Good Calories, Bad Calories: A Critical Review; Chapter 24 – The Carbohydrate Hypothesis III: Hunger and Satiety

cover

Introduction

This is another post in my ongoing series of posts on Gary Taubes’s Good Calories, Bad Calories (GCBC). One of the main challenges I have encountered while reviewing this chapter is that Taubes devotes several pages to discussing the work of Jacques Le Magnen and attempting to associate Le Magnen’s research with Taubes’s own theories. My undergraduate advisor actually spent some time in France and worked directly with Le Magnen, so of course all his students were educated on Le Magnen’s work. However, Taubes cites a number of texts by Le Magnen that I was either unable to find or are written entirely in French. For that reason I cannot comment on the specifics of the texts, and unless I find some of the specific texts Taubes cites these pages are outside the scope of this chapter review.

Not the Introduction

On pages 425-426 Taubes describes a diet that was designed by JB Sidbury and RP Schwartz to help obese children lose weight, stating “The diet that Sidbury eventually used in his clinic and claimed to be uniquely effective contained only 15 percent carbohydrates-‘the remaining being apportioned approximately equally between protein and fat […]’” Taubes makes great hay of Sidbury’s diet and how it reduced insulin levels and therefore fat mass, stating also “insulin will ‘facilitate lipogenesis’ and inhibit the release of fat in the adipose tissue, this in turn created what Sidbury called the ‘milieu for positive fat balance’ in the cells of the adipose tissue” and “’decreased insulin levels would then permit normal fatty acid mobilization’” and “he [Sidbury] described an approach to obesity therapy that differed from Robert Atkins’s only in the details of the application.”

Leaving aside that Sidbury and Schwartz never claimed their diet was “uniquely” effective, they do claim that their dietary treatment was effective to some degree, which is really no surprise if you read the details of their diet.1 From page 67 of Childhood Obesity:

Prior to our interest in the subject, we routinely had the dietitian give the mother a 1000 calorie diet for an obese child, whether 4 or 14 years old. The results could have been predicted with a little reflection. Indeed an adult should be given a 700 or 800 calorie diet if weight loss at a reasonable rate is the goal. We then arbitrarily designed a 300 calorie diet to be used for children 3 to 8 years, 500 calories from 8 years to puberty, and 700 calories over puberty. This schedule has been effective; hence we have continued it.

This is all to be expected, except that it essentially contradicts items 5 & 6 of Taubes’s “inescapable” conclusions found on page 454. For those that haven’t read GCBC, Taubes attempts to make the case that overeating, exercise, or caloric intake of one’s diet is of no real consequence with regard to weight loss or gain. The only factor that really matters, according to Taubes, is insulin which can be manipulated by dietary carbohydrates.

Of course if Taubes is correct then Sidbury and Schwartz could have prescribed diets of 6000 kcals or more and weight loss would have been just as effective so long as the diet was ketogenic.

* * *

Starting on page 436 Taubes attempts to make the case that carbohydrates cause infertility! So if you’re trying to get pregnant and you’re sitting down to a nice meal of meat and potatoes, put your fork down, discard your potatoes, and help yourself to some more meat.

He starts off by setting up the straw man of Conventional WisdomTM, or in this case Common Belief.

[T]he critical variable in fertility is not body fat, as is commonly believed, but the immediate availability of metabolic fuels.

I’m not even sure why he brings this part up. I guess to add to the list of all the Conventional WisdomTM he has “debunked.” At any rate, as evidence for what is commonly believed he cites a paper by Frisch and MacArthur titled “Menstrual Cycles: Fatness as a Determinant of Minimum Weight for Height Necessary for Their Maintenance or Onset” that concludes the following “The data suggest that a minimum level of stored, easily mobilized energy is necessary for ovulation and menstrual cycles in the human female.”2 The authors also mention that “If a minimum of stored fat is necessary for normal menstrual function, one would expect that women who live on marginal diets would have irregular cycles, and be less fertile, as has been observed, and that poorly nourished lactating women would not resume menstrual cycles as early after parturition as well-nourished women, as also has been observed.” Notice anything funny here? And he contrasts this with two papers by Schneider and Wade that conclude the exact same thing, only they used animals for their studies instead of people.3,4

Whatever. Not a big deal, but strap in because this next one is a whopper. Continuing on pg 436-437 Taubes tries to make the argument that insulin is responsible for infertility, citing some research by Wade and Schneider.

[I]nfusing insulin into animals will shut down their reproductive cycles. In hamsters, insulin infusion “totally blocks” estrous cycles, unless the animals are allowed to increase their normal food intake substantially to compensate.

However, if you actually read the research you will find that it wasn’t the insulin they were studying, but hypoglycemia.4 Insulin was simply a way of artificially inducing hypoglycemia in the hamsters. The authors even mention this:

[I]nsulin was used as a tool to demonstrate the effects of fuel partitioning on reproductive function. Treatments with high doses of insulin that produced hypoglycemia inhibited reproductive function. The results do not support a role for insulin per se, independent of effects on fuel availability.

Emphasis mine. Unless something was really wrong with you, you likely are not going to experience hypoglycemia if you consume a diet that includes at least some carbohydrates. Indeed, those deciding to consume low-carbohydrate diets would be at greater risk of hypoglycemia.5

* * *

If you’re still not convinced that meat = magic then Taubes has a tobacco tale for you on page 437; and a tall tale it is.

Consider nicotine, for instance, which may be the most successful weight-loss drug in history, despite its otherwise narcotic properties.

I wanna stop right here. This is a bold claim. The most successful weight loss drug IN HISTORY? If that’s true then the majority of smokers that I know should be thin. As a matter of fact they should be downright anorexic considering their frequency. Actually, the reverse is true if my experience is any indication. Of course using anecdotal arguments like this is not at all scientific, but c’mon has Taubes never heard of ephedrine? Sibutramine? Dinitrophenol? Amphetamines for god’s sake? Even cocaine?

Absurd historical claim nothwithstanding, he attempts to make the claim that if and when people gain weight after they stop smoking is because smoking is hormonally similar to eating a low-carb diet.

There seems to be nothing smokers can do to avoid this weight gain. The common belief is that ex-smokers gain weight because they eat more once they quit.

[…]

[A]s Judith Rodin, now president of Rockefeller University, reported in I987, smokers who quit and then gain weight apparently consume no more calories than those who quit and do not gain weight. (They do eat “significantly more carbohydrates,” however, Rodin reported, and particularly more sugar.) Smokers also tend to be less active and exercise less than nonsmokers, so differences in physical activity also fail to explain the weight gain associated with quitting.

There’s the ol’ Common BeliefTM again. I guess he figures he wore out Conventional Wisdom so he’ll go with another phrase that means the same thing. Nevertheless, reading this passage Taubes would have you believe that people lose weight after they quit smoking and weight gain in these instances is completely divorced from the amount of calories they eat. As evidence he cites a paper by Judith Rodin, but perhaps more importantly he does NOT mention contradicting evidence from other papers that he cited on the very same page! Por ejemplo, when discussing other aspects of nicotine he cites a review paper titled “Smoking Cessation and Weight Gain” published in 2004, which states

Mechanisms of weight gain [following smoking cessation] include increased energy intake, decreased resting metabolic rate, decreased physical activity and increased lipoprotein lipase activity (14–16,20–23). Nicotine significantly decreased body weight and food intake via a decrease in meal size and a longer inter-meal interval […]6

Another review titled “Weight Gain Following Smoking Cessation” that Taubes cites on this very page relates the following:

Nicotine has commonly been called an anorectic, an agent that suppresses eating. Consistent with this view, the vast majority of prospective studies have found a sharp increase in eating during the first few weeks of smoking cessation (e.g., Hatsukami, Hughes, Pickens, & Svikis, 1984; Perkins, Epstein, & Pastor, 1990; Spring, Wurtman, Gleason, Wurtman, & Kessler, 1991). The magnitude of this increase (approximately 250-300 kcals/day) is strikingly similar across studies, despite important differences in food measurement methodology (e.g., observation of food intake in in-patients, subject self-report by means of food diaries) and subject populations (female subjects, male subjects, or both).7

But Taubes dismisses all of this evidence by glossing over it and highlighting the single Rodin publication, which looks at current smokers and those that recently quit.8 If you actually read the text of the study you’ll find that the quitters on average did not gain significantly more weight than the smokers. Moreover, almost half actually lost weight after quitting. It is also worth noting that the measurement of caloric intake was self-reported, and self-reporting energy intake has been shown to be notoriously unreliable. But I’m sure this singular study with self-reported intake and non-significant results trumps all the other evidence to the contrary.

* * *

On page 446 Taubes says the following:

Avoiding carbohydrates will lower insulin levels even in the obese […]

Now this is a pretty anodyne and uncontroversial statement. I doubt you’ll find any nutrition professional worth their salt that would disagree with the above statement. What is interesting about this is not the statement, but the source Taubes cites for this. It absolutely backs up that claim, but it is devastating to his other claims. Namely, #6 and #9 of his “inescapable” conclusions found in the epilogue.*

The cited study take obese individuals and feeds them isocaloric high and low carb diets as well as hypocaloric high and low carb diets.9 All participants on the isocaloric diets10 maintained their weight whether fed high or low carb diets. All participants fed the hypocaloric diets lost weight regardless of the relative amount of CHO was in the diet. This is actually a pretty damn good experiment to test Taubes’s main hypothesis of calories vs carbs, and the good old calorie wins.

high low carb insulin

* * *

Not a major point but on page 446 Taubes says

It also makes us question the admonitions that carbohydrate restriction cannot “generally be used safely,” as Theodore Van Itallie wrote in 1979, because it has “potential side effects,” including “weakness, apathy, fatigue, nausea, vomiting, dehydration, postural hypotension, and occasional exacerbation of preexisting gout.”

It’s basically a misquotation on two accounts. Van Itallie actually states that low calorie diets “can generally be used safely.”11 Secondly, he states that low calorie diets that are ALSO low in carbohydrates have potential side effects. He is not speaking of carbohydrate restriction in general terms as Taubes implies.

* * *

Page 447, Taubes contends that, although cholesterol levels may rise on a low-CHO diet, it is by no means permanent.

The existing evidence suggests that this effect will vanish with successful weight loss, regardless of the saturated-fat content of the diet. Nonetheless, it’s often cited as another reason to avoid carbohydrate-restricted diets and to withdraw a patient immediately from the diet should such a thing be observed, under the mistaken impression that this is a chronic effect of a relatively fat-rich diet.

Maybe this is another minor point, but the “often cited” part of his claim is in reality a single newspaper article about a guy that sues the Atkins estate for his high cholesterol.12 The article seems to imply that the case is kind absurd and that a judge would almost certainly throw out the suit.

 

 

*For those that don’t have the book…
“6. Consuming excess calories does not cause us to grow fatter, any more than it causes a child to grow taller. Expending more energy than we consume does not lead to long-term weight loss; it leads to hunger.”
“9. By stimulating insulin secretion, carbohydrates make us fat and ultimately cause obesity. The fewer carbohydrates we consume, the leaner we will be.”

cloudReferences

1. in Childhood Obesity (ed. Collip, P. J.) (Distributed by Medical and Technical Publishing Co, 1975).

2. Frisch, R. E. & McArthur, J. W. Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science 185, 949–951 (1974).

3. Schneider, J. E. & Wade, G. N. Availability of metabolic fuels controls estrous cyclicity of Syrian hamsters. Science 244, 1326–1328 (1989).

4. Wade, G. N. & Schneider, J. E. Metabolic fuels and reproduction in female mammals. Neurosci. Biobehav. Rev. 16, 235–272 (1992).

5. Colle, E. & Ulstrom, R. A. Ketotic hypoglycemia. J. Pediatr. 64, 632–651 (1964).

6. Filozof, C., Fernández Pinilla, M. C. & Fernández-Cruz, A. Smoking cessation and weight gain. Obes. Rev. 5, 95–103 (2004).

7. Perkins, K. A. Weight gain following smoking cessation. J. Consult. Clin. Psychol. 61, 768–777 (1993).

8. Rodin, J. Weight change following smoking cessation: The role of food intake and exercise. Addict. Behav. 12, 303–317 (1987).

9. Grey, N. & Kipnis, D. M. Effect of Diet Composition on the Hyperinsulinemia of Obesity. N. Engl. J. Med. 285, 827–831 (1971).

10. (except for one that did not consume all of the prescribed diet).

11. Bray, G. A. Obesity in America: a conference. (U.S. Dept. of Health, Education, and Welfare, Public Health Service, National Institutes of Health, 1979).

12. Burros, M. Dieter Sues Atkins Estate and Company. New York Times 1 (2004).

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10 thoughts on “Good Calories, Bad Calories: A Critical Review; Chapter 24 – The Carbohydrate Hypothesis III: Hunger and Satiety

  1. Seth, related to the point about infertility, it’s actually well established that leptin levels have a major influence on fertility. And leptin levels are determined by body fat mass. So it is, in fact, body fatness that directly controls fertility, in women at least. This makes sense. If you don’t have enough stored energy to make a baby or produce milk, you shouldn’t get pregnant. (parenthetically, Taubes would argue that we can have a lot of fat but not have access to it due to high insulin levels, but all available evidence refutes this claim)

    I’m not aware of any evidence that “immediate availability of metabolic fuels” controls fertility, as claimed by Taubes. Not sure where he got this idea, perhaps from the observation that making hamsters hypoglycemic with big insulin injections stops menstruation? As you noted, that’s hardly convincing because hypoglycemia is a powerful stressor that has little relation to normal physiology in a non-diabetic person.

  2. For the people who believe that weight loss is purely a factor of calories in, calories out it’s worth looking into the large number of people who have got a fitbit or other activity monitoring, done the math on how many calories they are eating and get into a calorific deficit – and then don’t lose weight, or even put on weight.

    Like this article http://www.today.com/health/fitness-band-frustration-users-complain-weight-gain-trackers-t66146

    This quote sums it up well: Weight loss is more an art than a science. While we might like to think it’s a simple calculation of calories in and calories burned, most of us have numerous, fluctuating variables in our personal weight-loss equation.

    I know this isn’t necessarily related to this article however the sort of opinion underlying these articles seems to point at the author being in the “it’s all about calories” camp.

    My personal experience was that during a period I was looking to lose weight a calorific deficit worked for about 2 weeks then stopped working. Then I got so hungry it began to impact my work performance and my mood and life. A month later I needed to eat more to feel normal and my weight yo-yo’d pretty bad back. I wasn’t super overweight or anything though.

    These days I follow a much more overall health and wellbeing approach and am much better for it.

    It does surprise me that seemingly smart well educated people can recommend a a purely calorie focused approach to health. I mean, common sense indicates that a bowl of the healthiest food imaginable – for a example a salad I’d have with salmon, avocado, greens, olive oil, raw veges and some nuts – would have the same health impact as a McDonalds meal with the same calories.

    It’s obvious that calories do matter to some extent when losing weight. If you have a pet and feed them less and exercise them more you know they will lose weight. However it seems to only be part of the picture. There are many, many more strong influences. Also, many studies about diets tend to focus on say losing weight, without giving any consideration to how you feel, your wellbeing, how often you got sick, or many other key factors.

    I know that when I was on a large number of small frequent meals, high carb low fat diet recommended by a nutritionist along with a lot of personal training I did lose weight and get abs. The problem was that I felt terrible. I nearly lost my job because I was so flat and couldn’t concentrate. I also got so hungry when I had a cheat day I’d eat a 10+ stack of pancakes with cream and icecream. My metabolism was burning so hot it was incredible. It was unsustainable however and there was no way I could have stayed on this plan long-term. So if I was being studied during that time I’m sure some of the commonly studied data would have been positive, though I would never recommend someone eat like that unless for a short time for a bodybuilding competition or something.
    Like this article http://www.today.com/health/fitness-band-frustration-users-complain-weight-gain-trackers-t66146

    This quote sums it up well: Weight loss is more an art than a science. While we might like to think it’s a simple calculation of calories in and calories burned, most of us have numerous, fluctuating variables in our personal weight-loss equation.

    I know this isn’t necessarily related to this article however the sort of opinion underlying these articles seems to point at the author being in the “it’s all about calories” camp.

    My personal experience was that during a period I was looking to lose weight a calorific deficit worked for about 2 weeks then stopped working. Then I got so hungry it began to impact my work performance and my mood and life. A month later I needed to eat more to feel normal and my weight yo-yo’d pretty bad back. I wasn’t super overweight or anything though.

    These days I follow a much more overall health and wellbeing approach and am much better for it.

    It does surprise me that seemingly smart well educated people can recommend a a purely calorie focused approach to health. I mean, common sense indicates that a bowl of the healthiest food imaginable – for a example a salad I’d have with salmon, avocado, greens, olive oil, raw veges and some nuts – would have the same health impact as a McDonalds meal with the same calories.

    It’s obvious that calories do matter to some extent when losing weight. If you have a pet and feed them less and exercise them more you know they will lose weight. However it seems to only be part of the picture. There are many, many more strong influences. Also, many studies about diets tend to focus on say losing weight, without giving any consideration to how you feel, your wellbeing, how often you got sick, or many other key factors.

    I know that when I was on a large number of small frequent meals, high carb low fat diet recommended by a nutritionist along with a lot of personal training I did lose weight and get abs. The problem was that I felt terrible. I nearly lost my job because I was so flat and couldn’t concentrate. I also got so hungry when I had a cheat day I’d eat a 10+ stack of pancakes with cream and icecream. My metabolism was burning so hot it was incredible. It was unsustainable however and there was no way I could have stayed on this plan long-term. So if I was being studied during that time I’m sure some of the commonly studied data would have been positive, though I would never recommend someone eat like that unless for a short time for a bodybuilding competition or something.

    • No, the problem is that Fitbit or any other tool that predicts your energy expenditure will be inaccurate on an individual level. Even if your tracker says you are in a, say 500 calorie deficit during the day, the actual deficit may be way less. And it’s a fact that the popular 3500 calorie deficit = 1 pound weight loss is false. Check out the Supertracker tool at usda.gov to see how your calorie expenditure changes as you lose weight. And estimated calorie intake may be wrong aswell. But people’s inability to count calories in/out correctly doesn’t invalidate the theory at all.

      • I don’t think personally the accuracy of the calorie expenditure tracking is the issue. Purely because for many people a calorie deficit works initially and then plateaus. This happened to me also.

        Another factor is that the type of exercise makes a big difference to body composition. Anyone who has a lot of experience in exercise knows this pretty well. How you burn those calories – either walking, running, interval training, lifting weights etc – has an differing impact beyond the pure number of calories.

        The way I see it personally and through my own experience and seeing specific live case studies is that the calories in, calories out concept is OK for a very, very basic theory of health. Let’s say someone is extremely overweight and has never eaten healthy or exercised in their life, then it’s a good, simple, solid concept to share with them.

        Beyond that it’s just too simple to match the real complexity of reality.

        You seem like a smart person interested in nutrition. In my experience personally it’s usually the overweight or unhealthy people who are all about the calories in and out theory. They put on their 300 calorie lean cuisine microwave lunch and jog after work and wonder why they can’t lose weight. Ignoring the quality of ingredients, cooking method, type of exercise, sleep, etc just doesn’t make sense to anyone really passionate about health.

    • ”For the people who believe that weight loss is purely a factor of calories in, calories out it’s worth looking into the large number of people who have got a fitbit or other activity monitoring”

      If that’s true, how come this has never been observed in any metabolic ward studies? Consistently, in metabolic ward studies (and there are dozen of those), when someone is on a caloric deficit, he loses weight.

      • Hey François, what are your thoughts on this: http://ajcn.nutrition.org/content/79/5/899S.full

        This sums up my thoughts:

        We conclude that a calorie is a calorie. From a purely thermodynamic point of view, this is clear because the human body or, indeed, any living organism cannot create or destroy energy but can only convert energy from one form to another. In comparing energy balance between dietary treatments, however, it must be remembered that the units of dietary energy are metabolizable energy and not gross energy. This is perhaps unfortunate because metabolizable energy is much more difficult to determine than is gross energy, because the Atwater factors used in calculating metabolizable energy are not exact. As such, our food tables are not perfect, and small errors are associated with their use.

        —> So in short. Yes a calorie is a calorie. However, the human body is complex and like how they found having certain gut bacteria causes some people to ingest more calories than others means that it’s not as simple as many people think and there are many factors at play.

  3. Can you please do a review of The Paleo Answer: 7 Days to Lose Weight, Feel Great, Stay Young Paperback – October 16, 2012
    by Loren Cordain? I’m enjoying reading these reviews and would like it if you could write a review on a less commonly popular book that seems to be better researched than the ones you are currently reviewing. Thanks, Matt

  4. Hi Seth,

    Thanks for the interesting article!

    “Namely, #6 and #9 of his “inescapable” conclusions found in the epilogue.” <— Can you add these conclusions to this article? I don't have the book.

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