Thursday, August 16, 2012

What if It's All Been a Big Fat Lie? - New York Times

If the members of the American medical establishment were to have a collective find-yourself-standing-naked-in-Times-Square-type nightmare, this might be it. They spend 30 years ridiculing Robert Atkins, author of the phenomenally-best-selling ''Dr. Atkins' Diet Revolution'' and ''Dr. Atkins' New Diet Revolution,'' accusing the Manhattan doctor of quackery and fraud, only to discover that the unrepentant Atkins was right all along. Or maybe it's this: they find that their very own dietary recommendations -- eat less fat and more carbohydrates -- are the cause of the rampaging epidemic of obesity in America. Or, just possibly this: they find out both of the above are true.

Gary Taubes didn't do himself any favors by leading off the article in this way, essentially calling all the then leaders of the diet and nutrition research and practice "ignorant and to blame."  Then again, he probably wouldn't have made the fat paycheck he did if the article were not pointed.   It's been ten years since GT fired this shot across the bow of the powers that were - and his take is standing up quite nicely to the science that's been done the last ten years.

His effort back then - aside from stirring the hornet's next - was to stimulate research that would conclusively answer the question - what causes humans to become fat?  Taubes found the science of diet was so poor that it could not even justify the widely held belief that it was a simple matter of moral failings - humans were too gluttonous and lazy, and therefore ate more than they expended, resulting in a positive energy balance and the accumulation of excess body fat.

After Taubes' truly exhaustive review of the field, unique since as a reporter his research was not segmented into this field or that field, he provided a restatement of an old hypothesis.  His hypothesis was counter intuitive.  In short it was/is:  we eat too much and move too little because we store energy as fat.  Energy partitioned into fat, and unavailable as fuel, results in starvation at a cellular level, and therefore hunger and lethargy.  There are multiple mechanisms but the largest is this process - excess carb intake results in excessive blood sugar levels.  In self defense (high blood sugars are toxic above 160 mg/dl) the body secretes insulin, which commands the body to convert sugar to fat (and suppresses hormones that normally allow fat to be liberated from fat cells).  This hypothesis is referred to as the "alternate hypothesis" or "the carbohydrate hypothesis."

Aside from the petty drama about who's right and who isn't, the good news is that more and more folks are able to pursue carbohydrate restriction without being  cautioned by their health care providers that "high fat diets are bad for your heart."  In fact, the science is now crystal clear - low carb diets are better  than the rest for fat loss, restoration of metabolic health, and normalization of blood lipids and blood pressure.  For up to one year, these effects are clearly documented.  Beyond a year, tests have not been completed - for either low carb or low fat.  That I think Taubes is right, and that the villains were those who recommended the untested and STILL unproved low fat fad diet, is not nearly as significant as all the sick, obese folks, who have saved their health by avoiding excess carbohydrate consumption.  Many more will do so as the science becomes more clear and the choice to restrict carbs more and more widely accepted.

Would you believe after all the hoopla that there has never been a study which showed dietary restriction of cholesterol or fat (or both) is effective for "lowering" cholesterol?  And the reason I've put "lowering" in quotation marks is - there has also never been a study which proved (intervention study) that lowering cholesterol through diet is effective in reducing either mortality from heart disease or all cause mortality.

Dr. Mary Vernon, who has used low carb in the treatment of diabetes for several years, has commonly responded to the dietary-cholesterol-saturated fat conjecture by holding up a $100 bill and offering same to anyone who can show a conclusive study on the topic.  She's never lost and I predict she never will.

All of which leaves one shaking one's head and wondering - how did so many intelligent, educated professionals get so far off track so fast - and stay that way for so long, WITHOUT THE SUPPORTING SCIENCE THESE PROFESSIONS HANG THEIR COLLECTIVE HATS ON?

And the question folks don't ask out loud, yet, is "How many Americans died from these non-scientific, government directed and blessed dietary recommendations?"  The next one is something like "when will someone in the government be held accountable to stop saying fat is bad for you and grains are good for you?"

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