The Case for Keto: A Critical Review

I also cross-posted this review to substack, because that’s where all the cool kids are publishing stuff nowadays.

Introduction

Here we are again. Another Gary Taubes book. After reading it, I have pretty much the same feelings about this book as I did his previous books. To the lay reader it probably has the veneer of a thoroughly researched book by an author who sees through all the BS that’s out there and presents a no-nonsense recitation of the facts. But the reality is quite the opposite: Taubes seems to ignore a lot of evidence that is contrary to his ideas and the evidence he presents is usually taken out of it’s original context and placed into a new context that is created to really change the original meaning. I would say that this is Taubes’s biggest failing in writing the book, but I’m fairly certain this is not simply incidental human error.

Another flaw of the book (in my opinion) is a heavy reliance on a kind of anti-intellectual rhetoric mixed with a weird version of classism. What I mean by this is that nutritional experts and nutrition researchers are treated with contempt. It should be noted that he only treats the researchers that publish findings contrary to Taubes’s theories with contempt. If they happen to align with his theories they are treated with reverence. The narrative is very much infused with an elite ruling class of oppressive nutritional authorities and an innocent proletariat that just want to lose weight and go about their lives. You can believe all that if you want. I can’t stop you. Conspiracy theories are certainly in vogue nowadays.

Anyway, I am writing this introdution in between trying to sooth my finicky 4 month old son, so my thoughts my not be totaly coherent, but I think you are picking up what I’m laying down. But you didn’t come here for the introduction. You came here to witness me pick apart a book.

Not the Introduction

The first paragraph of TCFK is how we should have listened to a guy name Edwin Astwood:

On June 22, 1962, a Tufts University Medical School professor named Edwin Astwood tried and failed to correct how we think about the cause of obesity. We have been living with that failure ever since.

Taubes spends the next two pages building Astwood up by stating what a brilliant guy he is and listing his credentials, but he does not mention any of Astwood’s dietary arguments or what he believed and why. The thing Taubes does mention is the first sentence of a 1962 speech that Astwood gave in Chicago where Astwood says that obesity is similar to a sexually transmitted infection, in that the patient is often blamed.

So what are some of Astwood’s theories on obesity? Dr. Astwood argues that obesity is actually a heritable condition caused by a “defective enzyme” and dieting won’t help.

I wish to propose that obesity is an inherited disorder and due to a genetically determined defect in an enzyme; in other words, that people who are fat are born fat, and nothing much can be done about it. (1)

Big, if true. That would render the whole point of Taubes’s book moot, because why follow a ketogenic diet? It won’t matter if you’re fat or thin. Astwood goes on to argue that that there’s nothing wrong with being fat; in fact, it can be quite desirable in women if the fat is deposited in the right places. Seriously, he spends several paragraphs on this point. In doing so he gives us a phrase that I haven’t been able to forget: “I would not want to wager about how many enzymes determine the shape of voluminous pulchritude.” Quite a turn of phrase!

On page 23 Taubes invokes a narrative that he’s used before. To wit, German scientists developed the correct idea that obesity was caused by poor hormone regulation, but after Germany lost WW2 the science that had come from Germany fell out of favor. What replaced it was the incorrect notion that a calorie surplus caused obesity. The good German research was all but forgotten. Or that’s how Taubes tells it, at least.

Does he provide the slightest bit of evidence for this? Not at all, and in fact there is evidence to the contrary. German scientists were highly valued in the United States and elsewhere both during and after WW2. In fact, the US (and other countries like England) made a great effort to poach German scientists as a kind of “brain drain” operation. But nevertheless it is an interesting story for why Taubes’s pet theory of obesity has not been widely accepted for nearly a century.    

On page 27-28 Taubes dismisses the idea that issues of psychology could play a role in obesity, and seems to denigrate psychiatrists as something akin to grifters.

[O]besity treatment had become the purview primarily of psychiatrists and psychologists. These were the medical professionals charged with teaching fat people to get thin and supposedly elucidating our understanding of the disorder. They saw the obese and overweight, not surprisingly, from their own unique perspective and context, as clearly suffering from mental, emotional, and behavioral disorders. They found it easy to ignore a revolution in endocrinology, because that wasn’t their area of study.

A couple paragraphs later Taubes goes back to Germanophobic theory of obesity and writes the following:

Astwood’s proposition and his theory, and the thinking of the prewar German and Austrian authorities, effectively disappeared. In 1973, after forty years of research had worked out the science of fat metabolism and storage in great detail, Hilde Bruch, the leading U.S. authority on childhood obesity, remarked on its absence. It was “amazing how little of this increasing awareness,” she wrote, “is reflected in the clinical literature on obesity.”

Hilde Bruch was a German-born psychiatrist that emigrated to the US in the 1930s. And that quote is taken from a text where she is absolutely not referring to a dearth of German research in the literature or even a lack of discussion on hormonal regulation. Rather, she was referring to the lack of behavioral science and family systems theory in obesity research. In other words, Bruch does not refer to what Taubes states and instead the “leading U.S. authority on childhood obesity” says precisely the opposite of what Taubes claimed a couple paragraphs earlier.

Taubes likes to cite Bruch in his other works, too, but fails to really put her works into context. Because if he did it would hurt his case for keto. One example is from the text Taubes cites here. As she explains in the text, there are really only two obesity treatments in her view: “manipulate the energy balance so that an obese person expends more than he takes in and thus loses weight.”  The other is to “effect a change in the person himself so that he no longer abuses the eating function in futile efforts to solve other problems of living, and to help him gain sufficient inner strength so that he can face the task of reducing without undue mental strain.” (2)

She also discusses the impact of family dysfunction to obesity in her earlier work:

In such an environment which does not offer adequate emotional security, food gains an inordinate importance. Food is offered and received not alone for the appeasement of a bodily need but it is highly charged with emotional value. To many mothers the offering of food represents the only way of expressing their affection and devotion. The child increases his demands as his need for gratification and security in other respects remains unsatisfied. On the other hand, enjoyment of physical activities and social relation is greatly restricted. The atmosphere of fearful apprehension confers upon them the meaning of danger, threat, and insecurity. The development of obesity in such surroundings becomes comprehensible. Overeating and inactivity bring about the increasing storage of fat. But these symptoms do not befall a child suddenly; they are closely connected with his whole development. (3)

On page 29 Taubes is incredulous that medical textbooks don’t present alternative hypotheses that “compete” with the calorie model of obesity, stating “The absence of a competing theory is remarkable, especially given the stakes and the profound implications.”

One wonders if Taubes is equally incredulous that alchemy isn’t taught as a competing theory in chemistry textbooks, or that intelligent design is not included in (most) biology textbooks as a “competing” theory to evolution.

On page 30 Taubes mentions Dr. Reginald Passmore whom Taubes says was the author of “definitive” nutrition information for a generation of British medical professionals.

Passmore coauthored an article in the British Journal of Nutrition that began with the declaration: “Every woman knows that carbohydrate is fattening: this is a piece of common knowledge, which few nutritionists would dispute.” This observation resonated almost perfectly with what laboratory researchers were learning at the time about the hormonal orchestration of fat storage and fat metabolism.

That article certainly began with that declaration but ended quite differently. The article was about a study where people were fed excessive amounts of carbohydrate, with the expectation that the extra carbs would be converted to fat. But what Passmore found didn’t support that conclusion:

In each of the three series of experiments described above, it was found to be difficult to raise the RQs of the subjects significantly above 1.00. Thus, despite the large intakes of carbohydrate, there was no evidence of the net conversion of carbohydrate into fat in substantial amounts within 24 h. (4)

Emphasis mine. Taubes has a nasty habit of taking the words of researchers out of context and making them fit his own narrative. When writing an article, authors like to inject the mildest bit of drama into what would otherwise be a dry recitation of findings, so they craft their findings as if their results were surprising in some way. In this case the story was: Everyone knows carbohydrates are fattening, but we put this common wisdom to the test and our results might surprise you. Here’s what we did and how it challenges the conventional wisdom.

So it’s funny that when Taubes writes “this observation resonated almost perfectly with what laboratory researchers were learning at the time” it certainly wasn’t what that author was learning at the time. Or it would be funny if you think lying to a gullible audience is funny.

Throughout the text Taubes takes a very anti-establishment stance. He has taken similar stances in his other books, but I think TCFK is the most explicit and most pointed when it comes to attacks on “nutritional authorities.” Here’s a representative example on page 37:

[T]he nutritional and academic authorities have failed us, and they and we should acknowledge that. Had they not failed us, we would, almost by definition, never have reached this point of epidemic obesity. That’s the context of this discussion and all that follows. I believe it should be the context of every public discussion on obesity and weight control. If the conventional thinking and advice worked, if eating less and exercising more were a meaningful solution to the problem of obesity and excess weight, we wouldn’t be here. If the true explanation for why we get fat were that we take in more calories than we expend and the excess is stored as fat, we wouldn’t be here. So many more of us would be lean and healthy, and books like this one would not be necessary.

Emphasis in the original. It should be noted that, although Taubes frequently attacks the experts, when he finds one to quote that advances his pro-ketogenic argument, he goes out of his way to list his/her educational credentials, make sure you know they held professorships, mention how many years they did research, etc. You can see this very clearly in the first few pages of the book where Taubes lauds Dr. Astwood for pages, even describing an award he had won and comparing it to the Nobel Prize (“He won the Lasker Award, considered one step below the Nobel Prize, for the thyroid work”). So when it comes to attacking authorities versus embracing authorities, Taubes definitely wants to have his cake and eat it, too.

But I would like to address the maligning of the experts here. As I write this, the United States is mired in the depths of the COVID-19 pandemic. We have by far the most cases of the disease, and we are tied with the European Union for the most deaths.

Other countries have managed to get this pandemic under control. Where the US has over 200,000 new confirmed cases per day, South Korea has 745 cases/day, China has 100 cases/day, Taiwan has 5 cases/day, and New Zealand has 2 cases/day.

Why is that? Are those countries getting better health advice that the US? No, their public health officials were saying the same thing ours were: mask up, social distance, stay home if possible, wash your hands, etc. But there was clearly a difference in the application and execution of this advice.

Many factors led to the US being the hardest hit country: the White House’s efforts to “play down” the importance of the virus, inability to mobilize the resources of the federal government to acquire and effectively distribute supplies like ventilators and masks, our inability to perform widespread testing and contact tracing, nearly an entire political party that pretended the virus wasn’t real and openly participated in super spreader events… we could go on. But the advice of the epidemiologists and public health experts like Dr. Tony Fauci, Dr. Vin Gupta, and Dr. Peter Hotez is not to blame. These experts have been communicating every day exactly what we need to do to mitigate the spread of the virus for nearly a year now, but as a society we have been unable to universally coalesce around these messages and engage in effective mitigation and prevention.

This is similar to the obesity “epidemic.” The US also has the most overweight and obese people per capita. Again, why are other countries leaner and healthier in this respect? Other countries have nutrition experts and authorities that say basically the same thing our experts say. The problem in the US is that we are unable or unwilling to really apply those recommendations. It also does not help when people like Taubes write nutrition books full of deliberate misinformation.  

One of the key elements in Taubes’s argument is that some people are simply “born” thin, while others are less fortunate and are born with a metabolic deficiency which causes them to become fat. This argument is distilled on page 45-46:

Those who fatten easily are profoundly different from those who don’t and may have been from the womb onward. Their physiology is different; their hormonal and metabolic responses to foods are different.

If these differences are so pronounced, you would think that there would have been ways to identify and differentiate these individuals long ago. Much like how you can identify people with diabetes with a simple OGTT. But I know of no such test and Taubes doesn’t present evidence of any type of test or even hypothetical investigative tool that would do so. One would imagine that (if Taubes is correct) such a tool would be very valuable for identifying those people at very high risk of developing obesity and therefore a likely milieu of other chronic diseases such as heart disease, cancer, diabetes, hypertension, etc.

In fact, the topic has been widely studied and no enterprising researcher has been clever enough to cash in on creating such an important diagnostic tool. Taubes tries to conceal that from you, though. Take, for example, a passage from this very same page as the above. Taubes discusses the hearings before the Select Committee on Nutrition and Human Needs of the United States Senate in 1977:

I want to be sure we don’t oversimplify,” Bellmon said. “We make it sound like there is no problem for those of us who are overweight except to push back from the table sooner. But I watched Senator [Robert] Dole in the Senate dining room, a double dip of ice cream, a piece of blueberry pie, meat and potatoes, yet he stays as lean as a west Kansas coyote. Some of the rest of us who live on lettuce, cottage cheese and RyKrisp don’t do nearly as well. Is there a difference in individuals as to how they utilize fuel?”

The doctor in the hearing replies “We constantly hear anecdotes of this type, but, to date, people doing research in this field have been unable to find clear evidence that people remain thin because of some special metabolic characteristic.” But Taubes would have you believe that a slavish devotion to an ancient religion led the good doctor to this belief and not a lack of clear and compelling evidence.

Taubes does this throughout the book; framing a conclusion based on facts and evidence as if it is some sort of irrational, unscientific dogma. In reality, Taubes is guilty of the very thing that he accuses others of doing. Taubes himself has not meaningfully changed his beliefs on why people get fat in nearly 20 years despite all evidence to the contrary. He has called scientific studies that don’t fit his beliefs pseudoscience, and he has denounced the researchers and results he himself funded (through his organization NuSI) that he expected would prove his theories correct. He has even openly admitted that he would not alter his beliefs no matter what the evidence demonstrates.  

Whenever I go back and read ones of Taubes’s references I very often find that Taubes took the original author out of context, and something immediately following (or immediately preceding or both) will undercut the point Taubes is trying to make. I imagine Taubes at home on his computer writing a draft of TCFK, pulling an old nutrition book off his bookshelf, flipping though it while his finger traces the words and thinking “Can’t use that… Nope… That’s no good… Hmmm, doesn’t really support what I’m saying… Definitely not that… Okay, I could probably use that sentence as long as I make sure to leave it ambiguous as to what he’s actually talking about… And that’s it. Can’t use anything else.”

One such example is Taubes’s mention of a 1936 textbook on metabolism as an example of why thinking that the body strictly regulates calorie intake and fat accumulation is ridiculous. Page 52:

[O]ther experts in the early decades of the twentieth century saw it as a reason to question the whole way of thinking. Eugene DuBois, for example, the leading authority on human metabolism in the United States in the 1920s and 1930s, suggested in his seminal textbook that this simple mathematics tossed the whole energy balance (gluttony and sloth) concept of body weight regulation into the realm of the absurd. Considering how exquisitely accurate the imbalance has to be to avoid obesity, how few calories actually have to be stored in excess as fat every day to become obese, to lead to tens of pounds of excess fat every decade, he said, “There is no stranger phenomen[on] than the maintenance of a constant body weight under marked variation in bodily activity and food consumption.” (Another phrase used by physicists to describe this kind of problem is “spherically senseless,” meaning it makes no sense no matter which way you look at it.)

DuBois then goes on to illustrate in pretty striking detail how exactly this phenomenon occurs. Like I mentioned earlier, many researchers like to present problem/conundrum/question upfront, then go on to answer the question they proposed with their work. Much like Darwin is taken out of context by creationists to make it seem like Darwin himself didn’t believe in natural selection, Taubes does the same with the authors he cites.

DuBois actually seems to endorse the gluttony and sloth concept of obesity that Taubes rails against:

[I]n some individuals, with apparently normal endocrine glands, the weight increases to the point where it exceeds the normal limits. These are the cases of so-called simple or exogenous obesity. The term exogenous indicates that there is no endocrine disturbance, but that the fault lies either in too much food or too much laziness. It is not strictly exogenous because greediness and laziness certainly rest within the body. (5)

DuBois also throws cold water on Taubes’s metabolic defect theory:

We must conclude that simple or constitutional obesity, which seems to be in many cases an hereditary disease, is accompanied by no abnormality of metabolism striking enough to be demonstrated by our present methods.

On page 45 Taubes attacks Jean Mayer for accepting the fact that it’s pretty difficult to gain weight if you exercise a lot or don’t eat anything.

Our current obsession with physical activity is largely rooted in Mayer’s proselytizing in the 1970s. But at the beginning of his career in the 1950s, he studied a strain of obese mice. “These mice,” he wrote, “will make fat out of their food under the most unlikely circumstances, even when half starved.” […] Mayer’s mice did not get fat by overeating. They got fat by eating. Half-starving them didn’t make them lean.

Emphasis mine. That quote comes from a book on overweight that Mayer wrote in 1968. Taubes doesn’t cite any page number for this quote, but it’s found on page 49 for those that are curious.

Taubes has to remove quite a bit of context here to make this passage fit his anti-exercise narrative. If you bother to read the couple paragraphs preceding the above quote you will find that

  • The mice are inbred to create abnormalities like obesity to make it easier to study the condition. I’m not sure Taubes wants to equate obese people with inbred mice.
  • One of the reasons the mice are obese is because they don’t exercise like normal mice. Mayer describes them as “extraordinarily inert” and basically don’t move. He states that you can get them to lose weight by putting them on a treadmill or by introducing genes that cause them to pace around their cages all day. Sounds like this could be evidence that physical activity can cause weight loss after all.
  • Another thing that Mayer mentions is that if you put the obese mice on a reducing diet they will lose weight, but interestingly they lose much more muscle and less fat than you might expect. Mayer explains that this is because their particular abnormality makes it easier to burn lean muscle for fuel rather than fat. Kind of an interesting factoid, but I’m not sure that this aberration in inbred mice is terribly relevant to humans. (6)

If it’s not obvious to you, there are a lot of problems when you try to apply some logic to this bizarre thinking. Let’s take an example of ex-athletes. After an elite athlete retires from their sport, it’s not uncommon for these athletes to then gain some (or quite a bit) of weight. See Charles Barkley or Mike Tyson. For Taubes’s mice analogy to be true in humans you would have to believe that elite sportsmen like Tyson, Barkley, and others were actually just born obese. Their training and physical activity played little to no role in their lean periods while they were professional athletes, and the lack of intense training and playing at an elite level played no role in gaining weight after their retirement. Moreover, what appeared to be lean muscle on their bodies during their heyday was really just extra fat, since they can never be truly lean. Maybe what appeared to be muscle on Mike Tyson was just hardened fat, and much like the obese mice on low calorie diets didn’t actually have much lean muscle.

Or maybe all these obese athletes were on strict ketogenic diets while training and playing and just as they retired, they all went back on bread and pasta. I mean, this thought experiment really strains credulity.

There was a period of time around the 1940s to the 1960s where incoming freshman to Ivy League universities like Harvard would be asked to strip naked and be photographed from different angles as part of the new student orientation. The students were told this was for purposes of posture and if anyone’s posture was extremely bad they were sent to posture classes. However, that was not true and the students were not informed as to what the photos were really being used for, which was to lend an air of scientific respectability to a eugenicist.

What does that all mean? And what does it have to do with TCFK? Great questions I will soon answer. The eugenicist in question is a man named William H. Sheldon, and he had certain ideas about undesirable people and how to make a great society. To help humanity achieve this great society Sheldon believed we needed a way to identify undesirables, and so began Sheldon’s somatotyping project. Sheldon believed that one look at your body type revealed volumes about you: how intelligent you were, how ambitious you were, how sexually deviant, how lazy, how confident, and all other types of traits and behaviors. So he set out to prove this when he was at Harvard using these questionably-obtained photographs of college freshmen.

Long story short he writes some really racist things (like “Negro intelligence” comes to a “standstill at about the 10th year”), gets accused multiple times by his assistants of doctoring data, is not taken seriously by his fellow academics, leaves Harvard and has to rely on financial support from other rich eugenicists that liked his views, and fades into relative obscurity leaving behind a set of controversial racist, chauvinistic, and extreme eugenicist texts. (7,8)

Gary Taubes, however, seems to find value in his work and thinks it’s great to cite Sheldon on page 48 to support Taubes’s theories on obese people being born that way:

Cut back enough on the calories a fat person is allowed to eat, and the result is a less fat person. But as the Harvard psychologist William Sheldon observed in the late 1940s, starving a fat man (an endomorph, in his terminology) doesn’t actually turn him into a lean man (an ectomorph) or a muscular, athletic one (a mesomorph) any more than starving a mastiff turns it into a collie or a greyhound.

To reiterate, Sheldon was a deeply unscientific person and no one really takes his somatotyping work seriously. But even if we were to do so, Sheldon doesn’t even make the point that Taubes wants him to make in the book that he cites, because Sheldon mentions that endomorphs are generally lazy, not too bright, and eat a lot. I’m not going to copy-paste everything Sheldon wrote about endomorphs, but it’s deeply unflattering stuff that is written in some flowering language. I’ll mention a few here, just because I find them to be quite funny:

  • “There is an essential dislike of bodily exercise. The arms often show a limp relaxation like that of a seal’s flipper, and the hands are likely to be soft and flaccid.”
  • “The individual has a primary desire to be comfortable, and to bask in his comfort. He shows relatively great interest in being comfortable, and if he has any ingenuity, a considerable proportion of it is devoted to making himself comfortable.”
  • “All responses are conspicuously slow. Movement is slow and deliberate. Both verbal and motor reactions are slow, as revealed by the common reaction time experiments of the psychological laboratory. Eye movements are slow, including those involved in reading. The eye wink is observed to be slow, like that of a sleepy child.”
  • “There is a deep joy in eating, and a considerable fuss and ceremony are made overeating. Usually there is a history of having overeaten and of having desired more food than was needed to maintain normal weight or growth. In a true motivational sense the individual lives, partially at least, to eat.”
  • “The greatest of social satisfaction is to be derived from the festive board, and from lingering over a fine, well-served meal.” [I mean, who can argue?]
  • “Digestion is excellent and is a primary pleasure. To sit with a full belly and do nothing but digest, is to experience the fullness of life. Elimination too is pleasant and free from unpleasant psychological complications. It is especially pleasant to sit on the stool with the Sunday paper. If the individual is free from social inhibition, a fine belch is an excellent thing, and often flatus is most agreeable.” (9) [Who among us hasn’t enjoyed this from time to time?]

So if these are the primary traits of an endomorph, I’m not sure that it helps Taubes sell the idea that fat people aren’t fat because they eat too much and exercise too little.

On page 52 Taubes does his classic move of taking the introductory question of a paper out of context and ignoring the rest of the text:

Russell Wilder, the leading pre–World War II authority on obesity and diabetes at the Mayo Clinic, did ask precisely this question in 1930: “Why then do we not all grow fat?” After all, he wrote, “we continue to be protected against obesity, most of us, even though we hoodwink our appetite by various tricks, such as cocktails and wines with our meals. The whole artistry of cookery, in fact, is developed with the prime object of inducing us to eat more than we ought.” (That was almost ninety years ago when Wilder said “most of us” are protected against obesity. Today he might have to say “some of us,” but his point is still a good one.)

Wilder then goes on to answer his question with statements that are directly opposed to what Taubes is trying to argue. Wilder says that there is no difference in metabolism between the thin and the obese (contrary to Taubes’s earlier statements) but the difference lies in the brain, as obese/overweight people defend a higher setpoint than thin people. (Although he doesn’t explicitly say setpoint, as I don’t think that term was coined in 1930.)

Wilder also says the management of obesity is to control “calorie intake and output so that the latter will exceed the former” and “we can accomplish this reduction by either by limiting the food or increasing the outlets, that is, the expenditures of energy.” He also says that “I hope to have made it clear that there can be no gain of weight if the calories in the intake fail to meet those in the output.” (10) Wilder seems to have made it clear to anyone who does not want to deliberately misrepresent him.

Starting on page 67, Taubes brings up Hilde Bruch again, “a psychiatrist and psychoanalyst, known foremost for her work on eating disorders and obesity” as Wikipedia puts it.

“Researchers— physiologists, notably, and so not physicians or nutritionists and certainly not psychiatrists or psychologists— had discovered that the storage of fat in fat cells and the liberation of that fat from storage and its use for fuel (oxidation, in the lingo) wasn’t in any way the simplistic process that was implied then and is implied still by the nutritional authorities. Columbia University’s Hilde Bruch, who was the leading midtwentieth-century authority on childhood obesity, understood this and waxed indignant about it in a book she wrote in 1957 called The Importance of Overweight, which should still be required reading for anyone interested in understanding obesity.”

He devotes a few pages to Bruch and selectively quoting her. He brings up quotes from her on fat metabolism and fat regulation and how overeating is not a cause of obesity, but rather a symptom of some other issue. Taubes is again doing what I am going to now call the “Taubes Shuffle,” where you take quotes out of their original context and place them in a new context that makes it seem to a trusting reader like the author is supporting Taubes’s crackpottery, when that’s obviously not the case when you read the original text. In this instance, the Taubes shuffle makes it appear that Bruch’s book The Importance of Overweight is about the storage and metabolism of fat, but it’s really not. It’s really about environmental factors that lead children to overeat. Bruch focuses on family dynamics and domestic issues that influence how much children eat: overbearing parents, childhood trauma, chaos at home, overindulgent parents… All of these things, argues Bruch, can lead people to develop an unhealthy relationship to food, where food is a form of comfort, security, and self-soothing. Or weight is gained as a kind of armor against the cruel world. Many of the cases that are included in the book are heartbreaking. Bruch also argues that diets may work in the short term, but unless these psychological issues are addressed the weight will be regained later.

But of course Taubes’s book is not about how you need to get over your daddy issues to lose weight, it’s about how following a certain diet can make you lose weight—pretty much the exact opposite of what Bruch is stating in her book. In fact, if you look back at the passage in TCFK, immediately before Taubes introduces Bruch, he poohpoohs the idea that psychiatrists and psychologists would have any knowledge of the matter.

Another Taubes shuffle on page 69:

Researchers studying fat accumulation in animals would note how fat cells and the animals themselves could accumulate fat or mobilize it and burn it for fuel “without regard to the nutritional state of the animal,” as though how much or how frequently the animal ate was irrelevant to whether it was using up its fat stores or building them up.

A 1948 study is cited for this and immediately after that quote the authors discuss how “lowering of the fat content of the tissue during hunger is the result of mobilization exceeding deposition.” (11) So if words still have meaning this would be the opposite of the phrase “how much or how frequently the animal ate was irrelevant to whether it was using up its fat stores or building them up.”

Back to another Taubes shuffle on page 79 when bringing up low-carbohydrate diets in the treatment of obesity:

These unbalanced diets restricted in sugars, grains, and starches, fat-rich instead, induced significant weight loss without hunger. This was the case in report after report, independent of how many calories the patients in these various institutions were fed, whether fewer than five hundred calories a day (as at the Mayo Clinic) or whether the patients were encouraged to eat as many calories as they could, as was often the prescription. “The absence of complaints of hunger has been remarkable,” the Mayo Clinic’s Russell Wilder wrote in 1933.

But if you read the study that Taubes takes the Wilder quote from, Wilder is clearly talking about a low-calorie diet he prescribed to patients. The diet in question is not fat-rich and not unlimited in calories. It’s a diet that is between 500-600 calories/day and includes 100 grams of lean steak, 500 grams of vegetables, and alternating days of 100 mL of whole milk or 100 mL of orange juice with 50 grams of brewer’s yeast.(12) All with plenty of salt and a precise amount of vitamins and minerals.

So just to spell it out, Taubes put a quote by Wilder claiming that a lack of hunger is remarkable immediately after talking about fat-rich diets where patients are encouraged to eat as much as they could, when the quote refers to something completely different. The Taubes Shuffle.

This next one is not exactly a Taubes Shuffle, but it’s definitely a deliberate omission. Here Taubes lists foods from an old textbook that are contraindicated for obesity:

Here’s the British endocrinologist Raymond Greene’s version from his seminal 1951 textbook The Practice of Endocrinology: Foods to be avoided:

  1. Bread, and everything else made with flour
  2. Cereals, including breakfast cereals and milk puddings
  3. Potatoes and all other white root vegetables  
  4. Foods containing much sugar
  5. All sweets

Funny thing is there are eight items on that list, but Taubes only includes five. The other three being salt, fluids, and fats. I’m not sure why Taubes left fluids off (although drinking excessive amounts of water is popular in the keto diet community), but he has been a stout proponent of consuming more salt for years because that’s contrary to “conventional wisdom” and therefore he’s in favor of it. I think the reason he left fat off is obvious. A funny thing to read after reading Greene’s list is that Greene himself states that “this diet makes no claim to scientific accuracy […]” (13)

Since this is a text that is nearly 70 years old, there are some other interesting things about Greene’s recommendations, like that he also supports Turkish baths, amphetamines, diuretics, and dinitrophenol for weight loss.  

This next passage is almost worthy of leaving out because it’s not totally wrong, but I’ll mention it anyway. On page 81 Taubes mentions an Obesity conference in 1973:

Charlotte Young, a Cornell University professor, gave the only talk on dietary therapy, reviewing the hundred- year history of diets restricting sugar, starchy carbohydrates, and grains, and the results of the multiple clinical trials even back then, including Young’s own trials at Cornell. All these LCHF diets, Young said, “gave excellent clinical results as measured by freedom from hunger, allaying of excessive fatigue, satisfactory weight loss, suitability for long-term weight reduction and subsequent weight control.”

A couple things. 1) Young wasn’t exactly referring to all of the LCHF diets in the hundred-year history as Taubes says. She’s not even technically referring to a LCHF diet at all. She’s referring to a diet that she explicitly says is “moderate fat.” (14) Last I checked, moderate fat does not mean the same thing as high fat. 2) Young states that she tested 1800 calorie diets on obese men with varying degrees of carbohydrate: 30 grams, 60 grams, and 104 grams. All groups lost weight and were all successful in controlling hunger. She then says “In terms of practical interest, I concluded that the highest of the low carbohydrate levels used, 104 gm., was the most suitable for long term use.”* 3) Young wasn’t the only one with discussion of dietary therapy of obesity. She was the only one that had those words in the title of her talk, but many of the talks included discussions of how to treat obesity in different ways, from diet to exercise to fasting to pharmacological methods.

We have another Taubes Shuffle on page 87-88. He discusses insulin resistance and then basically states the thesis of his book: that any diet that works is not because it creates a calorie deficit, but rather that it creates in insulin deficit. Then he quotes Roxane Gay:

“I know the math,” Roxane Gay says in her memoir Hunger, as though that should be enough to solve her unruly body and reduce her excess fat. “In order to lose a pound of fat you burn 3,500 calories.” She then goes on to observe that this knowledge has clearly been useless to her.

I think the implication here is clear. When you link those two ideas you give the impression that Gay has attempted to lose weight by burning excess calories, but that’s useless because calorie deficits don’t work. Gay needs to reduce her insulin to lose weight, right?

Well, in fact if you read Hunger you’ll discover that chapter 46, where that quote is from, is all about how Gay doesn’t exercise. It’s about how much she hates it and considers it a waste of time. Gay says “I have a membership to Planet Fitness, though I have never visited the local facility. Basically, I donate $19.99 a month to their corporate existence and the idea that I can walk into a Planet Fitness, anywhere in the country, should I feel like working out.” (15) So to overly-explain what’s going on: it’s not that Gay is burning a ton of calories and not losing weight; it’s that she is not burning a ton of calories despite “knowing the math.” As a addendum, in chapter 65 she states that she tried low-carb diets. Those seemed to have been useless to her as well.  

Page 91:

Nutritionists and dietitians of the conventional school of thinking have been instructed and will tell us that carbohydrates are the preferred fuel for our bodies and our brains, thus implying that they are indispensable. But these nutritionists and dietitians are thinking about it the wrong way. The observable fact is that when carbohydrates are available in our diet, we do use them for fuel and we use them first.

That’s what “preferred” means.

Page 100:

Most of those who had been mentored in science weren’t particularly good at it. They didn’t understand what it meant to be skeptical of their own ideas and so to check and triple- check their assumptions. (“The first principle” of science, as the Nobel laureate physicist Richard Feynman put it so aptly, “is that you must not fool yourself and you’re the easiest person to fool.”)

If that ain’t the pot calling the kettle black, I don’t know what is.

Taubes continues to discuss the merits of LCFH diets, because, well, that’s what the book is about. He mentions a pediatrician named James Sidbury on page 118:

Sidbury knew that carbohydrates stimulate insulin and insulin facilitates fat formation and traps fat in fat tissues. He also knew, as he noted in a 1975 book chapter on this work, that kids with obesity crave carbohydrate- rich foods— “crackers, potato chips, french fries, cookies, soft drinks, and the like.” Restrict the carbohydrates and feed these kids only fat and protein, he reasoned, and their insulin would come down, and their fat metabolism would work as it does in lean kids. These children would burn their stored fat and lose weight without obsessive hunger and without constantly grazing on carbohydrates. He instructed parents to feed their children with obesity only 300 to 700 calories a day, made up of virtually all protein and fat. The kids lost weight as if by magic.

Funny how Taubes attributes all this magic weight loss to lack of carbohydrates and not to the extremely low calories. (16) Abracadabra!

Continuing:

Another example of this thinking also dates to the 1970s and comes from George Blackburn and Bruce Bistrian at Harvard Medical School. Bistrian and Blackburn developed what they called a “protein-sparing modified fast” to treat patients with obesity: 650 to 800 calories a day of nothing but lean fish, meat, and fowl. It had effectively no carbohydrates, making it a ketogenic diet, albeit a very low-calorie version. Bistrian and Blackburn prescribed the diet to thousands of patients, as Bistrian told me when I interviewed him in January 2003, and half of them lost at least forty pounds.

It’s wild how these ketogenic diets are very effective as long as they are very low calorie. But calories don’t matter of course because Taubes tells us so.

I’ve accused Taubes before of having it both ways in the most promiscuous manner. It is true in his other books like it’s true in this one. In chapter 11 he states that exercise doesn’t work, but if it does work it’s only because exercising is like being on a ketogenic diet:

I haven’t discussed exercise in this book in part because precious little evidence exists to suggest that we can lose any meaningful amount of fat and keep it off merely by increasing the amount of energy we expend through exercise or physical activity. We all may know people, though, who swear they lost weight merely by upping their workouts or returning to them after a lengthy absence. If that’s true, then the physical activity had to increase the length of time their insulin levels stayed under the threshold for mobilizing fat.

It’s not just about exercise, though. He also says that if low calorie diets happen to work for some people, it’s only because they restrict carbohydrates. Fasting type diets? They’re ketogenic, too, of course.

He loves to have it both ways in his rhetoric. Throughout the text Taubes denigrates so-called experts and nutritional authorities. He treats them with such contempt. His rhetoric is very anti-establishment and treats any author or nutrition researcher as just another pezzonovante. Yet when he wants to quote someone that ostensibly supports his ideas, they are introduced reverently often as a “leading authority” with a list of their bona fides and pedigree. (But when looking at what this person actually wrote, it’s usually clear his/her work doesn’t totally support Taubes’s ideas.)

He cites studies that support his ideas, but also says that other studies are most likely wrong. (“The best reason to ignore the latest study results, the latest media reports suggesting we should eat this and not that, is that the interpretation of these latest studies is most likely wrong.”)

Page 139:

After my 2002 article suggesting that Atkins was right all along, I was accused of taking a contrarian perspective not because I really thought the evidence supported it, but because it was more newsworthy and would earn me a large book contract. Reporting that the conventional wisdom was indeed right would not. The editors of The New York Times Magazine might not have even published such a version because it wouldn’t have been news.

Yes.

What’s interesting is that he doesn’t even argue against this notion. He just states it. And I would have to agree with him here. It’s much less likely that a longform article about how eating a plant based diet is usually pretty healthy and backed by evidence would have been published and led to a major seven-figure book deal.

Taubes wrote “What if it’s all been a Big Fat Lie?” Tell you what, I’ll pitch an article titled “What if You Already Know Pretty Much what a Healthy Diet Is?” to the New York Times and see if they bite.

A few years back I was working in a manufacturing plant. My boss was a smoker and one day when he was talking to me he excused himself to go outside and have a cigarette. And because I am was a smug prick I said “You know smoking takes years off your life, right?” He jokingly replied “Yeah, the worst years. It’s the ones at the end! It’s the wheelchair, kidney dialysis, adult diaper years. I don’t want that.” He was paraphrasing a Denis Leary bit.

Gary Taubes must have heard that bit, too, but instead of thinking it was a joke he must have thought it was a great argument for shortening your life because he makes that argument earnestly in chapter 12. He mentions that some “experts” claim that LCHF diets are bad for you and can shorten your life. His response is basically “So What? Do you really want to live a few more years in your nineties?” He even likens avoiding saturated fat to rearranging the deck chairs on the Titanic. We’re all gonna die anyway, so who cares? Live it up! (17)  

Page 151-152 Taubes mentions the article he wrote in 2002, claiming he was right all along:

In my [NYT] article, I noted that five clinical trials had recently been completed (albeit not yet published) comparing the LCHF/ketogenic Atkins diet to the kind of low-fat, calorie-restricted (semistarvation) diet recommended then and still by the American Heart Association. The trial participants ranged from overweight adolescents in Long Island, who followed the diets for twelve weeks, to Philadelphia adults weight averaged 295 pounds and who followed these diets for six months. The results of those five studies were consistent. The participants eating the LCHF/ketogenic high-fat diet lost more weight, despite the advice to eat to satiety, than those who ate the AHA recommended low-fat, low-saturated-fat diet. Moreover, their heart disease risk factors showed greater improvement.

A few things:

  • Taubes provides no evidence that the AHA recommends a low-fat, semistarvation diet, because there isn’t any. Read the org’s own nutrition recommendations yourself.
  • The results of the trials Taubes cites were not consistent and they did not all show greater improvement in heart disease risk factors.
    • For example, one study he cites by Foster et al., showed no significant differences in weight loss (low fat vs low carb) after one year. (18) That same study had mixed effects on risk factors. Comparatively, HDL was increased and triglycerides decreased in the low carb group (an improvement), but the LDL and total cholesterol were both increased (the opposite of greater improvement).

Figure 1 From the Foster Study

  • Additionally, two of the authors Taubes cites here (Brehm and Yancy) author a meta-analysis of low carb vs low fat diets a couple years later, and their findings show that it’s not all roses for low carb diets. (19) They show that at 6 months weight loss is greater on low carb, but at one year weight loss in the same. Moreover, some heart disease risk factors (like total cholesterol and LDL) show greater improvement on low fat diets, while HDL and triglycerides show greater improvement on low carb. Also, weight loss favors low carb in the short term, but after a year there is no difference between the diets. Basically, the results from several trials mirror the results of the Foster trial described above.  

The following piece is almost not worthy of inclusion, but I wanted to say a couple things about it anyway. On pages 152-153 Taubes discusses a study by Dr. Sarah Hallberg that got quite a bit of positive attention from the low-carb community a couple years ago. (20) Probably because Hallberg and two other authors, Steve Phinney and Jeff Volek, are part of the low-carb money-making ecosystem.

The study in question compares a group of obese diabetics following a low-carb, ketogenic diet to another obese group following no prescribed diet. Turns out the group that followed a diet lost weight, and with that weight loss some other benefits were gained as well, like improved insulin sensitivity, blood pressure, and other risk factors. Taubes evidently finds these results “particularly compelling” and the study is reinforcement of Taubes’s thesis that ketogenic diets can cure diabetes.

But in my humble opinion, there is nothing noteworthy about the results. I say this because pretty much any diet that results in an obese person losing a significant amount of weight will lead to those outcomes. This trial didn’t compare low carb to another diet, but other studies have done this before. Weight loss from low-carb or low-fat diets produce the same improvement in insulin sensitivity. (21) In fact, it doesn’t seem to matter much how you lose the weight (diet, physical activity, weight loss drugs, bariatric surgery) because they all will improve insulin sensitivity, with greater weight loss producing greater glucose control. (22) In other words, there is nothing uniquely beneficial to following a keto diet in this respect.   

Back in the salad days of Good Calories, Bad Calories, Taubes misleads the reader about the results of a Cochrane review:

In 2001, the Cochrane Collaboration published a review of “reduced or modified dietary fat for preventing cardiovascular disease.” The authors combed the literature for all possibly relevant studies and identified twenty seven that were performed with sufficient controls and rigor to be considered meaningful. These trials encompassed some ten thousand subjects followed for an average of three years each. The review concluded that the diets, whether low-fat or cholesterol-lowering, had no effect on longevity and not even a “significant effect on cardiovascular events.”

The deception here was that the review he cited actually stated a significant risk reduction in cardiovascular events if you replace saturated fat with unsaturated fat. (23) Here in TCFK he does much the same thing but is not quite as blatant about it. He cites a more recent version of essentially the same Cochrane analysis:

Now, thirty years later, the most recent unbiased review of this evidence—from the Cochrane Collaboration, an international organization founded to do such impartial reviews— concluded that clinical trials have failed to demonstrate any meaningful benefit from eating low-fat diets and so, implicitly, any harm from eating fat-rich foods.

To be fair to Taubes, the review does state that if you were to replace all the saturated fat in your diet with carbohydrate in your diet you wouldn’t be any better off. But the most interesting part of the review and the part that you’ll be interested in if you care bout health is that the review (again) found a significant benefit from replacing the saturated fats with unsaturated fats. (24)**

Another pretty obvious lie that can be easily verified are the statements made that there has been no clinical trial evidence that fruits and vegetables and such are good for you. It’s just something we collectively decided to believe despite zero evidence. Page 157:

As for the idea that a healthy diet must be mostly plants, that it must include fruits, vegetables, whole grains, pulses, and legumes, we don’t have even the ambiguous 1960s- era studies to support it. We have no meaningful clinical trial evidence to support this idea, as Michael Pollan infers in In Defense of Food, the book that brought us the mantra “Eat food. Not too much. Mostly plants.”

Emphasis mine. This statement is pretty egregious. You can do what I just did and go to PubMed, type in “plant based diet” and filter results to only show randomized clinical trials. I got 521 results.

Moreover, these results are not demonstrating how plant-based diets promote ill health, quite the opposite. The first result is a trial that concludes those that followed a plant-based diet (ad libitum consumption of “whole grains, legumes, vegetables and fruits”) resulted in “significant improvements in BMI, cholesterol and other risk factors.” If you’d rather use the search terms vegetarian diet, you get 216 results.

The only thing that Taubes can use to defend his use of that claim is the adjective “meaningful,” but only if he wants to claim that literally all of the trails that were conducted were personally meaningless to him for some reason.

Taubes even tries to argue that salt does not lead to hypertension, it’s actually insulin because insulin must be the cause of all human’s chronic diseases, I guess. Page 164:

By the mid- 1990s diabetes textbooks, such as Joslin’s Diabetes Mellitus, described chronically elevated levels of insulin as likely to be “the major pathogenic defect initiating the hypertensive process” in patients with type 2 diabetes.

Not surprisingly, Taubes takes this quote waaaay out of context, such that he changes it’s intended meaning. Here’s the full quote:

Should hyperinsulinemia be the major pathogenetic defect in initiating the hypertensive process in patients with NIDDM, it is unlikely that it sustains the hypertension indefinitely. (25)

Some of this stuff I don’t even know how to respond to it. Sometimes he sounds like an alien. Page 167:

Eating abundant fruits and vegetables, as a recent New York Times article said, “can promote health,” as though these foods contain indispensable ingredients that work to make us healthy and keep us healthy. By this logic, the more fruits and vegetables in a diet, the better.

Ummm…. Yeah. Yep.

At the end of chapter 12 Taubes actually brings up the climate change problem, but only briefly. His position is basically the following: Does eating animals contribute to climate change? Probably. But can we really know for sure? No, we can’t. So just go ahead and eat the cows. He doesn’t do the least bit of effort to actually investigate or evaluate the science. I imagine that is because he has done so and the results are not favorable to his keto diet promotion, therefore he pretends like it’s unknowable.

Much of the remainder of the book is devoted to unsourced and unverified anecdotes, testimonials, and claims from low-carb proponents that it really works for me! Or It really works for my patients! One example is Sean Bourke, a physician who owned a chain of for-profit weight loss clinics:

Bourke, a Yale- educated emergency medicine physician, is the cofounder of the dozen JumpstartMD clinics in the San Francisco Bay Area. He told me that some fifty thousand patients had come to these clinics looking for advice on controlling their weight since he opened the first one in January 2007. This is, in effect, his clinical experience. (With his JumpstartMD colleagues and a collaborator at the Lawrence Berkeley National Laboratory, Bourke recently published a paper in the Journal of Obesity on the results from over 24,000 of these patients, for whom he had complete clinical data.

The paper is not cited, but I believe I have found it and want to note a couple things: there is not data from over 24,000 patients included, the diets are explicitly low-calorie (spoiler: that’s the real weight loss sauce, not the ratio of carbs to fat), and the attrition rate is pretty high. Half the patients drop out at 6 months and about 2/3rds are gone after one year. I thought that adherence to LCHF was supposed to be easier.

Refs

1.          Astwood EB. The Heritage of Corpulence. Endocrinology [Internet]. 1962 Aug;71(2):337–41. Available from: https://academic.oup.com/endo/article-lookup/doi/10.1210/endo-71-2-337

2.          Bruch H. Eating disorders; obesity, anorexia nervosa, and the person within. [Internet]. New York,; 1973 [cited 2020 Dec 9]. Available from: http://hdl.handle.net/2027/mdp.39015000282544

3.          Bruch H, Touraine G. Obesity in Childhood: V. The Family Frame of Obese Children. Psychosom Med [Internet]. 1940 Apr;2(2):141–206. Available from: http://www.psychosomaticmedicine.org/content/2/2/141.abstract

4.          Passmore R, Swindells YE. Observations on the respiratory quotients and weight gain of man after eating large quantities of carbohydrate. Br J Nutr [Internet]. 1963;17:331–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14045336

5.          DuBois EF. Basal metabolism in health and disease [Internet]. Philadelphia: Lea & Febiger; 1936. p. 494 p. Available from: file://catalog.hathitrust.org/Record/002076603

6.          Mayer J. Overweight: Causes, Cost, and Control [Internet]. Englewood Cliffs, New Jersey: Prentice-Hall; 1968 [cited 2020 Dec 28]. Available from: https://books.google.com/books/about/Overweight_causes_cost_and_control.html?id=4bRktQEACAAJ

7.          Rosenbaum R. The great Ivy League nude posture photo scandal. New York Times [Internet]. Late Editi. 1995 Jan 15; Available from: https://www.proquest.com/newspapers/great-ivy-league-nude-posture-photo-scandal/docview/430004640/se-2?accountid=14784

8.          Vertinsky P. Embodying Normalcy: Anthropometry and the Long Arm of William H. Sheldon’s Somatotyping Project. J Sport Hist [Internet]. 2002 [cited 2020 Dec 16];29(1):95–133. Available from: https://www-jstor-org.offcampus.lib.washington.edu/stable/43610055?sid=primo&seq=1#metadata_info_tab_contents

9.          Sheldon WH. The varieties of temperament: A psychology of constitutional differences. [Internet]. New York and London: Harper and Brothers; 1942 [cited 2013 Jul 9]. Available from: http://archive.org/details/TheVarietiesOfTemperamentAPsychologyOfConstitutionalDifferences

10.        Wilder RM. The Management of Obesity. J Am Diet Assoc. 1930;6(2):91–100.

11.        Wertheimer E, Shapiro B. THE PHYSIOLOGY OF ADIPOSE TISSUE. Physiol Rev [Internet]. 1948 Oct 1;28(4):451–64. Available from: http://physrev.physiology.org/content/28/4/451.short

12.        Wilder RM. The Treatment of Obesity. Int Clin [Internet]. 1933 [cited 2020 Dec 30];4(43):1–21. Available from: https://babel.hathitrust.org/cgi/pt?id=mdp.39015070332682&view=1up&seq=17&q1=remarkable

13.        Greene R. The Practice of Endocrinology [Internet]. Philadelphia: Lippincott; 1951 [cited 2020 Dec 30]. Available from: https://catalog.hathitrust.org/Record/001580458

14.        Bray G, editor. Obesity in Perspective. Vol 2 [Internet]. Washington: U.S. Govt. Print. Off; 1975. Available from: https://catalog.hathitrust.org/Record/000040052

15.        Gay R. Hunger: A Memoir of (My) Body [Internet]. Harper Perennial; 2018 [cited 2021 Jan 1]. Available from: https://www.amazon.com/Hunger-Memoir-Body-Roxane-Gay/dp/0062420712

16.        The diet is 300 daily calories up to age 8, 500 to puberty, and 700 after puberty. That’s really low. That’s less calories than my infant son drinks in formula every day. But weight is lost “as if by magic.” Truly this is sorcery.

17.        He contentedly quotes another physician that prescribes LCHF diets who says her patients tell her “I don’t care if I die in ten years, I feel like crap today, I want to stop feeling like crap today.”

18.        Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, et al. A Randomized Trial of a Low-Carbohydrate Diet for Obesity. N Engl J Med [Internet]. 2003 [cited 2013 Jun 9];348(21):2082–90. Available from: http://www.nejm.org/doi/full/10.1056/NEJMoa022207

19.        Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy Jr WS, Brehm BJ, et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med [Internet]. 2006 [cited 2013 Mar 2];166(3):285. Available from: http://archinte.ama-assn.org/cgi/reprint/166/3/285.pdf

20.        Hallberg SJ, McKenzie AL, Williams PT, Bhanpuri NH, Peters AL, Campbell WW, et al. Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther [Internet]. 2018;9(2):583–612. Available from: https://doi.org/10.1007/s13300-018-0373-9

21.        Bradley U, Spence M, Courtney CH, McKinley MC, Ennis CN, McCance DR, et al. Low-fat versus low-carbohydrate weight reduction diets – Effects on weight loss, insulin resistance, and cardiovascular risk: A randomized control trial. Diabetes. 2009;58(12):2741–8.

22.        Grams J, Garvey WT. Weight Loss and the Prevention and Treatment of Type 2 Diabetes Using Lifestyle Therapy, Pharmacotherapy, and Bariatric Surgery: Mechanisms of Action. Curr Obes Rep. 2015;4(2):287–302.

23.        Hooper L, Summerbell CD, Higgins JP, Thompson RL, Clements G, Capps N, et al. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev [Internet]. 2001;(3):CD002137. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11687015

24.        Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane database Syst Rev [Internet]. 2015 Jun 10;(6):CD011737. Available from: http://doi.wiley.com/10.1002/14651858.CD011737

25.        Christlieb AR, Krolewski AS, Warram JH. Hypertension. In: Kahn CR, Weir GC, editors. Joslin’s Diabetes Mellitus. 13th ed. Philadelphia: Lippincott Williams & Wilkins; 1994. p. 817–35.

*Editorial note 4/15/2021: In this sentence I originally wrote “Young states that she tested 1800 calorie diets on obese men with varying degrees of carbohydrate: 30 grams, 60 grams, and 104 grams. She then says that the highest level of carbohydrate was the best.” However, Young didn’t really claim it was “the best.” That was my paraphrase. I have added Young’s actual quote for clarity.

**Editorial note 4/15/2021: It was brought to my attention that I was being unfair to Taubes and may have been a bit misleading about the results myself. I amended this section to be more accurate. Previously I had written “Taubes blatantly lies about the results of a Cochrane review” and “the review does not examine low fat diets” but a strict interpretation of a replacement of saturated fat with CHO would be considered a de facto low fat diet.

Good Calories, Bad Calories: A Critical Review; Chapter 5 – Diseases of Civilization

Introduction

Blogging is a dying art form, but recent events have led me to at least attempt to complete my review of Good Calories, Bad Calories. Below is my entry for Chapter Five: Diseases of Civilization.

Not the Introduction

In this chapter Taubes attempts to make the case that modern diseases such as heart disease, cancer, and diabetes are the result of modern diets (which he defines as being high in CHOs), and that isolated populations living on more primitive diets (which he defines as consisting almost exclusively of meat) such as the Inuit/Eskimo are nearly free of such diseases.

Page 90

As [Samuel Hutton, a physician] told it, his Eskimo patients fell into two categories: There were those who lived isolated from European settlements and ate a traditional Eskimo diet. “The Eskimo is a meat eater,” he wrote, “the vegetable part of his diet is a meager one.” Then there were those Eskimos living in Nain or near other European settlers who had taken to consuming a “settler’s dietary,” consisting primarily of “tea, bread, ship’s biscuits, molasses, and salt fish or pork.” Among the former, European diseases were uncommon or remarkably rare. “The most striking is cancer,” noted Hutton on the basis of his eleven years in Labrador. “I have not seen or heard of a case of malignant growth in an Eskimo.” He also observed no asthma and, like Schweitzer, no appendicitis, with the sole exception of a young Eskimo who had been “living on a ‘settler’ dietary.” Hutton observed that the Eskimos who had adopted the settlers’ diet tended to suffer more from scurvy, were “less robust,” and endured “fatigue less easily, and their children are puny and feeble.”

Wow, it sounds like the Eskimos eating meat were much more healthy than those that mingled with the Europeans and ate their bread and pork! Maybe we would all be better off if we ate more seal meat and less tea and biscuits, right? At least that’s the implication here. But before we start radically changing our diet to a carnivorous one, perhaps we should read what Hutton actually wrote. On page 17 of the source text Hutton states “The Eskimo constitution shows a low resisting power to disease.” (1) (Emphasis in original.)

As it turns out, the Eskimos that Hutton observed for years were not as healthy as Taubes characterizes them. In fact, they were riddled with diseases. The entire source text is devoted to describing the diseases of the Eskimo population, so you really have to do some advanced cherry-picking and spin to create a paragraph that might seem like traditional Eskimos are healthier and more robust than others. Hutton observes many diseases among the Eskimos, but he makes particular note of their weak circulatory system, which includes a weak heart and common hemorrhaging. Consider the rapid aging mentioned on page 17: “The Eskimo constitution, speaking broadly, is a weak one. Old age sets in at fifty, and its signs are strongly marked by the time sixty is reached. In the years beyond sixty the Eskimo is aged and feeble.” There is also a chapter on child mortality which was apparently very high, with nearly half of all children dying before the age of five.

Of course, it is important to mention that the lifestyle, climate, and environment of these people were so radically different from what most people experienced that it would be malpractice if anyone were to claim that diet alone was responsible for either the health or diseases of these Eskimos.

* * *

Taubes continues to make up lies about Ancel Keys, as he does throughout the book, by writing “When it was suggested to Keys that other nutrition transitions, including those witnessed by Schweitzer and Hutton, could be edifying, he argued that not enough was known about the diets or about the health of those isolated populations for us to draw reliable conclusions.” As evidence he cites pages 54-55 of a publication of a Swedish symposium on nutrition.(2) The cited text has nothing to do with any of what Taubes is claiming here. It’s a talk about food manufacturers and how they engineer food to increase palatability. Schweitzer and Hutton are not even cited much less mentioned and neither are isolated populations.

This symposium was also cited by Taubes in the prologue of GCBC as support for these two claims “As clinical investigators were demonstrating the singular ability of carbohydrate-restricted diets to generate significant weight loss without hunger” and, when referencing this symposium specifically, “Carbohydrate-restricted diets were portrayed as uniquely effective at inducing weight loss.”

Again, not true. There is nothing in this symposium supporting anything of the sort. A couple of paragraphs later Taubes presents his thesis of this chapter, which is that “obesity, diabetes mellitus, cardiovascular disease, hypertension and stroke, various forms of cancer, cavities, periodontal disease, appendicitis, peptic ulcers, diverticulitis, gallstones, hemorrhoids, varicose veins, and constipation” are all caused by white flour, white rice, and sugar. To push the libel of a dead scientist a bit further,

This led investigators to propose that all these diseases had a single common cause-the consumption of easily digestible, refined carbohydrates. The hypothesis was rejected in the early 1970s, when it could not be reconciled with Keys’s hypothesis that fat was the problem […]

None of that is true. None of it. The piece about Keys is unsourced and I suspect completely made up. The rest of the main thesis of the causes of the “diseases of civilization” is sourced to a book called Western Diseases: Their Emergence and Prevention by Hugh Trowell and Denis Burkitt, and it does not support Taubes’s statements at all. In fact, nearly the opposite. In the text they say that as diets rise in total fat, sugar, and cholesterol and decrease in fiber, unsaturated fat, and starch these diseases emerge.

To say that disease is traced to carbohydrates or sugar alone is nonsense and not at all what the authors say. Moreover, in order to help treat and prevent the onset of these diseases the authors recommend two diets: a high fiber diet (HF) and a high carbohydrate, high fiber diet (HCF). “An HCF diet of high unrefined starch (complex carbohydrates) is of necessity also low fat and low sucrose.”(3)

If the grift is not obvious to you by now, I just don’t know what to say.

* * *

Continuing with the Eskimo/Inuit narrative…

Page 91

[Ancel Keys] argued that not enough was known about the diets or about the health of those isolated populations for us to draw reliable conclusions. He also insisted that in many of these populations—particularly the Inuit —relatively few individuals were likely to live long enough to develop chronic disease, so little could be learned.

Page 106

Ancel Keys used the early-death rationale a quarter-century later to explain away their reported freedom from heart disease and cancer […]

You might have noticed that Taubes attempts to invalidate Inuit-early-death argument by using his rhetorical skills and associating it with the villain of the book, Ancel Keys. What is not addressed is whether the assertion that the Inuit die early enough that they don’t suffer from many chronic diseases is actually true. Nor is it addressed whether there in fact exists good-quality and reliable dietary data on the Inuit/Eskimo populations in the first half of the 20th century.

As it happens Inuit/Eskimo life-expectancy used to be and still is considerably shorter than their non-indigenous and mainland counterparts.(4–8) This is true of Greenland, Canada, or Alaska. A recent article published in The Lancet Oncology remarked that malignant diseases were nearly non-existant in the Inuit populations in the early 20th century, but as their life expectancy grew so did their incidence of carcinomas.(9) Whether this has anything to do with diet is another matter entirely.

Moreover, since the Inuit/Eskimo populations were very isolated there was not any good scientific evidence of their dietary patterns for quite a long time. Probably the best reports on the Inuit diet were anecdotal, coming from Vilhjalmur Stefansson and Samuel Hutton. Facinating perhaps, but not rigorous or at all scientific.

But the fact remains that, despite what Taubes might have you believe, Keys was right again. Regarding these isolated arctic populations, very little data was collected on the diet of the Inuit up to and including the time Keys made those remarks. Additionally, the Inuit were presumably free of chronic diseases such as heart disease and cancer BECAUSE of their much shorter lifespan compared to their “Western” brethren.  I say “presumably” because these populations lived in remote areas without much access to regular check-ups from physicians, health care, and emergency rooms.

But if Taubes can just discredit contrary arguments using no evidence then he is free to posit his own claims like the Inuit were free of heart disease and cancer BECAUSE of their meat-heavy diet.

Related to this theme is the question of diagnostics, and even if the Inuit were to live long enough to suffer from cancer, would it be accurately diagnosed and recorded? On page 94 Taubes snatches a quote from the introduction of a case study on cancer in an Eskimo, stating “It is commonly stated that cancer does not occur in the Eskimos, and to our knowledge no case has so far been reported.” But the conclusion of that study argues the opposite:

Though the apparent absence of cancer among the Eskimo has been made much of in some popular discussions, we know of no reason why it should not occur, and the present case demonstrates that it may in fact be found when adequate facilities for investigation are available. The difficulties of medical observation of these people are great, and in the majority of instances the cause of death is not determined by medical men. Even when it is, the conclusion must of necessity frequently be based on bedside data alone. These considerations are probably chiefly responsible for the absence until now of definite reports of cancer in the Eskimo.

Cancer may, however, occur relatively rarely in the Eskimo. In this connection, however, it should be pointed out that this may be due to the difference in the age distribution of the population as compared with, for instance, Canada as a whole. This difference is shown in Fig. 1. The preponderance of Eskimos in the age groups less than 25 years and the proportionately lower numbers above that age can be noted. The relatively younger average age of the Eskimo population would be expected to influence the incidence of cancer.

 

On page 91-92 Taubes mentions that several reports of European physicians traveling to remote areas with mainly native populations were published in places like the British Medical Journal. These reports show, according to Taubes, that chronic diseases are virtually absent from the native population unless and until Europeans arrive with their flour and molasses. When these foods arrive, Taubes claims, then the “diseases of civilization” inevitably follow. Taubes summarizes these physicians’ reports:

They would typically report a few cancers in towns where the “natives mingled with Europeans” and had copied their “dietetic and other domestic practices,” but not in those areas where lifestyles and diets remained traditional.

Interestingly enough, one of those reports where those quotes are pulled also mentions something Taubes doesn’t want you to know so he leaves it out.

This information led me to further inquiries, and I ascertained that native races of other continents were similarly immune when not brought in contact with civilization. I also noted the belief of several of my correspondents that it was the vegetarian diet of the natives which accounted for the exemption. (10)

Emphasis mine. Other BMJ reports mention similar patterns, like this one that says “Roughly the difference between the civilized and the uncivilized is a matter of diet. […] The diet of these people is very simple. They live chiefly on corn ground between stones. This is made into a cake which is imperfectly roasted over a charcoal fire. They very rarely eat meat.” (11)

I‘m not an Ivy-trained journalist like Taubes, but this seems like very relevant information that is worthy of inclusion in this chapter.

Taubes then goes on to surgically remove additional relevant information from Hrdlicka’s work. For a bit of context see this passage on page 92:

In 1908, the Smithsonian Institution’s Bureau of American Ethnology published the first significant report on the health status of Native Americans. The author was the physician-turned-anthropologist Ales Hrdlicka, who served for three decades as curator of the Division of Physical Anthropology at the National Museum in Washington (now the Smithsonian’s National Museum of Natural History). In a 460-page report entitled Physiological and Medical Observations Among the Indians of Southwestern United States and Northern Mexico, Hrdlicka described his observations from six expeditions he had undertaken. “Malignant diseases,” he said, “if they exist at all-that they do would be difficult to doubt-must be extremely rare.” He had not encountered “unequivocal signs of a malignant growth on an Indian bone.” Hrdlicka also noted that he saw only three cases of “organic heart trouble” among more than two thousand Native Americans he examined, and “not one pronounced instance of advanced arterial sclerosis.” Varicose veins were rare, and hemorrhoids infrequent. “No case of appendicitis, peritonitis, ulcer of the stomach, or of any grave disease of the liver was observed,” he wrote.

What Taubes removes are the passages on the observation of the native diet, which he likely hopes the reader will default to assuming what was asserted at the beginning of the chapter, which is “traditional diets” are meat-based, and the diseases of civilization are due to carbohydrates. Consider the following excerpts from the Hrdlicka text (emphasis mine):

  • The principal article of diet among the Indians throughout the Southwest and Mexico is maize, which is eaten in the form of bread of various kinds, or as mush, or boiled entire. […] Next in importance to corn and wheat in the Indian diet are meat and fat and beans. Meat is scarce.
  • Pork is rarely eaten, owing, perhaps, to Indian beliefs concerning swine, though the writer has been told a number of times by the natives that they dislike the taste of the meat.
  • Beans of many varieties are a more important article of diet, especially to the Mexican Indians, than meat.
  • In common with all the other Indians of the Southwest, [the Hopi and Zuni] have acquired the habit of using flour and baking powder, as well as canned fruit, and of drinking at their meals considerable quantities of weak, sweetened, warm, black coffee. They also hunt rabbits for food. Meat in general is very scarce.
  • Other important articles of the Indian diet are squashes, melons, sugar cane in the hot valleys of Mexico, and wild and cultivated fruit of many varieties, as well as pinons and other nuts, and some mushrooms. […] The tribes in the Southwest raise large quantities of peaches, which they consume either fresh or dried.
  • Milk is either disliked or is used but little, and of their own initiative the Indians make neither cheese nor butter.

This information kind of undercuts the thesis of this whole chapter, or even the entire book! No wonder it was left out.

* * *

Continuing this theme is the text The Natural History of Cancer, with Special Reference to its Causation and Prevention by the duplicately named William Williams.(12) The text is cited on page 93 and 95 where Taubes claims again that people in less developed countries and regions like Polynesia, Fiji, India, and Borneo have fewer cases of cancer than the more developed nations like the United States. This difference is chiefly because the less developed countries are carnivorous while the US is not.  At least that’s Taubes’s argument. If you look at the Willaims text, however, the argument is quite different: it seems as if the native diets are plant-based and perhaps that is what is protecting the natives from cancer? Could also be problem of diagnosis that was discussed earlier. In any case, here are some quotes from the text.

The natives of India live on millet or rice, a little milk, with the butter from the milk, and the vegetables they grow and of these they partake sparingly. They seldom eat any meat. It is only the Brahmins, the priestly caste, who form but a small fraction of the immense Hindoo population, whoever eat any flesh food. The immense majority of the people live a rural life, depending upon agriculture for their subsistence. Such are the conditions of existence in India; and India is typical of the tropics.

Now contrast the tropical mode of living with that prevalent in our country, where all the conditions are so different; where the average wage of the worker amounts to thirty-eight shillings a week; and where the alimentation comprises a meat consumption of over 130 pounds per head per year, together with an abundance of other highly nutritive proteid food products, fats etc.

Moreover, it is in the tropics that the human race is believed to have originated, and there the anthropoid apes, our nearest animal connexions; who are mainly vegetarians, still flourish and are seldom, if ever, affected with malignant tumours.

[Discussing Uganda, where cancer rates were much less than Europe] The natives are clean, intelligent, and “splendidly developed physically.” Their staple food comprises plantains, bananas, and sweet potatoes, while banana wine is extensively consumed but meat can seldom be obtained.

[When discussing Australia] Owing to the cheapness of meat and the gluttonous habits of the people, the amount consumed per head is exceedingly high. Under these circumstances, the tubercle mortality has diminished, while the incidence of cancer has greatly increased.

[In reference to New Zealand] Cancer and insanity have increased, and are; increasing while tubercle is declining. The people are prosperous, with; a diminishing birth-rate and immense quantities of flesh food chiefly beef and mutton are consumed. “Meat for breakfast, lunch, dinner, tea, supper, etc., just like the porridge-pot in Scotland,” as Dr. G. Macdonald, of Dunedin, wrote in answer to my letter of inquiry.

I could cite passages from pretty much each country in the 519-page text but suffice it to say that the link between meat consumption and cancer is not lost on Mr. Williams.

* * *

Taubes gives his audience a real gem on page 96, when he claims that flour and sugar are to blame for appendicitis. He cites as proof a text by A. Rendle Short entitled The Causation of Appendicitis.(13) However, Short states the exact opposite in the text. Some tidbits from the paper (emphasis in original source):

  • Wheat, Flour, and Grain need not be taken into account as directly giving rise to appendicitis. Such a theory would be incompatible with the facts to be explained.
  • Butter. — This cannot be the cause.
  • Tea cannot be accused of causing appendicitis
  • Coffee must be exonerated.
  • Sugar may be dismissed the court.
  • Rice cannot be blamed.
  • Currants and Raisins may safely be exonerated.
  • Meat. — There is much to be said for the widely accepted view that meat-eating is the cause of appendicitis.

Short also give a handy visual comparing sugar and appendicitis versus meat and appendicitis, in case you can’t read words on a page.

Short also lays some of the blame of rising appendicitis on a declining fiber intake. In chapter seven Taubes tried to make the case that dietary fiber has little to no value.

Also on page 96 Taubes singles out white flour and sugar as being implicated in cancer mortality. As evidence he cites a pre-20th century text titled Air, Food, and Exercises by Andrea Carlo Francesco Rabagliati, claiming it is an “intelligent” discussion on the diseases of civilization.(14) It’s very poorly written and even more poorly though-out so I can see why Taubes likes it. For one, Rabagliati writes in excruciatingly long paragraphs that go on for pages at a time. He doesn’t break up his thoughts into chapters or subchapters. There is no table of contents. He prints his own notes in the margins of the text. It just seems like a stream of consciousness writing style, like he wrote it in the span of three sleepless days while hopped up on bennies. And he somehow managed to find a place to publish it. Secondly, a lot of what he says just doesn’t make a lot of sense both from the vantage point of the 21st century as well as from the 19th century, as a book review from 1898 attests. The review states that the thesis is supported (in part) “by a good deal of inaccurate chemistry and pathology, and by the ignoring of facts which tell against the author’s views. […] Books of this class are generally written by able men in busy practice who have time for thought but not for research.”(15) Hmmm… Sound like anyone you know?

From the benefit of hindsight it seems even worse. For example, Rabagliati states that heredity doesn’t really matter when we talk about disease, and much of the book is devoted to a term that I think he coins: triphthaemia carbonifera, which is apparently the accumulation in the blood of waste products from the metabolism of starch and saccharine. According to Rabagliati, triphthaemia carbonifera causes herpes, pneumonia, cancer, bronchitis, tonsillitis, rheumatism, and the flu. He states that the people who get these diseases often invariably “live largely on bread, potatoes, puddings, and sugar.” There is no mention of viruses or bacteria or any of the actual causes, despite the germ theory of disease being pretty much accepted at the time. Additionally, his treatment of women is kind of laughable today:

I may add here what I am firmly convinced of, viz., that the diseases of women in general, the little ailments they have, the frequent complaints they make, amounting often not to illness but to malaise, or being “out of sorts,” are due, not to their sex but to their habits, and in particular to their habit of eating too often.

Having been written in the late 1800s perhaps I can cut the author a bit of slack, although it’s difficult to cut someone like Taubes some slack for thinking this is an intelligent discussion of disease from a 20th century perspective with the help of modern medicine.

* * *

Speaking of the ignoring of facts which tell against the author’s views, page 98 has yet another demonstration of that phenomenon:

The Scottish nutritionist Robert McCarrison was perhaps the leading proponent of the hypothesis that the chronic illnesses of civilization could be attributed to “the extensive use of vitamin-poor white flour and to the inordinate use of vitamin-less sugar.”

Of course, if you read McCarrison’s work, he is talking about malnutrition and not getting enough vitamins. His theory of the case, as it were, is not at all Taubes’s view as he includes meat this vitamin-poor milieu, stating “Meat is at best but poor in vitamins, and its value in these essentials is not enhanced by freezing and thawing.”(16) He is what you might call today a Raw Foodie, as he believes that cooking, canning, processing, pickling, freezing, and drying food all detrimental to their nutritional value. He states this because the cooking and boiling and processing removes the vitamin content. He also thinks fresh foods are just better for reasons that are unclear even to him, writing “there is something in the freshness of food, especially vegetable food — some form of energy perhaps; it may be certain rays of light or electrical property — which gives to it a health-promoting influence.” (17) It has nothing to do with carbohydrates, per se, but how the nutrients are effectively processed out of them. In fact, when he lists foods that provide “perfect nutrition” the first thing he lists is whole grain cereal and whole grain bread.

But let’s blame everything on flour and sugar anyway. Why not? No one is going to actually check your work — certainly not the publishing company.

* * *

On page 97 Taubes writes “In 1874, with the removal of tariffs on sugar importation in Britain, sugar consumption skyrocketed and led to the eventual development of the biscuit, cake, chocolate, confectionery, and soft-drink industries.” The source cited for this is an article by Berta Friend that is about consumption patterns in the US not Britain and begins in 1909, not 1874. All of that information is in the title, by the way.(18) There was a modest increase in sugar consumption in the US around 1930 but the paper states that increase was diverted to alcohol production. In fact, sugar consumption was pretty steady until 1960 when it started declining, according to the paper.

For good measure, the paper also has kind of an interesting graph of macronutrient consumption over time. According to the paper, total carbohydrate consumption steadily decreases while fat intake increases.

Refs

 

  1. Hutton S. Health Conditions and Disease Incidence Among The Eskimos of Labrador [Internet]. London: Wessex Press; [cited 2019 Nov 27]. 82 p. Available from: http://collections.mun.ca/cdm/ref/collection/cns2/id/111733
  2. Blix G. Occurrence, Causes, and Prevention of Overnutrition [Internet]. Uppsala: Printed by Almqvist & Wiksells; 1964. (Symposia of the Swedish Nutrition Foundation). Available from: https://books.google.com/books?id=wkptAAAAMAAJ
  3. Trowell HC, Burkitt DP, editors. Western Diseases: Their Emergence and Prevention. London: Edward Arnold; 1981.
  4. Iburg KM. Inuit Population Dynamics: A Demographic Analysis of North Greenland. Can Stud Popul [Internet]. 1944 Dec [cited 2014 May 4];26(2):141–58. Available from: http://ejournals.library.ualberta.ca/index.php/csp/article/view/15842
  5. Bothwell R, Drummond IM, English J. Chapter 15: The Social and Economic Impact of the Depression. In University of Toronto Press; 1990. p. 248. Available from: http://books.google.com/books?id=N_8qeHPqNKsC
  6. Health Council of Canada. The Health Status of Canada’s First Nations, Metis and Inuit Peoples [Internet]. Toronto, Ontario; 2005 Jan. Available from: http://www.healthcouncilcanada.ca/tree/2.03-BkgrdHealthyCdnsENG.pdf
  7. CQ Researcher, Inc CQ. Chapter 12: Saving Indigenous Peoples. In SAGE; 2012. p. 304. Available from: http://books.google.com/books?id=dajd0FjnVKoC
  8. Inuit Tapiriit Kanatami. Inuit and Cancer: Discussion Paper. 2008 Sep.
  9. Friborg JT, Melbye M. Cancer patterns in Inuit populations. Lancet Oncol [Internet]. 2008 Sep [cited 2014 May 4];9(9):892–900. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1470204508702316
  10. Hollander B. Freedom of Negro Races from Cancer. Br Med J [Internet]. 1923 Jul [cited 2014 May 4];2(3262):46. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2317323/
  11. Lane WA. An Address ON CHRONIC INTESTINAL STASIS AND CANCER. Br Med J [Internet]. 1923 Oct 27;2(3278):745–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20771328
  12. Williams WR. The natural history of cancer, with special reference to its causation and prevention [Internet]. New York: William Wood and Co; 1908 [cited 2019 Nov 28]. 519 p. Available from: https://openlibrary.org/books/OL7160713M/The_natural_history_of_cancer_with_special_reference_to_its_causation_and_prevention
  13. Short AR. The causation of appendicitis. Br J Surg [Internet]. 1920;8(30):171–88. Available from: http://doi.wiley.com/10.1002/bjs.1800083005
  14. Rabagliati ACF. Air, food, and exercises : an essay on the predisposing causes of disease [Internet]. London: Bailliere, Tindall & Cox; 1897 [cited 2019 Nov 30]. 278 p. Available from: https://archive.org/details/b28087586/page/n4
  15. Brigg J. Air, food and exercises; an essay on the predisposing causes of disease. Practitioner [Internet]. 1898;(v. 61):659–60. Available from: https://books.google.com/books?id=f2ICAAAAYAAJ
  16. McCarrison R. An Address ON FAULTY FOOD IN RELATION TO GASTRO-INTESTINAL DISORDER.: Being the Sixth Mellon Lecture delivered before the Society of Biological Research, University of Pittsburg, Nov. 18th, 1921,. Lancet [Internet]. 1922 Feb [cited 2013 Aug 6];199(5136):207–12. Available from: http://www.sciencedirect.com/science/article/pii/S0140673601256190
  17. McCarrison R. Nutrition and national health. [Internet]. Health and social welfare. London: Royal Society of Arts; 1945 [cited 2019 Dec 7]. p. 33–8. Available from: https://www.amazon.com/Nutrition-health-lectures-delivered-together/dp/B0007JVBH0
  18. Friend B, Page L, Marston R. Food Consumption Patters in the US: 1909-13 to 1976. In: Levy RI, Rifkind BM, Dennis BH, editors. Nutrition, lipids, and coronary heart disease, a global view. New York: Raven Press; 1979. p. 489–522.
  19. Barker JE. Cancer: How it is Caused, How it Can be Prevented. New York: E. P. Dutton & Company; 1924.
This is perhaps not worth including in the main text, but it is some interesting fodder, nonetheless. On pages 91, 92, and 98 in this chapter Taubes cites an early 20th century text on cancer by J. Ellis Barker.(19) After reading this text, a few things became clear to me. One is that Barker was prescient regarding at least a few factors that are now known to be linked to cancer in one way or another. For example, he mentions pollution, a lack of dietary fruits and vegetables, smoking, lack of exercise, and industrial chemicals as potential causes of cancer. He even indicts meat, which Taubes of course doesn’t mention. A couple quotes to this effect are found on page 63 “On the question of the relation of diet to diseases, some medical authorities have asserted that butcher’s meat is undoubtedly one of the means by which cancer is propagated” and page 401 “Cancer districts and cancer villages may be created by local food customs, such as the abuse of chemical preservatives. A wretched butcher introduces the habit of keeping meat fresh by the liberal application of poisonous chemicals. His assistants start businesses of their own and act in the same manner. Thus a local trade custom favouring cancer is created.”
The second thing I learned is that Barker also held some views that today we might consider somewhere between backward and abhorrent. On women: “The emancipation of women has benefited them. Fifty years ago the Englishwoman stayed at home and took no exercise. Now the women, having more leisure, take more exercise than the men, if only in shopping and in going after their amusements, while the men sit about in stuffy offices and workrooms and factories.” Page 453:” The disaster of our nutrition is increased by the improvement of the cooking appliances, by the cheapness of fuel and by the emancipation of the women. […] The emancipation of women has led to a widespread unwillingness to do the domestic cooking, an unwillingness which threatens to become universal.” And on race: ”Mr. Lothrop Stoddard in a most interesting book entitled The Rising Tide of Colour has pointed out the danger which threatens the civilized nations from a possible rising of the coloured races. A far greater danger threatens them from cancer. Chronic poisoning and vitamine starvation combined may increase the cancer death-rate to an unbelievable extent and may destroy the predominance of the white race.” (page 457)
He also accurately describes Taubes’s argument of this entire chapter on page 47. Namely, taking bits of anecdotes from very old sources to try and craft a scientific argument: “Unfortunately, those writers who maintain that cancer is a disease of civilization give only very meagre proof in support of their view. In most books, addresses, etc., in which it is stated that cancer is a disease of civilization, the evidence is restricted to one or two opinions received from a doctor residing in the wilds of Africa or Asia.”