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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?"
When it comes to the current thinking on nutrition, there is a definite point to what he's saying.
But to say that Exercise has no effect on weight loss is just plain wrong. Exercise changes the way your body processes the food you put into it (or, more accurately, your body adapts to the amount of exercise that you get). Building muscle causes you to require more calories in your diet to support that muscle. And building stamina causes you to burn a lot of calories in the process. And if you want to venture into the unscientific realm, consistent exercise helps to stabilize your mood and makes you less prone to food cravings (the cravings for sugary foods and for fatty foods are based in imbalances in Serotonin and Dopamine levels).
There is a dire need to re-examine everything we know about a healthy diet. People get so worked up about things like trans fats while completely ignoring the elephant in the room (high-fructose corn syrup). Everyone I know who's given up corn syrup, to the extent that it's possible in the US, has lost a minimum of 10 lbs.
But to suggest that exercise isn't a vital part of a healthy lifestyle is wrong, and potentially very dangerous.
"Don't blame me, I voted for Kodos!"
I lost 25 pounds after I simply cut out bread, potatoes, and sugar from my diet.
In the mean time, I added a gallon of olive oil every 60 days and a pint of cream a week.
Tho fit already (sports twice a week, regular walking and exercise) I started developing diabetes (of course my mom and grandparents had it so I'm kinda doomed there). Despite cutting out enormous amounts of carbs and sugars (I was previously drinking 1,000 calories of soda a day), I continue to slide in the bad direction on my blood sugar. It's not diabetic yet but it is just a matter of time.
My diet consists of large amounts of vegetables, meat courses, almost no grains (2-3 ounces a day tops).
I think people have different needs based on their genetic history.
I agree that a lot of "science" these days is opinion, hysteria, or someone's hidden agenda.
She was like chocolate when she drank... semi-sweet at first and then increasingly bitter.
I don't have time to LTTFP, but I know what worked for me. I was morbidly overweight, and I tried a number of things to get rid of it, including the traditional low-fat + exercise regimen. What finally worked was to eliminate or drastically cut high-glycemic carbs from my diet (rice, pasta, potatoes, bread, sugar, and the like). That, coupled with moderate exercise (walking 1 or 2 miles) helped me to drop 90 pounds in about a year.
I believe there is a relationship between high glycemic carbs, blood glucose spikes, and insulin, which will cause certain body chemistries to convert and store much of that intake as fat.
Wish I had discovered this 15 years ago.
Proverbs 21:19
Some people can get all they need to run their bodies on a lot less calories than others.
I can raise my burn rate for several days by playing hard sports for three hours. People comment that I feel like I have a fever.
My friend who has developed problems after a life time of being thin has low thyroid and other hormone feedback systems. And she is always hungry- constantly. Even when she eats, she will be hungry again a while later. And not eating does not cause the hunger to fade like it does for me- it just gets stronger.
I have another friend who has the *reverse* problem. He is slowly losing weight (like a pound a year) despite eating heavily and it is getting kinda critical. He has a messed up endocrine system too.
Some people are messed up so that any exercise just destroys muscle (they do not get stronger).
I wish people would not be so judgmental about these things.
Some people eat because they are sad- some were raised and trained on bad food- some were never trained to enjoy physical activity. Some people have hyper metabolisms that allow them to eat heavily and still remain thin.
And there is some evidence recently that fat people die less of many diseases. The anti-fat attitudes stink of group-think gone bad.
She was like chocolate when she drank... semi-sweet at first and then increasingly bitter.
I use the Physics Diet.
It has to work, because it's physics.
He makes the extraordinary claim that Official Nutrition has been getting it wrong for the last 40 years. However, he provides and discusses a solid body of relevant and eminently respectable (Lancet, JAMA, NEJM, etc..) citations to support his claim. Color me 95% convinced.
He notes that the application of the first law of thermodynamics (the slogan is "A Calorie is A Calorie") to a homeostatic dissipative system like the human body is beyond simplistic. It is simply wrong.
The core of his thesis is that a cellular-level metabolic disorder caused over time by consumption of concentrated and rapidly available carbohydrates, and the insulin spikes they provoke, is the cause not only of obesity but also of type II diabetes. Briefly, fat cells become too good at extracting glucose from the blood and storing it. This results in cellular-level semi-starvation in other body tissues, expressed at the organismic level by eating more and exercising less.
He depicts the high level of investment in the competing "gluttony & sloth" model of obesity which exists in our medical establishment and in our culture. Indeed, from his portrayal this viewpoint is very close to being an ideology rather than a theory, in that dissenters are cast into outer darkness rather than refuted.
He discusses the personalities and politics involved in the alleged disastrous wrong turn, and points up some interesting coincidences involving what research gets funded, and what research doesn't get funded, by for example sugar producers.
I'm intentionally being very brief. If you have a personal stake, read this book and form your own conclusions.
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phunctor
The recommended advice of replacing fats with carbohydrates was repeated so often and so forcefully by everyone, that it's now printed on the back of almost every box of food in the country, in the form of the "USDA food pyramid". It was so often repeated that when I was a child (in the 1970s) things like wonder bread with a bit of margarine were considered health foods (lots of carbs, no saturated fat).
I had always assumed that the medical community had done large-scale long-term studies demonstrating that such a diet led to an increase in lifespan, a reduction in disease, and a loss of unhealthy pounds. Apparently, such studies were never done.
But then the massive Harvard Nurses Heatlh Study was performed, ending in the mid-1990s. In that study, researchers followed 40,000 nurses for decades, in what was the largest and most comprehensive study on human nutrition ever. The study found that replacing fats with carbohydrates had absolutely no effect on longevity or disease. Furthermore, replacing butter with margarine (the standard dietary advice for decades) led to no benefit either. IIRC, the only nurses who lived longer and had less disease were those who ate nutrient-dense monounsaturated fats like almonds and cashews.
As a result of the Harvard Nurses Health Study, researchers in nutrition quietly dropped their assumptions about dietary fats causing disease.
I still can't believe it. The standard dietary advice from 1960 to 1990 must have been the single largest pseudoscientific load of crap in modern history. What a colossal embarrassment. If the USDA publicly admits that it was mistaken then it will be a long time before people trust it again.
I've been following the south beach diet for a couple of months now, and I have already lost a significant amount of weight. I don't follow it exactly, I use it mostly as a framework than anything else. It makes a lot of sense, and the scientific explainations of why it works makes sense as well. For those who don't know what it is, it's basically cutting out all highly processed foods from your diet and to stick to whole grains and whole unprocessed (ie not from a box) food.
It's not really a "diet" in the traditional weight-watchers sense. It's a change in eating habits, and I really think it could benefit a lot of people. Besides the weight loss, I feel like I have more energy and things like heart burn, which I suffered from regularly, are nearly eliminated.
I got nothin'
My girlfriend happens to be a doctor, and currently works in a 'obesity clinic', and she is going for a PhD in public health, with a focus on obesity, and she left me with the impression that:
- Real medicine never was a 'real' science. It's absolutely shocking how many publications, treatments and diagnosis are based purely on 'gut feelings', or incoherent theories. Just pull up any statistics on malpractices, and be shocked. No other 'science' could get away with so many errors, after such a long time of experimenting. This happens in part because medicine is a rather unique applied science: there're a lot of psychological factors, and incredible amount of measuring errors, a gigantic level of complexity and tons of historic 'baggage' that doctors have to face every day.
- Medicine is getting a lot better in this aspect - there seems to be a relatively new way of thinking (in the medical community, at least) called "Evidence based medicine", which, if i understood correctly, could be basically summed up as applying scientific principals to the medical processes
- Obesity in specific is extremely complex. Almost everything you do has some influence on you body-weight and composition. Of course the laws of thermodynamics apply to human beings, too, but there are a gazillion factors that influence just how exactly the body deals with excessive calorie intake, or lack thereof, ranging from genetical to psychological and social factors. Just a basic example would be that if you simply stop eating for a week, you usually lose LESS weight compared to if you start 'snacking' all the time, eating 5 little meals a day (basic theory behind this sems to be that the body switches to 'emergency mode' if there's no food around, trying to save as may energy reserves as it can)
- Most theories seem to me to be a wild mixture of anecdotal observations mixed with biochemistry, somehow resembling Freudian theories - they are coherent in them selves, but lack a level of 'scientific interconection' to other knowledges. So it's quite common for a specific theory in obesity to me contradictory to a theory of e.g. neuroscience. As long as both theories "kind of" work, it doesn't seem to be a top priority to resolve that discrepancy (in contrast to what i have observed in 'hard sciences'). AS far as I can tell, thee's no real proof or reason why Whiskey shouldn't be as bad as Vodka in a diet, yet (here, at least) it's common knowledge that whiskey's ok, but vodka will make you fat - and as long as this works, it doesnt matter that much why this happens, or if it happens at all.
My family taught me something when I was young and came to America, and miraculously became pudgy... "they have sugar in EVERYTHING here", so we cooked at home, and ate at home a lot, and bought mostly the basic building blocks of food, and... (ding ding) made it at home. There was never a shortage of sweets in the house, or of food. And once we dropped the soda pop and store bought cookie fads, our fat content dropped.
:) Salads, etc. My diet is as varied as it gets, and yet I'm in good shape and I've lost weight. Interesting? I was shocked. I have had two to three week breaks in my exercise routine, and yet no weight gained, and I lose little to none of my conditioning. (First day back I usually run half a mile, but I can get back to two to three miles a day the next day... shocked the life out of me since I was so used to what the idiots in school taught us. Seems almost everything school teaches can be thrown out once you graduate... preferably before. Including the lack of a good warmup before exercise, which is what destroys so many people's joints.) Strangely enough, I have "healthy levels" of the following. "Blood Sugar", "cholesterol", "blood pressure", "heart rate", with no murmurs, no palpitations and roughly no issues whatsoever.
Here's the catch. I work out and jog (swim, bike, etc, that's beside the point), but I do it to keep myself physically strong and resilient. I don't exercise to lose weight. It didn't really work, all it did was convert some of the fat to muscle. The rest went away as I began to eat regular healthy meals and cut down on the crap food to once a week or less. (Never cut the nasty stuff completely, or the cravings will find another way to surface, psychologically speaking. We're human and we're tempted, find a way to replace your cravings with something less nasty, that'd be it.)
My secret? I eat at least an egg a day, regular tea and hot chocolate, sausages or meat once a day
Rule #1? Live a good, healthy and complete life, stop struggling for shit you don't need, and stop fighting battles that don't gain you anything, not even satisfaction (which is more important than people think.)
Rule #2? Stop living with fear. Fear is the only thing you should fear, if anything at all. If something you do makes you "afraid", find out why, and get rid of the problem, don't just suppress the symptoms. Oftentimes fear will simply be some choice you make that you don't understand. Fear is among the worst stressors out there, yet few realize this. Getting into a fight with your boss and walking out of a job without fear is better than living each day at that job constantly afraid that you'll lose it someday and that you won't make payments on that brand new SUV you didn't really need (or want) or that three story house that only you and several ghosts live in (or whatever it is that keeps turning on the lights each night.)
All in all, remove fear by understanding what causes it and deal with it. That and discover the things that satisfy and please you, and surround yourself with those things. Often they are cheaper than you can imagine. Short of hunting and fishing, I have VERY few expensive hobbies. My garage is bigger than my house, as is my shop. Most of my "toys" I built myself, and will continue to do so. I use my life as an example, merely because I've been through all the problems many complain about, and have found ways to complete the needs behind each problem without rushing into a marriage or running into the arms of the nanny state or going on clinical drugs. Do I still have issues? Hell yeah. If I was perfect, I wouldn't be human.
" What luck for rulers that men do not think" - Adolf Hitler