Good Calories, Bad Calories, by Gary Taubes

Hi all!I'm replying to myself because I want to follow up on this from my previous message: I've had a chance to read Dean Ornish's Newsweek article and will now comment.One would expect that someone of Dean Ornish's reputation for integrity and intellect would play things straight up, but Ornish engages in the same kind of shenanigans we see here everyday, for instance: To say that participants on the low-fat diet reduced their fat intake "hardly at all" is misleading in the extreme. Participants on the low-fat diet reduced their fat intake by more than those on either the Mediterranean or low-carbohydrate diets. Low-fat dieters reduced their fat intake by 18.9 grams/day, with Med dieters next at a 10.5 grams/day reduction, and low-carb dieters bringing up the rear at a 1.7 grams/day reduction. In other words, low-fat dieters reduced their fat intake far more than those on the other two diets.What does Dr. Ornish base his figures upon? He drew them from this table: Changes in Dietary Intake, Energy Expenditure, and Urinary Ketones during 2 Years of InterventionThe 31.4% and 30.0% figures are "percent of total energy contribution". Because total energy intake was reduced (these *are* diets, after all), a lower fat intake contributed roughly the same percentage of total energy for the low-fat diet. If you look at the columns for the other diets, Med-diet participants increased their percentage fat intake slightly, while low-carb participants increased it from 32.1% to 39.1%. But dieters on all plans reduced their fat intake, with low-fat dieters having by far the greatest reduction. Aside from his bad math (200 calories/day at 365 days/year is 73,000 calories, not 10,000), Dr. Ornish is evidently a member of the "a calorie is a calorie is a calorie" camp. I've said enough about this fallacy in this thread already, but I'd be glad to go over it again with anyone who's interested. As long as Dr. Ornish adheres to this fallacy he'll be unable to perceive the evidence before his very eyes.Dr. Ornish is critical of the low-fat diet used in the study, referring to it in quotes, because is does not include a significant enough reduction in fat. The Ornish diet advises larger reductions in fat intake, and so Ornish believes, correctly I think, that the study does not reflect on the Ornish diet. I'm not familiar with the Ornish diet, but from this description it sounds like a pretty good diet, particularly the part about reducing intake of refined carbohydrates.Dr. Ornish goes on to describe studies conducted by his non-profit that demonstrate the effectiveness of the Ornish diet, but his earlier sloppiness with numbers means I'd have to actually read the studies before I'd accept his claims. Since I don't have that kind of time right now I'll withhold comment on his studies and just say that Dr. Ornish and I would probably agree that this recently concluded study cannot be used to judge the Ornish Diet. But we definitely appear to agree that it is great evidence by which to judge the dietary recommendations of the American Heart Association - they're a failure.Dr. Ornish cites two studies which he says indicate that low carbohydrate diets worsen heart disease, but I don't have time to look at them right now. The studies are:

• Abstract 3610: Comparative Effects of 3 Popular Diets on Lipids, Endothelial Function and Biomarkers of Atherothrombosis in the Absence of Weight Loss
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• The effect of high-protein diets on coronary blood flow

Dr. Ornish argues that studies that measure actual heart disease rates rather than risk indicators for heart disease are better, and I agree with him. He also argues that there is still a great deal of debate about HDL, and that the higher levels of HDL that result from a low carbohydrate diet are not necessarily an indicator of good health, and I agree with this also, in the sense that research is currently inconclusive on this point.When you go for your annual checkup as I recently did your doctor will review with you various biomarkers, most prominent among them HDL/LDL cholesterol levels and triglyceride levels. I think Ornish's point is that these biomarkers are not necessarily reliable as indicators of good health, and I again agree that current research is not conclusive. Taubes would likely agree, too. But as any doctor's visit will confirm, these are the indicators that the medical establishment currently thinks are most important, and the three diet study includes this table: Changes in Cholesterol and Triglyceride Biomarkers According to Diet Group during the Maximum Weight-Loss Phase (1 to 6 Months) and the Weight-Loss Maintenance Phase (7 to 24 Months) of the 2-Year Intervention.The table shows that the low carbohydrate diet beats the other two diets handily for HDL cholesterol, triglycerides and the cholesterol/HDL ratio, and comes in second for LDL cholesterol behind the Mediterranean diet. The low fat diet comes in last in all categories, though there's a near tie in one category.If HDL/LDL cholesterol and triglycerides are what doctors are going to annually lecture us about, but the research isn't conclusive about whether or not these are relevant biomarkers or not, then what confidence can this give us about the current state of most diet/health recommendations? As Michael Pollan, author of The Omnivore's Dilemma, once said, the state of diet/health research today reminds him of the state of science in the 1650's.This should not be construed as a condemnation or even a criticism of the medical research establishment. Like the alchemists of the Middle Ages trying to turn lead into gold, they are guilty only of grossly underestimating the task before them.Dr. Ornish concludes by making some general dietary recommendations that I agree with, and Taubes would likely agree, too, but Taubes would also likely add the wrinkle that sustained intake of heightened levels of refined carbohydrates over long time periods cause changes in metabolism that are very difficult to overcome.--Percy

This thread on Taubes book has turned into a debate between the dietary fat and carbohydrate hypotheses, but I recently came across a third hypothesis. Could it be that all these factors play a role?Before describing this third hypothesis, a brief update on the diet. I'm now down 17 pounds. What's amazing isn't the weight loss itself, but the way it was achieved. Traditional diets are what I call willpower diets, a constant battle between hunger and willpower. But you don't get hungry on a low carbohydrate diet, and that's what's amazing. I've lost all this weight without getting hungry.The only drawback I've encountered is monotony - the dietary choices of a low carbohydrate diet do not include a lot of variety. Nothing with sugar (0 grams/day isn't really possible unless one gets really anal about dieting, but I'm probably less than 15 grams/day), nothing with bread, nothing with pasta. We tried whole-grain pasta for a while, but when we gave it up was when I broke out of my plateau a few weeks ago, and I've concluded that whole-grain pasta represents an insignificant improvement over regular pasta. I'm already pretty certain that modern versions of whole-grain bread are very little different than their refined grain cousins.Now, on to this third hypothesis. The July 12, 2008, issue of New Scientist includes an article titled Rewriting Darwin: The new non-genetic inheritance. It says: In other words, perhaps the obesity epidemic is explained not by what people are eating now, but by what their parents were eating decades ago. The article concludes with a discussion of this possibility: Though not a possibility mentioned in the article, I think the same epigenetic factors (heritable changes passed on by means other than DNA) may have been at work in another substantial change observed in the health of western civilization over the course of the 20th century, that of increasing stature. Much of the 20th century was a period during which children became increasingly larger and taller (not fatter) than their parents. Perhaps the increasing nutritional quality of parents turned on genes responsible for increases in stature. Then in the late twentieth century beginning in the 1970s, increased intake of refined carbohydrates caused other epigenetic changes responsible for increases in obesity and diabetes II in succeeding generations.Interestingly, this epigenetic possibility could explain the Pima. Increased intake of refined carbohydrates during the late 19th century caused epigenetic factors to turn on genes that made the population more obese and diabetic. It would be interesting to see if the cycle could be broken by one generation following a low carbohydrate diet. Would the next generation have less of a problem with obesity and diabetes?Ultimately, the answers to the obesity and diabetes epidemics will not be simple. Dietary fat plays a role. Carbohydrates play a role, particularly refined carbohydrates. And while it's still very early in the research cycle, my bet is that epigenetic factors also play a role. The net contribution of each to the problem also remains to be seen, and likely that is complicated, too, with it varying widely across regions, races and segments of society.--PercyEdited by Percy, : Punctuation.

Dr. Zane Andrews of Monash University (Australia) has just published research in Nature describing a possible neurological contribution to adult-onset obesity. According to a news release from Monash Univerity: Full article: Killer carbs - Monash scientist finds the key to overeating as we ageFor those with a subscription to Nature, here's a link to the full article: UCP2 mediates ghrelin's action on NPY/AgRP neurons by lowering free radicalsDiet update: I've been plateaued the last couple weeks at about 19 pounds down. Except for the lack of variety the low carb diet continues to be a very easy diet to follow.I know that anecdotal information says that recidivism is the same for both low fat and low carb diets, but I'm finding that hard to believe. Hunger is the problem with low fat diets. While the desire for foods forbidden on low-carb diets, such as anything with sugar, does have some power, it can't hold a candle to hunger. Take away a special food that I haven't had in a long time and I might become peeved, but deny me food while ravenous and violence is a definite possibility. Hunger wears down the will and overcomes rationality, and there's no hunger on a low carb diet.--Percy

So the diet is 5 months old and I'm down 21 pounds! Hurray!Here are a few observations.I think that putting the "low carbohydrate" label on my diet is inaccurate, and I think this is true of most reasonable low carbohydrate diets. What the "low carbohydrate" label actually means is low levels of refined carbohydrates, such as sugar and refined flour products like bread and pasta. Many sources of complex carbohydrates are fine, and most low carbohydrate diets explicitly recommend them, such as many vegetables and fruits. Examples of vegetables and fruits that are usually explicitly excluded from low carbohydrate diets are corn and grapes, but many others are just fine.I've mentioned this one before, but it bears repeating: you don't get hungry on a low-carbohydrate diet if you include meat.The big danger to dieters is from refined carbohydrates that cause insulin spikes that sweep any available free fat in the bloodstream into fatty tissues.And the most dangerous form of refined carbohydrates is high fructose corn syrup, a common sweetener used in both carbonated beverages and candy.While the research is still inconclusive at this point, the possibility that the current diabetes epidemic that is affecting all income groups, races and religions is caused by wearing out the pancreas by subjecting it to frequent and high demands for insulin through the intake of refined carbohydrates must be given serious consideration. If you don't like the prospect of sticking yourself with needles for the rest of your life then you should immediately and drastically reduce your consumption of food products that have significant levels of refined carbohydrates. This includes the aforementioned soda and candy, and also any bread or pasta products made from refined flour.I don't believe bread or pasta in any form can be part of any effective low carbohydrate diet targeted at weight reduction. This includes even 100% whole grain products. Wheat grain kernels have three components: the kernel shell which is fiber, also called bran, i.e., indigestible carbohydrates; the embryo, also known as wheat germ; and the endosperm which provides nutrition for the embryo when it is planted and begins growing. The endosperm portion is by far the largest. Removal of the bran and germ leaves just the endosperm, which is what makes refined flour. Whole wheat products contain almost as much endosperm as refined flour products. This is mitigated somewhat by the presence of fiber from the bran, but not much, at least not in my experience, your mileage may vary. Best to avoid all breads and pastas in all forms.--Percy

No arguments here. The most important criteria of all is what works for us personally. Each of us is our own experimental laboratory building up databases full of dos and don'ts.I guess I'm hoping this thread successufully communicates two significant points:

1. As far as existing research is able to indicate, low carbohydrate diets are as safe as low calorie diets. Characterizations of low carbohydrate diets by organizations like the American Heart Association and the American Diabetes Association as dangerous quackery have no basis in existing research. In fact, if these and other organizations are correct in believing that lower triglyceride levels and higher HDL/LDL ratios are desirable for good health, then the research already indicates that low carbohydrate diets are healthier than low calorie diets.
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2. For those who find low-calorie diets difficult to follow because of hunger, a low carbohydrate diet that has a significant meat component will greatly alleviate, even eliminate, the hunger problem. My label for low calorie diets is "willpower diets", because such diets will only last as long as willpower can hold out against hunger.

There's an interesting article in today's New York Times about how people are dieting less now than 20 years ago and focusing more on seeking out healthy foods rather than avoiding bad foods, in other words, focusing on inclusivity instead of exclusivity: Instead of Eating to Diet, They’re Eating to Enjoy--Percy

So the diet is 6 months old and I'm down 26 pounds! Hurray!One thing that became apparent this past month was that I was no longer losing weight on the amount of food that had allowed me to lose weight before. I had plateaued for a few a weeks around 21/22 pounds down, but once I recognized this I reduced the amount I eat by maybe another 20% and resumed losing weight.I can't give calorie or carbohydrate estimates because I keep track of neither, but as I've been saying in this thread, I try to eat no refined carbohydrates whatsoever, meaning no sugar and no refined grain products such as bread or pasta. As a practical matter that's not really possible, but it's probably less than 10 grams/day, certainly less than 20. My diet is a bit monotonous as I eat mostly vegetables and meat, maybe a 50/50 mix, and some nuts, too. There's also a fair amount of fat in my diet from sources like regular salad dressing, butter and cheese. When I reduced the amount I eat I had to increase fat intake because I find it effective at holding off hunger.One other observation has to do with exercise. I engage in vigorous exercise several times a week, and I have no trouble maintaining energy levels on this diet. My ability to exercise appears to be neither better or worse.I miss pizza, cheesesteaks, subs, calzones, lasagne, even just a simple ham and cheese sandwhich. I'm eagerly looking forward to the end of my diet, but I don't have a specific target weight. When I reach a weight below which I shouldn't go I have a feeling my body will tell me, but I would be surprised if I end up losing more than 40 pounds. After I finish the diet comes the big question: can I keep the weight off?--Percy

That refined carbohydrates are bad for you may be a view that is quitely moving more and more into the mainstream. It's too early to be sure, but a couple recent articles are heartening. Our local paper recently ran an article about diabetes in the Latino community that had this to say: This is encouraging because of the lack of emphasis placed by the American Diabetes Association on the diabetic risks associated with carbohydrates. Hopefully it is only a matter of time before the ADA begins issuing forceful warnings, but in the meantime local health officials seem aware of the dangers.The January, 2009, issue of Scientific American also got into the act with this passing comment in a SciAm Perspectives article about evolution: Taubes couldn't have said it better himself!Increasingly in grocery stores one sees growing recognition of the dangers of refined carbohydrates, as the shelves more and more often offer low-carbohydrate substitutes. Good to see.Concerning the diet, the more I lose the slower I lose, but I'm down 28 pounds now.--Percy

My initial goal when I opened the thread was to make people aware of a hypothesis drawing increasing attention that it isn't fat causing the diseases of western civilization (obesity, diabetes and heart disease) but carbohydrates. I didn't originally plan on starting a diet, but I did, so I began posting my progress on the diet here, too.Current diet status is that I'm on a plateau at 26 pounds down. The big problem with diets isn't finding ones that work. Tons of different diets will work. The problem is finding one you can live with for the long term. Any diet that is based upon deprivation enforced via willpower will not work for most people for the long term. Some people have that kind of willpower, and I'm sure all our hats go off to them, but most of us don't. That's why a low carbohydrate diet is so important, because it eliminates one of the strongest forces for breaking down willpower: hunger.Exercise for weight reduction has just as spotty a record as diets. If you're making yourself exercise instead of exercising because you enjoy it, then at some point you'll just stop. Every January my club overflows with an influx of the recently resolved, and most are gone by March.--Percy

Very, very interesting possibility. Let me know if you happen to come across any research on people. I think I might be able to give this a try just to see what happens.--Percy

I apparently missed part of the Taubes/Ornish debate last summer. What happened first was that Taubes commented on a recently concluded Israeli study that compared a low-fat diet with a low-carbohydrate diet or Mediterranean diet. Taubes' comments are part of a New York Times article by John Tierney: Taubes argues that the study's results support the hypothesis that fat, and in particular saturated fat, is not the key factor in heart disease, and again chastises the American Heart Association for continuing to back a hypothesis that lacks evidential support.Dean Ornish, a professor of medicine at the University of California, San Francisco and author of diet books, believes that Taubes position on fat is mistaken, and he's tangled with Taubes on several occasions, in both broadcast and print media. His response is included in another Tierney NYT article: Ornish points out that his "dietary recommendations have evolved over the past 30 years," and that he now places greater emphasis on restricting the intake of refined carbohydrates, and so in this he a Taubes are in agreement. But he strongly disagrees with Taubes' position on saturated fat, and so he expresses concern about the "scientific validity" of the Israeli study, states that he'll post the details of those concerns in his next post. I think this must be his column in Newsweek that I tore apart earlier in this thread in my Message 259.My own experience is consistent with the Israeli study. As I reported last year, at my annual physical all my indicators were the best they've ever been. If saturated fat is really bad for us, and if the reason they're bad for us is because they produce unhealthy levels of LDL and so forth, then why does the research keep showing that diets high in saturated fat actually cause improvements in these measures?For reasons best known only to themselves, organizations like the American Heart Association and American Diabetes Association feel comfortable with this inherent contradiction in their position. Fortunately our grocery store shelves continue to provide increasing quantities of low-carbohydrate alternatives, so obviously the American public is increasingly turning a deaf ear to these organizations, at least while they're claiming the primary culprit is fat and not carbohydrates. That's good news.--Percy

I was looking for an old message and accidentally came across this that for some reason I never replied to: I don't know why I chose not to respond to this at the time, but it is clearly false that Taubes claims that carbs are the cause of cancer and Alzheimers. Here's what Taubes actually says in the broadcast (The Low-Fat, High-Carb Diet Hoax: Why Conventional Wisdom Wrong -- With Gary Taubes).The interviewer, Connie Bennet, asks, "You were saying that refined carbs and sugars give you cancer and heart disease and heart diseases and Type II diabetes". Taubes replies: The dietary fat hypothesis holds that the diseases of western civilization are caused by dietary fat. Taubes is saying that the dietary fat hypothesis is wrong, that these diseases are actually caused by increased intake of refined carbohydrates in the form of sugar and flour.Clearly Taubes is no more saying that carbohydrates are the cause of these diseases than the dietary fat people are saying that dietary fat is the cause. They're both claiming that a change in diet is the cause of elevated levels of these diseases in western civilization, they're just both focused on different dietary changes.Instead of doing honest criticism, people like Molbiogirl have been attempting to discredit Taubes views by purposefully misrepresenting what he says. You kind of expect this sort of thing from people unfamiliar with science who might be given to rhetorical approaches to discussion, but even after a year I find I'm still shocked that Molbiogirl in her PhD program and Dean Ornish in his professorship and Dr. Barbara Howard in her position at the American Heart Association and on and on, engage freely in this fallacious practice when it comes to Taubes.So people like Molbiogirl might say, "Taubes claims Polynesians don't get obese," but only those most uninformed or purposefully misleading would say such a thing, completely ignoring the context. Taubes of course is aware that some Polynesians unexposed to western diets still get fat. The point is that they don't get fat in the huge numbers that they do in western countries.The big question is why western civilization is plagued with obesity, diabetes and heart disease. When people are removed from their South Pacific island or from the jungle or from whatever was their native habitat and are placed into western civilization, they find themselves getting diabetic and fat at about the same rate as everyone else on western diets. What's the cause? For 50 years the answer has been dietary fat. And in that 50 years we've gotten fatter and more diabetic. Taubes believes it's because the cause is not dietary fat, it's carbohydrates.--Percy

Gee, what a coincidence, my own grandson will be here in about an hour!It was good to hear your story - it pretty much echoes my own.While I'm not really qualified to assess the consistency of the various statements of the study's purpose, they did seem to be relatively consistent and focused on the same goal. Combined with what you said about the weight loss criteria for remaining included in the study I gather that they're only interested in studying the impact of weight loss that exceeds a proscribed amount, and they want to see if the weight loss method makes a difference in the inflammatory effects of one aspect of the immune system. I'm always amazed at how much research there is in areas we never even heard of.--Percy

Hi Justin,Thanks for posting this. I was going to wait until I finished watching the video before responding, but I ran out of time. I've seen maybe the first 10 minutes. Taubes appears to have improved and refined his presentation, and the slides are certainly new. I can't comment yet on whether he's added any new material about developments since his book came out.For the benefit of anyone unfamiliar with Taubes' position on the exercise/diet equation, he believes that if you diet less you'll exercise less and weigh the same. And that if you exercise more you'll eat more and weigh the same.What I've never seen him mention is the willpower component of losing weight. If you diet and maintain your exercise level, you will lose weight. Or if you increase your exercise level and maintain your diet, you will lose weight. You will continue to lose weight (or maintain after achieving your goal) for as long as your willpower holds out. For most people the limits of willpower run out after at most a year, then they begin putting the weight back on.Taubes provides no diet advice, but he believes elevated intake levels of refined carbohydrates in western societies are responsible for the obesity epidemic. Although Taubes argues his position from a scientific basis, from a purely practical diet standpoint the advantage of a low carbohydrate diet is that it results in much less hunger than other diets and is therefore easier to maintain. His other claim, that you can consume more calories on a low carbohydrate diet and still lose weight, has not been scientifically proven or disproven at this point in time.--Percy

See Phys Ed: Why Doesn't Exercise Lead to Weight Loss? - The New York Times. Significant excerpt: This is part of Taubes argument in Good Calories, Bad Calories. Exercise brings with it increased caloric consumption and so does not lead to long term weight loss.As the article goes on to explain, exercise can help you reduce weight, but only "if you don't replace all of the calories afterward." What the article doesn't mention is that if you don't replace the calories you'll be hungry, which turns exercise into just another battle between hunger and willpower, and as I've argued throughout this thread, for most people willpower diets can only be carried on for so long.So how's my diet doing roughly a year and a half after I began? I once hit a low of 163 for one day, but more practically my low weight was probably 165. I now weigh around 172, a gain of 7 pounds. A low carbohydrate diet is a willpower diet, too, but the battle is against diminished variety rather than hunger. Most of the gain occurred during a three or four week period where I just couldn't resist having rice and pasta. I'm back on the wagon.--PercyEdited by Percy, : Typo.

Taubes hypothesis in Good Calories, Bad Calories is that it is carbohydrates rather than fat that is responsible for the diseases of western civilization (heart disease, diabetes and obesity), and evidence supporting his hypothesis continues to grow. This month's Scientific American includes a news note about the gathering evidence. You can find the article on-line at Carbs against Cardio: More Evidence that Refined Carbohydrates, not Fats, Threaten the Heart, but here's how it begins: Looks like time may finally be running out for the dietary fat hypothesis.--Percy