Good Calories, Bad Calories, by Gary Taubes

I think you raised this exact point a few days ago. The answer is that the triglycerides that form in the liver while insulin levels are presumably high because of elevated blood sugar levels remain in the liver after insulin levels decline, at which time they can become part of the process of VLDL production.You actually already accept that this is case, because you've already said that the glucose => triglycerides => VLDL process does indeed exist. The liver converts glucose to triglycerides, but won't produce VLDL at that particular time until the insulin response to the glucose diminishes. The only difference between us is that you believe the process rarely takes place.I bought a blood sugar test kit a few days ago and for a while I sampled my blood sugar at regular intervals. My blood sugar levels never drop below 90 and never rise above 120, except for one time I hit 141 about 15 minutes after eating a South Beach Diet snack bar that said it contained 18 grams of carbohydrate. Most of the time my blood sugar level is right around 100.My carbohydrate intake is so low that I'm wondering how my blood sugar level is being maintained. I would guess that the triglycerides in adipose tissue are being converted into FFAs, but are the FFAs used directly for energy, or are they first converted to glucose, or do both processes (and more?) take place. I'm trying to explain my extremely consistent blood sugar levels.--Percy

You offered a citation in support of your position that did not actually appear to provide any support, at least to me, so I suggested that it might be more helpful if you explained in layperson's terms how the citation provided that support. But what you've provided is just a restatement of your position. How does your citation support your position? The difficulty you're having supporting your positions should not serve as an excuse for taking out your frustrations on me and Taubes. It would be more constructive to just focus on the topic. You're not the only human being involved in this discussion, and all human beings have feelings. We've been over these two points before. Concerning the first point, I'm using myself as an example because I'm typical. Most people lose weight on low carb diets without experiencing the hunger associated with low fat diets.Concerning the second point, the dietary fat crowd concedes that low carb diets are effective but criticizes them for being nutritionally dangerous or being low calorie diets in disguise, and there are probably other criticisms. In other words, they don't share this particular aspect of your skepticism. Your request for evidence is not unreasonable, but it is unexpected as you personally are disputing a characteristic of low carb diets that isn't considered controversial. It might help if you explained why you doubt the consensus view on this particular aspect of low carb diets. Is it that you don't really believe there's a consensus, or is it something else specifically? True, but it is widely believed that there is a dominant factor. For advocates of the dietary fat hypothesis, it is believed that the dominant factor is dietary fat. This has become the mainstream view, and it is the cause of all the low fat foods in grocery stores.For advocates of the carbohydrate hypothesis, it is believed that the dominant factor is refined carbohydrates, but this hypothesis has not found any widespread degree of acceptance and has had little influence on dietary recommendations.The result is dietary recommendations that over the past half century have caused people to increasingly deemphasize fat while simultaneously increasing carbohydrate intake, and the result is an increasingly fat and diabetic population.I understand that you would like a discussion that involves more citations, and I encourage you to bring whatever references you like to the discussion, but arguments and explanations should be in your own words with references serving only as pointers to the sources of information.--Percy

I think part of the problem is that you're judging Taubes' mass market book using the criteria of a peer reviewer for a technical journal. If that's to be your approach then no doubt you'll be able to write thousands of pages of criticism once you have the book in hand.Science books written for the mass market have to be written in terms that laypeople unfamiliar with the area can understand. That requires addressing things at a level of detail that apparently drives researchers like yourself crazy.Taubes doesn't say that the triglycerides are stored in the liver. He says they're produced in the liver for temporary storage, but doesn't say where they're actually stored. Honestly, I would have assumed the liver myself, but from what you say that must not be the case. But you're again putting me in the position of having to say, "No, Taubes isn't saying that," and I'm becoming concerned at the frequency with which this is occurring. A little more focus on accuracy on your part would be appreciated, especially since you're attributing what are actually your own misinterpretations to Taubes and then excoriating him for them. I'm sure Taubes' book has its share of mistakes, but please criticize him for mistakes he actually makes.The reference information Taubes provides for this is:

• Mayes and Botham 2004
• Berneis and Krauss 2002
• DeFronzo 1992

--Percy

I quoted Taubes' own words.Much of your recent criticism has left the realm of dispassionate and objective topical discourse. It would really help keep the discussion on a constructive footing if you could just focus on the topic, and if you could think of us as partners on an adventure of exploration instead of as enemies on opposite sides of a battle line. The road you're marching down just leads to acrimony and accusations where nothing will be learned. Many aspects of this discussion seem to upset you into caustic responses, and that's just not helpful. If you're just here to yell at people, if you're just here for thunder instead of light, then please let me know now so I can stop wasting my time.When we started we hoped to explore two separate issues:

• The current issue, which is whether blood sugar spikes encourage the production of small, dense LDLs, which play a role in heart disease.
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• The next issue, which is whether it is really true that low carbohydrate diets produce weight loss without hunger and at higher calorie levels than low fat diets, and if so, the mechanisms behind that ability.

Excoriating me and Taubes isn't going to help get answers to these questions.--PercyEdited by Percy, : Restore version of message that was lost when site went down.

I thought that Taubes' offered those references in support of this paragraph from page 175: But evidently he was instead offering them in support of the overall hypothesis that blood sugar spikes encourage the production of small, dense LDLs that in turn lead to heart disease.So what you're looking for is citations to research supporting the view that elevated glucose levels encourage the production of triglycerides. I don't think that possibility is considered controversial, so it wouldn't be expected that Taubes would offer citations for it. You yourself have offered diagrams that include this possibility, e.g., this one, the box at the top shows glucose being converted to fatty acids, which it does not specify are free or bound up in triglycerides, but we already know from statements elsewhere like Wikipedia that the liver can produce triglycerides: But you've maintained that this is a very uncommon process, and so I was hoping we could seek evidence of whether that is so or not.--Percy

I think this study is in the general neighborhood of the initial part of the process that Taubes describes, that elevated glucose levels cause increased triglyceride output from the liver: Effects of dietary fructose or glucose on triglyceride production and lipogenic enzyme activities in the liver of Wistar fatty rats, an animal model of NIDDMThe abstract concludes: This is consistent with Taubes premise, which is that repeatedly abusing the body's metabolic processes with blood sugar spikes causes insulin resistance and obesity, creating an environment where elevated blood sugar levels cause increased triglyceride production by the liver. This is the part that I've been saying is not controversial, and it doesn't appear to be an incredibly rare process as you've been claiming.I think we should next focus on what Taubes means by "temporary storage" of triglycerides. I can't answer that question. Do you have any guesses? Is adipose tissue really the only place that triglycerides are stored? They're never stored elsewhere for use by the liver in VLDL production?--Percy

You have to keep in mind that we're approaching this on two completely different levels. From my point of view, trying to figure out the story from individual research papers is like trying to do a jigsaw puzzle where the pieces are the size of grains of sand. This is what researchers do. This is what I do in my own field, in a manner of speaking. But in this field I'm a layperson, and I'm not going to be able to piece together the story from research papers.Research papers present huge problems for those unfamiliar with an area of research, even for those working in fairly similar areas. We encountered this problem with LindaLou, where it became apparent that one can find research papers supporting either side of an issue. The problem is that the first papers focusing on a given issue are preliminary, often cursory, but as the issue attracts attention (and grant money) the studies become higher and higher quality, but it can be very difficult for laypeople to tell the different in quality between studies (there's also the quack journals). Compounding the problem is that the funding process does not encourage replication studies, and so it is rare to find studies that examine the exact same question.I'm in no way trying to discourage you from trying to piece together the puzzle from research papers. I'm just telling you up front that that particular approach is not where it's worthwhile for me to spend my time. I know you like to work from citations and excerpts, but what really works best is when you describe your position or your information in your own words and provide citations only as references to the source of the information.At one point you commented that you feel as you imagine Cavediver must feel sometimes, but there's a big difference in this discussion. Cavediver is not claiming that the low level physics research indicates that in the macro world objects should fall up. But the mainstream health establishment is claiming that dietary fat is the big bugaboo of modern health. They claim that the research supports a conclusion that dietary fat is the primary culprit behind heart disease, diabetes and obesity. These claims are responsible for huge efforts to get people to reduce intake of dietary fat, and this whole process is taking place at the same time that modern health with respect to these diseases in western countries continues to worsen.So the big central question is what accounts for this huge disconnect between what it is claimed the research indicates, and the actual experience of the western world.In other words, whether it's insulin or glucose or ooblick that influences triglyceride production in the liver is of most interest to researchers like yourself, whose responsibility it is to piece together the story and make recommendations about diet. Ferreting out details like this is actually just tiny steps on the way to understanding what causes heart disease, diabetes and obesity.But I don't have to be a researcher to know that objects don't fall up, no matter how much the researchers might claim that that's what the research indicates. All it tells me is that they don't really know, and the medical establishment has a long history of making dietary recommendations long before they really know what's going on and that later on turn out to be completely backwards, for example, the early condemnation of eggs because of cholesterol content.--Percy

Yes, you're right, this is a side issue, but it's what I have time for right now. We're still having Internet issues, so an hour of my time every evening has been going to figuring out the problem. I will come back to the technical issues you mentioned in your last few posts, just not right now. Well, let me not be specific then. Whoever is responsible for promoting the message about the adverse health effects of dietary fat and low carb diets (and my doctor is certainly one source I can be specific about as far as promoting this message), the fact remains that this message is out there in an extremely prominent, powerful and almost omnipresent way. I remember that you keep saying this. Hey, excoriate is my word, find your own! I think you need to separate in your mind your dislike of Taubes for blaming the community of which you are a part from your disagreement with Taubes about his dietary conclusions.When I criticize what I'll call this unknown source of the dominant dietary message, it's an expression of my own frustration with the years and years of what may very likely be incorrect and even possibly adverse dietary advice. Whoever is to blame deserves to be excoriated.--Percy

It's funny how you never hear of something, and then suddenly you hear about it from all over. Our company had a book sale in the lobby, and the proprietor recommended The Omnivore's Dilemma to me. Then the next day my wife said that on a walk her friend had mentioned The Omnivore's Dilemma. Then here you are a week or so later recommending a talk by the author of The Omnivore's Dilemma.So I thought it worthwhile to give this a listen, and then right in the first five minutes Michael Pollan said something that echoed Taubes precisely: Taubes' book says nearly the identical thing, but Taubes also goes a bit further: Pollan echos Taubes on another point concerning nutrition as religion: And Taubes makes the same comparison, though again he goes a bit further: I don't know what Pollan will go on to say from here, but so far his message seems just a friendlier (toward the health research community) version of Taubes'. It appears that Pollan may see the same problems as Taubes, but refrains from actually blaming anyone.Pollan says outright that today the dietary evil is trans fat, and I remember that about this you said that the answers are complex and do not reduce to a single simple answer, and I of course agree, but the national authorities on health responsible for reducing the research to public recommendations say that the big dietary evil is fat, and while the health community as a whole does not view it as anything like that simple, the fact of the matter is that in the past and probably in the present, too, our public health authorities have had no problem finding prominent health researchers who will state as if there is no ambiguity that the big dietary evil is fat. The scientist who filled this role back in the early 1970s when the McGovern committee did its investigating into diet and health was Ancel Keys. The McGovern committee produced the report Dietary Goals for the United States, which started the whole "fat is evil" attitude still prevalent today.Interestingly, Pollan is also blaming a group, but he's blaming the average person, not the health community, for engaging in what he calls "nutritionism", and I won't provide his detailed definition, but generally its when you overemphasize the nutritional content of food to the near exclusion of other qualities. I think Pollan would probably agree that people who eat low-fat cream cheese (think edible plastic) are engaging in nutritionism.Pollan next agrees with Taubes about the health dilemma, and provides a little information about the "French contradiction" that is consistent with the carbohydrate hypothesis: Taubes would agree with all this, and in fact has said much the same thing, and note that Pollan says that the French eat more saturated fat than we do, which means their carbohydrate intake must be lower, completely consistent with the carbohydrate hypothesis and contrary to the dietary fat hypothesis.I'm beginning to wonder why you cited this Pollan talk as containing a truer message than Taubes, because Pollan has just stated in his own words Taubes' thesis: You gave me the impression that Pollan was going to contradict Taubes. Instead it is so far the exact same message with different packaging. Pollan even traces the origin of our current dilemma back to the 70s, just like Taubes, perhaps back to the same McGovern committee as Taubes.I'm now at 13:11 and Pollan has just launched into an exposition that precisely aligns with Taubes views about the lack of valid science behind modern nutritional recommendations. As far as I can see, Pollan and Taubes must agree on far, far more than they disagree, so I'm going to stop quoting Pollan every time he agrees with Taubes, I'd probably end up quoting half his talk. From here on in this message I'll only take note if I come across any notable differences between Pollan and Taubes. And if the agreement becomes too congruent I might just stop listening, I don't have infinite time and I already know what Taubes thinks, I don't need Pollan to echo him.I have to make an exception for this one, and I'm going to stop listening now: Though they might quibble about the exact year, I'm sure Taubes would concur.--PercyEdited by Percy, : Grammar.

Here's a lecture to the endocrinology department at UC Berkeley by Gary Taubes. I've watched it all the way through, and it is an even more clear presentation of his thesis than his book. It's rather long at 1:48:17, but after watching it you'll have a clear understanding not only of what he is saying, but also of some of the evidence behind what he is saying: At one point you questioned the lack of hunger associated with low carbohydrate diets, and I know you like studies, so here's one: The Effects of High Protein Diets on Thermogenesis, Satiety and Weight Loss: A Critical Review. From the first paragraph of the Satiety section: There's a lot more detail in that section if you're interested, but you can see that it really isn't controversial.--Percy

Taubes and Pollan agree on a great, great deal, most significantly that the dietary recommendations that emerged in the 1970s have contributed to worsening health trends regarding heart disease, diabetes and obesity. They also agree that the state of research regarding diet's effect on health is rudimentary at best.So apparently it is Taubes' advocacy for a specific alternative, the carbohydrate hypothesis, that is at the root of your objections. While seeking Pollan's position on carbohydrates I found a review of Pollan's book In Defense of Food which said at one point: So clearly Pollan disagrees with Taubes about carbohydrates, but the first sentence reveals a clear distinction between Pollan's and Taubes' books. Taubes' book is "a heavier read than Pollan's, thickly documented and heavy on the science," and though you've made clear that your criteria is the quality of the science, and though you express an interest in exploring the scientific issues, instead all you do is relentlessly slam Taubes and the book that is "heavy on the science." Are you under some weird misimpression that what you're doing resembles objective scientific practice in any way?I think examination of scientific issues like this requires objectivity and emotional detachment. If you've got your mind made up already and have only entered into this discussion to take jabs at Taubes at every opportunity then this isn't really a dialogue and there's no point in me responding anymore.--Percy

If this data is important to your conclusions about Taubes' views on carbohydrates then it might be worthwhile examining it.I didn't really have much luck looking into this. I know there was the Seven Countries Study concerning diet and heart disease around 50 years ago, but it didn't collect information on carbohydrate intake.I found no information about formal studies.The informal information I found on France said it was known for a high fat intake, not carbohydrate.Countries like Italy and Greece include the regions from which the outlines of the Mediterranean Diet were drawn, and upon which the South Beach low carb diet is based, so while I'm sure there are regions of Italy where pasta consumption is high, there are other regions where it isn't, and on a national level it might possibly average out, we'd have to have data to know for sure.I once traveled in Greece for two weeks, and I didn't find the land of lamb kabobs to be consuming many foods notable for their carbohydrate content. Standard fare in most tavernas is a Greek (of course) salad consisting of tomatoes, cucumber and a few olives, and souvlaki (a couple kabobs with lamb, peppers, onions, etc.). Bread, while not absent, wasn't served that much. I don't remember any pasta at all, though I'm sure there must have been some. We didn't see a lot of soda, either.So I guess what we want to do is take a look at the available studies of populations with high carbohydrate intake coincident with low obesity rates.--PercyEdited by Percy, : Grammar.

I have a few minutes before I have to leave this morning, so I'm poking around on the Internet. It would be great to find a table for each country of obesity rates by year along with fat and carbohydrate intake levels, but no such luck. I'm only finding anecdotal information.From France Battles a Problem That Grows and Grows: Fat in the NY Times on 1/25/2006, this indicates the growing success of fast food restaurants, and probably indicates an increase in inexpensive refined carbohydrates in their diets in the form of hamburger rolls, french fries, soft drinks and deserts: This article at Navigator.com (France heading for US obesity levels says study) comments on the same thing you did, but this reporter didn't know whether this was myth or not: I'm continuing to look for the source of the "French paradox" information, but all the articles I'm finding early in the Google list are from the same time and are actually reporting on the release of a study's results about obesity in France.To the extent that Taubes has a thesis it is that repeatedly spiking blood sugar levels, usually through intake of refined carbohydrates found in bread, pasta and products that include sugar like soda and ice cream, over a number of years eventually causes metabolic syndrome. The increasing evolution of the French diet to more closely resemble that of the American diet to have a greater emphasis on prepared meals and fast food, which is higher in refined carbohydrates than the more traditional French diet, is coincident with an increasing obesity rate.--Percy

Taubes doesn't have any metabolic pathways of his own, he's just trying to present the research, and I've just been trying to present what he presents. You have been so certain that Taubes is wrong that you jumped to numerous wrong conclusions and left me saying multiple times, "No, Taubes isn't saying that."Would you please relax? If Taubes is wrong then the evidence will show that he's wrong, but you have to figure out what he's saying first. You're driving both me and you crazy jumping with a big "Aha!" on every little detail, and you've been mostly wrong with your citations so far and wasting both our time.Taubes isn't saying anything all that controversial. Paraphrasing Taubes from the conclusion of his lecture at Berkeley, "The carbohydrate hypothesis is consistent with the evidence and deserves to be explored by further study." Given that you agree with Pollan, and given that Pollan agrees with Taubes, and given that they both agree that health research is in its infancy, it's hard to find much problem with that.But Taubes does say much that is very specific, for instance the part about carbohydrates role in heart disease by causing an increase in levels of small, dense LDLs, and the part about sustained intake of refined carbohydrates over the years playing a significant role in the onset of metabolic syndrome associated with diabetes type 2 and obesity. As that book review said, Taubes' book is rather heavy on the science, and soon you'll have the book in hand. You might also want to listen to that lecture he gave at Berkeley, the link's in Message 84, because it focuses more exclusively on details of diet/health relationships and metabolic processes, and it will only take an hour and forty-eight minutes, while reading the book will take you at least 10 hours. This is just another shot at Taubes. Haven't you done enough of this? Do see anyone here going after your side like this? Anyone, for example, bringing up your errors, like that VLDLs are the same as small, dense LDLs, and then accusing you of starting religions or being a sloppy researcher or leaving out significant steps?Of course not. Refraining from that kind of childish stuff is what viewing this as a partnership of exploration means: accepting that everyone involved in the process is honest and earnest and sincere but is also human and makes mistakes. It's a very bad thing to view every misstep or mistake as a dishonest attempt at misrepresentation and subterfuge, and it's an especially bad thing when you're actually just jumping to conclusions.Discussions will not get anywhere if each side just sits in their respective corners shouting insults at each other. In addition to simple fairness and decency, that's why I'm not doing it and won't do it, so I really, really, really wish you would please stop.--PercyEdited by Percy, : Grammar.

I'm back to looking into the origins of the "Other countries have a high intake of carbohydrates and don't get fat" information.I found this at The Economist saying that French figures on obesity are self-reported: If true, that means the data isn't reliable unless there are other studies of how French self-reporting of obesity correlates with reality so that the figures can be adjusted.Here's something from the Associated Press: One of the countries you mentioned was Greece, and this AP article says that the men of Greece having a higher obesity rate than the US. It also mentions refined carbohydrates as a possible culprit. Oh, next it says this: One would think that if your assertion were true that France, Italy and Greece have low obesity rates coincident with high carbohydrate intake that I would find hints of it somewhere.The intake levels of refined carbohydrates correlates with obesity, so unless France, Italy and Greece strongly emphasize unrefined carbohydrate varieties (e.g., cereals high in fiber, products made from unrefined flour), if they truly have high intake levels of carbohydrates then they should be fat.--Percy