Monday, November 05, 2018

An expert review of “The Case Against Sugar”.(January 26, 2017 by Stephan Guyenet)


Bad sugar or bad journalism? An expert review of “The Case Against Sugar”.

 by 


Photo by Lauri Andler


I’ve been asked by a number of people to review Gary Taubes’s new book, The Case Against Sugar. I reluctantly agreed that it would probably be a good idea for me to do so. In this post, I’ll provide something that is not available anywhere else (to my knowledge): a review of the book from the perspective of a former researcher who is an expert in some of the topics it discusses. [update 7/22/17: there is now a second detailed expert review of the book available here]
The Case Against Sugar is a journey through sugar history and science that argues the point that sugar is the principal cause of obesity, diabetes, coronary heart disease, and many other common noncommunicable diseases. This differs from the prevailing view in the research and public health communities that obesity and noncommunicable disease are multi-factorial, with refined sugar playing a role among other things like excess calorie intake, physical inactivity, cigarette smoking, alcohol and illegal drug use, and various other diet and lifestyle factors. I side with the latter view. In case anyone is wondering, I’ve never had any contact with the sugar industry and I have no other relevant conflicts of interest.
I’ll break the review into two parts, the first covering the historical aspects of the book, and the second covering its scientific aspects.
The History
Taubes excels at constructing detailed historical narratives to make his points. In The Case Against Sugar, he presents a colorful and informative history of sugar and the sugar industry. He also provides a history of the use of sugar in tobacco processing and how it may have contributed to the rise of cigarette smoking, which I wasn’t aware of.
His discussion of the history of research on sugar, dietary fat, obesity, and noncommunicable disease is less compelling due to its one-sided nature. For example, The Case Against Sugarportrays an epic struggle decades ago between researchers who believed that saturated fat was the primary cause of coronary heart disease, and those who believed that sugar was. These views are embodied by the American researcher Ancel Keys and the British researcher John Yudkin, respectively.
Taubes makes hay of the fact that Keys was supported in part by the sugar industry, painting Yudkin as a righteous underdog standing up to a corrupt and aggressive Keys. Yet he never gives serious consideration to the strength of the evidence supporting each man’s beliefs, instead using a historical narrative to imply that Keys was a stooge of the sugar industry who unfairly won the argument due to his sharp elbows (whether or not this is true, it’s also true that Yudkin’s evidence was not as compelling as Keys’s). This tactic of using historical narratives as a substitute for evidence is one that recurs throughout the book.
In his haste to undermine Keys, Taubes neglects to mention that Yudkin had his own conflicts of interest: he was funded by the egg, edible oil, and dairy industries, all of which had an interest in pinning the blame for obesity and chronic disease on sugar (1). It’s interesting to note that if we substitute the egg, meat, and dairy industries for the sugar industry, Taubes’s arguments about the corrupting influence of industry on science sound very similar to those that are made by certain people in the vegan community about animal foods.
The truth is that both sides have somewhat of a point, but both are also exaggerated and incomplete. Each industry jockeys to promote its own interests, and those that are sufficiently well heeled often do so by supporting research. This includes the sugar industry, as well as the egg, edible oil, meat, and dairy industries. If Taubes wants to decry research funded by the sugar industry, he should apply the same principle to research funded by other industries, including Yudkin’s. Yet Yudkin gets a pass, while Taubes probes every nook and cranny of history to uncover the dastardly Keys’s conflicts of interest.
A related point is that in 2017, research institutions and reputable scientific journals have policies in place for disclosing and limiting conflicts of interest. These policies aren’t perfect, but they’re much better than what we had two decades ago. In contrast, the book industry has no policies for managing the conflicts of interest of its authors, and it also has virtually no accountability for what it publishes. Taubes points his finger at others while never disclosing his own conflict of interest, which is that his fame and fortune rely on perpetuating his controversial ideas to an audience that has little basis for evaluating them.
In chapter 8, The Case Against Sugar discusses the process that led the Food and Drug Administration to designate sugar as “generally recognized as safe” (GRAS). GRAS is a designation that is given to substances that have been consumed for a long time and are not overtly toxic, like vinegar. Taubes implies that sugar was unjustly given GRAS status by the FDA due to food industry influence, but this reveals a lack of understanding of the GRAS designation (he repeated this claim in a recent article; 2). The purpose of the FDA is not to be a nanny that prevents us from eating food that has long-term health consequences, and consequently GRAS status doesn’t imply that a substance supports leanness or health when consumed regularly. You can eat your way to obesity and heart disease on an all-GRAS diet: Everything in pizza, white bread, French fries, soda, ice cream, potato chips, and bacon is GRAS. By all logic, sugar should be GRAS, but that doesn’t make it healthy.
Also, revoking GRAS status means that a substance cannot be sold as food. Is Taubes suggesting that the FDA should have made the sale of sugar illegal, yet continue to allow us to buy cigarettes, whiskey, and cheese crust pizza? That seems a bit extreme.
The Science
Scientifically, The Case Against Sugar suffers from a condition Steven Pinker has called the “Igon Value Problem”. This term describes the tendency of certain science journalists to arrive at obtuse conclusions due to a superficial understanding of their subject matter (3). There are many examples of this in The Case Against Sugar, but the underlying theme is that Taubes misunderstands (or chooses not to apply) the scientific method itself.
Evidence of this can be found on the first page:
The purpose of this book is to present the case against sugar– both sucrose and high-fructose corn syrup– as the principal cause of the chronic diseases that are most likely to kill us, or at least accelerate our demise, in the twenty-first century… If this were a criminal case, The Case Against Sugar would be the argument for the prosecution.
Trials proceed by very different principles than science does. The prosecutor is not expected to present a balanced case– he is expected to be biased against the defendant. What ensures balance in the legal process is the inclusion of a defendant who is equally biased in favor of himself. Yet in The Case Against Sugar, the defendant is nowhere to be found. What results is an argument that is carefully crafted to support the prosecution, while facts that support the defense are omitted, minimized, or misrepresented.
This is the opposite of the scientific method, which emphasizes objective analysis of facts and seeking evidence that might falsify your beliefs. This might be forgiven in a popular book, but in this case Taubes attempts to take the scientific high ground, portraying his views as rational and evidence-based and those prevailing in the scientific community as biased, irrational, and corrupt.

The Igon Value Problem doesn’t take long to rear its ugly head. In the introduction, Taubes deploys an argument that he believes is sufficient to negate most of the scientific literature on obesity and chronic disease… drumroll please… Occam’s Razor:
If this were a criminal investigation, the detectives assigned to the case would start from the assumption that there was one prime suspect, one likely perpetrator, because the crimes (all the aforementioned diseases [including obesity, diabetes, cardiovascular disease, Alzheimer’s, and several others- SG]) are so closely related. They would only embrace the possibility that there were multiple perpetrators when the single suspect was proved insufficient to explain all the evidence. Scientists know this essential concept as Occam’s Razor.
What if I were to tell you that the structure of DNA is actually a single straight strand rather than a double helix? Would you believe me just because my hypothesis is simpler than the conventional one? Of course not, and for good reason: evidence suggests the more complex hypothesis is correct. The truth is that Occam’s Razor is a weak argument that only applies when two hypotheses are equally well supported (or equally unsupported). As soon as one hypothesis has a stronger evidence basis than another, Occam’s Razor becomes irrelevant. Yet for Taubes, this flimsy argument is sufficient to throw most of the relevant scientific literature out the window, besides, of course, a few tidbits that support the prosecution.
Besides its misapplication of Occam’s Razor, the passage above manifests the Igon Value Problem in a second way: the diseases in question are actually not all correlated with one another, or even with sugar intake. Statistics demonstrating this are readily available. For example, sugar intake is higher today in the US than it was in the 1970s, and while obesity has increased three-fold, coronary heart disease mortality has declined by over 60 percent (4, 5, 6). Taubes neglects to inform the reader that sugar intake has been declining since 1999 in the US, a period over which obesity and diabetes rates have increased substantially (7, 8, 9).
Taubes argues that sugar is the only factor that reliably shows up when a culture develops Western noncommunicable diseases, supporting the point with examples of cultures that adopted sugar-rich diets and became ill. Yet he makes no effort to look for a counterexample that could refute his argument: a traditionally-living culture that has a high intake of sugar and does not suffer from Western noncommunicable diseases. If such a culture can be found, this piece of evidence is sufficient to reject Taubes’s argument that sugar reliably associates with the onset of these diseases in a population. Let’s do Taubes’s research for him. A well-studied Tanzanian hunter-gatherer tribe called the Hadza gets 15 percent of its average year-round calorie intake from honey, plus fruit sugar on top of it. This approximates US sugar intake, yet the Hadza do not exhibit obesity, cardiovascular disease, or any of the other disorders Taubes attributes to sugar (10, 11). In fact, many hunter-gatherer groups relied heavily on honey historically, including the Mbuti of the Congo whose diet was up to 80 percent honey during the rainy season (10). Yet they do not exhibit obesity or insulin resistance (12).
The Igon Value Problem frequently appears in Taubes’s portrayal of opposing viewpoints from the scientific community. For example, Taubes repeatedly asserts that researchers, physicians, and nutritionists simply assume that obesity causes diabetes. In fact, there is abundant and compelling evidence supporting this “assumption”, and such evidence is only a few keystrokes away on Google Scholar (13, 14, 15, 16). Yet it receives no mention in the book. Instead, the reader is gravely informed that today’s scientists, physicians, and nutritionists simply inherited the idea from the previous generation of scientists, who themselves essentially plucked it out of thin air. This is followed by Taubes’s alternative viewpoint, which seems downright reasonable by comparison despite the weak evidence offered to support it.
Here’s a third example. Taubes upbraids the research community for its belief that body fatness is determined by calorie intake, rather than the impact of foods on insulin. He supports the latter proposition with semi-anecdotal observations from Africa suggesting that a group of people eating a high-sugar diet supplying “as little as sixteen hundred calories per day” were sometimes obese and diabetic.
A person who actually wants to get to the bottom of this question should conduct their investigation in a very different manner. The first order of business is to look up the relevant metabolic ward studies, which are the most tightly controlled diet studies available. These studies consistently show that calorie content is the only known food property that has a meaningful impact on body fatness. This is true across a wide range of carbohydrate-to-fat ratios and sugar intakes, and a correspondingly wide range of insulin levels (17).
What makes Taubes’s oversight so extraordinary is that he was involved in funding one of these metabolic ward studies, which compared two diets that differed more than tenfold in sugar content. The results showed that a 25 percent sugar, high-carbohydrate diet caused slightly more body fat loss than a 2 percent sugar, very-low-carbohydrate (ketogenic) diet of equal calories (18). Despite these clear and consistent findings, Taubes continues to insist that calorie intake is not an important determinant of body fatness, and he offers the reader questionable evidence in support of this while omitting high-quality evidence to the contrary. All while exuding righteous indignation about the scientific community’s misguided beliefs.
A fourth and final example of the Igon Value Problem. Taubes states that obesity researchers have been barking up the wrong tree since World War II because they are so focused on calories that they have no interest in the influence of hormones on body fatness. This is another instance in which a cursory Google Scholar search could have prevented a colossal mistake: the search term “leptin obesity” alone returns 385,000 results, all since 1994. In fact, researchers are extremely interested in hormonal influences on body fatness, which is why the topic has been studied extensively and so many relevant hormones have been identified (for example, leptin, ghrelin, glucagon, GLP-1, epinephrine, and amylin).
Taubes’s revisionist history of obesity research allows him to argue that the reason why insulin’s central role in obesity hasn’t been uncovered is that no one is looking. The truth is that researchers have examined insulin up, down, and sideways, and found that it is unlikely to contribute to common obesity. Yet this evidence isn’t discussed in The Case Against Sugar, nor in Taubes’s previous book Good Calories, Bad Calories— it is simply assumed not to exist.
In the final chapters of The Case Against Sugar, Taubes argues that insulin resistance is the primary cause of common noncommunicable diseases like coronary heart disease, diabetes, Alzheimer’s disease, and gout, and that sugar is the primary cause of insulin resistance (he goes out of his way to emphasize that dietary fat, calorie intake, and physical activity are irrelevant). The former proposition can be reasonably argued, while the latter is a case of Taubes cramming a square peg into a round hole. Taubes leans heavily on the animal literature, correctly stating that high intakes of refined sugar sometimes cause insulin resistance in rodent models. But he omits two inconvenient facts: First, sugar is not very fattening in rodents, particularly relative to added fats like lard; and second, added fats also tend to cause more severe insulin resistance than sugar (19, 20, 21, 22, 23, 24).
The combination of added fat and sugar is even more harmful than fat alone, and the most fattening and insulin-resistance-inducing diet of all is to give rodents free access to a variety of highly palatable human foods (25, 26). Sugar alone cannot remotely explain the effects of palatable human food on body fatness and health in rodents– or in humans– although it does contribute.
The mechanism Taubes proposes for how sugar causes insulin resistance is that the fructose component, making up 50 percent of table sugar, overloads the liver, rendering it less sensitive to the insulin signal, and this eventually causes whole-body insulin resistance. Taubes is correct about the impact of fructose on the liver, although again he leaves out critical information: realistic doses of fructose primarily overload the liver if a person is overconsuming calories and liver energy stores are already full (25). This is probably why hunter-gatherer groups such as the Hadza can eat as much sugar as Americans and not develop health problems (26, 27). These facts do not fit Taubes’s narrative that calories are irrelevant, and they are not shared with the reader.
Here are two other inconvenient facts that Taubes omits from his finely crafted narrative: Both sedentary behavior and overeating calories cause pronounced insulin resistance, and conversely, physical activity and eating fewer calories powerfully combat insulin resistance (28, 29, 30, 31). Physical activity almost instantaneously increases the insulin sensitivity of muscle tissue, which is a major determinant of whole-body insulin sensitivity. Again, abundant evidence of this is only a few keystrokes away on Google Scholar, yet Taubes dismisses the idea out of hand.
During the course of his argument, Taubes uses sleight of hand to portray the views of researchers as more favorable to his ideas than they really are. For example, in chapter 9 he argues that obesity and physical inactivity are not the real causes of insulin resistance, rather sugar causes both insulin resistance and obesity. To support his theory, he invokes the work of Stanford endocrinologist Gerald Reaven, claiming that he “was bringing back the notion that carbohydrates were bad”. This seemed mighty fishy to me, so I looked up what Reaven actually thinks. Here’s a quote from a review paper he wrote (emphasis mine) (32):
Since being overweight/obese and sedentary decreases insulin sensitivity, it is not surprising that the prevalence of the manifestations of the [insulin resistance syndrome] is increasing at a rapid rate. From a dietary standpoint, there are two approaches to attenuating the manifestations of the [insulin resistance syndrome]: (a) weight loss to enhance insulin sensitivity in those overweight/obese individuals who are insulin resistant/hyperinsulinemic; and (b) changes in macronutrient content of diets to avoid the adverse effects of the compensatory hyperinsulinemia [i.e., replacing carbohydrate with unsaturated fat- SG].
Taubes neglects to inform the reader that Reaven thinks obesity and physical inactivity cause insulin resistance, and that these factors explain the rising prevalence of metabolic disease– precisely what Taubes is arguing against in that passage. Furthermore, Reaven explains in no uncertain terms that he does not think insulin resistance causes weight gain.
Rather than straightforwardly reporting what Reaven’s studies revealed and what the man believes, Taubes takes Reaven’s argument that people with existing insulin resistance may benefit from carbohydrate restriction and warps it to make it appear as if Reaven supports Taubes’s beliefs about the origins of insulin resistance. In doing so, Taubes flips Reaven’s position by 180 degrees. If you want the real scoop on Reaven’s important work, go straight to Reaven’s book Syndrome X.
I’ll end this section on a positive note. In The Case Against Sugar, Taubes finally acknowledges the importance of food reward in eating behavior and obesity. As a reminder, food reward is the seductiveness of certain foods (like ice cream and chips) that motivates us to eat them, and as common sense suggests, it’s an important influence on what and how much we eat. Previously on his blog, Taubes argued at length that food reward has nothing to do with obesity, and (remarkably) that the brain itself is unimportant (33). In The Case Against Sugar, he argues that the seductiveness of sugar is precisely why we eat it, ultimately leading to obesity. He even briefly discusses dopamine, the chemical mediator of reward, acknowledging both the importance of food reward and the brain generally in food intake and obesity.  This is progress.
Conclusion
Science is imperfect, and scientists are as well. Pioneers such as John Ioannidis, Brian Nosek, Vinayak Prasad, Adam Cifu, Chris Chambers, and David Allison are making a good faith effort to identify flaws in the scientific process and address them. Journalists have an important role to play here as well, by helping to identify problems and raising awareness about how to fix them. Taubes also views science as flawed, but primarily where it disagrees with his personal beliefs. Rather than contribute to the solution, Taubes adds to the problem by promoting an unscientific thought process that systematically excludes opposing evidence.
To answer the question posed in the title, refined sugar is bad, although not the singular cause of all humankind’s ills. A core principle of journalism is the accurate, objective, and complete transmission of pertinent facts to the reader. The Case Against Sugar is a journey through sugar history and science that is heavily distorted through the lens of Taubes’s personal beliefs. By this metric, it is not journalism, but advocacy. To a general audience that has little basis for evaluating its claims, the book will be misleading. Yet for readers who are willing to take The Case Against Sugar with a case full of salt, it does contain some interesting history.

Comments

  1. Taubes has become unsufferable.
    You should rename your upcoming book to something like “The Case for Sugar – How eating refined sugar can make you thin and healthy” and open it with the RCTs that did exactly this!
    While not ideal, it’d really get people who would otherwise not read it to actually learn about the true causes of hunger, obesity, diseases, etc.
    Keep up the good work. Can’t wait for your book.
  2. Thanks for your review! Some points I noticed:
    1)Funding of Yudkin. You link to an Atlantic piece, which quotes David Merritt Johns, a journalist and PhD candidate, though without any reference. Where is the original source showing that Yudkin was indeed sponsored by these industries? Besides, the real problem isn’t the funding, but the fact that Keys faked his statistics repeatedly to get a desired outcome. Yudkin, to my knowledge, didn’t fake anything.
    2) The Hadza. People like to point to the Hadza, but the comparison doesn’t work. If you look up the original studies on the Hadza, you notice that their honey consumption is only seasonal (mainly wet season), not all year round, in contrast to Western sugar consumption. So much less of a metabolic concern.
    3) Occam’s razor. Science starts by looking for the simplest explanation. Only if that doesn’t work, you look for more complex explanations. So if sugar/fructose can explain all of these diseases, there is no need to come up with a multifactorial approach. The DNA example actually shows this nicely. Indeed it was first assumed to be single stranded. Only later it was found to be double stranded. And then it turned out that double-stranded is in fact the simplest solution for the task at hand (replication).
    4) You refer to rodent studies, which sometimes have shown that fructose isn’t all that bad. However, rodents still got uricase, hence they can metabolize fructose-derived uric acid (which blocks insulin, increases CV tension etc.). Humans can’t, that’s the whole problem. Rodent studies need to knock out uricase gene to get sensitive to fructose. If they do, rodents are highly sensitive to fructose.
    5) Over-eating. This is not a cause, but a consequence. And the main cause of over-eating is: sugar. Due to it’s hormonal and neurological effects. People don’t overeat on a high fat, LOW SUGAR diet, because fat has high satiety, while sugar INCREASES appetite.
    6) The Taubes study you mention included almost no added or liquid sugars (page 3). And “sugar” doesn’t mean sucrose, but also dextrose and lactose, which don’t include fructose.
    • 7) Of course, we also know that a high carb, LOW SUGAR diet is no problem at all. In fact, this is what many traditional diets look(ed) like, from Asia to Southern America (rice etc.).
      8) The Mbuti pygmies of the Congo you mentioned also have a honey season of max 2 months. And as the Hadza, they gain weight during honey season. Of course this is not a problem, because it’s not permanent. In fact many animals gain weight during PART of the year.
      • I’d like to add a point 9, as put forward in this blog: https://novuelvoaengordar.com/2017/01/15/guyenet-refutes-the-idea-that-sugar-is-fattening/
        Taubes himself, also made this argument in an interview with David Ludwig https://www.dietdoctor.com/conversation-dr-david-ludwig-gary-taubes
        9. The point “Taubes neglects to inform the reader that sugar intake has been declining since 1999 in the US, a period over which obesity and diabetes rates have increased substantially (7, 8, 9).” is misleading. From the blog I referenced: “If sugar is fattening, what effect would be expected if our consumption were reduced? We would keep getting fatter, but at a slightly lower rate. That is what the orange curve in the graph above confirmed.”
        • “If sugar is fattening, what effect would be expected if our consumption were reduced? We would keep getting fatter, but at a slightly lower rate. That is what the orange curve in the graph above confirmed.”
          That makes no sense. If I eat X amount of sugar per day, I might weigh 200 pounds. If I eat 2X sugar daily, my set point might go up to 230 pounds. If I drop back down to X, then my weight should go back to 200, not up to 240.
          The only way your weight could still be going up as sugar consumption drops if you haven’t yet reached your new set point. But sugar consumption dropped in 1999, not last month.
          I suppose Taubes could also be arguing that set points are bunk?
          • It’s a bit simplistic of an explanation, but let me try to work with your own example. You are clearly assuming that with the consumption of X amount of sugar you are at a balanced weight of 200 pounds. Fair enough. Consuming 2X will then make you gain weight, you might go up to 230 pounds. Fair enough. What makes you think that going back to X will make you loose weight, rather than simply retain it?
            Now look back at the graph, and imagine the 1980 levels are 2X (as people were clearly gaining weight even back then), it has since risen to 6X, and people were still getting more obese, and now it has recently come back down to 5X (altough other people than me are arguing even that’s debatable, but simply assume that it did go down). Now, what makes you think that going down from 6X to 5X people should suddenly stop getting more obese? The point I am trying to make is that the average sugar consumption levels are still above a reasonable threshold and thus on average the population is getting more obese (although perhaps at a slightly slower rate, as the graph seems to suggest).
            Hope this helps. 🙂
          • Your argument might work at an individual level but not at a population level. If you cut back your sugar, you may lose weight, but you might still be obese.
            At a population level, with slightly less avg sugar consumption weight gain might be slower, but still cause a % of the population to become obese after time. To take your example, the relative drop in sugar consumption has not gone from 2x to x (50% reduction), but about 10% if Stephan’s data is accurate. So even if sugar consumption has gone down slightly, the avg consumption is still high enough to make x% of the population meet the definition of obesity. It just might take people longer to get to there.
    • You (Clark) say fat has high satiety while sugar increases appetite. I don’t think the data support this. In the satiety cascade, fat has low satiety gram for gram, whereas carbohydrate is more satiating and protein most satiating of all. Energy density is best predictor of overconsumption.
    • Clark do you read Yudkin? You should, and not just his diatribe on sugar that Lustig and Taubes worship.
      Yudkin’s concern with high sugar consumption in the UK started in the 1950’s. In 1958’s This Slimming Business he noted the 5x increase in sugar consumption over a period of 100 years. He considered it a liking/addiction which caused overconsumption. He also linked it to the overconsumption of fat:
      “I believe, lastly, that at least some of the high amount of fat we eat comes about because of the use of sugar with fat in such foods as cakes, ice cream, and other sorts if confectionery. Sugar thus becomes a fat carrier, as well as providing Calories itself.”
      Like his associate Keys, Yudkin used the calorie theory of obesity: “The irrefutable, unarguable fact is that overweight comes from taking in more calories than you need.” Eating less % carbohydrate and more % fat in a diet results in a reduction in calories-in, because less fat calories are needed to satiate. Yudkin advocated high % fat diets, but not high calorie diets.
      Yudkin’s work resulted directly in a carb counting methodology, using “carbohydrate units”, or CU’s. His 1958 is full of tables of them. A typical dieter would have an allowance of 15 per day and could eat any food they liked (6 oz of Coke has 3 CU’s, the same as 3 oz of potatoes). It’s almost exactly equivalent to current ADA carb exchanges, and very similar to glycemic load. I’ve used the ADA methodology and it works very well. But adhering to it is WAY more complicated than simply counting calories for weight loss. You end up having to count both. Unless your satiation signals are working better than mine do, you end up eating too many calories.
  3. @”Here are two other inconvenient facts that Taubes omits from his finely crated narrative: Both sedentary behavior and overeating calories cause pronounced insulin resistance, and conversely, physical activity and eating fewer calories powerfully combat insulin resistance”
    What you fail to consider or mention here is that there is also causation in the direction of diet toward physical activity or sedentary behavior. When I eat carb-/sugar-rich meals it *makes* me feel lazy and ‘stuck to the couch’ … when low-carbing, I automatically, with no particular will or effort, feel active and energetic and want to get up and do things, be it go to the gym, or work etc.
    • I agree with you David. I am an active individual and exercises 4-5 times a week. I eat a diet with minimal sugar (including fruits) and refined carbs, consisting mainly of fresh veges and decent amount of protein in the form or meat and eggs. When I do indulge myself in refined carbs sometimes, I feel totally lethargic and devoid of energy the next day and I don’t feel like exercising. On the contrary and counter intuitively I feel the “most energetic” when I am on my normal low refined carb diet and especially when I train in the fasted state.
      • I’m exactly the opposite. The more carbs I eat, the more I exercise. Yudkin decries carbs because they enter the bloodstream so quickly after eating. Under sedentary conditions he’s right, the carbs result in little satiation. However when you’re walking 10,000 steps a day, or riding 20 miles, or backpacking, ready availability of glucose and full glycogen reserves are useful.
    • I’m exactly the same, David. On my old “normal diet”, my brain controlled me such that I was very reluctant to go up the stairs for something. On LCHF, I’ll go up and down all day without any reluctance. Now, I don’t care WHY this happens. I do care THAT it does. It’s a very common report of those on LCHF and Yudkin etc., noted it.
  4. There’s one thing that’s crucial in all of this, I believe. Hunger. The control of hunger within a range of calories which keeps you thin, is the key to weight control. Trying to do it the other way around, i.e. by crude calorie counting will result in failure if hunger is not satisfied. I come from an undoubtedly insulin-resistant family and had a belly since the age of 23. I’m now 66 and am the same weight as I was at 20 for the last three years, without hunger. For me the key was a low-carb high-fat moderate protein diet with no modern junk at all.
    Gary’s theories are partly correct and partly incorrect in my view, but he fundamentally espouses a regime which works very well for me and which I have no difficulty in sticking to. The man who inspired me to try it was Prof.Noakes. He, e.g. does believe that calories count, but like myself that you get longterm failure or complete misery if hunger is not suppressed.
    I’m a retired doctor and when I’m asked how it works, I frankly tell people that there are various theories, but that at the end of the day, it works for most. It works for IR people by being more suppressive of hunger than other diets.
    • Although he did not go into it on this post, i believe Stephan would agree with you that hunger suppression is a key reason why low carb (high protein) diets do work. He’s written about it before.
  7. Clark, In regard to 3, I did not do biological research, but the research I did was not about looking for the simplest solution I could imagine. I was looking for all the complicated and intertwined variables that could contribute to system I was researching. Then I would try to isolate each one individually. I was by definition looking for complexity. Science is about accurately observing and describing phenomena, not trying to simplify them.
    • Sure, if you’re looking into a complex system, you are going to consider many variables. But even then (or especially then), you are going to search for the simplest solution that is able to explain/model your system.
      • You need to toss out the idea that you are looking for simplicity when doing science. You are only looking for the most accurate description. Think of physics, Newtonian mechanics is the simplest description, yet it is not the most accurate. Quantum mechanics is significantly more accurate, but definitely not as simple or intuitive.
        • The simplest that is accurate. That is what Occam is all about. If it’s not accurate, you have to look further. Newton wasn’t accurate for high speeds.
  8. While I find your tone a bit too ad hominemish for my taste (creating a certain veil of subjectivity), I can not but agree that Taubes is dead wrong and is articulating his stance based on his own agenda. The only thing he’s right about is that Calories in Calories out is not the end all be all, because everyone knows this and still obesity is a (growing) problem. The physics are correct, but the complexity of human behaviour is not appreciated with the advice of ‘eat less move more’.
    Your own research on this subject is therefore very important!
    Thanks for this thorough rebuttal.
    Best, Nils
    • Hi Nils,
      It’s difficult for me to contain my frustration over Taubes’s gross misrepresentation of science and the scientific community. Taubes has been making ad hominem attacks against researchers for years, stating or implying that people who disagree with him are not real scientists. His public profile is so large that actual scientists can’t effectively defend themselves against his accusations. This situation has become worse than ever with the publication of his new book and the media frenzy it has generated. The scientific community is fed up. Given Taubes’s behavior, I think it’s fair to ask the question “is Taubes a real journalist”?
      I agree 100% with what you said about calories, but unlike what Taubes claims, this is something that is commonly accepted among researchers. Calories determine body fatness but that doesn’t mean calorie counting or portion control is the solution to obesity.
      • Hi Stephan,
        Understandable frustration, but if you stoop to his level, then you’re bound to lose as he’s on familiar grounds and has the home field advantage! 😉
        On a more serious note, while researchers may understand that eat less move more isn’t practically useful advice for most, it is still the message that is being conveyed by dietitians and government bodies (at least here in the Netherlands). Until a message is sent out that actually helps people, people like Taubes will always have a following (or Jimmy Moore for that matter).
        Best, Nils
  10. I don’t know if Taubes’ reasoning is correct, but 3 years ago I eliminated sugar and went on a low carb, high fat diet and I have never felt so good. I am 54. My HDL is up, triglycerides are down, I have increased energy, and my weight dropped from 175 to 160, what I weighed in high school. This is just one anecdote of course, but a growing number of people are doing LCHF and experiencing similar benefits (including T2D reversal), so removing sugar and other carbohydrates from the diet certainly seems worthy of consideration.
    • yes, it seems anecdotal evidence (incl. me) supports this, and is arguably ahead of science. it may well be taubes is arguing incorrectly to arrive at the correct conclusions, which may be a shame as it could make the scientific community preliminarily disregard these very conclusions in light of his sometimes shaky reasoning. i hope soon a more foolproof and thorough research comes along.
  11. Thanks for your comprehensive review Stephan.
    As a Type 1 diabetic with 33 years experience, I would like to share my opinion. I can tell you that Taubes is definitely on the right track, and, as his book is investigative, it does a decent job of trying to understand a problem that is hurting so many people, economies and the planet (imagine the net weight of all the plastic used for finger stick blood glucose tests). The past 40+ years of nutritional thinking has missed something, that must be clear to everyone? I do agree that correlation is not causation but where are the scientists these past 40+ years? Where are the studies to support or disprove Gary’s hypotheses? Hopefully, they are working hard at solving the mysteries.
    I gave up all digestible carbohydrates (all carbs are sugars, whether refined, whole grain, etc…) 1 year ago. I am 14 kilograms lighter, have glucose readings in the narrowest range of my life (HgA1c’s 5.4, 5.3 and 4.9 mmol/L this past year with a low 1.2 standard deviation meaning I am generally between 3.5 and 6.0 mmol/L).
    I don’t eat any refined sugar at all, in fact, when I used an insulin pump, I fooled myself into thinking I could eat refined sugar and just bolus to cover. This is bad thinking (but was supported by my endocrinologists!), I ate sugar, I took insulin, and as I entered my 30’s and 40’s I kept getting fatter and fatter and I watched my insulin needs increase, change and become unpredictable. I did hands-on research on myself as I would eat similar foods and take similar doses and observe my body reject or ‘resist’ the insulin in different ways.
    To get rid of the body fat I tried to burn more calories I consumed but that never really worked because I had to manage my insulin/food balance manually. This led to lots of hypo and hyperglycemia. If you’ve never had hypoglycemia, you don’t truly understand the power of the body to generate hunger! This led to over treating the hypoglycemia which would lead to hyperglycemia almost every time! I called it chasing the dragon, imagine the Chinese dragon in motion, up and down, down and up. Calories-in-calories-out never worked because the insulin question could not be answered by my human brain. It’s a WOW thing the body does that we cannot replicate. Just a note, hyperglycemia is a root cause of many long-term diabetic complications, including, but not limited to many diseases of the vascular system which can be the root cause of all the other diabetic complications..
    The moment I eliminated digestible carbs/refined sugars from my diet, the dragon was slayed, just like that. The weight started coming off so fast I feared I had Pancreatic cancer! Blood pressure of 135/90 went under 120/80 and has stayed there (117/73 as I write this so a little stressful). Oh, I don’t regularly exercise but lead an active life living in Switzerland, I don’t count carbs but bolus for broccoli and a few other non-digestible veggies that cause a blood sugar response, I eat saturated fats in various forms, and proteins from grass fed sources whenever possible, I avoid all processed foods, especially all cooking oils except olive and coconut. I am healthier than I’ve been since I was pre-diabetic (when I was 11 years old). Oh, and in case you think cholesterol really matters, my ratios are amazing!
    Sugar, to me, is the poison that Gary Taubes accuses it of being. Am I grossly different than those without Type 1 diabetes? Personally, I don’t think so, I think I am just more in touch with my metabolic processes because I cannot function on auto-pilot, I have to fly the insulin powered engine! Imagine a dog flying an airplane, I was the dog and my body, the airplane, I might have hit a few of the right buttons and controls over the years but I was heading for a crash sooner or later. Now the dog is just sitting in the pilot’s seat but the plane is parked (his paw is up on the stick though, giving the humorous appearance that he is flying).
    Partly because of what Gary Taubes and others like him have written and are writing, I have made changes to my life that work for me. Is it all supported by science, maybe not. Does he write with passion and conviction, yes! Does his writing make me ask more questions, absolutely! Don’t believe everything you read, right, but question everything and look to your body for the answers.
    Rob Roman
    @Type1Roman on Twitter
  12. I have no axe to grind, just my story. I am 61 yrs old, 5’5″ and 135 lbs. I have always exercised although not intensively. Throughout my adult life I slavishly followed a low fat diet, rich in fruit, veg, whole grain and non processed food. Six years ago I was diagnosed with Type 2 diabetes and immediately put on medication since non of the other steps( weight loss, more activity) were indicated. I complied out of fear and injected myself daily with insulin for five years. Steadily my waist size and weight increased despite no change in diet or activity. One year ago I read about and began to follow a low carb/healthy fat lifestyle. Within weeks my blood glucose was normal and I lowly stopped the injections. I eat a healthy, real-food diet and am satisfied; never hungry. I am off all medication and all blood test results are significantly improved( glucose, cholesterol etc) I’ve lost the abdominal fat insulin had given me. How do I align this with Dietary Guidelines given today?
  13. There are credentialed researchers who view the insulin hypothesis as highly creditable, Stephan; some, perhaps, with expertise superior to your own. One wonders whether you would characterize them with disdain.
  14. I agree with the main point of this article, that refined sugar is bad but not the only cause of ill health. But there are a number of misleading statements in this article as well.
    First, there is no good evidence for Stephan’s claim that U.S. sugar consumption has fallen since the late ’90s. Stephan recently made this assertion in another venue, and I pointed out that the data he used are suspect, but he’s still using it. I find that disappointing. https://medium.com/@robertagreer/no-sugar-consumption-hasnt-fallen-f64280d56e5?source=linkShare-df749b90cf3-1485531182
    Second, sugary drink consumption is associated with poor health even after controlling for caloric balance.
    Third, honey and fruit sugar consumption can’t absolve processed sugar of health problems, because there are good studies showing honey and fruit are not associated with health problems, and sensible mechanisms underpinning the theorized difference between these foods and refined sugars.
    A better statement of the facts would be something like, “Sugar is a primary driver of poor health in America and Westernizing food cultures, although there are other causes of diet-based chronic disease as well. And no, exercising isn’t enough to keep sugar-related health issues away.”
    • Hello Robert,
      The USDA data are approximately correct. How do I know? Because they are consistent with estimates from other methods. For example, NHANES has recorded a 23% decline in sugar-sweetened beverage consumption in the US between 1999 and 2010.
      NHANES suggests that total added sugar has declined as well:
      A third source of data, Framingham study FFQ data, shows the same decline:
      Don’t you think you should have tested your hypothesis before calling for me to retract mine?
      • True, sugar consumption is not rising that fast anymore or even stagnating/falling in some Western countries, BUT at an enormously high and dangerous level (several hundred percent above 1800s levels and way beyond WHO guidelines).
        At such high levels, it is perfectly reasonable to expect disease prevalence to progress, as many of these diseases take some time to develop and are partly inherited (via epigenetic markers).
        Moreover, mortality is often a bad marker, because there are countermeasures (e.g. drugs) that can reduce it *even if* incidence goes up. Even incidence can be a tricky measure if there are preventive measures. This is why the sugar industry could argue that sugar doesn’t cause cavities when caries prevalence stopped rising. Well, because brushing teeth was effective, not because sugar is harmless…
      • Stephan, I apologize for being accusatory. Ordinarily when I deal with people making arguments similar to yours, they have clear ties to the sugar industry. But you seem genuinely independent and ethical, so I’m sorry to not switch gears.
        That said, I think there’s still serious problems with your counter-evidence to Taubes. The NHANES study about sugar-sweetened beverages is insufficient evidence when we’ve been talking about refined sugar consumption more generally. The Framingham data is interesting, but involves only one region, and although that doesn’t change the reliability of its associational findings, it makes the data of very little value for determining sugar consumption nationwide.
        The NHANES study about total added sugar gets you much closer to what you’re claiming. I have reservations about how it estimates the added sugar contents of foods: Because it treats a muffin as a muffin, it wouldn’t capture any increase in added sugars that would result from an increase in “non-fat” processed foods that are loaded with more sugar to remain palatable. Additionally, these food questionnaires don’t ask about portion size, which could easily account for “hidden” added sugars. But these are admittedly quibbles with what is otherwise among the best food intake studies available.
        But maybe that’s the whole issue to begin with: Even these studies you produce now, which are leagues better than the cooked USDA numbers, have serious flaws, and so are inadequate to contend with the weight of other evidence strongly linking sugar to poor health outcomes. Recall that we’re dealing with RCTs in animals, the well-studied endocrinological mechanisms of refined sugar and poor health, double-blind studies of diabetes biomarkers in human subjects, and crushingly consistent associations found in serious epidemiological studies.
        I’ll also point out that your CDC link shows a leveling off of obesity since about 2005 (looking at overweight, obesity, and extreme obesity rates every six year)::
      • 1988–1994 32.6 23.2 3.0
        1999–2000 33.6 30.9 5.0
        2005–2006 32.2 35.1 6.2
        2011–2012 33.3 35.3 6.6
        So even assuming that you’re correct in saying that sugar consumption has dropped off, the data is still broadly consistent with Taubes’ thesis linking sugar to poor health. As sugar consumption has stabilized or dropped by around 10%, overweight/obesity has also stabilized after a reasonable lag of a few years. So unless Taubes has said that sugar is the only problem in the American diet (which would clearly be wrong, given processed meats, many problematic vegetable oils, etc.), it still doesn’t seem like your counter-evidence is up to the job of refuting his scientific claims.
        Does Taubes say that fruit and honey are bad? I know in “Why We Get Fat” he’s pretty anti-fruit, but that position would be pretty hard to maintain in light of recent studies. If he doesn’t distinguish between industrial sugars and historically-available sugars, then your points about hunter-gatherers land squarely, but in any event they can’t be a meaningful counter-example to the (correct, in my view) claim that refined sugar is a major driver of poor health.
            • Although not critical to supporting your argument that SSB consumption is down, Coca-cola and Pepsi are public companies and have openly publicized the business challenges they have been facing as sugar-sweetened soda sales continue to decline. Both companies have been investing heavily in sugar-free drinks for that reason – it’s what sells nowadays.
        2. As far as the insulin resistance preceding and therefore its proximal cause hypothesis goes, this doesnt make sense biochemically as a centralized insulin resistant state would generally preclude the adipose tissue from taking up and storing the excess energy which is what characterizes obesity. Instead, insulin resistance results in extraadipose storage which is why you get NAFLD and atherosclerosis.
        3. Interesting review but one particular sentence caught my attention:
          “a review of the book from the perspective of a former researcher who is an expert in some of the topics it discusses.”
          Have you left academics?
        4. It’s easy to forget that these food phobias are based on people’s desire to have a virtuous and clean diet. They’re terrified of glucose and insulin spikes and hepatic DNL and triglycerides entering their adipose tissue. That’s what they imagine happens the moment a slice of bread goes post-prandial. They believe that dietary carbs leads to inflammation, insulin resistance, diabetes, and CHD. All day long on Twitter, the LCHF experts are telling this to their followers that every worsening public health statistic is due to carbohydrates. I guess this is a form of what’s termed orthorexia, and I’m sure there are reasons some people fall prey to it. But this fear is behind a lot of Taubes’ audience.
        5. FYI Taubes just appeared on Joe Rogan’s very popular podcast, given a huge forum for his views. You may want to contact Joe. He has been pushing the evils of sugar ifor a while now, but I find him to be very open-minded and evidence based and I think he would like to read this review.
          • I listened to Taubes on that podcast, and he came across as a pompous ass. I’m a statistician with no domain knowledge (and a vague predisposition to support the anti-sugar case due to listening to Rogan’s guests over the years), but the way he contests the standard narrative suggests a profound lack of understanding of dynamic processes in general. I was thinking as I listened that he didn’t do very well in mathematics. Indeed, he brags on the podcast about getting bad grades in physics, so it’s no surprise. Everything is a story about good guys and bad guys, no experimental thinking at all.
            • Agreed with that. He’s very arrogant. “I was too dumb to do better than a C- in freshman physics” … followed by “I’m the only one who did this” “No one else” “They’re all bad scientists” etc.
        6. This was an enjoyable read. I used to be a big believer in the sugar fearful camp. have Taub’s book “Good calories, bad calories” myself and thought it was a really good read at the time. However after starting to do more through research I started to understand the huge biases that he presents in the book and how unscientific they are.
        7. Hi Stephen,
          The study you reference (17) ‘A review of the carbohydrate-insulin model of obesity’.
          Are you aware of the limitations and criticisms of this study: Firstly, it was a pilot study. Observational in nature. The participants were not in calorie balance as intended. They started the LCHF diet after HCLF diet.
          But most importantly, the fact the data from this study actually showed carb-restriction on the Isocaloric Ketogenic Diet diet INCREASED energy expenditure, therefore suggesting small evidence of a metabolic advantage on LCHF diets. The official abstract from the study reads “Energy Expenditure Increases Following An Isocaloric Ketogenic Diet in Overweight And Obese Men.”
          • Hi Adam,
            I am very familiar with both the strengths and weaknesses of the study as I have read every word of the paper twice, written about it, and corresponded with the first author. Keep in mind that as part of the funding organization, Taubes was intimately aware of study design and approved of it before it refuted his beliefs.
            Also, let me explain what it means to do a pilot study. The point is to determine whether there is sufficient rationale to believe a hypothesis is promising enough to test further (i.e., spend a bunch of money and time on it). The study very clearly showed that there wasn’t. Another thing to consider is that this was the SIXTH straight metabolic ward study to show that lower-carbohydrate diets do not accelerate fat loss when calorie intake is strictly controlled. This is all in ref #17. How many studies are we going to have to do before Taubes and co. get the message? 100? 1000?
            The whole point of the “metabolic advantage” is that it’s supposed to get you fat loss. In this study, the ketogenic diet had a slight metabolic advantage, but the extra calories came out of muscle tissue and glycogen, with fat loss actually slowing relative to the high-sugar diet. Let me repeat that: on the same number of calories, fat loss was slower, and muscle loss was greater, on a ketogenic diet as compared to a high-sugar diet. How can this possibly be reconciled with Taubes’s idea?
            • A question on these seemingly contradictory points: Calories are the only reliable measurement researchers have found. Taubes’ study showed that with calories being equal people lost slightly more weight on high sugar. Doesn’t that mean that high sugar would be a reliable weight loss diet outside of the calorie model? I haven’t read through the study and I don’t usually understand them when I try, but maybe the answer is there. Any insights on this are appreciated.
        8. I think the discussion is good. I think some of the comments about Gary T. are a bit over-ripe. I don’t agree with Gary T., but I do think he is a fine researcher, but like all researchers, he has a bias. In my job, I have to ready every policy that comes out of Health/Human Service and in my research work, I have to read considerable amount of studies about cancer and in doing so, nutrition is a large aspect of our catalog work. Our team has a database of every study and have build a “researcher database”, where we provide meta analysis not just on studies but on every doctor/group that publishes work. The most key attribute we maintain is a section on “known bias”, where we document and discuss and continually update the various biases we see in each publication and tag it to the researcher. Trust me, everybody has a bias, not matter how fair they are trying to be. Or even if they might not care if they appear biased, like Gary T. It helps us to create fair meta analysis and actually use it, because we consider the bias of the researcher first. When you work in a job where you read about 10,000+ pages of dense material a week you either love your job and become good at sifting through the material or you quit the job in search for other types of analysis. I love my job as to many of my other peer readers. The part that is funny to me, is the controversy of research today, considering the major trends and the countless counties in the U.S. that are extremely healthy and the many cultural cohorts in the U.S. that are very healthy (ie Mormon/Amish groups.) But, in our analysis, 3 factors can’t be disputed. Even if we’re eating more/less sugar as a society than we were, on average we eat about 2 times as much as we should, conservatively 9g of refined sugar should be our limit, conservatively today its about 18g. Second, we’re not very active. Conservatively, we do about 5,000 steps a day, we should do at least 10,000 steps to be healthy. Third, men and women don’t eat the amount of natural healthy fiber they should each day, men about half what they should and women eat more but still are quite lower than they should. (Aside note, women are becoming worse in their healthy veggie intake.) All 3 inputs at a minimum need to be considered. Never just one as being the “Bad Guy”, like sugar. Population health data on mormon zipcodes will blow your hair back on their differences to typical Amercians. Amish studies on cancer done by OSU are interesting as well as pedometer rates of activity. They move at least 3x more than the American Average. Very little money is spent on these healthy cohorts for disease management compared to U.S. tallies of cost. But, the key thing that is lacking in nutritional studies is a word that isn’t used much today anymore. Vitality. I think it died with Jack Lalanne. High fiber diets provide so much energy to support a vital lifestyle, being active. Not being sick. Sedentary lifestyle should only be embraced when you get an illness for a very short-term to regain energy/vitality and go back to life. People that walk less than 5,000 steps have health that is very similar to people confined to wheelchairs in many cases. Its funny that in our database, the word “vitality” and words similar were in so many studies in the 1950s/60s and even 70s. Exercise doesn’t equal vitality. Purpose and activity is vital. Hippocrates said Walking is man’s best medicine. I think he also said if you are not your own doctor, you are a fool. I think we need to re-think “vital signs” beyond blood pressure and what’s easy to measure. In my opinion, any study on nutrition that doesn’t factor for Activity/Fiber/Sugar inputs is biased and ones that don’t even try to track the vitality of the participants are shallow. Without vitality being considered, why are we studying it in the first place. It should be the outcome, not the scale. Bias is a hard nut, because so much of it has to do with how clinicians are trained. I have 81 presentations written by various teaching hospitals about various cancer types and what is taught by each university to doctors. Very few are the same. Some say this cancer site is over diagnosised another will say it isn’t, one discourages a certain test another one values it. Bias is ubiquitous in health care. I’d give Gary T a pass, because he’s no more biased than 80% of the other researchers. I wish all had a “5” in our database on overall bias consideration score, but the reality is less than 8% get that score.
          • Listen to Gary on Joe Rogan’s podcast, and tell me he deserves a pass.
            He is totally self-aggrandizing, with his whole “6 months of work for 4 weeks of pay” BS. This kind of attitude among science journalists causes the public to distrust all scientific research, and encourages good vs. evil rather than experimental thinking.
          • Granted that Gary put his money where his mouth is with NuSI. But his new book regresses to the old form of cherry-picking the historical literature.
        9. Very interesting read, Stephan.
          It’s very frustrating that he continues on like this.
          I choose to believe he’s just kidding himself, rather than purposely misleading people to make money or continue being famous. …but I might just be kidding myself.
        10. Does your blog have a contact page? I’m having a tough time locating it
          but, I’d like to send you an email. I’ve got some
          creative ideas for your blog you might be interested in hearing.
          Either way, great website and I look forward to seeing it
          expand over time.
        11. I am sure that Gary Taubes does not have everything right, but it would be a shock if he did. There is evidence that LCHF diets work better in the real world and its common knowledge that exogenous insulin is very fattening. The question of metabolic advantage is just icing on the cake as satiety and reduced caloric intake on LCHF diets is enough of an advantage. As a clinician I was quite despondent about achieving weight loss in patients with fatty liver using the conventional low fat approach but have had good responses to LCHF diets with > 10kg weight loss very common. The hostility of the nutrition community to LCHF diets and their proponents is unhelpful when the efficacy and safety appear probably better in the real world. I think its clear that Nutritional Guidelines have been a failure in the real world and the reactions to LCHF look like cognitive dissonance to a clinician that just wants something that works for real world patients. I am sure the theories will evolve, but the research community needs to actually consider that they may have taken the wrong path and actually do serious research to clarify whats good about LC diets, as people will vote with their feet based on real world results, and ignore the researchers if they don’t.
          • The exact statements by Taubes are irrelevant by now. The cat is out of the bag and millions appreciate that for them low carb is the solution. I am horrified at spending 3 decades doing vegetarianism, then low meat, followed by high carb, relatively low fat paleo. What all that rice, potatoes and apples gave me was a TG/HDL ratio above 5, a blood glucose of 103, and an expanding waist line. 6 months of low carb, low protein, food dropped 16 lbs, reduced waist by one size, got to a near optimal BMI of 22, TG/HDL of 2, glucose 86. Fasting insulin is 2.5 (caveman level) and HG1AC is low. My wife insists with the rice for lunch and her HG1AC is pre-diabetic.
            All this with a single dietary, relatively short intervention. It is difficult not to believe that there are some intentional lies being spread in nutrition, for big pharma profit reasons, and I appreciate that our primate cousins do in fact get 2/3 fat from the diet via SCFA. I am comfortable enough now that I have re-introduced carrots, beets, squash and potatoes (and one apple a day), all good foods that perhaps need to be avoided as you are trying to reset your metabolism. we are certainly more susceptible to metabolic disorders when we work at a computer all day.
          • Thank you Andrew Mc and others ; I am a primary care doc, and the LCHF approach does seem to work a little better. This is NOT a scientific statement , just ordinary clinical observation. Rob Roman’s story was quite compelling . The strong influence of Big Pharma cannot be exaggerated. They drove diabetes care with a “we must lower blood glucose ” approach on everything while ignoring the possibility of lowering insulin’s effects.
            Thanks also to other commentors, I do feel that Taubes does have a PR issue. He does manage to consistently communicate some sort of arrogance. I keep trolling the web for info regarding what is REALLY going on at NuSi , and find little. In addition, whenever P Attia is asked about it he is incredibly unwilling to talk. I want to support their joint efforts, but something seems amiss. The NuSi website has no “news” since 2015 . Really?
            • My primary care doctor diagnosed my Type 2 diabetes in 2007 and gave me this guide published by Novo Nordisk
              The core of the guide is carb counting, more or less by the same method as Yudkin laid out in 1958. By no means is it a high fat diet: all foods are included but some are highly restricted. It was very effective for controlling my out of control blood glucose, and also worked for weight loss. Before counting carbs I had no sense of what a serving was.
              The guide was free and required none of Novo’s extensive array of diabetes drugs.
            • I’m a retired primary care doc and I saw people lose weight on just about every diet and aome of them keep it off for many years. If any one diet had more success, it was Weight Watchers. When I started gaining weight in my fifties, I tried the low carb, high fat plan for two miserable, hungry, weight gaining months. It’s just not a panacea and the few people for whom low carb was successful, were eating a lot of insulin-raising protein. It’s really easy as a physician to accept the successes that you see for any given condition and to generalize them to the population — “X seems to work well.”
              The other thing that I see a lot is people who cut out “carbs” like cookies, donuts, ice cream, and other calorie dense, hyperpalatable choices which owe more than half of their calories to fat. “Cutting down carbs” often has a verrrrry elastic definition.
        12. There was a book a while ago that argued the Taubes “anti-sugar” case, and also made the point “a calorie is not a calorie” (meaning a sugar calorie is much worse for you than say a protein calorie). But at Amazon.com, I found a bunch of such books, including this one (not the one I had in mind) that seems to make Taubes point. So Taubes is simply parroting the anti-sugar foodie rhetoric.
          Book on Amazon.com, a best-seller from a few years ago, not the one I had in mind however:
          Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease Paperback – December 31, 2013 by Robert H. Lustig, MD (Author)
        14. Thanks for the interesting review. I agree that there is a lot wrong with the book, and that trying to blame everything on sugar is pretty silly and based on poor logic.
          A couple of quick points that occur to me in Taubes’ defence though:
          “A well-studied Tanzanian hunter-gatherer tribe called the Hadza gets 15 percent of its average year-round calorie intake from honey, plus fruit sugar on top of it. This approximates US sugar intake. Yet the Hadza do not exhibit obesity, cardiovascular disease, or any of the other disorders Taubes attributes to sugar (10, 11)”
          That’s interesting. I would imagine though (correct me if I’m wrong) that the Hazda diet is, in comparison to western diets, fairly uniform across the populace, so that everyone is getting broadly similar levels of sugar in their diet. By contrast, I would have thought that in the US for example, sugar intake varies much more from person to person, and that many people are getting substantially more than 15% of calories from sugar, while many are also getting less. That could put sugar back on the hook to some extent (assuming that the people eating more sugar are the ones getting diabetes etc).
          “Taubes neglects to inform the reader that sugar intake has been declining since 1999 in the US, a period over which obesity and diabetes rates have increased substantially (7, 8, 9).”
          Also interesting. I agree that Taubes should definitely have mentioned this, and that the book is much more of a polemic than a neutral investigation. However in relation to this, it’s worth pointing out that Taubes argues that the damage sugar causes builds up both over long periods of time (he talks about diabetes having an incubation period of around 20 years in most people; this doesn’t seem to be true, at least not any more/at current levels of consumption, given the rise in childhood T2 diabetes but that’s another discussion…) and also over generations, as mothers pass on damage to their children, leading to a worsening of the problem in each generation. In light of that, a recent decline in sugar consumption does not particularly undermine his argument in itself.
          Looking forward to your book.
        16. In the absence of insulin, Type 1 diabetics get rail thin, and regardless of how much sugar they eat, they begin to consume their own fat and muscle. Add insulin back and they gain weight provided there is available food. Too much insulin and they require more sugar to maintain glucose levels. And…if they eat too many carbs and take the appropriate amount of insulin for the over consumption of carbohydrates….folks with Type 1 diabetes can get fat, and even get Type 2 diabetes as they become insulin resistant from being overweight or obese. The only way they’re storing that fat is due to injected insulin. It’s self administered. For Type 1 diabetics, insulin dosage is based strictly on the amount of carbohydrates consumed. Not protein and not fat.
          In my case, I needed immediate control of my elevated glucose levels (daughter is Type 1 so I knew too well carbohydrates are the main macro-nutrient affecting blood glucose) as well and was attempting to avoid medicine; not to lose weight – I began restricting carbs and eating non insulinogenic foods. Immediate result was normalization of blood glucose. As I kept eating “low carb” the weight fell like a rock. Without exercise. Hunger minimized – something I found very difficult when simply calorie counting (actually something I always and consistently failed at – despite having a solid understanding of the laws of thermodynamics – that knowledge never helped to curb my hunger). From 6’1″ @311 to currently 208+/-5 pounds. (I’d like to lose more too – I bet if I threw in some exercize…nahh..) And doing this in middle age where my contemporaries seem to be going in the opposite direction on the scale.
          I am fairly confident I didn’t gain super willpower in calorie control after 45 years of age (and now 50). And yes. I am N=1. But other ills I was suffering – asthma, reflux, puffy hands after a night’s sleep – all inflammation problems have gone. Simply by going ketogenic/low carb – whatever you want to call it. I feel fantastic. So I keep doing what I’ve been doing. I see no reason to put more than a minimum of carbohydrates into my diet. Fats and protein seem to be powering me just fine.
          For me, I’ll pass take a pass on most carbohydrates. Especially sugar. You may not like Taubes argument, but I certainly think he’s onto something important. Insulin and fat storage go hand in hand. More sugar => more insulin secreted (or injected if Type 1 or Type 2 insulin dependent) => more modern health problems over time.
          • Nicely said Jimmy, my exact experience too and similar to my earlier reply. We type 1’s are much more intimate with hands-on metabolic function than doctors, researchers, authors, etc…I’ve been low carb for a year and never had better control of my blood sugar compared to the previous 33 years of a carbohydrate rich diet which was ridiculously out of control.
            Wish you continue success!
            @Type1Roman
          • I would find going low carb as difficult as you find counting calories. It should be obvious to anyone that cutting out delicious carbs is a huge sacrifice for most people.
        17. A word in defense of Gary Taubes from another perspective, namely from far away, from The Netherlands. As a journalist writing about food and health I greatly appreciated Good Calories Bad Calories for it’s historical perspective on the development of nutritional science. And also for it’s boldness to take a different look on subjects that seem to be set in stone, like the diet-heart hypothesis, the calorie-in-is-calorie-out paradigm, and for giving us the insulin hypothesis. Taubes’ book was an eye opener and a game changer, and not just for me. It got lots of people worrying and doubting about the official dietary guidelines.
          Alas, the Nusi pilot program didn’t prove Taubes right. Many other trials failed to confirm the insulin hypothesis, as Stephan mentioned above. So we must pipe down on our initial low carb-enthousiasm. But there’s still a lot to be said for a low carb diet, low in processed food, rich in fibre and nutrients. Taubes role was of great importance in raising that awareness, because he made us think again. In Holland we nowadays have a scientifically approved program for patients to reverse diabetes type 2 by improving their diet. It works, it’s based in part on the insulin hypotheses and it’s paid for by your medical insurance. Let’s not forget Taubes was also the first to doubt the role of saturated fat in the etioligy of atherosclerosis. Remember his NYT article ‘What if it’s all a big fat lie?’
          I read (and reviewed) Taubes new book The Case Against Sugar. I loved it for it’s historical research and it’s style of reasoning. We’re not sure hòw sugar is bad or toxic, other than for the empty calories. Taubes makes that point more than once. But he (and his publisher) obviously felt the need to deliver a poignant message. Something to remember, something to make the book stand out. And sell. That became the notion of insulin resistance as the root of all evil. Supported by a weird interpretation of Ockham’s Razor. One might counter that one by abusing Einstein: ‘Make it simple, but not too simple’.
          I consider The Case Against Sugar a briljant book, as a narrative. But, having written a book on sugar myself, I must say it’s full of flaws. There’s so much research that gets sugar of the hook that is not mentioned. And there are so many other insights condemning sugar that are missing from the book. I got the impression it was written in haste, because of the timing probably. And I noticed Taubes had given up on his holy task as a journalist: showing both sides of the argument. That’s too bad. But still: he got us thinking and discussing again.
        18. The blog eliminated some of my text. That should have read
          “… As long as it’s not >evil-du-jour<”
          But the angle brackets were eliminated along with their contents.
          Moderator. Please fixup if you can.
        19. I’m grateful to Taubes because he has gotten tens of thousands of people to take a hard look at their sugar intake, me included. I doubt that we are all thin now, I’m not, but I think very few of us would go back to our previous sugar habits. And while I know people who got thin when they quit sugar, most of us think sugar isn’t the only cause of obesity, but it’s pretty high up in the list.
        20. Why is Taubes refighting a battle that was over 50 years ago? And in such repetitive fashion?
          Read Yudkin’s This Slimming Business and Keys’ Eat Well and Stay Well instead. Both excellent. Both concisely written. Both by fully vetted academic nutritionists. And both out of print for decades.
          The case for Yudkin’s low carb diet is persuasive. He has a sense of humor, with cartoon illustrations by Heather Standring and quips from Ogden Nash. His diet requires discipline to work. Yudkin’s carb counting – what he calls carb units, or CU’s – are as tedious to use as Keys’ calorie counting, or “scientific reducing”. Yudkin’s work is a forerunner of modern carb counting. His tables of CU’s are almost exactly the same as the tables used by the ADA for their diabetic carb exchanges. The principle has been expanded and refined into glycemic index and load tables. It’s a good method for weight loss and diabetes control.
          Taubes lacks the common sense of Yudkin, who was not bound by Atkins dogma. For instance, Yudkin said the following about the advantages of pairing foods to optimize their nutritional effect:
          “Bread and cheese, milk and rice pudding, meat and potatoes; these are combinations of foods which have very sound nutritional backing as well as being gastronomically desirable.”
          When Taubes develops this level of wisdom I’ll consider buying that book. It isn’t The Case Against Sugar. Try again.
        21. I eat sugar. I’m not overweight nor do I have diabetes or even any insulin problems. Therefore sugar is harmless and everyone should eat it.
        22. It’s interesting that thus far there has been no mention of the endocannabinoid system in this discussion. If one Googles endocannabinoid system fructose: “Endocannabinoids are endogenous lipid mediators made from essential fatty acids available only from dietary sources. The two best characterized endocannabinoids, 2-AG and AEA, are both metabolic derivatives of a single fatty acid precursor AA in phospholipids. Endocannabinoids are formed enzymatically on demand from the pool of AA plasma phospholipids formed from LA or ingested as AA.”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775234/
          If one Googles endocannabinoid system arachidonic acid: “Endocannabinoids are the substances our bodies naturally make to stimulate these receptors. The two most well understood of these molecules are called anandamide and 2-arachidonoylglycerol (2-AG). They are synthesized on-demand from cell membrane arachidonic acid derivatives, have a local effect and short half-life before being degraded by the enzymes fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL).”http://norml.org/library/item/introduction-to-the-endocannabinoid-system
          If one Googles endocannabinoid system saturated fat: “Endocannabinoids are products of dietary fatty acids (FA) and were originally thought to be generated on demand, though it is now known that AEA can be stored in intracellular lipid droplets [28]. As such, modulation of cannabinoid receptor function can occur via modification of dietary FA intake. Current dietary guidelines recommend a shift away from animal-derived fats in favour of plant fats, in an effort to reduce saturated fat intake and cardiovascular disease risk, which has resulted in an increased intake of polyunsaturated fatty acids (PUFA), especially that of linoleic acid. Linoleic acid is easily converted by the human body to AA via γ-linoleic acid and eicosatetraenoic acid, a pathway dependent on the actions of two desaturases and one elongase.”https://www.hindawi.com/journals/ije/2013/361895/
          If one Googles – endocannabinoid system obesity: “The endocannabinoid system (ECS) is an endogenous signalling system involved in maintaining energy balance. The ECS works both centrally and peripherally to promote metabolic processes that can lead to weight gain, and recent investigations suggest that obesity may be associated with ECS overactivity.”https://academic.oup.com/eurheartjsupp/article/10/suppl_B/B34/415898/Endocannabinoid-system-and-its-implications-for
          If one Googles – endocannabinoid system T2 diabetes: “Endocannabinoids (ECs) are defined as endogenous agonists of cannabinoid receptors type 1 and 2 (CB1 and CB2). ECs, EC anabolic and catabolic enzymes and cannabinoid receptors constitute the EC signalling system. This system participates in the control of lipid and glucose metabolism at several levels, with the possible endpoint of the accumulation of energy as fat.” https://www.ncbi.nlm.nih.gov/pubmed/18563385
          If one Googles – endocannabinoid system NAFLD: “Chronic liver diseases represent a major health problem due to cirrhosis and its complications. During the last decade, endocannabinoids and their receptors have emerged as major regulators of several pathophysiological aspects associated with chronic liver disease progression.”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165953/
          If one Googles – endocannabinoid system alcoholism: “Over the past fifty years a significant body of evidence has been compiled suggesting an interaction between the endocannabinoid (EC) system and alcohol dependence.”https://www.ncbi.nlm.nih.gov/pubmed/22459871
          If one Googles – endocannabinoid system nicotine: “Several lines of evidence have shown that the endogenous cannabinoids are implicated in several neuropsychiatric diseases. Notably, preclinical and human clinical studies have shown a pivotal role of the cannabinoid system in nicotine addiction.”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373509/
          If one Googles – endocannabinoid system addiction: “Recent studies have shown that the endocannabinoid system is involved in the common neurobiological mechanism underlying drug addiction.” http://www.cell.com/trends/neurosciences/pdf/S0166-2236(06)00025-7.pdf
          If one Googles – endocannabinoid system gut bacteria: “This review highlights research that reveals an important – and at times surprising – role for the endocannabinoid system in the control of a variety of gastrointestinal functions, including motility, gut-brain mediated fat intake and hunger signaling, inflammation and gut permeability, and dynamic interactions with gut microbiota.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940133/
          I find it peculiar that endocannabinoid research is not factored into the obesity equation.
        23. After years of reading Taubes account of Keys vs Yudkin it’s become something like a medieval mystery play staged by the Atkins Guild.
          As I read Yudkin, and about how his standing in nutritional academia sank over time, I get a completely different picture of the man. Taubes uses him as a stalking horse for his Atkins-faith. He creates a caricature of the actual scientist Yudkin, something like Herod the tyrant in the mystery plays.
          Does Taubes know how sloppy Yudkin’s work was? Has he seen the lack of references? The lack of even rudimentary statistical analysis? The graphs showing trends but without units on the axes? Yes Yudkin was a genius, who created CU’s and promoted the value of carb counting. But he was also grounded in CICO, and believed that exercise was of great importance.
          Outcomes matter. Yudkin outlived Atkins by 12 years. It would behoove Taubes to pay more attention to how Yudkin did it. If you read what Yudkin wrote it’s no big secret. Counting. Carbs AND calories.
        25. Thanks for the article Stephan. I am going to come at it from a Biochemical point of view but first I would say that in my opinion the following have contributed to our obesity problem
          1. We eat too quickly
          2. We drink way more energy dense liqids than was historically the case. For example if you drank 4 x 250ml glasses of full cream milk in a day that’s over 600 Cals…compare that to 4 x glasses of water
          3. We exercise less. 100 or so years ago most people had to work hard (physically) to get by in life. I acknowledge this may be hard to prove.
          So to the Biochemistry. Humans are not in a state of equilibrium…we need to ingest nutrients/energy to maintain homeostasis. The 3 macro nutrient types are carbohydrates, protein and fat. Ultimately all these are broken down into the same handful of compounds – Pyruvate, Acetyl-Co which are used either to build complex molecules the body requires or to generate ATP via the TCA cycle and oxidative phosphorylation. ATP is then used in membrane pumps and to provide energy for endergonic pathways.
          Looking at carbs…the main carbs humans consume are polymers of glucose, lactose, sucrose and maltose. Sucrose is half glucose half fructose. Lactose is half glucose half galactose. All of these are ultimately converted to glucose or one of the intermediates in glycolysis. At times when glucose is not needed for cellular energy needs the excess is first converted to glycogen and stored in liver and muscle. If your glycogen stores fill up then fatty acids can be produced and stored in the adipose tissue.
          Regulation of blood glucose is a big deal to the body and there are intricate control mechanisms in place to keep blood glucose in a narrow range. Most people see insulin as the primary hormone here but other hormones also influence such as adrenaline, thyroid,cortisol and glucagon…in fact glucagon prevents us from suffering from hypoglycemia…which if left unchecked leads to coma and death. When your blood sugar drops glucagon stimulates glycogenolysis and gluconeogenesis to supply the glucose needed to raise blood sugar.
          People say ‘exercise more’ doesn’t help but at a Biochemical level when you exercise you use more ATP and therefore you must be benefitting from an energy balance point of view.
          The reason why I believe low carb ‘works’ for weight loss is that carbs are so easy to overconsume…especially as drinks. Could it be that those on low carb diets are serially consuming less energy over time than they used to?
          The caloric value of macronutrients is not 100% accurate so counting calories is an inexact science. The thermic effect of breaking down macronutrients causes differences in the amount of energy that is bioavailable so that has an effect too.
          I am interested in topics such as insulin and leptin resistance and would love to know the Biochemical mechanism of each beyond just theories
          • I think generally you are correct. The key to any “diet” is adherence and LC tends to suppress appetite.Any diet that leaves you constantly hungry will eventually fail. LC seems to work for some people, other lifestyles work for other people. My own experience as a desk jockey is that LC works quite well for me, though I struggle when I am doing a lot of higher intensity exercise as this really ramps up my appetite and it can be difficult to stay LC for the next day or so.
            • Only glucose fermentation to lactate can supply required energy in anaerobic conditions eg when sprinting. In those circs you may need more carbs. Interestingly you actually need more oxygen per mole of ATP produced when using fat for energy as opposed to glucose…not that it really matters
        26. ‘Outcomes matter. Yudkin outlived Atkins by 12 years. It would behoove Taubes to pay more attention to how Yudkin did it. If you read what Yudkin wrote it’s no big secret. Counting. Carbs AND calories.’
          And Keyes lived to 100. Yudkin to 85. Atkins died from injuries as the result of a fall. Likely doesn’t mean much. Did they actually follow their own diets rigorously.? Who knows.
          I know Keyes moved to Italy and tried to follow a Mediterranean diet – not the published one. He wrote a book about it at one point.
          Anecdote is not data.
        27. This may not be relevant but I recently started taking iodine as an experiment to cure a general feeling of sluggishness and as well as fixing that I’ve been losing weight quite rapidly so I wonder if metabolism is part of the problem.
          Does fat have more iodine than sugar?
        28. Very interesting article! Every time I see another paleo principle debunked, I suspect more and more that food itself is not even the problem. Stephan Guyenet points at hyperpalatability in modern diets and the culture that surrounds and supports this way of eating. There’s something in this that mirrors the condition of information overload and ADHD. Something hyperstimulating (hyperpalatable), yet relatively meaningless (lacking in nutrient density), making us mentally dysfunctional (obese). We are out of sync with our environment, plain and simple. We no longer live in the environment in which we evolved, because we altered it to something that no longer fits. We got too clever without also getting wise. I’m very much looking forward to The Hungry Brain. We need a totally new approach to diet and weight loss, and I think Stephan is onto something important. The question is, will people be willing to listen and make changes in their lives? For me, going in this direction has taken years of adjusting other areas of my life. I will probably eventually move out of the city and become a homesteader. This has all been possible only because I’ve always been a relatively anti-social person and can handle not sharing meals with friends and colleagues very often. For many people, it will be even harder. Trying to lead a healthy, natural existence can be very isolating, because very few around us will be doing the same. That is the biggest problem we face now.
        29. @jack What you call anecdotal has been quantified. Dr. Perls longevity model predicts both Atkins’ and Keys’ longevities within a year.
          It took me some time to find the information needed to run the model for Keys. Henry Blackburn, who worked with him and is now in his 90’s, was very helpful. The prediction for Atkins is based on his well-reported cardiac problems in the 10 years before he died, not by his fall.
        30. Ok guys, after 5 years of self experimention, i would say that, REGARDING WEIGHT LOSS, S. GUYENET IS WRIGHT. For me, regarding weight loss, low-carb theories (carbs make you fat: LOL) or low-fat theories (the fat you eat is the fat you wear”:LOL) are ENTIERLY BULLSHIT. I dont speak about vitamins, minerals, toxins and all that stuff. I’m talking about Weight loss.
          I’ve lost weight on low’carb diet and then i’ve decided ton give a try on guyenet theories. Damn guyenet technique is the most effective way toi l’oseille weight. After 25 kilos overweigt i’m now PERFECTLY LEAN WITHOUT ANY HUNGER.
          So How i did it ? Guys, i’ve choose three ingrédients:
          -protein: eggs
          -fat: full fat cottage cheese (hello mcdougall ahah)
          -carbs: pure table sugar (hello Gary Tarbes aahah)
          Ok, so i’ve eat only that (plus coffe, Water, salt and sometimes carott, just for fun.
          The results? I’ m now 10 kilos leaner that what i sas on a very low’carb diet.
          Common guys. Why asian were so lean? Not because they dont eat fat but because they eat the same thing, mostly rice, every meal, every day, every month.
          Why Masai were so lean? Not because they dont eat carbs but because they eat the same thing: milk and blood , every meal, every day.
          Do i eat extra? Of course! Every week, with my parents or friend. But it’s ont meal or two per week plus alcohol (à glass) every three Days.
          You can choose you own ingredients, it could even be pizza and you’ll lose weight. But if so, choose only one type of pizza (margherita for exemple) and stick to eat: every meal every days every months. You’ll lose weight.
          Guyenet is Wright. Period.
        31. Thank goodness a real scientist is weighing in on this book. Just bought your book The Hungry Brain on audible. Can’t wait to read it. Keep up the great work Stephan.
        32. I was a vegan prior to 2001 and had read several popular books by people like Andrew Weil. Due to a wasting syndrome, apparently due to low stomach acid (which doctors never mentioned), I decided to try and become a nutritional expert for my own purposes, beginning with survival (I am 5’9″ and went down to 95 pounds at one point). Doing so, I encountered people like Taubes, Ray Peat, and Mary Enig. I didn’t simply accept any ideas at face value, but decided that I needed to see actual scientific evidence too (and was shocked to discover how little, if any, evidence many nutritional claims were based upon; in some cases, the evidence suggested the opposite of the claim!).
          Besides reading, I also “experimented” with different diets, and then I remembered, my great grandparents lived to advanced ages (he was over 100 when he died), but their diet was nothing “special,” or was it? They ate only a little meat, had no significant source of omega 3s (and not much omega 6s – they used olive oil), but did eat plenty of dairy, along with fruits and vegetables. They would eat some cake and cookies, but again, in small amounts. Pasta was eaten frequently, and bread was not viewed as “the enemy.” One thing I discovered is that ice cream seems to be a good “fattening” food, unless eaten in small amounts, but otherwise dairy was not an issue.
          Since I can’t cite a huge number of scientific papers here, I’ll sum up my current position, and note that I have been eating this diet for over a dozen years now, and I’m thin and do not have any chronic diseases (in my early 50s). I eat three meals a day, spaced out roughly evenly. I rarely eat snacks between meals, but if I do it would be something like a piece of dark chocolate and a raisin or two, with a bit of coconut oil. My meals contain sugar, salt, and butter or coconut oil to satisfy my tastes, but I always make sure to eat quite a bit of protein, usually in the form of cheese (I eat a boiled egg each day too). Also, I do not drink anything sweetened (usually just filtered water). I avoid any foods that are free radical generators, so I never eat fried good. I eat plenty of foods that have some if not a great deal of anti-oxidants (dark chocolate, berries, dried fruit, some kind of vegetable or beans, etc.), and small amounts of baked goods (low in unsaturated fatty acids) in order to prevent the diet from becoming boring.
          So, what are the key factors (my guess, based upon my research and experiences):\
          1. Foods should not be major free radical generators.
          2. At least some of the foods should be anti-oxidant rich.
          3. Coconut oil or butter are good fat sources (but don’t heat up butter to high temperatures).
          4. Dairy and eggs are a great source of protein, but do not heat these to high temperatures, especially while exposed to air, which makes it into a free radical generator.
          5. I do not take any supplements in large amounts. I do take small amounts of nutritional yeast, vitamin C, magnesium citrate, etc. each day.
          6. No drinks should be sweetened.
          7. Meals should be spaced out at least a few hours and there should be enough protein and fat so that you don’t get hungry too soon afterwards (fat may not be as important, both in terms of nutrition as well as satisfying hunger – you can “experiment” and decide for yourself).
          8. Restaurant food is very bad – plenty of “hidden” sugar (and usually free radical generating food) in particular – I have eaten in restaurants twice since 2002, one time eating jello and the other ice cream (the ice cream bothered my stomach and I later learned about carrageenan, which I now avoid).
          9. I have avoided “essential fatty acids” as much as I have found to be reasonably possible, which changes one’s biochemistry and makes one less susceptible to chronic inflammation, from what I can tell (read some of what biologist Ray Peat has to say, if you are interested in the subject). A high omega 6 diet seems to be responsible for obesity, in those with low-grade chronic inflammation (which can lead to things like cancer, diabetes, heart disease, etc.).
          10. It seems to take a few months, minimum, to see what a new diet is going to do you, so those who want results in a week or two might not want to waste their time.
        34. You can often tell the people that are trained in academics from the self trained by the focus they give to industry support. On average if you are immersed in academics then you tend to discount it (unless its your intellectual enemies then it is the end of the world), self trained and you think it is the defining piece of info.
          I trained in academics and don’t care where people get their money. I don’t care because the way you get funded is rarely a sugar industry representative finding a newly minted PhD and suggesting he support sugars and denigrate fats for a little cash. No, what happens is Ancel Keyes has a hypothesis and he starts testing it in the ways available to him (which were basically garbage but what we had at the time) and starts publishing his results and then when famous he starts getting funding to continue on the same path he was on. Is there the possibility of influence from sugar industry? Sure, but it pales to the amount of influence from being famous, influencing policy, becoming dean, etc. And outside of fraud – we have the reports and can assess the data, or try to replicate to validate the hypothesis without knowing the source of funding. As an aside, while some of Keyes work is not great, people only remember him for controversial stuff while Keyes did an incredible amount of basic hardcore nutritional research.
          • Hi Kevin,
            Great comment. I agree 100%. It frustrates me to no end when people assume that industry funding means that a person’s work is biased and can be discarded out of hand.
        36. Your book inspired me to do like the Hazdas and eat some honeycomb. I got a round container from Glory Bee. It’s not inexpensive at about $1 per ounce. The comb is clean and light unlike tree combs.
          Eating the comb directly was a chore. The honey extracts from the wax pretty fast leaving crumbly chewing gum-like residue which doesn’t break down. A teasponful is a LOT, and I can’t imagine how the Hazdas could wolf down big chunks of it. What works better is putting a teaspoonful on a piece of hot toast and microwaving it to melt the comb, so that both honey and comb permeate the bread. This is quite chewy, messy and very tasty. If it cooled off it would probably be like chewing sweetened plywood. So far as I can tell there are no digestive problems, and a piece of this is more satiating than regular honey on toast. It puts a waxy film on your teeth.
        37. It is sad to see the credentials of the author attacked. Early on this post we are introduced to “Igon Values”, a term that comes from Pinker mocking the razor-thin understanding that Gladewell has on a subject. Gladwell is a journalist famous for oversimplifying the subject matter and to draw conclusions from a handful of anecdotes.
          So this piece starts by paining Taubes book in the same light, and prepares us for a series of appeals from authority.
          He first deploys this appeal to authority to mock the use of Occam’s razor in the book. Not a problem per se, but if you are going to claim that Occam’s Razor does not apply here, then you need to show *why*. Stephan claims that the book fails to point out that sugar consumption in the US is in decline, but provides no data for this, while the book does provide the rationale for how this is measured. So Occam’s razor is dismissed by presenting half an argument.
          In addition to the ad-hominem above, Stephan reaches into another fallacious argument, the straw man, when he says “Taubes argues that sugar is the only factor”, for anyone that has read the book, they would know, this is not the case. Perhaps Stephan did not pay close enough attention as he was looking for “gotchas” or perhaps he chose to misinform his readers, or even perhaps his reading comprehension skills are lacking. I am open to other theories, but going by Occam’s razor, the most likely reason is that he is misrepresenting the material, because he has already made up his mind.
          Stephan then condescendingly brings up the “Hadza” as an example of a tribe that consumes a lot of sugar and does not fit the bill. Luckily, elsewhere on this thread this claim has been addressed.
          Not looking good so far.
          He moves on: ” Taubes repeatedly asserts that researchers, physicians, and nutritionists simply assume that obesity causes diabetes”. Well, that is not what he says, now is it? In fact the book covers extensively the struggle for those that go outside the box that he is painting with that statement. What is important to point out is that (a) these findings did not get much traction for long periods of time for reasons discussed in depth in the book and (b) that those that did were attacked or mocked early on.
          The articles that you quote, come after 1998. In the above case, the struggle of the early researchers, nutritionists and physicians that are quoted in the book happen 10 to 20 years before.
          I would go on, but the rest of the argument presented on this post is just as weak.
          • Hi Tandi,
            I stand by my statement that Taubes has a superficial understanding of obesity science, and I have provided ample evidence to support it. If you have read the book, you know that it spends a lot of time discussing the history of obesity research, and uses this history to make scientific points, rather than actually considering bodies of evidence in a way that is recognizable as a scientific thought process. Furthermore, having reviewed the history of obesity research for my recent book, I can tell you that Taubes’s portrayal of it is often inaccurate. As I showed in my review, in some cases his historical claims can be clearly refuted by simple Google Scholar searches.
            If you can’t see the problem with Taubes’s use of Occam’s Razor, then you are being willfully ignorant. It is simply not defensible.
            In “The Case Against Sugar”, the central hypothesis is clearly stated on several occasions: Sugar is “the principal cause” of modern noncommunicable disease, including obesity, diabetes, cardiovascular disease, and Alzheimer’s disease. My review uses direct quotes from the book to demonstrate that. It’s hard to understand how you could perceive my portrayal of this point as a straw man, when I am drawing it from direct quotes that are unambiguous.
        39. Great blog you have here but I was curious if you knew of any forums that cover the same topics talked about here? I’d really like to be a part of group where I can get feed-back from other experienced individuals that share the same interest. If you have any suggestions, please let me know. Thanks a lot!
        40. This will be an EYE OPENER: I’m a 57 year old mail in reasonably good health 6’3″. I’ve never dieted a day of my life, but I’ve slowly put on the weight over the years as my activity level has diminished some. Just a year ago I weighed between 215 and 220 lbs depending on the time of year. My 27 year old son (6’2″ and 190 lbs and in great shape) had a girlfriend tell him about the evils of sugar from the reading she had done and how we needed to stop eating sugar and the approximate 58 other sugar substitutes we eat in all the processed foods that are even worse for you than sugar. My son and I decided to do an experiment starting on June 1, 2016 and give up all sugar (we probably gave up about 90% of what we ate previously) for 30 days. Previously I would drink 3-4 milk shakes/week in the summer (still haven’t drank a milk shake over a year later). I like most people were addicted to sugar (it is extremely addicting). The first month I lost about 15 lbs and the second month another 7 lbs! He lost 15 lbs total over the 2 months and has also kept it off. I didn’t exercise any more than before which is minimally (I should definitely exercise more, but my point is that exercise had nothing to do with the weight loss). I ate anything I wanted and as much as I wanted as long as it had zero or almost zero grams of sugar or sugar substitutes in it (pasta (try finding pasta sauce with no sugar – I would find 2 grams but no added sugar), bread and butter, fish, cheeses, chicken, some red meat, eggs, potatoes, steal cut oats, etc). I ate all the fresh or steamed vegetables and fresh fruits I wanted because they are high in fiber and are in their natural state. My weight is stable at about 190 since about the 4th month. I learned to drink coffee with only a little half & half or black (no sugar…didn’t think I would ever enjoy it without sugar). I allow myself a little sugar here and there (desert) knowing the impact should I decide to indulge too much. I could definitely lose more weight if I became more strict again on allowing any sugar. I’m comfortable with my current weight and my cholesterol and blood pressure medicine have been cut in half and my cholesterol ratios are great. I could go on and on about resistant carbohydrates and other things that can benefit us, but in the final analysis I’m fully convinced on the evils of sugar and weight gain. I’ve shared this information with friends and they have ALL experienced the same great results if they cut most of the sugar out.
          I’m now happy drinking water as about 90% of what I drink (I like to add fresh lemon when I have it).
          Don’t drink fruit juice (not in natural state and too much like sugar with no fiber like actual fruit.
          SUGAR IS KILLING AMERICANS, bankrupting our health-care system and the government isn’t doing enough to regulate it and I’m not in favor of big government. Any other societies/cultures that adopt our American diet are doomed to the same fate. Good luck everyone and get off of the most addictive substance on the planet one day at a time like I did because you can do it too…SUGAR!!!
          • Hi Neal,
            First, congratulations for finding a dietary strategy that helps you control your weight and health.
            Second, I think this is a great example of how people attribute effects to sugar that are probably not all due to sugar. For example, the calories in the milkshakes you were drinking 3-4X per week are 30-45% from fat. Cutting out sugar cuts out all kinds of junk foods that are fattening because of sugar, refined starch, added fat, palatability, and overall calorie density. This is why fresh fruit didn’t impede your weight loss.
            That said, if cutting out sugar is a simple heuristic that is effective for you and not too hard to stick with, then it’s certainly worthwhile.
        42. You did not address his claim, you used straw-man arguments like the “Igon Value Problem” which is your way of saying “he just is a journalist, he could not possibly understand.” And you go on and on nitpicking at things without ever giving his claim any real thought. “Is sugar the root cause of diseased of civilization?”
          Shame
          • Hi Jordan,
            You appear to have either not read my entire review, or not understood it. I provided several specific examples of how Taubes came to major erroneous conclusions due to a lack of understanding of the relevant evidence. The fact that he’s a journalist is not why he made these mistakes. He made them because he didn’t take a complete or objective view of the evidence. This is what I mean by the Igon Value Problem.
            I addressed his major arguments and showed how they are flawed. If that’s what you call nitpicking then all I can do is refer you to a dictionary.



Posted by at

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)