Fat, Sick Nearly Dead

Gary Taubes, co-founder of the Nutrition Science Initiative, has just published a new commentary arguing that the way we think about obesity is the result of science politics instead of good science.

The former science journalist argues in his most recent essay, published in the British Medical Journal, that we still don’t know what really causes weight gain, and that the idea that obese people just eat too much neglects much of the research done on diet and weight loss.

He also claims that the common solutions to obesity — encouraging people to eat less and exercise more — have been ineffective, because they are based on misunderstandings of why people become fat.  

Fatter people are not merely less disciplined, he has argued. And leaner people deserve no praise for their ability to keep their bodies svelte. Each of us is more or less a roll of the genetic dice, and some people are just more likely to grow chunkier than others.

The key, says Taubes, is eliminating the dietary triggers that cause our bodies to store fat in the first place. The real triggers for obesity are sugars and high-glycemic carbohydrates (such as wheat), which have been shown to stimulate the insulin response and cause our fatty tissue to accumulate more fat.

A controversial diet

Since 2002, Taubes has been publishing articles and books — “Good Calories, Bad Calories,” (Knopf, 2007) and “Why We Get Fat,” (Knopf, 2010) — arguing that it is carbohydrates, not fat, that cause disease and obesity. Most of what is taken for granted by the mainstream medical and nutrition community is based on incomplete and questionable science, Taubes argues.  

Over the years, he has had his critics. His detractors say he has ignored mounds of research that contradicts his positions, his own meat-laden diet is “gross,” and some of the experts he quoted in previous work later claimed Taubes twisted their words and misrepresented their views.

Taubes quoted John Farquhar, a cardiologist at Stanford University in his first piece on obesity in the New York Times Magazine in 2002, but Farquhar later claimed his words — and those of his colleagues — had been manipulated.

“I was greatly offended at how Gary Taubes tricked us all into coming across as supporters of the Atkins diet,” Farquhar later said in a newsletter published by the Center for Science in the Public Interest.

Other scientists, like low fat-diet promoter Dean Ornish, MD, balk when Taubes says that diets low in fat and rich in carbohydrates are what really cause obesity.

Taubes said in an interview with Business Insider that he is not trying to push a diet, he simply wants the scientific and medical community to widen the discussion on the actual causes of obesity and the reliability of the available research.

In this recent paper, Taubes points to forgotten scientific research that he claims supports his long-held contention that spikes in insulin levels caused by sugar and starches are really what balloon our waistlines. 

A controversial history

Taubes claims the alternative “insulin hypothesis” has its own long but neglected history and was once a serious alternative to the conventional “calories in, calories out” theory that has dominated nutrition science since the mid-20th Century. 

Most scientists — even diehard fans of the energy balance hypothesis (a.k.a the “calories in, calories out” theory) don’t really know where it came from, or that there ever was an alternative theory, Taubes said.

The conventional “energy balance” hypothesis is a tautology, Taubes claims. People eat too much, so they become obese.  But obese people must take on more calories to sustain their weight, so obese people eat too much because they are obese.

Taubes claims that an alternative theory, proposed by German and Austrian scientists in the early 20th century, may do a better job of explaining how our bodies accumulate and store excess fat, and why some people grow so much fatter than others.  

Wilhelm Falta and Gustav Von Bergmann were among the first researchers to argue that underlying biological factors — not just what we eat — regulate how fat we get.

They argued that obesity was a “hormonal, regulatory disorder” and not simply the result of eating too much or exercising too little. However, American health and nutrition science in the years that followed WWII ignored these ideas.

Taubes thinks it is time to revive their theories.

Bodily Chemistry

In our bodies, insulin spikes when we eat something that signals to fat tissue to store the sugar in our blood as fat. Falta believed that more insulin means more sugar being turned into fat, making us fatter.

“When insulin was injected into both diabetic dogs and humans in the laboratory as early as the 1920s, they would put on weight and fat,” Taubes said. 

Gustav Von Bergmann — for whom Germany’s highest honor in medicine is named — was another scientist working on a slightly different problem, but it led him to a similar conclusion. 

He was working on the problem of not only why some people gained weight more than others, but why people gain weight in different places. He came up with the concept of lipophilia (literally, “love of fat”).

Some cells are “lipophilic” than others, Von Bergmann thought. Those tend to gather more fat than other fat cells.

People that are “constitutionally predisposed to fatten” (we would now say genetically) have cells that are more lipophilic. This, thought Von Bergmann, was also the reason we tend accumulate fat in certain places and not others (the belly and not the forehead, for example).

So, if some fat cells were gathering more than their “fair share” of energy consumed (i.e. calories eaten), this must mean that other parts of the body were being deprived of energy and the body would compensate by growing hungry or tired.  

“If you discuss insulin regulating fat accumulation, you are pretty much stuck with carbohydrates [sugars and starches] in the diet being the problem,” Taubes said.

The effect of the war

This notion would later prove unpopular with the handful of men who dominated American obesity research in the second half of the 20th Century and was, in some cases, literally erased from the scientific literature.

Later scientists were interested in and supported many of Falta and Von Bergmann’s ideas, says Taubes. But anti-German sentiment in the aftermath of WWII and the rise of English as the language of science left this research largely forgotten.  

“Pre-war, they would discuss different hypotheses to explain what they were seeing and the observations that supported them and the studies that were done that supported them and the studies that didn’t support them,” Taubes said. “It was a very scientific approach. And then post war it became all about energy balance, and gluttony and sloth, and there’s nothing left to discuss, nothing left to question. So even the type of dialogue changes. It ceases to be a scientific dialogue after the war.” 

By the 1960s, most of the people studying obesity in the United States were psychologists and psychiatrists. Obesity was treated as a mental disorder, not a physiological one.  

“They’re not trying to figure out why fat cells accumulate too much fat, they are trying to figure out why people eat so much or exercise so little,” Taubes said. “It’s all this energy balance conception, as opposed to the simple question, why do you put too much fat in your fat cells?”

“The more I understood this, the crazier it seemed,” Taubes said. “We had this disorder of excess fat accumulation, and yet researchers write entire papers, journalists write entire books that never actually discuss what regulates the amount of fat that goes in and out of fat cells. It would be like writing a book about why there are giants and dwarves, without ever discussing growth hormones and growth hormone receptors and other regulators of human growth.”  

Taubes cites other research from the 1960s that shows the hormone insulin is responsible for how much fat cells accumulate.  

Had American scientists been aware of Falta’s and Von Bergmann’s ideas, they might have been able to knit them together into a single coherent alternative to the dominant energy balance hypothesis.

The Present Situation

Taubes concludes his latest essay by calling much of the current experimental research “flawed” and “substandard science” and says he has founded the Nutrition Science Initiative to perform independent, skeptical research into the real cause of obesity.

What is lacking is a body of randomized, controlled studies that evaluate which diets actually work. He believes observational studies are pseudo-science. 

“They’re basically conventional wisdom confirmation machines,” he said. “If you think about who eats a mostly plant-based diet, it’s not poor Asian emigres, who aren’t in these studies anyway.”

“They’re people who think that a vegetarian lifestyle is a healthy lifestyle. They are health-conscious individuals, and if you actually look at the data they are a higher socio-economic status, they are better educated, they smoke less than meat eaters.”

“Like a comparison a friend of mine said, you’re basically comparing Berkeley vegetarians who eat at Alice Waters’s Chez Panisse once a week after yoga practice to redneck truck drivers from West Virginia on the town at Denny’s.”

“On one level, if you are looking at experimental evidence from clinical trials we know that obese and diabetic individuals do much better on diets that have a lot fat and saturated fat in them,” Taubes said.

To truly be effective, a study would have to select randomized groups of people, put each group on a different diet and then follow them for several years to see how they do.

To this end, Taubes is launching the Nutrition Science Initiative, in the hope of sponsoring objective scientific research into the causes of obesity. He hopes to conduct such studies there.   

But such experiments would also require a high-degree of compliance: sticking to any diet for 10 years or more can be tough.

His own diet, as reported on his blog, closely resembles the controversial Atkins Diet. By ditching sugars and starches for meat and cheese, Taubes believes some dieters predisposed to getting fat can keep the insulin trigger at bay, and thus prevent fatty tissue from absorbing energy. 

“I do indeed eat three eggs with cheese, bacon and sausage for breakfast every morning, typically a couple of cheeseburgers (no bun) or a roast chicken for lunch, and more often than not, a ribeye or New York steak (grass fed) for dinner, usually in the neighborhood of a pound of meat. I cook with butter and, occasionally, olive oil (the sausages). My snacks run to cheese and almonds. So lots of fat and saturated fat and very little carbohydrates. A deadly diet, according to Dr. Oz.”

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