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The Obesity Epidemic — Is Medicine Scientific?
An anonymous reader writes "An award-winning science author, Gary Taubes, has written a book that pans the medical community's treatment of the obesity epidemic. What is interesting is that it looks like the medical community is behaving in a very unscientific manner. Taubes points out that the current medical orthodoxy — that consuming fat makes you fat and exercise makes you thin — has no basis in research. In fact, all the available research points in quite another, and more traditional, direction. Here's the (excellent) podcast of an interview with Taubes on CBC's 'Quirks and Quarks.' So, has medicine become a non-science? Is it mostly a non-science? Somewhat?"
From personal, scientifically-measurable experience, I can tell you that gaining and losing weight isn't a matter of 'good calories' or 'bad calories'. It's a matter of calories. Burn more calories than you consume over a period of time, and you will lose weight. Burn fewer calories than you consume over a period of time, and you will gain weight. Yes, it's that simple. I suggest you all put down this claptrap, and read The Hacker's Diet by former AutoCAD developer and AutoDesk VP John Walker. It's done wonders for me.
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But insulin makes you hungry and eating carbs especially sugar makes you release insulin.
***Quis custodiet ipsos custodes***
Calories in greater than calories out => gain weight.
Calories in less than calories out => lose weight.
At least, that's how I thought it worked. I decided late last year, as a new years resolution, to start Operation Flab. My weight had crept up, ours is not a physically active field to begin with, and middle age (I'm 46) didn't help.
I've made some healthier choices in my diet, cut back on portions, exercise vigorously 3 times a week, and have lost significant weight. I feel 100% better. There is no magic: I didn't gain it overnight, and I'm not going to lose it overnight either. Heroics never work, because too great a lifestyle/diet change will never last.
I didn't bother with a health club membership or anything like that. My sole expense was an MP3 player.
...laura
This thread is ripe for turning into a flame-fest, but you may want to do at least some casual reading on what insulin is and the processes the body goes through to process fats, proteins and sugars. There's a thousand variables involved in how the body processes raw materials it takes in and what it does with the materials it creates from them. No combination of those will result in your blanket statement.
Here's a link to an article by Taubes that originally ran in 2002, and sounds like it was the seed for this book.
"What if It's All Been a Big Fat Lie?"
http://query.nytimes.com/gst/fullpage.html?res=9F04E2D61F3EF934A35754C0A9649C8B63
It's long for a NYTimes article, but it's an interesting read. I'm sure the book updates much of the data.
Probably not whole grains. That whole grains are better for you is a myth. No cultures with a tradition of long lived good health eat wheat or rice bran - or any non soluble bran. They feed it to animals and eat the animals. Also, such cultures treat soy with great wariness and respect. This too they feed to animals, unless fermented and aged, and even then they eat it in very small quantities.
The reason is partly phytates, and partly irritation of the bowels, and partly plant estrogens. Wheat bran is non soluble and so is an irritant to the bowel. But because of phytates, it prevents the absorption of minerals. The plant hormones in soy are just plain bad for you. Brown rice is lower in delivered nutrition than polished. It is not how much nutrients a product contains. Its how much it delivers to you when you eat it.
We are embarked on a huge uncontrolled experiment in nutrition, and one undertaken without the slightest evidence in its favor. We started out with a diet which obtained about one third of its calories from saturated fats, about one third from protein, and one third from partly refined carbs, generally all eaten together with a variety of vegetables. Curiously enough, heart disease was rather low. I say partially refined - the bread before the invention of modern industrial baking was sourdough long fermented and slow risen, and was made from high extraction but not whole wheat flour. It was chewy, low GI and very digestible. These foods were eaten slowly in sociable meals. They were not wolfed down on the way from one place to another, or held in one hand while typing with the other.
We moved from this to a diet which substituted refined and often hydrogenated vegetable oil, high in polyunsaturates, for the animal fat. We then added to this recently the most industrialized kind of processed food there is: soy 'milk' and meal of various kinds. This too raised the proportion of vegetable oil in the diet. We then had a campaign to lower total fat consumption, which led us to a high carbohydrate diet, but high in those same vegetable oils.
Our last state was worse than our first. Nothing in our evolutionary history has prepared us for such a diet. Its consequences are continual hunger, over eating, endless snacks, obesity, and degenerative diseases.
What do we need to do? Go back to the traditional comfortably off working family diets of about 1900. Meat and two vegetables, high extraction sourdough bread in liberal quantities, oatmeal, full fat milk, butter, cheese, fish in moderation. Minimal amounts of vegetable oil, minimal amounts of sweets. Pastry made, if one has to eat pastry, with suet. No snacks.
Women are the especial victims of our current dietary mania and the diet industry. If we could do one thing to improve the health of society, it would be to abolish dieting, dieting books, and conversations about dieting and one's weight. Couple that with only eating at mealtimes, cooking only real food from scratch, using ingredients available in 1910, and we would all be infinitely better off.
Read "Nourishing Traditions." It will change your life.
Speaking as someone who is currently in medical school, allow me to put forth the falsifiable claim that you don't know what you're talking about.
The vast majority of medical school applicants come with degrees in scientific fields (usually Biology or Chemistry). To be considered for admission they must to do well on the MCAT, a difficult test which stresses scientific knowledge and reasoning abilities. Once in, they are drilled for the first two years with what's called "basic" sciences, where they are expected to gain an in-depth understanding of a wide breadth of information all directly based upon accepted scientific literature. Mastery of this information is tested via the USMLE Step 1--again, another very difficult test.
So, please, enlighten us as to where you're getting this idea that modern medicine is taught unscientifically, because as far as I can tell your notion is not based in reality.
The funny thing is, a common argument that I hear on a frequent basis is that because medical school is taught by PhDs and not MDs, it is focused too much on scientific details and not based on clinical reality. There is no point in training a family doctor to be able to draw out the TCA cycle or recite G-protein signaling transduction pathways as such information has no impact on treatment or diagnosis.
-Grym
The palate in America is very sweet. Granted, I only have a few weeks in Spain to base my opinion on, but it seemed quite conclusive and corroberates with what I've heard from some family members who've traveled more than I have.
Take a churro. In America, it's a deep-fried dough stick rolled in sugar and cinnamon. In Spain, it's a deep-fried dough stick. It's savory by our standards. You get a cup of hot chocolate, and it tastes almost like coffee. You get ham, and it's not the artificially sweetened ham we're used to, it's just a big hunk of organically-fed pig that's been sitting in a barrel of salt for a few years. Even bread in America has high fructose corn syrup in it. Now, most of the food in Spain except for the ham, seafood and churros is bordering on objectively disgusting, but everyone I saw over there is very thin.
You seem to forget a tiny inconvenient fact about predators: they don't get their fat from the local store. They have to RUN, sometimes all day, in order to get something to eat. Just buying some fat shit in Wall Mart, eating it in front of the TV, then turning in to a late-night slashdot session, for sure WON'T make you look like a Cheetah. Sure, you should train your body to get its energy from fat. However, the only way to do it is to EXERCISE, with the correct heart frequency and for a prolonged time periods (at least one hour per exercise, at least 3-4 times a week). I've been running for the past 8 months. I feel WAY better, my waist circumference has decreased significantly, my heart frequency is now around 60-65 (was: 75+), and my blood pressure went 10-15 points down. I don't go out of breath by going 2-3 floors by stairs any more. Actually, I even barely notice it. I really don't believe I'd have seen the same effect if I just started "eating like a predator" instead. I'm still over 100kg though, but I'm working on it.
I'm not splitting hairs at all. Left handed sugars for example are not metabolised, but otherwise carry identical amounts of energy as regular right handed sugars which are metabolised readily.
That's because our bodies have specific nutritional requirements. You can push one chemical pathway by loading up with one set of energy carrying fuels and the body will respond in one way. You can push an entirely different set of pathways by using different fuels and attain a different response from the body.
All calories are NOT equal.
Deleted
Taubes is extremely biased in his presentation of available evidence. For a scathing critique of his abuse of science see this article.
1. Muscle must be fed. Fat doesn't. Strength training builds muscle, which if nothing else consumes calories all the time, just much less at rest.
2. What goes in must either be used or go out. If I eat 6 pounds of food a week, and manage to consume 3 pounds of that as energy, eliminating 3 pounds as indegestible waste (you know what I mean), I neither gain or lose. If I work harder, or replace fat with muscle, I need more energy. It comes from somewhere.
3. If I eat less, I will eventually lose weight. The key word is 'eventually'.
4. If I work more, and don't change my diet, I will eventually lose weight.
5. The equation is, eat less, work more, and be patient. My body may well try to hoard resources in response to the apparent famine or starvation of not so much food.
6. Keep a balanced diet. Not feeding your body nutrients, especially calcium and trace elements, is very bad.
7. Portion control. Just do it.
8. Keep at it. Patience.
9. Drink plenty of water.
10. Read items 1-9 regularly and heed.
deleting the extra space after periods so i can stay relevant, yeah.
Sure... provided you have no real understanding of the processes involved.
The common, simplistic explanation of nutrition is that you consume food, which your body then breaks down, releasing the energy of chemical bonds, which your body then uses as fuel. We measure the energy released in a unit called calories.
This description is fine, and it suffices for most day-to-day discussions of food, with one caveat: It's fiction, almost from top to bottom.
Just for starters, when nutritionists talk about calories, they're not really talking about calories like a physicist would. They're really talking about "food calories," which I believe are equivalent to kilocalories. This may be a minor point, but it serves to illustrate that if you think nutrition science maps directly onto physics, you are wrong.
Second, and more importantly, any good college chemistry instructor will tell you that the body does not "release energy" from the chemical bonds in food. Chemicals form bonds because the bonded compounds are the lowest-energy state for those particles. In other words, it takes energy to break a chemical bond, not the other way around. Digestion allows us to extract energy from food because we break down certain chemical bonds and cause those chemicals to form other, different bonds -- bonds with an even lower energy state than the original form. Our bodies can then take advantage of the surplus (and exactly how is still another story).
If you understand this, it should be obvious that digestion can be a fairly complex process, not all food is equal, and you can't measure the "calories" in a food as if you had a gas gauge.
Breakfast served all day!
yes, lets start eating lots of low GI food.
Your weight is based on how you respond to your appetite, not on how much you exercise. Fat and protein are low GI. So are most whole grains and basmati rice. It's the white flour and sugar (the primary non naturally occuring foods in our diet) that have the highest GI. Fructose (fruit sugar) is the only low GI sugar.
and for those who don't know, high GI foods increase your appetite by causing a spike in insulin levels which makes you hungry after the food you eat has been broken down.
What you're saying makes sense, but I think you miss the major items in the article. Three major points:
1. Easily digestible carbohydrates stoke your appetite. Fats and proteins suppress your appetite. For example, pick a day and eat as many cookies as you want. Pick another day and eat as much cheese or beef as you want. You'll eat less than half as many calories on the meat or cheese day.
2. For some people, strenuous exercise tends to stoke the appetite. It does no good to burn 500 calories on the treadmill or do squats, pulldowns, and shoulder press until your arms and legs can't move if you go home hungry enough to eat two cheese steaks. When I was lifting weights 6 hours a week, a typical lunch was two cheese steaks with a salad and a dessert. I didn't get any fatter - but I didn't get any thinner either. (I also didn't get much stronger - I seem to get much better strength gains from strength training from just two or three 45 minute workouts per week.) Exercise is extremely helpful and important, but if strenuous exertion stokes your appetite, take that into consideration and only exercise moderately. Thin + mild exercise is better than Obese + strenuous exercise.
3. (Most important) Cutting fat in your diet has not been linked to reducing your risk of heart disease. When some guy who lives on McDonalds Super Size meals has a heart attack, we've been taught it's because of the fat, period. But in fact, he's had tons of sugars in his soda, burger buns, and condiments, tons of starch in the fries, trans-saturated (i.e. not naturally occurring) fats used to cook the food, and tons of salt on the fries and in the sandwiches. (Ground beef and chicken have relatively little salt naturally, but fast food burgers and chicken are almost all positively loaded with it.) The beef in his burger probably had nothing to do with his problems.
My bet is that the mother in the previous post might find her appetite reduces further if she put more fats and protein in her diet, and if she did moderate exercise (but not so strenuous as to send her appetite through the roof), it would help even more.
More proteins and fat, and less simple sugars = a lower appetite. That makes it easier to Eat Less And Exercise More.