.

A while back I was very fortunate to connect with a very bright guy named Chi Chiu and recently began having a discussion with him about Gary Taubes new book Why We Get Fat.  I meant to get around to purchasing and reviewing the book myself, but given Chi’s passion for the topic (and the fact that he’s an evidence based uber genius) I asked him to do a guest blog about it.  I have to say…he certainly didn’t disappoint.  If you’re thinking about purchasing or have already read Why We Get Fat, you need to read this!

.

Take it away Chi!

.

This is not your typical review, because at the time of writing it, I do not own the book nor have I read it. It would have been easy for me to simply buy the book, read it, and write you a review, but I chose not to. Instead I’ll let Gary Taubes himself, try to convince me, to buy his book.

Gary Who?

.
Gary Taubes is a science writer who has a Masters in applied physics and one in journalism. He has written numerous articles, but became an overnight sensation with the most controversial article of 2002 in the New York Times, ‘What If It’s All a Big Fat Lie” in which the role of (saturated) fat as a cause of cardiovascular disease was questioned. A bestseller “Good Calories, Bad Calories” followed. Taubes has won several awards during his career and recently he published “Why We Get Fat and What to Do About It.”

Where to start?

Most coaches get annoyed when they get advice from people who have no real world experience. I don’t care that Gary Taubes is a writer-only, and is not in the trenches with us. I’ll judge him solely on the information he provides.  He recently started a new blog to promote his book and there are numerous podcasts and YouTube interviews available, so you can get a general sense of what the major concepts in his book are and whether it is worth spending your hard-earned money on.

My first impression of Taubes is that of a reasonable man, posing reasonable questions.  He does not defy the energy balance and he seems to be genuinely annoyed by the failure of the widely promoted low-fat dogma combined with exercise approach to combat obesity. So let’s see what else he’s got to say.
.

The Significant 20 kcal

His first post on his blog is about the significant 20 kcal per day. It’s a thought experiment on how eating one or two bites (20 kcal) too many can lead to 2 pounds of excess fat a year and 40 pounds in a period of 20 years (365 x 20 kcal x 20 years / 3500). So when you overshoot only 1 energy percent of your energy requirement, obesity will be inevitable.

With only such a small margin, it would be impossible to maintain a stable weight for longer periods. He argues that the body does not have such an accurate bookkeeping system and that therefore the laws of thermodynamics, while true, cannot explain why we do or do not get fat.

The 20 kcal per day thought experiment is actually a classic one, with many variations found in textbooks. He uses it to ridicule the counting calories approach as a means to maintain or lose weight. In a podcast Taubes jokes that the laws of physics only make sense, when you apply math skills of an eighth grader. And although it’s amusing, that doesn’t necessarily make it true.

Whether the body has an accurate enough bookkeeping system or not, is actually irrelevant. Thermodynamics controls this process all by itself, because weight change is self-limiting. Those extra two bites lead to more mass, which needs to be maintained and carried around. This comes at an energy expense and quickly leads to energy equilibrium. The other way around is that losing weight will lead to less mass and lower resting metabolism. These natural restrictions create a bandwidth and explain perfectly why a set point can be reached without high precision bookkeeping (Katan MB 2010).

This is a well-known fact and physiologists have developed mathematical models that accurately predict the required energy surplus to gain a certain amount of mass during a specific period. According to one of those models, a woman in her twenties with a BMI of 23 needs an excess of 370 kcal per day to get to a BMI of 29 in a period of 30 years (Katan MB 2010), a far cry from the 20 kcal Taubes suggests. 

In the same post he devotes at least a dozen paragraphs on why thermodynamics does not explain why we get fat, while ridiculing experts in the process. He uses a restaurant analogy to show that the laws of physics will only tell you that a restaurant is crowded because more people went in then there went out.

Well, the restaurant analogy therefore tells you quite accurately why people get fat and even what to do. Hire a door bitch!

[Note from Mark : A door bitch is a person who stands outside of a bar or club alongside the bouncers and chooses which people beautiful people to let in and which to keep out.  Don’t worry…I had to look it up too]

Of course it doesn’t tell you why people want to get into the restaurant in the first place and he ridicules the experts for not knowing the answer. In my experience, authorities that tell you that they do not know the answer are usually the real experts. Unlike the dime a dozen wannabe gurus whom seem to have all the answers. Taubes also claims to have the answer which I will cover in the next section.

Although the laws of thermodynamics don’t tell you the complete story, they give you the boundaries. You cannot create something (mass) from nothing and the calories in / calories out concept is therefore not useless. After reading this post I was wondering whether this was representative for his book. The fact that he mentions that there is a whole chapter on the significant 20 kcal per day, suggests that the book must be filled with incorrect assumptions and useless over bloated analogies.

Why Diets Work, When They Do

While I found the first post somewhat amusing, the second blog post made me wonder whether I was actually wasting my time. The main concept of his post boils down to the following assumptions. 

1. Carbs are bad and make you fat

.

2. Restricting calories is restricting carbs

.

3. Weight loss through calorie restriction is carb restriction and any weight loss success may therefore be solely attributed to carb restriction. 

He covers a couple diet intervention studies and accuses the authors for not controlling the relevant variables, because they only control calories instead of carbs. The authors of the study actually only set out to control one single variable and that’s (the adherence to) the diet. Nothing wrong with that and for the most part they succeeded nicely. Adherence to the diet is the deciding factor, because it simply makes you eat less.

.

Taubes then goes on that the hypothesis of carb restriction as a causal factor for weight loss, has never been tested and that therefore all results of the covered studies are unreliable. He needs more than 3800 words for this rant and fails to mention one of dozens metabolic ward studies (Grey N 1971, Kinsell LW 1964, Krehl WA 1976) that already refuted his unfounded assumption. No significant difference in weight loss has ever been established in studies designed to compare a low-carb with isocaloric high carb diet. The authors of the covered studies did not control the carb variable, because they already knew that particular answer. It would have been as useful as testing whether hot water is indeed warmer than cold water.

.

Taubes articles and the increasingly popular paleo diet have fuelled the low-carb interest. They seem to inspire each other and Taubes does mention hunter-gatherer tribes more than once in his interviews. The general idea seems to be that hunter-gatherers eat low-carb.

Taubes mentions in a PODcast that Eskimo’s don’t eat carbs at all, while demonstrating great athleticism. This is a common misconception. I actually own a ‘carbs gone wild’ edition of an Inuit cookbook with no less than 240 pages exclusively with plant based recipes. That’s a whole lot of pages for a non-carb population. It comes as no surprise, that a study found that the Inuit actually have a daily carb intake of 127 grams  (Bang HO 1980). Taubes was of 20 times with the calories in/calories out calculation, but with the Eskimo’s he manages to miss the mark by 127 times. The 127 gram carbs may still be considered low-carb, but the Inuit are not living fossils nor are they representative for all hunter-gatherer tribes. The dietary pattern of the Kitava Indians for example, consists of around 70% carbs and yet obesity, diabetes, heart-disease and exercise for that matter, are non-existent in that tribe (Lindeberg S 1994). Paleo is not low-carb per se and carbs are not the causal factor for all western diseases.

It’s All Insulin, Bro!

In his third blog Taubes cites a couple of biochemistry books. The basic premise boils down to the following.

1. Insulin stimulates fat cells to accumulate fat while inhibiting fat mobilization

2. Chronic high insulin levels lead to insulin resistance and less uptake by the muscles and more uptake by the fat cells

3. Carbs lead to a high insulin response, which leads to B, which leads to A, which leads to why we get fat

He then goes to say that this insulin resistance is the underlying defect of obesity, diabetes and heart disease. Notice that he states ‘the’, not one of them or a risk factor, but the defect. He also states ‘underlying’, not contributing, not shared, not correlated, but he suggests it’s the causal factor. We get fat because we become insulin resistant, seems to be his main message.

This does not explain why more than 25 percent of obese persons are not insulin resistant (Stefan N 2008, Wildman RP 2008). The statement that it is the underlying defect, is at least an exaggeration, but that does not mean that insulin resistance may not be one of the causal factors.

Taubes mentions a lot of rodent studies, because human studies on the subject do not exist, for good reasons. To study it, you need to shut down the insulin receptors, but then you’ll die within days, which is an inconvenience. The fact that there is not enough time to get you obese, is of course the major obstacle. The next best thing is to shut down the liver insulin receptors and that’s what researchers have done with the so-called “knock-out mice”.

Having no receptors will of course lead to 100% local insulin resistance, which progressed into systemic insulin resistance with these mice. This was an interesting finding, but even more interesting was the fact that the mice did not get obese (Cohen SE 2007, Michaels MD 2000). So the little evidence that actually exists on the topic, suggests that insulin resistance is not the causal factor of obesity. 

If the insulin hypothesis is the heart of his book, it’s flawed. Not to mention all the nitpicking I can do on the claims he makes on insulin physiology, but it would take multiple posts to debunk all of them, like carbs being the sole driver of insulin response or his rather incomplete picture on how fats get stored and oxidized, etc. I can only add that I find it shocking, how many of his ideas seem to be based on conflicted or even refuted theories.

Saturated Fat, Can You Handle Me Baby?

The last part of his third blog post and the main topic on his fourth is the diet-heart hypothesis. He refutes the idea that saturated fat (SFA) causes heart disease and I have to agree with him. A recent review (Mozaffarian D 2010) containing intervention studies, suggests that saturated fat increases coronary events, but they were mostly JADAD level 2 studies. In other words they were poorly controlled. If you have no idea what that means, may I suggest purchasing Mark’s product How to Read Fitness Research.

In the same year another publication (Ramsden CE 2010) showed no causal relation between SFA intake and coronary incidents. The authors were rigorous in obtaining missing data and shed new light on well-known studies. They also suggest that coronary incidents increase when you replace SFA with omega-6 oil. A practice that is actively promoted for deep frying and may get people killed.

.

An invitation-only symposium last year in Denmark, lead to a recent consensus statement  (Astrup A 2011) shedding even more doubt on the contributing role of SFA in coronary disease. Even Dr. Daniel Steinberg, a world-renowned cholesterol specialist with over 400 published articles, states in his book that he does not support the diet-heart connection.

What to Do About It…according to Taubes

The subtitle of Taubes book is ‘What to do about it’ and that seems obvious. Stay off the carbs, don’t worry about the increase of dietary fat and the obesity epidemic will soon be over.

I counsel ‘how to lose the love handles’ clients, elite athletes, and bodybuilders (two of whom happen to be national champions) so I know a thing or two about weight loss. I have been involved in various nationwide multicenter lifestyle programs for obesity, diabetes, COPD, pregnancy, kids, low back pain, and RSI.

In most cases I co-developed the programs with experts, trained the practitioners and collected the data. In a 2-year multicenter (n=80) obesity program I’ve seen the results of thousands of obesity clients. I’ve seen the effect on weight, on physical, emotional and social functioning. I’ve seen the joy, the pain, the envy, the relapses and the recoveries. I’ve collected data through SF-12 surveys, the MHI-5, diaries, HRV measurements, weight scales and other health related tools. So, I know a thing or two about obesity.

I was shocked by the McKinsey report (2011) on the ‘real’ cost of obesity, which estimates a stellar sum of 450 billion dollar annually in the US alone. I find that hard to believe, because I found the report very limited. We have no idea what causes the obesity epidemic or whether it’s even bad for your health. There is no mention of the obesity paradox, a phenomenon where obese people are healthier and live longer than their slimmer counterparts.

So what about the unnecessary costs of overtreatment of obesity? No mention of confounding variables either. Most studies are from the United States, where the income gaps are huge. We know that low income is correlated with obesity, but most studies have not corrected the relationship of social economic status (SES) on disease endpoints. This is not a minor issue, knowing that in the US around 50 million (!) people lack health insurance (during any period of time).

So do poor obese people die from fat accumulation or from insufficient, but unrelated treatment? Or do poor obese people eat more cheap calorie dense food, deep fried in so-called heart-healthy omega-6 oil, which may get them fat and killed at the same time?

We also know stress kills and obese people have a lot to stress about like negative self-image issues, ridiculing, and even discrimination. On top of that, most of them weight cycle their whole lives, adding more to the stress, while increasing inflammation, which seems to be an integral part of weight cycling.

So what is it, that makes the obese sick? Is it fat accumulation, is it excess omega-6, is it lack of health-insurance, is it a negative self-image, an increase of inflammation, discrimination and therefore the McKinsey report itself? The interventions to heal the obese may actually contribute to the sickness, the increased mortality and therefore to the cost of obesity.

Obesity is not a simple problem that can be solved by buying a book, based on some serious flawed theories. If you think you are actually helping your obese clients with a low-carb diet and high intensity interval training, you may in fact have shortened their lives by a couple of years. Working with the obese requires specific knowledge and commitment, so if your program is an overweight XXL version of the program you have for your non-obese clients, please quit and give your clients a refund!

Not Your 23 Dollar Bill

From a hypothesis point of view, I’ve seen nothing novel in Taubes vision in Why We Get Fat. fat. Anyone who has some notion on alternative nutritional views will notice the familiar concepts. And of course some of it has merit, but some of it is out of context or even downright wrong.

If you already bought the book, or were sold on the concept, don’t feel bad about it. It’s like accepting counterfeit money. Nobody will blame you for it. It’s not like you accepted a 23 dollar bill and Taubes book is not as obvious as a 23 dollar bill. It looks like real money, it feels real money. it may even smell like real money, but that doesn’t make it real.

Then there is the ethical question. If it can pass for real, because people do tend to lose weight when following a low carb diet, what would be the harm in embracing the book? The same holds true for counterfeit money. If it looks real and you can pay with it, why should you stop using it?

There are actual several reasons. First of all is that someone gets hurt further down the line, because it will come out eventually. This will reflect badly upon you, which is of course your problem. But mind that it will reflect badly on our profession as well, which concerns us all.

The second reason is that we make progress, because we have rational in-depth theories that we turn into great experiments with outcomes we learn from.  Storytelling without conclusive evidence however, has kept us in the dark ages for centuries.

Do you really want to return to medieval ages where science had no place and babies died for what we now consider trivial reasons? I don’t think so!

Conclusion

Believing is accepting without proof, which is not a bad thing by itself, if you’re open to non-supporting evidence. Taubes selective citations and inappropriate examples suggest that he is more than just a believer, he seems to be a radicalist, ridiculing anyone opposing him. Judging Taubes own blog posts and interviews, I can only conclude that his book is unreliable. It’s not all bad, but if you cannot separate the good from the bad information, it will make you unreliable.

.

The many flaws in his hypothesis make it impossible to answer the question of why we get fat. The subtitle ‘and what to do about it’ offers no real solution and does not take into account the complexity of (treating) obesity. This is the reason why I did not buy this book and will not recommend it to anyone else.

References

• Astrup A (2011), Dyerberg J, Elwood P, Hermansen K, Hu FB, Jakobsen MU, Kok FJ, Krauss RM, Lecerf JM, Legrand P, Nestel P, Risérus U, Sanders T, Sinclair A, Stender S, Tholstrup T, Willett WC. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010? Am J Clin Nutr. 2011 Apr;93(4):684-8. Epub 2011 Jan 26.
• Bang HO (1980), Dyerberg J, Sinclair HM. The composition of the Eskimo food in north western Greenland. Am J Clin Nutr. 1980 Dec;33(12):2657-61.
• Cohen SE (2007), Kokkotou E, Biddinger SB, Kondo T, Gebhardt R, Kratzsch J, Mantzoros CS, Kahn CR. High circulating leptin receptors with normal leptin sensitivity in liver-specific insulin receptor knock-out (LIRKO) mice. J Biol Chem. 2007 Aug 10;282(32):23672-8. Epub 2007 Jun 7.
• Grey N (1971), Kipnis DM. Effect of diet composition on the hyperinsulinemia of obesity. New England Journal of Medicine, Oct 7, 1971; 285 (15): 827-831.
• Katan MB (2010), Ludwig DS. Extra Calories Cause Weight Gain — But How Much? JAMA, January 6, 2010—Vol 303, No. 1
• Kinsell LW, et al. Calories do count. Metabolism, Mar, 1964; 13: 195-204.
• Krehl WA (1967), et al. Some Metabolic Changes Induced by Low Carbohydrate Diets. American Journal of Clinical Nutrition, Feb, 1967; 20: 139-148
• Lindeberg S (1994), Nilsson-Ehle P, Terént A, Vessby B, Scherstén B. Cardiovascular risk factors in a Melanesian population apparently free from stroke and ischaemic heart disease: the Kitava study. J Intern Med. 1994 Sep;236(3):331-40.
• McKinsey Quarterly (2011) The real cost of obesity, January 2011
• Michael MD (2000), Kulkarni RN, Postic C, Previs SF, Shulman GI, Magnuson MA, Kahn CR. Loss of insulin signaling in hepatocytes leads to severe insulin resistance and progressive hepatic dysfunction. Mol Cell. 2000 Jul;6(1):87-97.
• Mozaffarian D (2010), Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2010 Mar 23;7(3):e1000252.
• Ramsden CE (2010), Hibbelna JR, Majchrzaka SF, Davisa JM. N-6 Fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. British Journal of Nutrition (2010), 104: 1586-1600
• Taubes G Blog post 1 to 4 on www.garytaubes.com

Chi L. Chiu has a master’s degree in nutrition, one in health sciences and is currently a grad student psychology. He is the owner of Chivo personal training, Chivo physical therapy, Chivo sports performance and Chivo Continuous Professional Development center for lifestyle professionals. He is a member on various government en non-government funded advisory boards and works with clients on a daily basis.

.

PS: Leave a comment below and let me know what you think.  Agree?  Disagree?

.

PPS: No…he doesn’t have a blog.  I’m trying to push him into it…trust me.

.

.

The other day I wrote a post in which I included a video talking about the science of willpower (self regulation). If you missed it, you can check it out HERE.
 

..
In any case, the main take home points were:
..

..
- When it comes to willpower, we only had a limited amount to expend within any given day and it doesn’t seem to be specific to any specific task. In other words, when you use restraint to not dropkick the complete jackass who just went head of you in the express checkout with more than 8 items you use up some of the willpower you might’ve needed that night to make it to the gym or prevent yourself from eating an entire bag of Doritos when your team loses in the hockey playoffs.
.
- Some people are particularly more succeptable to using up their willpower than others.
.
- We can train our willpower to get stronger just like we train our muscles with resistance training. Using restraint and practicing self discipline in the short term (i.e., really grinding it out when you don’t feel like sticking to your plan) will help you build up greater willpower in the long term.
.
- Planning exercise bouts in advance takes away from the need to use willpower to show up for workouts as they are already planned.
.

.
My Thoughts
.

..
After watching the video I had a few other thoughts too…
.
- If using our willpower helps to strengthen it, does not using it cause it to become weaker? This would certainly make sense and it would explain why it is so hard to get back on track after a lengthy layoff.
.
- If this is true, does not using restraint and frequently checking Facebook, Twitter, email, and text messages mean we’re weakening our willpower in the long term?  If so, I’m dead. 
.
- If willpower becomes depleted over the course of a day, does it make sense to train or prep meals in the morning for those who have a history of blowing off late day training sessions or meals.
..

.
Action Points
..

.
I guess we don’t have the answers to the questions above, but they are certainly worth considering. Knowing what do do know though…I think we can confidently take some specific actions.
.
- Plan the days and times you’re going to train in advance. Truth be told, I’m not into programs that are set in stone and I’m all for adusting difficulty based on how you’re feeling, mood, etc. But when you’re set to train…you should train.
.
- Along the same lines, I don’t think it matters whether you eat 1, 3, or 6 meals per day, but I think you need to have a plan regardless…especially in the beginning…even if it is just changing one small habit at a time.  Plan it.
.
- When just starting to exercise or improve your nutrition (or coming back after a layoff) you have to fake it till you make it. You’ll have to grind it out…but it will get easier.
..

.
Research shows you can bank on that!

.

.
If you’re a regular reader of my blog you’ll know that I think long term weight/fat loss has less to do with physiology and more to do with psychology.  Now don’t get me wrong, you have to eat the right foods and do the appropriate exercise.  That is a given.  But I think all the arguments on the internet about the amount of carbs we should eat, the type of exercise we should be doing, and the magical supplements we should be taking are all secondard to having the appropriate psychological environment for weight loss.  After all, a plan you don’t follow is only as good as the paper it is written on. 

.

If you think back to the number of times that you or someone you know has failed at achieving their dream body, has it been because they didn’t know what they should and should not be eating?  Has it been because they didn’t know that they should exercise regularly?  Or has it been that even when a plan was going well, they were unable to make it stick or to follow through on the commitment in the long term?

.

I would say that the latter is definitely more common.  But before I get hate mail about this I want to touch on two very important points. 

.

1 - There are some people who are limited by other metabolic issues like food intolerances and so on.  I can acknowledge this and I HAVE seen in…but it is unlikely and this probably does not apply to you.  And even if it does, you still need to get a solid exercise and nutrition program in place before you start to address these details.    Without such a plan, you’ll never be able to lose weight regardless of whether or not you’ve addressed these issues.

.

2 – Not sticking to the plan may have something to do with willpower, but you are not necessarily to blame for this problem.  In fact, it frustrates me when fitness professionals belittle and blame their clients for something that may not be as much in their control as we’d like to believe.

.

Fortunately, today I’ve got a really great explanation for WHY our willpower fails and a couple methods to improve our ability to self regulate our behaviours so we CAN stick to our diet and exercise program and get the results we deserve. 

.

Check out this video by my friend and colleague, Dr. Kathleen Martin Ginnis on willpower, planning, and exercise adherance.  I think many of you will be able to relate. 
.

.

Does this make sense?  What do you think? Could we not use this to improve exercise AND diet?