Wednesday, November 7, 2007

Atkins site interviews Gary Taubes

The official Atkins web site just published this interview with Gary Taubes, author of the mind-blowing new book, Good Calories, Bad Calories. Here's the URL to the interview on their site:

They've removed a lot of terrific information from their site over the past few years, essentially dumbing it down. Apparently it's an effort to be more "safe" and "accessible" -- that's just my observation and interpretation. But it's why I'm quoting the interview here. There's no telling how long anything good will stay anywhere on the Web, really.

Challenging the Conventional Wisdom on Diet: An Interview with Gary Taubes

Author and science journalist Gary Taubes has written a new book called Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control and Disease (Knopf, September 2007). The book demonstrates how, when it comes to dietary recommendations, public health data has subjected to twin misinterpretations: a deeply ingrained belief that dietary fat and cholesterol are the root causes of coronary heart disease and an equally damaging failure to recognize the negative health consequences of our increased consumption of refined carbohydrates such as sugar, white flour and white rice. The result has been an increased incidence of chronic disease like diabetes, heart disease, cancers and obesity.

After examining the history of how we got to this point, Taubes calls for researchers and clinicians to reexamine the real science, in hopes that we can become healthier. His book is an eye-opening challenge, both for consumers and the medical community, as we all grapple with the question of what constitutes a healthy diet.

"We don’t need another diet book," Taubes said in a recent interview with Atkins. "We need a book that explains to the medical establishment what’s actually going on, what the real science is and what we should believe until compelling evidence tells us otherwise."

Q: How did you get so passionate about the subject of public health and nutrition?

A: I have a scientific background, and I’m curious and a little relentless about it. I like answers to make sense, and I’m also obsessed with this question of good science and bad science and how easy it is to misinterpret data -- to see what you want to see and not what’s really there. This is what I’ve spent the last 20 years of my life reporting. With this book, I just kept following the evidence. I didn’t have an agenda; I just wanted to know what the truth is. And what’s fascinating about this subject is some of it seems so obvious. It’s sort of insane that we got to a point where obesity -- a chronic disorder of fat accumulation -- is treated as a behavioral defect, but that’s what happened.

The real question we should be asking is: What causes obesity? The same way with lung cancer -- you want to know, do cigarettes cause lung cancer? The same way with AIDS -- does the HIV virus cause AIDS? The answer is critical because obesity is associated with an increased risk of all chronic Western diseases – cancer, heart disease, diabetes, etc. -- so whatever makes us fat makes us sick also.

One theory says that “eating too much” causes obesity. Supposedly if you say that obesity is caused by overeating, you’ve solved the problem. Well, you could always ask the next question: What causes the overeating? But for the last 50 years, no one has bothered to ask this question. This has gone along with the assumption that diets only work by reducing the amount of calories consumed.

Q: So how did science get off track when it came to obesity and these chronic diseases?

A: Prior to World War II, the best nutritionists, the best physiologists and the best clinical, medicine specialists were in Germany and Austria. They never believed that obesity was a disorder of overeating. They said it’s a disorder of excess fat accumulation, and the question is: What regulates fat accumulation? They suspected insulin. But since they couldn’t measure insulin levels in the bloodstream, they couldn’t conclusively, logically get to this place where they could blame insulin for this fat accumulation. Then, this school of research just evaporated beginning in 1933 when the Nazi party took over in Germany and vanishing entirely in 1938 when the Germans invaded Austria.

There’s a 10-year gap in obesity research for the second World War. Then obesity research was recreated in the US following the principles of Louis Newberg, who was at the University of Michigan. Newburg has always been convinced that obesity is caused by what he called a “perverted appetite.” Fat people eat too much. The idea is, supposedly, that if you say that obesity is caused by overeating, you’ve solved the problem. Therefore, the discussion is not about what causes obesity because we ostensibly know that already.

And by the 1950s this meaningless concept called “eating too much” had taken hold. Obesity was considered an eating disorder or a behavioral problem. But everybody knows it doesn’t help trying to tell fat people to eat less – after all, they spend their whole lives trying to eat less. If obesity was just about eating less or exercising more, then none of these people would be fat. That’s always been effectively obvious to physicians who take their obese patients seriously.

Imagine if diabetes was treated by psychologists, instead of clinicians. The world would be crawling with diabetics, or even more diabetics than there are already!

Q: What about competing hypotheses during the period the “eating-too-much” theory took root? What was the most popular? Why didn’t it prevail?

A: At one time, you had two paradigms battling it out. And what we’re trained to think is that the paradigm that wins is the one that’s right, but in fact, paradigms win for a lot of different reasons. And in this case the dominant hypothesis won because the people pushing it were influential and the people studying restricted-carbohydrate diets on obese patients were not. And it’s that simple.

All you have to do is read the medical literature back through the 19th century and into the 20th century, and you notice that the standard treatment for obesity by physicians and hospitals was always to get rid of the carbohydrates -- the fattening potatoes and fattening bread and fattening beer. In the 1960s, the conventional wisdom dating back 130 years was still around. One 1963 British Journal of Nutrition article says, basically, “Every woman knows that carbohydrates make you fat.” At the same time, you have this group of people who started studying carbohydrate-restricted diets. In fact, at every obesity conference between 1952 and 1973, the only discussion of dietary treatments of obesity would be one that focused on the unusual efficacy of dietary carbohydrate restriction.

But during the 1960s, two researchers with very dynamic personalities, Ancel Keys and Jeremiah Stamler, gained influences in the American Heart Association. Suddenly the American Heart Association is pushing a low-fat, low-cholesterol dogma without the tests ever having been done to actually prove that it does anything beneficial.

So then you get this mainstream theory that fat causes heart disease. And it just snowballs from there. I was stunned to find out was that what we believe today was determined mostly by about a half dozen very influential, quote “authorities” unquote, in the 1970s. There were literally six to 10 men who hosted the conferences, wrote the textbooks, went to the proceedings and wrote the NIH reports for funding. And we believe what those people believed.

I don’t believe in conspiracy theories. But these people could not have done more harm or killed the underlying science more effectively had there been some grand conspiracy manipulated by the sugar industry behind the scenes.

Q. How have theories with very little evidence taken such deep root in our culture?

A. Most doctors aren’t taught to think like scientists. They’re not taught to be skeptical.

They’re basically trained in med school to receive the wisdom of their professors and to memorize it and learn how to integrate it to diagnose patients. They’re simply not taught to be skeptical of what they’re told.

They're also like anyone else: Once we’ve convinced ourselves that something is true beyond a shadow of a doubt, the natural tendency is to interpret all the evidence to reconcile it with this thing we now know to be true. So even if the evidence actually refutes our hypothesis, we’ll find a way to see it as a confirmation. Or at least to reject it as somehow meaningless.

Another problem is the do-good agenda. Doctors and public health officials and nutritionists mean really well; they want to save lives. So they get an idea: Fat causes heart disease. And they know they haven’t done the studies to really test this hypothesis, but they also know that people are dying out there, by the tens of thousands -- hundreds of thousands -- a year. And they want to put a stop to it.

So what do they do? They take a leap of faith. They say, “Okay, I’m not sure this is true, but I have sufficient reason to believe it’s true, therefore I’m going to tell everyone that I’m right and that they should eat less fat. And in order to get everyone to eat less fat, I have to act like I’m right 100%, because I can’t say, ‘I think I’m right’ or people won’t follow my advice.” So they have to be conclusive. Then they have to get a consensus, so everyone appears right. And eventually the whole business becomes about building consensus instead of doing science.

So these people want to save lives, which is an honorable pursuit. But what’s forgotten in this process is that they never actually proved their hypothesis. They never actually tested their hypothesis in any rigorous way, so they don’t know if it’s true or not. And then they get into the position where they’ve been telling people for 20, 30 years, “This is true! This is true! This is true!” And there are not that many people in the world who can step back from this position and say, “Oh, excuse me, I made a mistake.” We’re just not wired that way. I’m not, you’re probably not, and they’re certainly not.

Q. Do you think your book will have a positive impact?

A. What I tried to do was write a book that spoke both to the inquisitive lay reader but also to physicians and smart people outside the field of obesity and public health who might put some pressure on the people inside the field to think clearly and do real science. And if that happens, anything could happen. But I don’t think we should ever underestimate the ability of the dogma to defend itself.

I wrote it because I wanted to have an effect. I kept telling my editors, "We don't need another diet book. We need a book that explains to the medical establishment what's actually going on, what the real science is and what we should believe until compelling evidence tells us otherwise."

I do believe that some of this will be integrated into the conventional wisdom, over the course of about 10 years. So we might see subtle differences in discussions about the actual cause of obesity; it might turn a little more toward the discussion of the regulation of fat tissue. But it’ll be done as though, “Oh, we knew this all along.” There will be no point at which the establishment will say, “Oh you know, until Taubes wrote this book or until Atkins came along, we actually didn’t know that.” That’s extremely unlikely to ever happen.

One of my hopes is that people will buy this book and give it to their doctors…and not because I want to sell more books, although I have nothing against that. The point is that there are potential side effects to going on these diets. Switching from running your body on carbohydrates to running on fats is a big change. It doesn’t hurt to have a doctor overseeing that, helping you lose weight, helping you break the carbohydrate addiction. But then you need a doctor who’s open-minded, who’s willing to work with you instead of just a doctor who’s going to say, "You’re going to kill yourself" or " It doesn’t matter. All diets are the same, etc." And so ultimately I guess I wrote the book for physicians, who might in turn help their patients prevent and cure themselves of these chronic diseases – obesity and overweight being one of them.

About Gary Taubes

Gary Taubes, author of Bad Science and Nobel Dreams, is a correspondent for Science magazine. The only print journalist to have won three Science in Society Journalism awards, given by the National Association of Science Writers, he has contributed articles to The Best American Science Writing 2002 and the 2000 and 2003 editions of The Best American Science and Nature Writing. His 2002 New York Times article, "What If It's All Been a Big, Fat Lie?" addressed some of the same questions he explores at greater length in Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control and Disease (Knopf, October 2007).

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