Good calories, bad calories Challenging the conventional wisdom on diet, weight control, and disease

Gary Taubes

Book - 2007

After seven years of research in every science connected with the impact of nutrition on health, science writer Taubes shows that almost everything we believe about a healthy diet is wrong. We are taught that fat is bad for us, carbohydrates better, and that the key to a healthy weight is eating less and exercising more--yet we see unprecedented epidemics of obesity and diabetes. Taubes argues persuasively that the problem lies in refined carbohydrates, via their dramatic effect on insulin, and that the key to good health is the kind of calories we take in, not the number. He also argues that there is no compelling scientific evidence that saturated fat and cholesterol cause heart disease. Based on the evidence, he concludes that the only h...ealthy way to remain lean is to eat fewer carbohydrates or to change the type of carbohydrates we eat.--From publisher description.

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Subjects
Published
New York : Knopf 2007.
Language
English
Main Author
Gary Taubes (-)
Edition
1st ed
Item Description
"Borzoi book."
Physical Description
xxv, 601 p. ; 24 cm
Bibliography
Includes bibliographical references and index.
ISBN
9781400040780
Contents unavailable.
Review by Choice Review

With this meticulously researched treatise purporting the efficacy of a low-carbohydrate, calorie-unrestricted diet, Taubes passionately challenges the time-honored theory that caloric restriction is key to weight loss. Even though Taubes, an award-winning correspondent for Science, stridently upholds the benefits of the low-carbohydrate regime most recently advocated by the best-selling, and often panned, Dr. Atkins' Diet Revolution (1973), he allows readers to make their own conclusions by providing 66 pages of citations that include classics by Ansel Keys and Theodore Van Itallie. Also, even though he portrays the medical establishment as a cliquish group that is reluctant to accept novel ideas despite contrary evidence, Taubes consistently scientifically verifies his allegations. Although it is biased toward the less conventional low-carbohydrate diets, this well-written, logically presented book will be useful in a range of information centers. Public library patrons will appreciate the in-depth discussion of various weight-reducing diets. Undergraduate students will find the information presented useful in the formulation of debates about conventional medical wisdom. The extensive bibliography will provide health care students, professionals, and researchers with a broad overview of historical and current research about weight control. Summing Up: Recommended. All levels. C. Brown University of Oklahoma

Copyright American Library Association, used with permission.
Review by New York Times Review

GARY TAUBES is a brave and bold science journalist who does not accept conventional wisdom. In "Good Calories, Bad Calories," he says what he wants is a fair hearing and rigorous testing for ideas that might seem shocking. His thesis, first introduced in a much-debated article in The New York Times Magazine in 2002 challenging the low-fat diet orthodoxy, is that nutrition and public health research and policy have been driven by poor science and a sort of pig-headed insistence on failed hypotheses. As a result, people are confused and misinformed about the relationship between what they eat and their risk of growing fat. He expands that thesis in the new book, arguing that the same confused reasoning and poor science has led to misconceptions about the relation between diet and heart disease, high blood pressure, cancer, dementia, diabetes and, again, obesity. When it comes to determining the ideal diet, he says, we have to "confront the strong possibility that much of what we've come to believe is wrong." The best diet, he argues, is one loaded with protein and fat but very low in carbohydrates. Taubes spent five years working on the book, which runs to more than 450 pages. The bibliography alone goes on for more than 60 pages. He also says he interviewed more than 600 doctors, researchers and administrators, though he adds that "the appearance of their names in the text ... does not imply that they agree with all or even part of the thesis set forth in this book." Taubes does not bow to the current fashion for narrative nonfiction, instead building his argument case by case, considering the relationship between dietary fat and heart disease, carbohydrates and disease, diet and obesity. As a result, the book can be hard to read, tedious in many places and repetitious. Yet much of what Taubes relates will be eye-opening to those who have not closely followed the science, or lack of science, in this area. (Disclosure: At one point he approvingly cites my articles on the lack of evidence that a high-fiber diet protects against colon cancer.) For example, he tells the amazing story of how the idea of a connection between dietary fat, cholesterol and heart disease got going and took on a life of its own, despite the minimal connection between dietary cholesterol and blood cholesterol for most people. He does not mince words. "From the inception of the diet-heart hypothesis in the early 1950s, those who argued that dietary fat caused heart disease accumulated the evidential equivalent of a mythology to support their belief. These myths are still passed on faithfully to the present day." The story is similar for salt and high blood pressure, and for dietary fiber and cancer. In fact, Taubes convincingly shows that much of what is believed about nutrition and health is based on the flimsiest science. To cite one minor example, there's the notion that a tiny bit of extra food, 50 or 100 calories a day - a few bites of a hamburger, say - can gradually make you fat, and that eating a tiny bit less each day, or doing something as simple as walking a mile, can make the weight slowly disappear. This idea is based on a hypothesis put forth in a single scientific paper, published in 2003. And even then it was qualified, Taubes reports, by the statement that it was "theoretical and involves several assumptions" and that it "remains to be empirically tested." Nonetheless, it has now become the basis for an official federal recommendation for obesity prevention. But the problem with a book like this one, which goes on and on in great detail about experiments new and old in areas ranging from heart disease to cancer to diabetes, is that it can be hard to know what has been left out. For example, Taubes argues at length that people get fat because carbohydrates in their diet drive up the insulin level in the blood, which in turn encourages the storage of fat. His conclusion: all calories are not alike. A calorie of fat is much less fattening than a calorie of sugar. It's known, though, that the body is not so easily fooled. Taubes ignores what diabetes researchers say is a body of published papers documenting a complex system of metabolic controls that, in the end, assure that a calorie is a calorie is a calorie. He also ignores definitive studies done in the 1950s and '60s by Jules Hirsch of Rockefeller University and Rudolph Leibel of Columbia, which tested whether calories from different sources have different effects. The investigators hospitalized their subjects and gave them controlled diets in which the carbohydrate content varied from zero to 85 percent, and the fat content varied inversely from 85 percent to zero. Protein was held steady at 15 percent. They asked how many calories of what kind were needed to maintain the subjects' weight. As it turned out, the composition of the diet made no difference. As I read Taubes's book, I kept wondering how he would deal with an obvious question. If low-carbohydrate diets are so wonderful, why is anyone fat? Most people who struggle with their weight have tried these diets and nearly all have regained everything they lost, as they do with other diets. What is the problem? On Page 446, he finally tells us. Carbohydrates, he says, are addictive, and we've all gotten hooked. Those who try to break the habit start to crave them, just as an alcoholic craves a drink or a smoker craves a cigarette. But, he adds, if they are addictive, that "implies that the addiction can be overcome with sufficient time, effort and motivation." I'm sorry, but I'm not convinced. Gina Kolata is a medical reporter for The Times and the author of "Rethinking Thin: The New Science of Weight Loss and the Myths and Realities of Dieting."

Copyright (c) The New York Times Company [October 27, 2009]
Review by Booklist Review

Noted science journalist Taubes probes the state of what is currently known and what is simply conjectured about the relationship among nutrition, weight loss, health, and disease. What Taubes discovers is that much of what passes for irrefutable scientific knowledge is in fact supposition and that many reputable scientists doubt the validity of nutritional advice currently promoted by the government and public health industry. Beginning with the history of Ancel Keys' research into the relationship between elevated blood-cholesterol levels and coronary heart disease, Taubes demonstrates that a close reading of studies has shown that a low-cholesterol diet scarcely changes blood-cholesterol levels. Low-fat diets, moreover, apparently do little to lengthen life span. He does find encouragement in research tracking the positive effects of eliminating excessive refined carbohydrates and thus addressing pernicious diseases such as diabetes. Taubes' transparent prose brings drama, excitement, and tension to even the most abstruse and clinically reserved accounts of scientific research. He is careful to distinguish the oft-confused goals of weight loss and good health. Given America's current obsession with these issues, Taubes' challenge to current nutritional conventional wisdom will generate heated controversy and create popular demand for this deeply researched and equally deeply engaging treatise.--Knoblauch, Mark Copyright 2007 Booklist

From Booklist, Copyright (c) American Library Association. Used with permission.
Review by Publisher's Weekly Review

Taubes's eye-opening challenge to widely accepted ideas on nutrition and weight loss is as provocative as was his 2001 New York Times Magazine article, "What if It's All a Big Fat Lie?" Taubes (Bad Science), a writer for Science magazine, begins by showing how public health data has been misinterpreted to mark dietary fat and cholesterol as the primary causes of coronary heart disease. Deeper examination, he says, shows that heart disease and other "diseases of civilization" appear to result from increased consumption of refined carbohydrates: sugar, white flour and white rice. When researcher John Yudkin announced these results in the 1950s, however, he was drowned out by the conventional wisdom. Taubes cites clinical evidence showing that elevated triglyceride levels, rather than high total cholesterol, are associated with increased risk of heart disease-but measuring triglycerides is more difficult than measuring cholesterol. Taubes says that the current U.S. obesity "epidemic" actually consists of a very small increase in the average body mass index. Taube's arguments are lucid and well supported by lengthy notes and bibliography. His call for dietary "advice that is based on rigorous science, not century-old preconceptions about the penalties of gluttony and sloth" is bound to be echoed loudly by many readers. Illus. (Oct. 2) (c) Copyright PWxyz, LLC. All rights reserved

(c) Copyright PWxyz, LLC. All rights reserved
Review by Library Journal Review

Journalist Taubes joins the scientific fray on the causes of obesity in modern society. Departing from the conventional thought that overeating and sedentary behaviors are the major culprits, he focuses on refined carbohydrates and sugars as causes of diabetes, heart disease, and other illnesses. He highlights studies to show how research outcomes have been biased or manipulated to fit conventional theories about health, diet, and weight. He discusses the politics that often steer research in a direction other than where the evidence actually leads, as well as researchers' own preconceived biases that influence results. Taubes details what he sees as flaws in hundreds of scientific studies, disputing findings that drive modern nutritional practice. Some of his own premises about diet-e.g., consuming too many calories does not cause people to become overweight and dietary fat does not increase one's risk of heart disease-are controversial. While the book is thought-provoking, its sheer volume of detail and complexity of writing will deter all but the most determined readers. Not recommended.-Janet M. Schneider, James A. Haley Veterans Hosp., Tampa, FL (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

Prologue: A Brief History of Banting Farinaceous and vegetable foods are fattening, and saccharine matters are especially so....In sugar-growing countries the negroes and cattle employed on the plantations grow remarkably stout while the cane is being gathered and the sugar extracted. During this harvest the saccharine juices are freely consumed; but when the season is over, the superabundant adipose tissue is gradually lost. -Thomas Hawkes Tanner, The Practice of Medicine, 1869 William Banting was a fat man. In 1862, at age sixty-six, the five-foot-five Banting, or "Mr. Banting of corpulence notoriety," as the British Medical Journal would later call him, weighed in at over two hundred pounds. "Although no very great size or weight," Banting wrote, "still I could not stoop to tie my shoe, so to speak, nor attend to the little offices humanity requires without considerable pain and difficulty, which only the corpulent can understand." Banting was recently retired from his job as an upscale London undertaker; he had no family history of obesity, nor did he consider himself either lazy, inactive, or given to excessive indulgence at the table. Nonetheless, corpulence had crept up on him in his thirties, as with many of us today, despite his best efforts. He took up daily rowing and gained muscular vigor, a prodigious appetite, and yet more weight. He cut back on calories, which failed to induce weight loss but did leave him exhausted and beset by boils. He tried walking, riding horseback, and manual labor. His weight increased. He consulted the best doctors of his day. He tried purgatives and diuretics. His weight increased. Luckily for Banting, he eventually consulted an aural surgeon named William Harvey, who had recently been to Paris, where he had heard the great physiologist Claude Bernard lecture on diabetes. The liver secretes glucose, the substance of both sugar and starch, Bernard had reported, and it was this glucose that accumulates excessively in the bloodstream of diabetics. Harvey then formulated a dietary regimen based on Bernard's revelations. It was well known, Harvey later explained, that a diet of only meat and dairy would check the secretion of sugar in the urine of a diabetic. This in turn suggested that complete abstinence from sugars and starches might do the same. "Knowing too that a saccharine and farinaceous diet is used to fatten certain animals," Harvey wrote, "and that in diabetes the whole of the fat of the body rapidly disappears, it occurred to me that excessive obesity might be allied to diabetes as to its cause, although widely diverse in its development; and that if a purely animal diet were useful in the latter disease, a combination of animal food with such vegetable diet as contained neither sugar nor starch, might serve to arrest the undue formation of fat." Harvey prescribed the regimen to Banting, who began dieting in August 1862. He ate three meals a day of meat, fish, or game, usually five or six ounces at a meal, with an ounce or two of stale toast or cooked fruit on the side. He had his evening tea with a few more ounces of fruit or toast. He scrupulously avoided any other food that might contain either sugar or starch, in particular bread, milk, beer, sweets, and potatoes. Despite a considerable allowance of alcohol in Banting's regimen-four or five glasses of wine each day, a cordial every morning, and an evening tumbler of gin, whisky, or brandy-Banting dropped thirty-five pounds by the following May and fifty pounds by early 1864. "I have not felt better in health than now for the last twenty-six years," he wrote. "My other bodily ailments have become mere matters of history." We know this because Banting published a sixteen-page pamphlet describing his dietary experience in 1863- Letter on Corpulence, Addressed to the Public -promptly launching the first popular diet craze, known farther and wider than Banting could have imagined as Bantingism. His Letter on Corpulence was widely translated and sold particularly well in the United States, Germany, Austria, and France, where according to the British Medical Journal, "the emperor of the French is trying the Banting system and is said to have already profited greatly thereby." Within a year, "Banting" had entered the English language as a verb meaning "to diet." "If he is gouty, obese, and nervous, we strongly recommend him to 'bant,' " suggested the Pall Mall Gazette in June 1865. The medical community of Banting's day didn't quite know what to make of him or his diet. Correspondents to the British Medical Journal seemed occasionally open-minded, albeit suitably skeptical; a formal paper was presented on the efficacy and safety of Banting's diet at the 1864 meeting of the British Medical Association. Others did what members of established societies often do when confronted with a radical new concept: they attacked both the message and the messenger. The editors of The Lancet, which is to the BMJ what Newsweek is to Time, were particularly ruthless. First, they insisted that Banting's diet was old news, which it was, although Banting never claimed otherwise. The medical literature, wrote The Lancet, "is tolerably complete, and supplies abundant evidence that all which Mr. Banting advises has been written over and over again." Banting responded that this might well have been so, but it was news to him and other corpulent individuals. In fact, Banting properly acknowledged his medical adviser Harvey, and in later editions of his pamphlet he apologized for not being familiar with the three Frenchmen who probably should have gotten credit: Claude Bernard, Jean Anthelme Brillat-Savarin, and Jean-François Dancel. (Banting neglected to mention his countrymen Alfred William Moore and John Harvey, who published treatises on similar meaty, starch-free diets in 1860 and 1861 respectively.) Brillat-Savarin had been a lawyer and gourmand who wrote what may be the single most famous book ever written about food, The Physiology of Taste, first published in 1825.* In it, Brillat-Savarin claimed that he could easily identify the cause of obesity after thirty years of talking with one "fat" or "particularly fat" individual after another who proclaimed the joys of bread, rice, and potatoes. He added that the effects of this intake were exacerbated when sugar was consumed as well. His recommended reducing diet, not surprisingly, was "more or less rigid abstinence from everything that is starchy or floury." Dancel was a physician and former military surgeon who publicly presented his ideas on obesity in 1844 to the French Academy of Sciences and then published a popular treatise, Obesity, or Excessive Corpulence, The Various Causes and the Rational Means of Cure. Dancel's thinking was based in part on the research of the German chemist Justus von Liebig, who, at the time, was defending his belief that fat is formed in animals primarily from the ingestion of fats, starches, and sugars, and that protein is used exclusively for the restoration or creation of muscular tissue. "All food which is not flesh-all food rich in carbon and hydrogen-must have a tendency to produce fat," wrote Dancel. "Upon these principles only can any rational treatment for the cure of obesity satisfactorily rest." Dancel also noted that carnivores are never fat, whereas herbivores, living exclusively on plants, often are: "The hippopotamus, for example," wrote Dancel, "so uncouth in form from its immense amount of fat, feeds wholly upon vegetable matter-rice, millet, sugar-cane, &c." The second primary grievance that The Lancet 's editors had with Banting, which has been echoed by critics of such diets ever since, was that his diet could be dangerous, and particularly so for the credibility of those physicians who did not embrace his ideas. "We advise Mr. Banting, and everyone of his kind, not to meddle with medical literature again, but be content to mind his own business," The Lancet said. When Bantingism showed little sign of fading from the scene, however, The Lancet 's editors adopted a more scientific approach. They suggested that a "fair trial" be given to Banting's diet and to the supposition that "the sugary and starchy elements of food be really the chief cause of undue corpulence." Banting's diet plays a pivotal role in the science of obesity-and, in fact, chronic disease-for two reasons. First, if the diet worked, if it actually helped people lose weight safely and keep it off, then that is worth knowing. More important, knowing whether "the sugary and starchy elements of food" are "really the chief cause of undue corpulence" is as vital to the public health as knowing, for example, that cigarettes cause lung cancer, or that HIV causes AIDS. If we choose to quit smoking to avoid the former, or to use condoms or abstinence to avoid the latter, that is our choice. The scientific obligation is first to establish the cause of the disease beyond reasonable doubt. It is easy to insist, as public-health authorities inevitably have, that calories count and obesity must be caused by overeating or sedentary behavior, but it tells us remarkably little about the underlying process of weight regulation and obesity. "To attribute obesity to 'overeating,' " as the Harvard nutritionist Jean Mayer suggested back in 1968, "is as meaningful as to account for alcoholism by ascribing it to 'overdrinking.' " After the publication of Banting's "Letter on Corpulence," his diet spawned a century's worth of variations. By the turn of the twentieth century, when the renowned physician Sir William Osler discussed the treatment of obesity in his textbook The Principles and Practice of Medicine, he listed Banting's method and versions by the German clinicians Max Joseph Oertel and Wilhelm Ebstein. Oertel, director of a Munich sanitorium, prescribed a diet that featured lean beef, veal, or mutton, and eggs; overall, his regimen was more restrictive of fats than Banting's and a little more lenient with vegetables and bread. When the 244-pound Prince Otto von Bismarck lost sixty pounds in under a year, it was with Oertel's regimen. Ebstein, a professor of medicine at the University of Göttingen and author of the 1882 monograph Obesity and Its Treatment, insisted that fatty foods were crucial because they increased satiety and so decreased fat accumulation. Ebstein's diet allowed no sugar, no sweets, no potatoes, limited bread, and a few green vegetables, but "of meat every kind may be eaten, and fat meat especially." As for Osler himself, he advised obese women to "avoid taking too much food, and particularly to reduce the starches and sugars." The two constants over the years were the ideas that starches and sugars-i.e., carbohydrates-must be minimized to reduce weight, and that meat, fish, or fowl would constitute the bulk of the diet. When seven prominent British clinicians, led by Raymond Greene (brother of the novelist Graham Greene), published a textbook entitled The Practice of Endocrinology ** in 1951, their prescribed diet for obesity was almost identical to that recommended by Banting, and that which would be prescribed by such iconoclasts as Herman Taller and Robert Atkins in the United States ten and twenty years later. Foods to be avoided: 1. Bread, and everything else made with flour . . . 2. Cereals, including breakfast cereals and milk puddings 3. Potatoes and all other white root vegetables 4. Foods containing much sugar 5. All sweets . . . You can eat as much as you like of the following foods: 1. Meat, fish, birds 2. All green vegetables 3. Eggs, dried or fresh 4. Cheese 5. Fruit, if unsweetened or sweetened with saccharin, except bananas and grapes "The great progress in dietary control of obesity," wrote Hilde Bruch, considered the foremost authority on childhood obesity, in 1957, "was the recognition that meat . . . was not fat producing; but that it was the innocent foodstuffs, such as bread and sweets, which lead to obesity." The scientific rationale behind this supposed cause and effect was based on observation, experimental evidence, and maybe the collected epiphanies and anecdotes of those who had successfully managed to bant. "The overappropriation of nourishment seen in obesity is derived in part from the fat ingested with the food, but more particularly from the carbohydrates," noted James French in 1907 in his Textbook of the Practice of Medicine. Copious opinions were offered, but no specific hypotheses. In his 1940 monograph Obesity and Leanness, Hugo Rony, director of the Endocrinology Clinic at the Northwestern University Medical School in Chicago, reported that he had carefully questioned fifty of his obese patients, and forty-one professed a "more or less marked preference for starchy and sweet foods; only 1 patient claimed preference for fatty foods." Rony had one unusual patient, "an extremely obese laundress," who had no taste for sweets, but "a craving for laundry starch which she used to eat by the handful, as much as a pound a day. . . ." So maybe carbohydrates are fattening because that's what those with a tendency to gain weight eat to excess. To others, carbohydrates carry some inherent quality that makes them uniquely fattening. Maybe they induce a continued sensation of hunger, or even a specific hunger for more carbohydrates. Maybe they induce less satiation per calorie consumed. Maybe they somehow cause the human body to preferentially store away calories as fat. "In Great Britain obesity is probably more common among poor women than among the rich," Sir Stanley Davidson and Reginald Passmore wrote in the early 1960s in their classic textbook Human Nutrition and Dietetics, "perhaps because foods rich in fat and protein, which satisfy appetite more readily than carbohydrates, are more expensive than the starchy foods which provide the bulk of cheap meals." This belief in the fattening powers of carbohydrates can be found in literature as well. In Tolstoy's Anna Karenina, for instance, written in the mid-1870s, Anna's lover, Count Vronsky, abstains from starches and sweets in preparation for what turns out to be the climactic horse race. "On the day of the races at Krasnoe Selo," writes Tolstoy, "Vronsky had come earlier than usual to eat beefsteak in the officers' mess of the regiment. He had no need to be in strict training, as he had very quickly been brought down to the required weight of one hundred and sixty pounds, but still he had to avoid gaining weight, and he avoided starchy foods and desserts." In Giuseppe di Lampedusa's The Leopard, published in 1958, the protagonist, Prince Fabrizio, expresses his distaste for the plump young ladies of Palermo, while blaming their condition on, among other factors, "the dearth of proteins and the overabundance of starch in the food." This was what Dr. Spock taught our parents and our grandparents in the first five decades, six editions, and almost 50 million copies of Baby and Child Care, the bible of child-rearing in the latter half of the twentieth century. "Rich desserts," Spock wrote, and "the amount of plain, starchy foods (cereals, breads, potatoes) taken is what determines, in the case of most people, how much [weight] they gain or lose." It's what my Brooklyn-born mother taught me forty-odd years ago. If we eat too much bread or too much spaghetti, we will get fat. The same, of course, is true of sweets. For over a century, this was the common wisdom. "All popular 'slimming regimes' involve a restriction in dietary carbohydrate," wrote Davidson and Passmore in Human Nutrition and Dietetics, offering this advice: "The intake of foods rich in carbohydrate should be drastically reduced since over-indulgence in such foods is the most common cause of obesity." "The first thing most Americans do when they decide to shed unwanted pounds is to cut out bread, pass up the potatoes and rice, and cross spaghetti dinners off the menu entirely," wrote the New York Times personal-health reporter, Jane Brody, in her 1985 best-selling Good Food Book. * When the first American edition of The Physiology of Taste was published in 1865, it was entitled The Handbook of Dining, or Corpulence and Leanness Scientifically Considered, perhaps to capitalize on the Banting craze. ** Endocrinology is the study of the glands that secrete hormones and the hormones themselves. Excerpted from Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease by Gary Taubes All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.