exactly your body *does* with the calories you put into it. But honestly the simplest thing is - if your body isn't interested in the calories it can shit them out. You don't use up every scrap of food you consume to fuel your body - if you did you'd never shit.

Last person to tell me carbs are evil told me I "should" be eating meals that are mostly lean meat. This was after I told them I am vegetarian about 80% of the time. I very rarely eat "lump of meat with some veggies" type meals; if I do eat meat it's usually covered up with sauce to disguise it's meat-nature. This is clearly not the diet for me!
From: (Anonymous)
2013-01-07 03:44 pm (UTC)

(Link)

Oh grief the thermodynamics-diet people piss me off no end.


Unless John Walker (http://www.fourmilab.ch/hackdiet/) is outright lying, the thermodynamics diet does work on at least one person (him), and I have no evidence that it doesn't work on me too (though I'm usually nowhere near as maniacal as him about counting calories).

if your body isn't interested in the calories it can shit them out.


Does that actually happen, in healthy people? If I go through half a week of binge eating, I can easily gain one kilo and a half that will take me more than a month to lose back. (I usually weigh myself every day, so I can tell actual fat and/or muscle gains from day-to-day fluctuations due to the instantaneous amount of water and shit in my body when I step on the scale, and I'm not counting the latter.) It does intuitively make sense that there could be a point beyond which the body doesn't know what to do with any more calories and would just not even bother to digest them -- but IME if there's such a point it's nearly impossible to reach it short of actually getting sick from eating.

--
Army1987
From: michaelvassar
2013-01-07 07:48 pm (UTC)

(Link)

I used to have your attitude about the establishment, but I ultimately concluded that there was no establishment consensus to fall back on, or at least, no way to discover what it was without making my own guesses in a manner analogous to trying to figure things out for myself. As best as I can tell, you don't get let into any kind of establishment, in life in general, if they think you have any beliefs at all or that you think having belifs is a good thing. They are, however, very smart, and very good at agreeing with smart people who make a claim and saying that they already agree, by which they mean that they know some smart people are making that claim and wouldn't be that shocked if that was the way the wind blew for a few more years.
From: (Anonymous)
2013-01-20 01:06 am (UTC)

Some recommended further reading

(Link)

Gary Taube's (very long and thorough) rebuttal of Guyenet (in six parts! Yikes!).

Part 1 (http://garytaubes.com/2011/09/catching-up-on-lost-time-ancestral-health-symposium-food-reward-palatability-insulin-signaling-carbohydrates-kettles-pots-other-odds-ends-part-i/)
Part 2a (http://garytaubes.com/2011/11/catching-up-on-lost-time-%E2%80%93-the-ancestral-health-symposium-food-reward-palatability-insulin-signaling-and-carbohydrates%E2%80%A6-part-iia/)
Part 2b (http://garytaubes.com/2011/11/catching-up-on-lost-time-%E2%80%93-the-ancestral-health-symposium-food-reward-palatability-insulin-signaling-and-carbohydrates%E2%80%A6-part-iib/)
Part 2c (http://garytaubes.com/2011/11/catching-up-on-lost-time-%E2%80%93-the-ancestral-health-symposium-food-reward-palatability-insulin-signaling-and-carbohydrates%E2%80%A6-part-iic/)
Part 2d (http://garytaubes.com/2011/11/catching-up-on-lost-time-%E2%80%93-the-ancestral-health-symposium-food-reward-palatability-insulin-signaling-and-carbohydrates%E2%80%A6-part-iid/)
Part 2e (http://garytaubes.com/2011/11/catching-up-on-lost-time-%E2%80%93-the-ancestral-health-symposium-food-reward-palatability-insulin-signaling-and-carbohydrates%E2%80%A6-part-iie-as-in-%E2%80%9Cend-and-enough-already/)

Also, here's an article by Taube's partner at NuSi, Petter Attia, regarding calories and thermodynamics. (http://eatingacademy.com/nutrition/do-calories-matter)

I've been in nutritional ketosis via a high fat, low carb diet, for over 18 months. (Taubes has been doing it for years, as have countless others). The science is legit!

@atClaudioRivera (http://twitter.com/atclaudiorivera)
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