Posts Tagged ‘Lifestyle Medicine Clinic of Duke University Medical Center’
Mainely Tipping Points 28: WHY WE GET FAT
In WHY WE GET FAT (2011), Gary Taubes—a highly respected science researcher and writer, drives a scientific stake into the heart of the “calories in/calories out” paradigm that began developing in the 1950s and grew to become the medical orthodoxy we experience today. Taubes explains the proven science behind why some people get fat—a question totally lost in the wilderness of the “energy balance” paradigm and its attendant low-fat/high carbohydrate diet. The circular logic of this paradigm holds overweight people in a vicious, unscientific, damaging, deeply cultural polarity: either people of low character eat too much (gluttony) or exercise too little (sloth).
Taubes traces the history of when research in nutrition and obesity “lost its way” and observes that these fields have “resisted all attempts” at correction. Much understanding, Taubes writes, was lost after World War II with “the evaporation of the European community of scientists and physicians [particularly the Germans] that did the pioneering work” (ix). Since that time, writes Taubes, “individuals involved in this research have not only wasted decades of time, effort, and money but have done incalculable damage….Their beliefs have remained impervious to an ever-growing body of evidence that refutes them while being embraced by public-health authorities and translated into precisely the wrong advice about what to eat and, more important, what not to eat if we want to maintain a healthy weight and live a long and healthy life” (ix).
Taube’s earlier book GOOD CALORIES, BAD CALORIES (2008) is an extended, densely researched book written to start a conversation with “the experts.” Taubes believes that it might take another lifetime to change this paradigm, but, meanwhile, he sees that the disease burden (obesity, diabetes, heart disease, and cancer) being created by eating the wrong foods is “overwhelming not only hundreds of millions of individuals but our health-care systems…” (x). Taubes wrote WHY WE GET FAT so the lay person could understand what’s wrong and have the courage to take personal charge of his/her health rather than relying on “some of the misconceptions that pass for public-health and medical advice in this country” (xi).
So, why do some people get fat? All real food, as compared to some of the chemical brews passed off as food today, is composed of fats, proteins, and/or carbohydrates. In a nutshell, people have genetic tendencies toward fatness or thinness that combines with a hormonal chemical disorder caused by eating too many carbohydrates—which throws off the body’s ability to regulate fat accumulation appropriately in both fat and thin people.
Here’s a gross simplification of Taube’s main explanation: Fat accumulation is regulated by hormones, and the most important hormone is insulin. Ideally, when our insulin levels are elevated, we accumulate fat in our fat tissue. When insulin levels fall, fat is liberated from fat tissue and is burned for fuel. However, easily digestible carbohydrates, like highly processed sugars and grains and starchy vegetables, make the body produce more insulin. And, this insulin works to trap fat inside fat cells; it does not release them to burn for energy. Thus, obesity is a hormonal imbalance, not a caloric imbalance. Worse, this hormonal imbalance makes an overweight person hungrier because the body is growing larger, and it makes that person sedentary because all the food energy is being stored, not burned. Gluttony and sloth are effects of this hormonal imbalance, not causes (10).
Insulin, Taubes writes, works also with other hormones, like the sex hormones, and countless enzymes to partition fuel around the body. This chemical process decides what food energy is burned, what is stored, and in which tissues it is stored (fat, muscle, liver). An insulin disorder can partition a disproportionate amount of consumed calories into storage as fat, rather than having them used for energy by the muscles. In lean people, the factors work to burn as fuel a disproportionate share of the consumed calories, which creates high energy levels (128).
Some people, Taubes explains, develop insulin resistance, which means the body has to secrete higher and higher insulin levels in order to perform the same tasks—a “vicious cycle” intensified by eating easily digestible carbohydrates. Next, these people start to manifest the precursor to heart disease, metabolic syndrome. Body fat accumulates, especially around the waist; blood pressure rises; triglycerides levels rise; LDL cholesterol particles become small and dense; HDL cholesterol levels fall; and blood sugar becomes erratic (glucose intolerance). Diabetes occurs when the pancreas can no longer secrete enough insulin to keep the body balanced. And Alzheimer’s and most cancers are “associated with metabolic syndrome, obesity and diabetes” (195-198).
Taubes’ subject is why we get fat, so he does not address the health effects on the lean, energetic person whose leanness is created by this hormonal disorder, which is, in turn, caused by eating too many of the wrong kinds of carbohydrates. He does note that that as we age, our muscles become increasingly resistant to insulin and more energy gets partitioned into fat (130-131).
There are generational components to these disorders. Taubes notes that worldwide studies demonstrate that children born to a mother with hormonal imbalances that have created obesity are likely, also, to struggle with obesity. The nutrients the mother’s body supplies to her baby affects his/her levels of glucose, which, in turn, affects the pancreas so that it develops more insulin-secreting cells, which, in turn, makes the baby fatter at birth. These babies have a tendency both to oversecrete insulin and to become insulin-resistant (132).
Exercise, Taubes demonstrates effectively, will not make one lose weight. Indeed, for weight loss, exercise is counterproductive because it creates hunger (40-56). And, undereating does not work. At some point one must return to eating normally, and the weight returns. Taubes reports that the eight-year, billion-dollar National Institutes of Health initiative, the Women’s Health Initiative (WHI) of the 1990s, showed that a low-fat diet did not result in weight loss and “did not prevent heart disease, cancer, or anything else” (33-39).
Taubes looks at many current studies, among them the 2007, two million dollar, government-funded A TO Z Weight Loss Study from Stanford University which compared four diets: Atkins (low carbohydrate), LEARN (a traditional diet with 55-60 percent carbohydrates), Ornish (low fat), and the Zone diet. The Atkins diet won, substantially and significantly, across the measured categories (weight loss, dropping triglyceride levels, dropping blood pressures, and improved cholesterol conditions)—prompting lead researcher Christopher Gardner, a twenty-five year vegetarian, to note that the results were, for him, a “`bitter pill to swallow’” (191-192).
Taubes notes that Atkins diet participants were allowed to eat as much red meat and meat fat as they wanted (191-192). And, that “since the 1960s, when it was first argued that animal products could be bad for our health because they contains saturated fat, nutritionists have typically refrained from pointing out that meat contains all the amino acids necessary for life, all the essential fats, and twelve of the thirteen essential vitamins in surprisingly large quantities.” Meat, writes Taubes, “is a particularly concentrated source of vitamins A and E, and the entire complex of B vitamins.” Indeed, “vitamins B12 and D are found only in animal products….”(176).
Vitamin C is the “one vitamin that is relatively scarce in animal products.” But, “the more fattening carbohydrates we consume, the more of these vitamins we need. We use B vitamins to metabolize glucose in our cells. So, the more carbohydrates we consume, the more glucose we burn (instead of fatty acids), and the more B vitamins we need from our diets.” When we eat carbohydrates, we “excrete vitamin C with our urine rather than retaining it” (176).
Without carbohydrates in the diet, Taubes notes, “there’s every indication that we would get all the vitamin C we ever needed from animal products.” Thus, Taubes concludes, “Carbohydrates are not required in a healthy human diet.” And, “another way to say this (as proponents of carbohydrate restriction have) is that there is no such thing as an essential carbohydrate” (176).
The solution to both obesity and leanness accompanied by excessive energy is actually pretty simple: stop eating carbohydrates, especially the easily digestible ones, like, bread, pasta, potatoes, sweets, beer, fruit juices, and sodas. (I’d add cold breakfast cereals to this list.) Taubes notes that before the 1960s, conventional wisdom recognized that these foods were “uniquely fattening.” And, he notes that this message has been at the heart of an “unending string of often best-selling diet books” (11). He also notes that “when physicians stopped believing it, a process that began in the 1960s and concluded in the late 1970s,” their change coincided “with the beginning of the current epidemics of obesity and diabetes” (150).
Taubes does note that if the obesity has gone on too long, the body may not be able to reset its own chemistry (205). And, that if one is taking medications to lower blood sugar or blood pressure, one should work closely with a doctor because following a low-carbohydrate diet lowers both so that a dangerous “double whammy” effect can occur (216).
Taubes reproduces the Atkins-version diet used by Dr. Eric Westman of the Lifestyle Medicine Clinic at the Duke University Medical Center. Westman has been working with this diet since 1998 (202). And, Taubes points to four other doctors with similar clinical practices across the country (202).
My only critique of this diet is that it allows artificial sweeteners and does not distinguish well between good fats and bad fats. But, you can read Tipping Points 14 to understand how to sort those fats out for yourself.
Written by louisaenright
March 17, 2011 at 5:43 pm
Posted in Mainely Tipping Points: Essays
Tagged with A to Z Weight Loss Study, Atkins diet, calories in/calories out myth, Christopher Gardner, diabetes, Eric Westman, Gary Taubes, HDL cholesterol, insulin resistance, LDL cholesterol, LEARN diet, Lifestyle Medicine Clinic of Duke University Medical Center, metabolic syndrome, obesity, Ornish diet, WHY WE GET FAT, Zone diet