More Heresy on Obesity

Obesity — its causes and consequences — is a frequent topic on this blog (and the podcast too). In the podcast, Eric Oliver argued that “the causal relationship between weight and maladies like heart disease, cancer, and even diabetes has not been firmly established.” That certainly strikes some as heresy. In a recent EconTalk podcast, noted heretic Gary Taubes lays out a well-argued position:  

Taubes argues that for decades, doctors, the medical establishment, and government agencies encouraged Americans to reduce fat in their diet and increase carbohydrates in order to reduce heart disease. Taubes argues that the evidence for the connection between fat in the diet and heart disease was weak yet the consensus in favor of low-fat diets remained strong. Casual evidence (such as low heart disease rates among populations with little fat in their diet) ignores the possibilities that other factors such as low sugar consumption may explain the relationship.

Anyone for the paleo diet? 


Cor Aquilonis

I'm on a low-carb paleo right now, and just started strictly a couple weeks ago. Sure, I lost a little weight, but I really enjoy feeling full between meals and getting full, restful sleep. I plan to stick with it for the foreseeable future.

I like life better without the sugar and grains.

John B

The basic diet of most of the peoples of the world includes carbs, like grains, rice etc.

How do you feed everyone without them?

Cor Aquilonis

1) I don't know.
2a) Not my job.
2b) While I'm sympathetic to the plight of the undernourished of the world, I neither have the resources nor the education nor the power to make any meaningful impact on their lives. I recognize this fact and accept it.
3) You'll notice every sentence I used in the above post had the subject of "I." You'll notice none of them had the subject "you" or "they." That would be because I was talking about myself, not you or them.

Conclusion: Brush up on your reading skills. I didn't propose the paleo diet as the solution to all the world's dietary ills. I just said that it agrees with me.

Adam

Way to be a jerk about it, geez. The sad thing is that you have a good point, but it gets lost in cheap shots like, "brush up on your reading skills."

al

It is very important to know that fat cannot be directly absorbed to the body unlike sugar, sugar therefore has a much faster absorption in the human body than anything else and is therefore more harmful to your metabolic system than anything else. Basic grade level 10 biology (in canada anyways). Eat more fatty food, eat little sugar.
http://en.wikipedia.org/wiki/Fatty_acid_metabolism
http://en.wikipedia.org/wiki/Citric_acid_cycle

M R

Taubes speaks the truth, I'm living proof. Try low-carb/high fat for a month, you'll see the difference too. Fat does not make a person fat, fat does not cause high cholesteral; carbs do.

Mike B

I think the important figure is total calories. Most of the effects from ANY diet is that people control what they are cramming into their maw. If you want to really shed the pounds you can either increase your physical activity or decrease the number of calories you eat. Both are uncomfortable which is why people are packing away the pounds. The only difference between modern times and ancient times is that before food was hard to come by so we had no choice except to diet.

If you want to get picky about it, yes certain types of have various affects on the body. Carbs make you fat and certain types of fat clogs your arteries. However if you're only eating 1500 cal a day you won't be eating enough of either to make a difference.

Wout Mertens

The reasoning you're following is not what the science seems to indicate. Read Taubes' book for more information, but the gist of it is that you're hungry because you're getting fat, not the other way round.

One of the interesting experiments described is that when you take a female mouse and remove its ovaries, it will eat a lot and get fat. If you however give it only the same amount of food as before, it will still get fat, but it will stop moving about, only eating and sleeping. This means that their body is storing the energy from food as fat instead of using it.

Furthermore, if there is any artery-clogging fat it's probably Omega-6 oils (which is in high abundance in vegetable oils) which are inflammatory.

Gary

A great topic. Of course the real question is why governments continue to go down a low fat route, including taxing fatty foods, given the lack of evidence. An evidence based approach would rather tax sugar and sweeteners (especially sweeteners!), and wheat.
Could the vested interests of the farming community, food producers/processors and cholesterol-reducing drug companies and their lobbying powers have a little something to do with it?

Ultimately the lesson is not to trust anything anyone tells you until you know who their paymaster is.

Iljitsch van Beijnum

Yeah, that's what we need, for the current richest 1 billion to eat even more meat, and of course only the type produced in the most natural resource wasting way, and then for the other 6 to catch up to us.

Anyone who thinks they can lose weight by eating more of some high energy food (fat, carbohydrates, meat, whatever) is in need of a thermodynamics refresher course.

Cor Aquilonis

Ummm. I'm pretty sure the thermodynamics you are referring to occur in a closed system. The human body isn't a closed system. Of course, I'm not a physicist, but I also doubt you are.

James

No, the thermodynamics doesn't require a closed system. It's simply that if you take in more energy, in the form of food calories, than you expend, then that energy has to go somewhere. We know from observation that much of it is stored in the body, as fat.

And BTW, I do have a physics degree.

Cor Aquilonis

Congratulations on your physics degree, I'll have to take your word for that.

Color me skeptical that the Laws of Thermodynamics map so perfectly to the human biological system that Calories In Must Equal Calories Out And Much of The Difference Shall Be Fat. While I don't doubt that the overall system follows the Laws of Thermodynamics, I doubt that it applies a simplistically as I frequently hear it applied. I suspect that there's more going on then that, but then, I don't have a pile of weighty scientific evidence for you in my back pocket.

Let's just say I have to see more compelling evidence supporting your thesis before I move beyond being a dietary agnositc who has found low-carb paleo useful for her own diet.

Neil (SM)

@Cor Aquilonis: Perhaps the calories-in-calories-out idea describes a perfect system in which every ounce of food one eats is metabolized and creates a fixed amount of calories. The reality is much more complex, where every person has a unique metabolism, and some foods are metabolized differently than others. And also it seems for many people fats are not absorbed nearly as well as carbs.

@Iljitsch van Beijnum: the article is certainly not claiming high-carb will make one lose weight. What seems more important to the discussion is the claim that weight may very well not be connected to health.

John S.

Prepare for a cascade of replies all the people who are eating less, feeling healthier, sleeping better and even having better sex on a diet that excludes (or includes) component X. I don't doubt their sincerity, but don't they realize that anecdotal evidence is worthless? Alternatively, if they want me to put faith in their testimonial, then they should explain to me why I should ignore the testimonials of other equally sincere individuals who achieve the same results on other diets. Patients of Dr. Ornish, for example.

Cor Aquilonis

Why, yes, I realize anecdotal data isn't proof of anything. So, please don't assume I'm ignorant of the (low) value of sharing my directly relevant experience on a comment thread. I'm not trying to convince you of anything, nor am I asking for your faith. I'm just sharing my experience.

Donald

Dr. Lustig provides a causal relationship between sugar (more specifically fructose) in his lecture "Sugar: The Bitter Truth". Well worth watching - http://www.uctv.tv/search-details.aspx?showID=16717

Rose

Here's a good listing of clinical trials that show an edge for low-carb diets: http://www.dietdoctor.com/weight-loss-time-to-stop-denying-the-science

EP

Low-carb will be great out of the gate because you'll be shedding water weight over the first few weeks. After that, it's a matter of compliance. There's probably a psychological edge to a diet that involves cutting a food out rather than reducing it because it's easier to make a decision about whether to eat a particular item. There's really no good study that actually compares diet outcomes while controlling for compliance.

Wout Mertens

One could argue that compliance is a success factor of a diet as opposed to a failing of the people following the diet...

When you look at http://www.dietdoctor.com/weight-loss-time-to-stop-denying-the-science it's quite obvious that low-carb seems to have good compliance regardless of other factors.

Brian Utterback

While Gary Taubes complaints about the "establishment" wisdom has a lot of validity, his own attempts at producing a narrative that can be understood likewise falls short. See http://www.sciencebasedmedicine.org/index.php/why-we-get-fat/ at the "Science Based Medicine" website for more details.

finance

Bottom line, if you want to lose weight you've got to cut calories (or burn more calories) there is no other way. The best diets are those that reduce calories while making sure that the body still receives sufficient levels of calories, vitamins and minerals.

The only attractive feature of a low fat, low sugar diet is that it fools your body in thinking that its not hungry, body is tricked into thinking because the sugar levels do reach a certain trigger level that its not hungry.

That's it! Bottom line the best diet is on that you can maintain (no hunger) and where the calories are restricted. Everything else is complete BS, the laws of thermodynamic cannot be suspended by eating only one kind of food, less food is the magic solution (and sticking to the diet too)

Ze

Taubes is wrong about a lot, and you'll see his rants replicated, such as the poster who states that fat cannot be directly absorbed by the body. This is patently false. Why do people think this? Becuase Taubes' books claim that insulin spikes are needed to store fat - totally ignoring other factors which allow fat to be absorbed, such as ASP http://en.wikipedia.org/wiki/Acylation_stimulating_protein.

Fat, protein, and carbs can all be stored.

As for low-carb "success" - anytime you restrict yourself from an entire macronutrient, sure you can lose weight. Keep in mind part of your weight loss is simply muscle glycogen loss, not fat.

Liz M

If you read Good Calories Bad Calories, you'll see that Taubes does not actually say this. He says that, ordinarily, fatty acids are freely flowing both in and out of the adipose cell membranes, but insulin prevents fatty acids from leaving adipose tissue (one of its many effects).

He says that the one of the detrimental effect of eating sugar or other high-carb food is that it induces hormonal effects that induce both weight gain and excessive hunger. Fat, on the other hand, is stored easily, but it is inherently satiating, and it is very difficult to overeat on a diet of meat and vegetables.

Taubes also does an excellent job of showing that the evidence for saturated fat and cholesterol causing heart disease was at best ambiguous when the government started pushing the hypothesis, and now it looks almost completely certain to be false. He shows a plausible metabolic pathway by which sugars and other carbohydrates, when consumed in excess, can cause heart disease.

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Joel Upchurch

It is important to remember that physicians are not scientists. Physicians are narrowly trained technicians and people need to treat them with the same level of skepticism as their auto mechanic. Most Physicians aren't really trained to do properly controlled studies. This results is a lot of very shoddy medical research that is usually disproved by later research.
http://goo.gl/Sggb
http://goo.gl/7x40

Morten

Paleo taps into some powerful dieting mechanics, namely high protein and low energy density. Most standard American diets are protein deficient or intermittently deficient which up regulates hunger, for more information look up "protein leverage hypothesis". Low energy density: filling your stomach sends a hormone fullness signal and when you can do it while ingesting fewer calories you lose weight.
Then there's a million (individual) reasons while it makes you feel better but that wasn't the subject of the original post.
How paleo lets you burn fat and gain muscle I have no idea. Certainly doesn't fit with calorie in, calorie out.
To eat paleo you simply replace all your bread, pasta, beans, rice with vegetable dishes and ditch sugar, eat a bit more so you don't get too few calories. No need for a carnivore diet. It should be possible to get fat on paleo though with enough coconut flour, almond meal, and dried fruit. Just drown out the protein with fat and carb.

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EP

"Most standard American diets are protein deficient or intermittently deficient which up regulates hunger, for more information look up “protein leverage hypothesis”."

You'd be hard pressed to find any evidence suggesting Americans eat protein deficient diets. It even exceedingly rare to find a preplanned diet that is deficient.

Morten

For 'protein leverage hypothesis' please try google or read these two links:
http://sydney.edu.au/news/science/397.html?newsstoryid=7980
From the Uni of Sydney press release there is a link to the paper in PLOS One which is free. In the experiment they used lean individuals who usually got about 18% of their energy from protein and got them to up their ad libitum feeding calorie intake by 12% by reducing their protein intake to 10%. At 15% and 25% they ate the appropiate amount of calories for their basal metabolic rate.
Another link on protein leverage hypothesis:
http://mangans.blogspot.com/2010/12/protein-leverage-hypothesis-of-obesity.html

Travis

It's also worth diving up carbs as well. Taub has a great argument, and it's well known that Sugar isn't the most healthy thing to eat, yet it's in virtually everything and in particular is piled into things which are "fat free."

Sugar is the demon, really, but it always seems to get off scott free.

However, the argument that Obesity is not related to other maladies like diabetes or heart disease does seem like heresy to me, as the causes for obesity are not limited to overconsumption of fat.

EP

It's much simpler than all this:
1. Avoid high-fructose corn syrup
http://ericwpepin.wordpress.com/2011/11/03/the-good-fat-diet/
2. Eat omega-3 fatty acids, not omega-6 fatty acids (though you do need a tiny amount)
http://ericwpepin.wordpress.com/2011/09/08/most-of-what-you-need-to-know-about-high-fructose-corn-syrup/

It also doesn't hurt to exercise and eat fiber.

PAFgirl

I kind of have one question to ask all of you that are spouting on about calories in, calories out. Have you ever been fat? Ever? Do you know what it's like to follow every dietary recommendation your doc throws at you, the establishment, the culture.... and still not only not lose weight, but gain? Have you ever trained for a marathon and ended up 2 sizes BIGGER while being completely compliant because you started with a metabolic derangement to begin with?

If the answer is no, and you haven't struggled through the "suggestions" of people who have not been through what you are going through, then you kind of need to shut up.

Here's the thing. You do what works for you. And until you find what works for YOU, keep looking. I will argue anyone personally who says that the weight loss on paleo/low carb/keto is muscle glycogen loss. Seriously? So the 12 inches I've lost off of my belly, and the 42 lbs.... that's a lot of glycogen huh?

Diets can be difficult, or they can be simple. Paleo isn't that difficult. Meat and animal protein. Minimally processed fats. vegetables and what carbs come with them. We complicate things when we stray to far from nature. For instance, cows did not evolve to eat corn, but we feed it to them anyway. They are sick, we eat them, we get sick. We didn't evolve to eat almost 2/3 of our diet from processed foods. If you simplify things, no matter what you call your diet, your health will improve. If you don't know what an ingredient is, don't put it in your mouth. As your health improves, your body will get back to a natural state, storing fat as needed, not ad nauseam.

If you're eating a diet that is treating you and your body well, awesome. If not, and you're shaking your head at Paleo, stop shaking it so much and do some reading, then give it a good try. The diet you're eating right now will always be there to go back to.

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Jeremy Vaught

Booyah! I've been hoping Freakonomics would cover this subject.

My story is that since high school I've slowly gained weight. I have a large frame anyway, according to the gym, if I were 0% body fat I'd weight 196lbs.

Anyway, in 2004/2005 I went from 270lbs to 235 by doing many many many hours of running/swimming/biking and being hungry because I was reducing what I ate.

Then I stopped working out much and over the next few years and gained the weight back.

This last January, I started eating low-carb/Paleo, and with just basic exercise, I made it from 270 to 230 in about 9 months and never was hungry the entire time.

All the while, I'm sick less, not tired in the afternoon, not hungry, and eat great food. It just doesn't include sugar, much bread, pasta, or potatoes. The benefits way outweigh drinking Coke and eating ice cream all the time.

Ericka C

Awesome, Jeremy!

Josh Bobbitt

I've been doing the paleo thing for almost a year now. It's amazing. I've lost nearly 50 pounds, which is nice, but my health markers have improved SIGNIFICANTLY. I no longer have insulin resistance issues. I don't have mood swings from not eating for a few hours. I'm more productive. I'm more happy. I'm stronger. I also discovered that I do, in fact, have a gluten intolerance, and that it REALLY hurts when I eat any at all.

More than that, it's completely changed the way I look at food. Now I think about food, where it came from, and what it's doing to do to my body. That's made an incredible difference.

Jon

Couple thoughts on obesity and autoimmune diseases:
* Its about food quality, not quantity
* Fat doesn't make you fat
* Its about balance (Omega 3: Omega 6 / Acid:Base)
* Its about systemic inflammation

I have been on the Paleo Diet for the past year and, like so many of the other commenters, it has made a profound difference in my overall health.
I just turned 44 and come from a family full of the effects of the SAD (Standard American Diet). High blood pressure, heart disease (dad had a sextuple bypass 10 years ago), type-2 diabetes, and everyone is on statins.
One year ago I stopped eating gluten, grains, legumes, refined sugars, processed foods, and most dairy. Almost immediately I lost weight, went down 2-3 holes on the belt-o-meter and had much more energy than I used to. My LDL went down, my HDL went up and my C-Reactive Protein (inflammation) went down. My LDL particle size went from small dense to large buoyant (which is what you want to prevent heart disease).
Most of these effects happened without me doing hardly any exercise, but when I added the exercise I got stronger and feel even better.
Paleo is not a diet, it is indeed a lifestyle (I'll never go back to SAD) and it works. I am hardly ever hungry because I eat plenty of animal protein, fat and vegetables.
If you want to learn more about Paleo you can start here: www.ispeakpaleo.com

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Theresa

Testimonial: I can only speak for myself. I have never been on a "diet" in my life but steadily gained weight over the years and after each pregnancy (53 years old/6 pregnancies). Blood tests weren't good 2 years ago and dr put me on statin and I didn't know enough to question or refuse it. About 5 months ago, my son told me about the paleo diet. I have lost 30 pounds, many inches, 4 clothing sizes, feel and look great, and took myself off statins. After the dr saw my blood tests and knowing that I had not been on statins for 5 months, he said "Oddly enough, your LDL has gone down, your HDL is as high as I've ever seen, and your triglycerides and fasting blood glucose are perfect." Yes, oddly enough.

Will never go back to flour and sugar.

Ericka C

LOL, oddly enough... The drs are puzzled by the facts! Returning to real food and ancestral eating is endless benefits. Good for you!!!

DoctorSH

I thought a calorie was a measurement of energy burned.

So how can you eat a calorie??

Jill Escher

I've been on a Paleo-ish diet for more than a year as part of my recovery from a lifelong sugar addiction, and the results have been phenomenal: loss of 30+ pounds and down to a normal weight, loss of sugar cravings, enjoyment of a wide variety of delicious and inexpensive fresh whole foods (I'm not a big meat eater), great sleep, the disappearance of a multitude of maladies including skin tags and various aches and pains, a steady and strong energy, and much improved digestion and mood. No downside whatsoever, I'll never return to pizza, pasta, bagels, and all that, for sure.