Thursday, March 10, 2011

Taubes in Oz, 2

Gary Taubes appeared on the Dr. Oz show this week, and I posted a link to Gary's comments earlier.
As Gary points out, some of what is seen in the video is just part of having a popular TV show; there has to be tension, information must be communicated with haste to hold anyone's attention long enough to get them to see the commercials that pay the salaries of those that put on the show, and therefore, depth must be lacking.  To that end, Gary's obviously worked on both condensing his message and speaking much more quickly! 

I was appreciative for Mehmet Oz's attempt at balance and respect.  It's far easier to entertain when you can be attacking, condescending, and disrespectful.  Mehmet let Gary say what he had to say, and was a gracious host in most respects.  On that point, as Gary pointed out, TV time is what sells books, and I'll bet Gary makes out on this one.

Mehmet starts out on a bad foot, in my book, by saying something like "You are not a doctor, why should we listen to you?"  Part of the show reinforces the significance of the host, fine, but HOLY COW what a pretentious thing to say - nevermind the fact that if he were hosting William Davis or Mike Eades or Kurt Harris, who are doctors and who agree with Gary T, Mehmet wouldn't treat their message any differently.  Ok, Oz, we get from your repeated references to cutting folks' chests open that you are a very prestigeous man, a friggin' heart surgeon - presumably, your audience cares about that and I understand that your show is FOR your audience.  I'm more concerned with how much you know about the science of diet than with your paper qualifications.  Frankly, Gary T's book leaves Oz no excuse for not knowing the science as well as he does.

How does Mehmet Oz treat Taubes' review of the science?  On the one hand he's appreciative, to include inviting Gary T to speak to his students, but on the other, he seems not to care or know about the science.  The show then boils down to a contrast of Gary's perspective, which is that we've been sold a lot of snake oil packaged as 'proven science'; and the host's perspective which amounts to *deeply held belief*.  Mehmet comments about his largely vegetarian food choices a couple of times as "sacred and foundational to who we are as humans."  Perhaps he justifies those kinds of statements in his books and previous shows and thus doesn't repeat/defend them with Taubes present - but it comes off as if he doesn't know that whole grains turn into sugar in the bloodstream almost as fast or faster than table sugar itself.  Or that all plants, being unable to run when threatened, survive by their toxins towards would be predators, and have many toxins that hurt humans.  Or that LDL as a cause of CVD (by sticking to the artery walls like glue - IOW, a "grease clogged pipe model"), is many years out of date as even a reasonable conjecture.  Or that there is virtually NO evidence to support the conjecture that saturated fat consumption increases risk of disease.  Or that grains, whole or otherwise, are implicated in all of the autoimmune disorders, and downright lethal to the 3% of the population with celiac.  Or that getting whole grains is not so easy, primarily because truly whole grains do not keep well; most of the so called whole grains are on the order of 10% whole grains, making the "whole" expression nearly ludicrous.  Or that his dearly beloved disease fighting vegetables are equivalent to using a fire extinguisher on a burning fire, while the low carb model is equivalent to depriving the fire of fuel before it starts (which Taubes points out but Mehmet misses). 

Honestly, I was stunned - even Slate magazine knows saturated fats are not the boogeyman, why doesn't this self proclaimed heart disease expert and Oprah confidante know as much as a pop magazine?  The clinical trials have been done, the facts are in, low carb/high fat does not result in a high risk fasting lipid profile.  The government tried for years and with billions of dollars to show that low fat diets reduce cholesterol and therefore risk of disease, and none of those tests showed the hoped for result.

At one point in the show, trying to make his point that low carb diets are hard to stay on, Oz puts one strawberry on Gary T's plate and says "If you eat just one strawberry" you'll trigger the insulin response and your diet is ruined.  I know what he was trying to go for - that carb restriction is too hard for folks to sustain for a lifetime - but that was a silly way to make the point.  If he made one real point the whole time, it was that in studies of large groups of people, folks don't stay on a low carb diet.  As to why that may be true, I think it is a combination of factors.  For one, eating is a highly social behavior, and it is hard to stay low carb when the people you love and live with do not (note to the paleo hopefuls - get with a community, either at a CrossFit gym, or online, or use Jedi mind tricks to get your family/significant other to do it with you).  For another, if you think that low fat, high carb diets are great for weight loss, but you hear the message all the time that low carb/high fat will give you:
--cancer from too much meat
--heart disease from too much fat
--micro-nutrient deficiency because you don't eat 3,000 servings a day of fruit and vegetables
--constipation because the only way in the world to avoid constipation is to shovel grain into your pie hole like there's no tomorrow ...
--and your doctor, who doesn't know that the standard way to check cholesterol, via the Fridewald method, gives an inaccurately (false high reading) of LDL, and doesn't know that LDL isn't predictive of disease risk unless it is small, dense LDL (which your doctor won't typically measure), will tell you to go on a statin due to the fact that your LDL will be higher (via Friedewald measures) than he/she would like AND, you have a pulse and an insurance company that will pay the ~$3/day
Then you are probably going to relapse after weight loss.  In this way, low carb diets are just as ineffective for health improvement as would be cessation of smoking for four months. 

In other words - in a world of diet and health insanity and mis-information, supplied by those as uninformed or as swayed by deeply held belief as is Oz, I suspect it is much harder to sustain a low carb lifestyle than it will be once the reality of carb restriction is more widely accepted (which sometimes seems right around the bend).  Either way, low carb controls appetite, improves health, and manages body composition while allowing one to eat to satiety and sustain athletic pursuits and a high muscle mass.  If you do it, it works and works without hunger. 

It did seem like Gary made his point well as regards the necessity of treating the obese differently than those that can remain lean on a diet such as the one Oz recommends.

Lastly, I thought Oz's test of the low carb diet was interesting, primarily for the fact that it seems to confirm he's been eating so much carbohydrate that he cannot function normally without it.  He reported at the end of his low carb day that he felt grumpy and low energy - and that is exactly what would be expected for someone who is fueled all the time with carbohydrate laden foods.  Such a person does not have enough fat burning capacity to generate sufficient glucose or ketones, nor to burn stored fat at the cellular level.  They are in effect an exogenous sugar junkie, as addicted to carbs as any heavy coffee drinker is to caffeine.  If Oz was trying to show that low carb diets are uncomfortable, it may have fooled some, but it also confirmed his metabolic inflexibility.  Oz would be well served by developing the capacity to go without carbs for a day, which, once developed, he could sustain with a weekly carb fast.  He could then sustain his preferred approach to eating but have the flexibility to skip meals when not hungry or when busy, without fear of crashing blood sugar, irritability from low blood sugar, or of loss of mental acuity due to a blood sugar drop. 

You and I, my carb restricting friends, gain the benefit of that metabolic flexibility as a natural result of the way we prefer to eat.

In terms of execution, Oz also ate too much food (made a point of showing he ate every bite).  One of the consistent results shown by interventions with carbohydrate restriction is spontaneous reduction of intake.  No diet is going to make you feel good when it requires that you eat more food than you feel hunger for.  A better test would have specified that he only eat what he was hungry for.

The whole show was likely a win win - Oz pulled off looking clever and significant for the commercial watching throngs that support his lifestyle, and Gary T probably punched up his Amazon numbers.  Those who have eyes to see and have ears to hear will benefit from their exposure to Gary's work, hopefully as much as I have. (Edited @ 12.49 CDT)

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