Good Calories, Bad Calories.
Challenging the Conventional Wisdom on Diet, Weight Control and Disease
by Gary Taubes
Alfred A. Knopf, New York, 2007 In the past few years several books have been published that present a contrarian's view attacking the conventional wisdom regarding fat, cholesterol and cardiovascular disease. Now a new book by Gary Taubes has just been published. The author's name should already be familiar to readers of this newsletter because his articles in the New York Times Magazine have been repeatedly quoted in connection with high vs. low fat diets and the issue of cholesterol and heart disease. He is a highly regarded medical journalist and the only print journalist to have won three Science in Society Journalism awards. In Taubes' latest effort we have a comprehensive treatment of the title subject which includes fascinating early history and a very detailed discussion of the scientific research and clinical and epidemiologic evidence associated with the establishment views of diet, heart disease and diabetes as they have evolved over the last 50 years, views that in some cases have generated dogma now cast in stone, enshrined in medical textbooks and public health policies, and indelibly etched in the minds of both the general public and a substantial fraction of nutritionists and the medical profession. This book critically reviews alternate hypotheses which are contrary to this conventional wisdom and explores in great detail the research that forms their foundations and the culture that is responsible for these hypotheses being ignored and ridiculed. The title of the book is misleading—it is not a diet book in the usual sense, but if one accepts the author's arguments, it could profoundly alter the way the reader looks at the connection between diet and health.
This book represents, according to the author, five years of research which included a comprehensive examination of the published literature and a careful look at the older literature that is so casually dismissed today. Included are interviews with some of the principal players including those now retired, and an examination of the impact, as reflected by the media coverage and official guidelines that periodically appear, on public behaviour, beliefs and public health positions. The author is neither an academic nor an employee of an industry with a vested interest in the status quo, but rather a keen and experienced observer of science and pseudoscience in action, and he brings to this project a fresh viewpoint presumably uncontaminated by the profound influence of dogma and the conventional wisdom, forces that, as this book clearly demonstrates, play a dominant role in undermining science's supposed goal, search for truth. The thrust of the book is best described by quoting his conclusions which most readers will recognize as contradicting the conventional wisdom now firmly enshrined as a set of sacred truths which will probably endure over the professional careers of their influential contemporary proponents. In addition this conventional wisdom will probably continue to influence public health pronouncements and the areas and focus of intense and well supported research. These are consequences which individuals in the developed world may someday come to profoundly regret. Here are his conclusions, which also provide a general outline of the book and its topics.
- Dietary fat, whether saturated or unsaturated, is not a cause of obesity, heart disease, or any other chronic disease of civilization.
- The problem is carbohydrates in the diet, their effect on insulin secretion, and thus the hormonal regulation of homeostasis, i.e. the entire harmonic ensemble of the workings of the human body. The more easily digestible and refined the carbohydrates, the greater the adverse effect on our weight, well-being and health.
- Sugars, and specifically sucrose and high-fructose corn syrup, are particularly harmful, probably because the combination of fructose and glucose simultaneously elevates insulin levels while overloading the liver with carbohydrates.
- By virtue of their direct impact on insulin and blood sugar, refined carbohydrates, starches and sugars are the dietary cause of coronary heart disease and diabetes. Also, they are the most likely dietary causes of cancer, Alzheimer's disease and other chronic diseases.
- Obesity is a disorder of excess fat accumulation, not of overeating and or due to a sedentary behaviour.
- Consuming excess calories does not in general cause humans to become fatter. Expending more energy than we consume does not necessarily lead to long-term loss of weight but it leads to hunger.
- A disequilibrium in hormonal regulation of adipose tissue and fat metabolism results in fattening and obesity.
- The primary mediator of fat storage is insulin. When insulin levels are high, either chronically or after eating, we accumulate fat in the fat tissue. When insulin levels fall, there is a release of fat from fat tissue for use as fuel.
- Carbohydrates make us fat and ultimately cause obesity by stimulating insulin secretion.
- Carbohydrates also increase hunger and decrease the amount of energy we expend in metabolism and physical activity by driving fat accumulation.
Thus Taubes makes a case for what might be called The Carbohydrate Hypothesis of Chronic Diseases
, and this book concentrates on the potential impact of this hypothesis on heart disease, vascular disease and diabetes.In spite of the very high order of scholarship and meticulous research reflected in this work, it is probably not a book that mainstream medicine will welcome, nor is it one that they will recommend to patients, medical students, graduate students, etc. After all, aside from an attack on the conventional wisdom, the message that comes through loud and clear is that we now have a milieu associated with medical and nutritional research where the standards of evidence are considerably more lax than in the hard sciences such as physics, chemistry, molecular biology, etc. and that this has had a strong impact on the time honoured processes associated with getting at the truth concerning questions of great importance.A lot of what Taubes describes might be called "Official Science," a term used by Christopher Essex and Ross McKitrick in a book on climate change (Taken by Storm, Key Porter Books, 2007, Toronto). Official Science is the end result of the evolution of a hypothesis or mere model to an accepted truth and then to a dogma without any justification for this elevation. The status as Official Science makes it almost impossible to challenge the dogma, publish a contrarian view or results, or even obtain funds to study the matter, and anyone even questioning the dogma runs the risk of becoming a professional outcast. Hypotheses should survive by withstanding attempts at falsification. This is the way science is supposed to work. But this process has been cleverly undermined by using the media, individuals with vested interests and appeals to so-called authority in order to keep alive questionable hypotheses, prevent studies that might invalidate them and allow citation bias, even in refereed journals, to conceal inconvenient truths. Taubes presents case after case to illustrate this deplorable state of affairs in what most people look up to as the sacred and highly esteemed establishment that creates so-called evidence based medicine. Thus this book is in fact an expose of what has fundamentally gone amiss today with science as it is used and manipulated in the fields of health and nutrition.This book may erode or even destroy the reader's confidence or belief that medical and nutritional research, as it has been conducted for the past 50 years in fields such as diet, diabetes and heart disease, is capable of providing guidance that is based on sound principles of scientific research and an unemotional, unbiased and open-minded search for the truth. But Taubes' carefully researched and documented history of the conflict between dogma and authentic science should prove to be of value for anyone trying to sort out the steady stream of conflicting views that have emanated from the recognized experts and their critics, gain a perspective regarding the role of various high profile organizations attempting to influence public health issues and rethink long held beliefs, recognizing that they may only be either hypotheses or in fact merely the result of junk science.Reviewed by William R. Ware PhD
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