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.

1. Dietary fat, whether saturated or unsaturated, is not a cause of obesity, heart disease, or any other chronic disease of civilization.
2. 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.
3. 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.
4. 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.
5. Obesity is a disorder of excess fat accumulation, not of overeating and or due to a sedentary behaviour.
6. 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.
7. A disequilibrium in hormonal regulation of adipose tissue and fat metabolism results in fattening and obesity.
8. 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.
9. Carbohydrates make us fat and ultimately cause obesity by stimulating insulin secretion.
10. 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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The Inflammation Syndrome
by Jack Challem. John Wiley & Sons, New Jersey, 2003
ISBN 0-471-20271 (hard cover edition)

There is currently considerable interest in the subject of inflammation both among medical researchers and clinicians and as well, the general public. The February 23, 2004 issue of Time magazine featured "Inflammation, The Secret Killer" as the cover story, and recent issues of several health oriented magazines have had inflammation as the feature topic. While inflammation is an essential and integral part of the normal immune reaction and the response to injury, chronic inflammation may be asymptomatic and present serious health risks which can be much more dangerous and extensive than one might expect. Chronic inflammation, which is involved in diseases such as rheumatoid arthritis, inflammatory bowel syndrome and Crohn's disease, is now implicated in diseases where the connection is far less obvious, such as atherosclerosis, cancer, and Alzheimer's disease. Thus from the layman's point of view, the obvious questions are:

• Do I have or am I at risk of having chronic inflammation?
• What are the causes?
• What can I do about it?

These are questions that might reasonably be put to one's physician, but the complexity of the subject does not lend itself to the fifteen minute office visit setting, and some, perhaps even many individuals are interested in acquiring a fairly detailed knowledge of what is now considered a serious health issue.

The three books address the above questions, although the approach, depth of treatment, and emphasis differ considerably. The principal authors of two of the books are MDs. Jack Challem is a leading health and medical writer and coauthor of the popular and widely-read book Syndrome X.

Challem's book introduces the reader to what he calls the Inflammation Syndrome, which he describes as the cumulative effect of low-grade inflammation that grows into chronic, debilitating disease. He discusses six general categories of inflammatory triggers: (1) age-related wear and tear; (2) physical injuries; (3) infections; (4) environmental stresses including tobacco smoke, air pollution etc.; (5) allergies and food sensitivities; and (6) dietary imbalances and deficiencies. He carefully distinguishes between the triggers of inflammation and what causes the normal response to go out of control. There is a very strong emphasis on the dietary aspects of inflammation and his "anti-inflammation" approach is primarily through diet modification involving both the elimination of foods that trigger inflammation and adding and emphasizing foods he considers beneficial in this context. Challem also provides a simple questionnaire that readers can use to evaluate their level of inflammation.

Part II of the book outlines fifteen steps to fight the Inflammatory Syndrome, and both diet plans and recipes are presented. While anti-inflammatory drugs are discussed, Challem's attitude is somewhere between negative and highly cautious. Part III is titled "The Anti-inflammatory Supplement Plan" and includes a detailed discussion of omega-3 fatty acids, vitamin E, glucosamine, the B vitamins, etc. Finally, in Part IV there is an informative discussion of about twenty diseases and specific conditions that have a connection with chronic inflammation. This final section should leave little doubt in the reader's mind as to the importance of avoiding or dealing with chronic inflammation.

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Stop Inflammation Now!
by Richard M. Fleming, M.D. with Tom Monte. G.P. Putman's and Sons, New York, 2004
ISBN 0-399-15111-7 (hard cover edition)

Stop Inflammation Now! This book is sub-titled "A step-by-Step Plan to Prevent, Treat, and Reverse Inflammation—the Leading Cause of Heart Disease and Related Conditions." The principal author, Richard Fleming, is a nuclear cardiologist. The main emphasis of this book is on heart disease, and the depth of the discussion of this topic is one of the book's strengths. But aside from the title, it would seem appropriate to classify it as a diet book rather than a book on inflammation. It promotes a two-step, very low-fat (15% of energy intake in the phase 2 diet) and low-protein diet plan coupled with exercise. Inflammation is discussed here and there in the book, but the level of treatment of the subject is minimal compared to the books by Challem and by Meggs and Svec. It in fact differs from these two books in many respects. For example, Fleming considers fish to be an inflammatory food (page 20), and fish is a very minor part of his Phase II diet (page 163), whereas fish is a significant part of the anti-inflammatory diet plans of both Challem and Meggs. Fleming is also against fish oil supplements. But while Meggs recommends eating fish three to five times a week and imitating the Mediterranean diet by the liberal use of olive oil, he is close to Fleming in suggesting very little meat, poultry, cheese, butter, milk, and other animal products. Challem deals with the meat issue by recommending meat from free-range or grass fed animals and eggs from free-range chickens or eggs enriched with omega-3 fatty acids. Challem is also enthusiastic about olive oil and eating lots of fish.

In the opinion of this reviewer, Fleming's book should be viewed in the context of the high-carb vs. low-carb controversy and the debate as to the connection between fat and heart disease. The book, by and large, promotes one view favored by the very low-fat school. The philosophy is similar to that of Dean Ornish before he started recommending fish oil and fish in his diet (see www.Ornish.com). Also, there are some, perhaps many, who would find the Phase II diet consisting of 17 servings of fruits and vegetables per day to be a bit difficult to manage. At issue is the balance of macronutrients and the emphasis on very low fat consumption that puts him at odds with other interpretations of the modern nutritional literature. This is a highly complex and controversial subject. Fleming's book should be read along with such books as Walter Willett's Eat, Drink and be Healthy, the Harvard Medical School Guide to Healthy Eating, Arthur Agatston's The South Beach Diet(Agatston is also a cardiologist) and Stephen Sinatra's Heart Sense for Women (Sinatra is also a cardiologist) to obtain a balanced picture (see also the IHN research reports "The Diet Zoo" and "Dietary Fat and Coronary Heart Disease: Is There a Connection?").

Readers desiring a broad background on the subject of inflammation should be well served by either The Inflammation Syndrome or The Inflammation Cure or better, by both.

Reviewed by William R. Ware

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The Magnesium Factor
by M.S. Seelig, MD, MPH and A. Rosanoff, PhD
Avery (Penguin Group, Inc), New York, 2003 The front cover of the paperback edition expands on the title as follows: "How one simple nutrient can prevent, treat and reverse high blood pressure, heart disease, diabetes, and other chronic conditions." A bold claim indeed! Dr. Seelig has been studying the role of magnesium in health and disease for over 35 years. She is chair of the Magnesium Advisory Board which oversees the New York Weill Cornell Medical Center's Magnesium Information Center. Dr. Rosanoff has been involved in the study of magnesium nutrition for the past 17 years. The authors' thesis is as follows; (a) Magnesium deficiency is widespread and aggravated in part by its removal from many foods during processing. (b) Magnesium is involved in innumerable human biochemical processes and is directly involved in the action of more than 350 enzymes and indirectly implicated in many more. (c) Magnesium deficiency is involved in many disease states, including heart disease, hypertension, Syndrome X and diabetes. (d) Deficiency is easily corrected with rather low levels of supplementation (up to 700 mg/d) or attention to diet or both. Supplements are inexpensive, safe for almost everyone, and normally very well tolerated.

The following list of chapters provides a good indication of the scope of this book and the relevance of magnesium to health and disease:

• Magnesium: the mineral that combats heart disease and keeps blood vessels healthy.
• Metabolic Syndrome X, diabetes and magnesium.
• High blood pressure, salt and magnesium.
• Obesity, physical activity and magnesium.
• Fat, cholesterol and magnesium.
• Magnesium, stress and the Type A personality.
• Magnesium and genetics; family history and sex differences.
• Magnesium and other heart disease risk factors.
• Are we really low in magnesium?
• Do you need more magnesium?
• Making sure you have enough magnesium.
• Magnesium, the silent guardian of our hearts and arteries.

In the chapter "Making Sure You Have Enough Magnesium," guidance is provided on maximizing magnesium from food and water, and on selecting supplements. Guidance is also given on the appropriate ratio of magnesium to calcium intake. Many readers will find the discussion of magnesium and hypertension of particular interest, and as well, the chapter titled "Fat, Cholesterol and Magnesium" contains a modern discussion of this subject which is currently very relevant. Included is a section on the HMG-CoA reductase inhibitory action of magnesium which includes a discussion of the similarities and differences in its action compared to the statin class of drugs which inhibits the same enzyme.

Ten appendices include a magnesium questionnaire which is provided for self-assessment of status, tables of common foods classified by magnesium content and a list of common medications that influence magnesium status. The book also contains some interesting case histories describing the almost magical effects of correcting a magnesium deficiency.

This appears to be an authoritative treatment of a very important subject, both for the layman and the health-care professional. It is up-to-date and comprehensive. The authors make a strong case that magnesium is clearly an important and often overlooked factor in some of the most serious and prevalent disorders that are encountered in the practice of medicine, in fact, frequently on a daily basis. It is probably true that not nearly enough attention is given to this essential mineral nor is there sufficient awareness of the potential role magnesium plays in a number of disease states or the need in some cases for aggressive supplementation. This book should provide a wake-up call.

Published in 2003, The Magnesium Factor includes very recent research and an extensive set of references. Unfortunately, while the references are listed by chapter, they are not cited in the text.

Reviewed by William R. Ware


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THE PALEO DIET
Lose Weight and Get Healthy by Eating the Food You Were Designed to Eat
Loren Cordain, Ph.D.
John Wiley & Sons, New York, 2002 (hardcover or paperback) Loren Cordain is a professor in the Health and Exercise Science Department of Colorado State University, is a respected expert on the early human diet, and has published significant original research in this area.

The thesis of "The Paleo Diet" is that we have essentially the genetic make-up and metabolism of our Stone Age ancestors, and that the human genome has changed less than 0.02% in the last 40,000 years. The Stone Age or Paleolithic era actually covers the period from the first appearance of stone tools, about two million years ago, up to the end of the last Ice Age about 15,000 years ago. Homo sapiens are thought to have arrived on the scene in Africa about 100,000 years ago in the so-called Upper Paleolithic period. It is now reasonably well established that when Homo sapiens migrated out of Africa to Europe, Asia, and beyond, replacing earlier Homo species, they were still hunter-gatherer tribes, a situation that prevailed for thirty to forty thousand years prior to the advent of raising, grinding and storing grains and raising animals for food (see for example "The Seven Daughters of Eve", by Bryan Skyes, W. W. Norton, 2001, for a fascinating and up-to-date discussion by an Oxford genetics professor of the use of female mitochondrial DNA in this context). Basic to Cordain's argument is the belief that the rate of mutation would not have allowed humans to adapt to the profound changes brought about in diet that came with the advent of agriculture and animal husbandry, which occurred about 10,000 years ago. Thus it is argued that modern man should still eat a diet based on the balance of nutrients in the diet of our Stone Age ancestors, i.e. based on our genetic blueprint, a diet which for example included nuts, seeds, roots, leaves, fruit, honey (rarely!), lean meat and fish. Thus the Paleo philosophy requires avoiding many of the diet changes that started about 10,000 years ago. Further rapid and profound changes have occurred in the last century with the development of the modern food and drink industry.Cordain develops this thesis early in the book and then moves rapidly to apply its basic principles. In Part One he develops arguments for the proper balance of fat, protein and carbohydrate, and the types of each that are consistent with the Paleo Diet. The ground rules are simple: eat only lean meats, fish and other seafood, fruits and non starchy vegetables, and avoid cereals, legumes, dairy products and processed foods. Finally he discusses how, in his opinion, our modern diet went wrong and how his approach corrects the problem. He also discusses the optimum balance of omega-3 vs. omega-6 essential fatty acids.Part Two, titled "Losing Weight and Preventing and Healing Disease," includes a discussion of Syndrome X (also called the "Metabolic Syndrome") which he calls "The Civilization Disease" and attributes the syndrome, as have a growing number of nutritional scientists, to our modern Western diet with its emphasis on refined grains and sugars, which results in problems with glucose and insulin control, obesity, diabetes, heart disease etc. At the end of Part Two the author elaborates at some length on the proposed connection between the modern Western diet and a variety of diseases and health problems. An example is the relationship between celiac disease and cereal grains. Another is lactose intolerance. The remainder of the book provides detailed information on applying the principles of the Paleo Diet with a discussion of what to eat and what to avoid, meal plans, recipes, and the general principles of "Living the Paleo Diet."This book is an important addition to the modern diet literature, and its theme is related to the debate regarding high vs. low carbohydrate diets, although the author's criticism of low-carb "fad diets" seems at variance with recent research results as well as most modern versions of this type of diet. Some readers may consider his restrictions too severe, and may find some of his beliefs debatable (e.g. "saturated fats are mostly bad"), but the general principles seem definitely worthy of serious consideration. "The Paleo Diet" is highly recommended reading for anyone trying to adjust their diet to optimize health.Reviewed by William R. Ware, Ph.D.

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EAT, DRINK, AND BE HEALTHY
The Harvard Medical School Guide to Healthy Eating
Walter C. Willett, M.D., Dr. P.H.
Simon & Schuster, 2001, Fireside Edition (paperback), 2002 New books on diet and health appear monthly on bookstore shelves. The discriminating reader will have long since discovered that many, ranging from the bizarre to the mundane, are not worth a second look. Walter Willett's new book Eat, Drink and Be Healthy is different, and in fact has little in common with the majority of books that aim to provide guidance on what to eat and drink. We now live in a world where "evidence based medicine" has become the norm, at least among many physicians and medical scientists, and this book may well have the soundest and most extensive foundation in nutritional science of any diet book recently published.

Walter Willett is chairman of the Department of Nutrition at the Harvard School of Public Health and a professor of medicine at Harvard Medical School. He is one of the principal architects of three major and highly significant investigations, the Nurses' Health Study, the Physicians' Health Study, and the Health Professionals Follow-Up Study. These epidemiologic studies are the basis of much modern thinking on health and nutrition. Willett is one of the world's leading nutritional epidemiologists and author of a definitive textbook on nutritional epidemiology. This new book, written for the lay public, offers his views on diet and health based on a careful and thoughtful analysis of the underlying science. One-third of the book is devoted to recipes, which serve as illustrations of the principles set forth.

Central to the book's basic philosophy is a new food pyramid, Willett's so-called "Healthy Eating Pyramid," which is radically different than the pyramid promoted for decades by the U.S. Department of Agriculture—the so-called USDA Food Guide Pyramid, which Willett describes as follows: "At best, the USDA Pyramid offers wishy-washy, scientifically unfounded advice on an absolutely vital topic, what to eat. At worst, the misinformation contributes to overweight, poor health, and unnecessary early deaths. In either case it stands as a missed opportunity to improve the health of millions of people." This represents a strong condemnation of what has been for decades the basis of nutritional advice, and sets the tone of the book. Willett's pyramid is based on seven fundamental principles: (a) exercise and watch your weight; (b) eat fewer bad fats and more good fats; (c) eat fewer refined-grain carbohydrates and more whole-grain carbohydrates; (d) choose healthier sources of proteins; (e) eat plenty of vegetables and fruits but hold the potatoes; (f) use alcohol in moderation; and (g) take a multivitamin for insurance. Chapters 3-11 address the scientific basis of this advice and provide valuable details, while gently introducing the reader to the mysteries of randomized trials, cohort studies, case-control studies and what has been learned from metabolic studies. Chapter 4, titled "Surprising News About Fat" provides the basis for the growing consensus that very low-fat diets are not necessarily healthy and instead one must be selective about their fat intake to make sure that healthy fats are plentiful. In fact, each chapter (except perhaps the recipes) is likely to provide "surprising news" for many.

Readers will find the chapter on vitamins and minerals of particular interest. The author discusses the role of selected micronutrients in health and disease, discusses relevant studies, and provides useful information on food sources. He concludes that many diets are probably deficient in vitamins E, D, B6, B12, and folic acid, and, while encouraging the reader to derive their micronutrients from food, nevertheless recommends a daily multivitamin or vitamin-mineral containing the recommended daily allowance (RDA), advice that one does not often hear from mainstream medicine. Some readers, while agreeing with the author's position that this insurance is desirable, will in fact want more insurance than is provided by the RDA.

Willett's stated goal is to "…offer straightforward, no-nonsense advice on nutrition based on the best information available," and anyone reading this book will probably agree that he has achieved this objective. Anyone interested in diet, health and longevity should definitely read this book.

Reviewed by William R. Ware, PhD



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How to Find Health Information on the INTERNET
Bruce Maxwell
Congressional Quarterly Inc., Washington, DC, 1998
350 pages

Finding specific information on the Internet is getting to be about as easy as finding the proverbial needle in the haystack. My recent search for "cancer" on Alta Vista yielded almost 2.5 million references and "cancer treatment" weighed in with 28,000. To find anything helpful within this maze of data is clearly a daunting task. Fortunately, it has just become very much easier with the publication of Bruce Maxwell's How to Find Health Information on the INTERNET. Mr. Maxwell, an investigative journalist specializing in public access to information, has scanned thousands of web sites, news groups, mailing lists, and support organizations that offer free health information on the Internet. From these he has selected about 600 sites which meet his stringent criteria for quality and provide accurate and reliable information. He describes each site and gives clear instructions on how to access them. The book provides extremely useful information about general medical/health resources on the Internet and also gives specific sources of information for about 25 major categories of disorders from allergies to substance abuse. Alternative medicine, dental health, nutrition, drugs, exercise, men's and women's health are among the many other subjects covered in this excellent guidebook. I found Bruce's references to support groups and newsletters of particular interest. Using his directions one can easily join a discussion group on a topic of specific interest or sign up to automatically receive a newsletter dealing with anything from myeloma to panic disorder. An excellent 25-page index rounds out this gold mine of information. A MUST if you are looking for free health information on the Internet!



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Encyclopedia of Nutritional Supplements
Michael T. Murray, ND
Prima Publishing, 1996. This book is my favourite reference book for information about nutritional supplements. Its 564 pages are packed with useful and carefully referenced information about vitamins, minerals, essential fatty acids and a host of other supplements from carnitine to phosphatidylserine. Encyclopedia of Nutritional Supplements is written by Dr. Michael T. Murray, ND, one of the world's leading authorities on natural medicine. Dr. Murray writes in an easily understandable language and systematically covers functions, food sources, deficiency symptoms, beneficial effects, available forms, principal uses, dosage, safety and interactions for each supplement covered in the book. I particularly like the fact that Dr. Murray supports his statements with numerous references to medical and scientific journals. The Encyclopedia also contains a quick reference guide for specific health conditions providing recommendations for dealing with a number of common disorders from acne to varicose veins. A detailed index completes this "Five-Star" selection!



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