Good Calories, Bad Calories review - continued

... Continuation of the review of Good Calories, Bad Calories ...

His work is detailed and referenced to original research sources throughout. It seems difficult to argue in opposition to his findings - perhaps he left something out that would lead us elsewhere? I am a skeptic so as I read this I did my own cross checking. And he appears to be telling us a true story and uncovering a public health disaster - caused by public health officials themselves.

In many cases he looked at several angles such as cross checking claims about 1900s beef consumption with historical data on cattle herd sizes. Other book reviews are supportive of his work and have not found errors. However, other authors such as Anthony Colpo argue persuasively that parts of what Taubes writes are likely in error. Regardless, the key take away is that there was little to no evidence for the U.S. government's official dietary recommendations.

For example, a report published in the American Journal of Preventative Medicine in January 2008 suggests the government's nutrition recommendations, particularly with regard to recommending a low fat diet, may be causing more harm than good because sugar (and excess carbs) replaced the fat. They note there was no evidence that recommending a cut in fat consumption would be "beneficial" overall. While the government lacked evidence to reduce fat there was a belief that recommending less fat would cause no harm - but that was never tested.

According to the Harvard School of Public Health, "The low-fat, high-starch diet that was the focus of dietary advice during the 1990s-as reflected by the USDA food guide pyramid-is dying out. A growing body of evidence has been pointing to its inadequacy for weight loss or prevention of heart disease and several cancers."

I found his suggestions similar to those in the Cochrane Reviews, from the Cochrane Collaboration. Cochrane Reviews summarize only those studies that are completed to rigorous standards (such as double-blinded randomized controlled trials of sufficient size and control) and are the foundation of evidence-based medicine.

Here the Cochrane Review finds that low fat diets are no better for weight loss than other diets. (Stated another way and per other commentary, there is little evidence in favor of any popular diet versus any other.)

Here the Cochrane Review finds low carbohydrate diets (which typically means high protein and high fat) reduce cardiovascular risk and decrease total cholesterol levels (perhaps because all weight loss leads to improvements regardless of how the weight loss is achieved?). "Healthy Heart Program" multiple risk factor interventions do not seem to work to reduce cardiovascular risks, says the Cochrane Review. Saturated fat consumption may slightly increase cardiovascular risks but other studies have not been long enough to know if there is any change in mortality due to dietary restrictions. (In the Cochrane Reviews you can also find that salt reduction for an extended period results in blood pressure drops of -1 to -5 mmHg, which may or may not be significant depending on the individual.)

And if that were not enough, "Compared to normal-weight subjects with a BMI between 20 and 25, the risk of death, heart attack, or stroke was lower in subjects who were overweight (BMI 25 to 30), and in those with class I obesity (BMI 30 to 35) and class II-III obesity (BMI 35 or greater)." Even the American Diabetes Association is now acknowledging that there may be benefit from low carbohydrate diets. (This update was introduced during the last week of December 2007, a traditional dead zone when few people will notice the ADA's change.)

The author's implication is the low fat eating mantra was wrong and resulted in replacing protein and fat in our diets with refined carbohydrates, leading to today's obesity epidemic.

You can read a review of the book in the public pages of the Wall Street Journal here written by Scott Gottlieb, M.D.

The NY Times book review is here and a separate review is here.

The book is available at bookstores nationwide and through online resellers.

There is apparently a rising awareness that the USDA's dietary recommendations are not based on evidence and may have caused a decrease in health.


Taubes explains how sloppy science and political wrangling (not necessarily by politicians but also scientists) led to today's directive to eat low-fat foods. While eating low fat may be perfectly fine, the alleged benefits of low fat eating probably do not exist. And may cause harm for some people. Which is a bit of surprise for most of us.

Early in the book he notes the USDA's Food Pyramid and the similar American Heart Association dietary guidelines have not been tested to see if they have benefits outweighing the risks. (Junkfood Science summarized the recent report from the nearly $0.7 billion Women's Health Initiative that discovered - there's no difference in mortality between low and high fat diets.)

Taubes shows how bad science, inept use of statistics, finding correlations without causation but drawing conclusions anyway, poor data analysis and methodology, cherry picking of data and studies, ignoring mortality data, a "disease marketing" organization spreading fear to raise funding, media reporters who quickly adopted an unquestioning bias favoring the low fat diet, a fading politician who just lost a Presidential election and whose staff was unaware of contrary studies, the use of "independent" expert panels that were not independent, stacking expert panels primarily with those who agree with the leadership, the desire for "consensus" and the denigration of anyone who disagreed as skeptics led to the silencing of contrary viewpoints. Low fat/low total cholesterol proponents agreed the evidence was weak and contradictory but argued that there was no time to wait for "final scientific proof" - the country needed to act immediately as American lives were at stake.

(There are surprising - perhaps scary - parallels between the process that led to the flawed policy on diet and several contemporary public policy issues. I am interested in the organizational processes that lead to flawed decisions - I'll briefly touch on that at the end.)

A major study found that total cholesterol lowering diets actually increased heart disease - but chose to not publish their result for an incredible 16 years because "We were just disappointed in the way it came out" disagreeing with the consensus view. Others found that low total cholesterol was associated with colon cancer and still others found that low fat diets paradoxically increased heart disease risks. As shown later in the book, the NY Times wrote that those who disagreed with the consensus view that low-fat diets were the solution "were all in the pocket of the industries being hurt".

Beginning after 1977, the government organized "independent" expert panels to review the situation and make recommendations on dietary guidelines. But the "independent" studies and expert panels were tightly interwoven through professional social networks and were not independent at all. The panels were stacked with those who all agreed with one another before the meetings began. He suggests that just half a dozen influential researchers essentially controlled the what got funded, researched, published and issued as policy. And their bias was to support their own past work and to discard contrary evidence.

When coupled with a environmental movement seeking a reduction in meat consumption this led to a Senate committee issuing dietary recommendations (written by lawyers and ex-journalists) to decrease fat in the diet. The low fat concept was born as a political issue with government guidelines that the National Academy of Sciences, the FDA and the National Institutes of Health called a "political document rather than a scientific document". They said the recommendations lacked evidence. The national Food and Nutrition Board said there was only sufficient evidence to state that people should manage their weight.

Being rebuffed by the above agencies, the politicians pushed the dietary food guidelines to the U.S. Department of Agriculture, which today owns the Food Pyramid. The government saw the need to create "social pressure" to force Americans to change their dietary practices to eat less total fat and less saturated fat.

According to government data the author cites, the average American did reduce their fat intake and change their diets by rather a lot. And they replaced it with carbohydrates, especially refined carbohydrates. And they gained weight. A lot of weight.

My own view is slightly different than Taubes - I think the increase in carb consumption comes not only from official-but-flawed recommendations but also because manufactured and prepared food is heavily tweaked to encourage us to eat more of it. Two-thirds of manufactured food is manipulated with additives including MSG, autolyzed or hydrolyzed yeast extract and so on, plus excess sugars, specifically designed to encourage you to eat more because that is how the manufacturer makes money. Carbohydrate based foods are also the cheapest to manufacture - creating inexpensive high calorie foods. A study seems to confirm the idea that flavor enhancement and increased flavor variety encourages us to eat too much. And eating too much of anything, especially tweaked carbohydrate that literally dissolves into blood glucose, will lead to weight gain - and seems to also enter into a cycle of wanting to eat even more.

(Side note: One of the ways the USDA calculates calories and types of food consumed by Americans is nonsensical. )

The low fat/high starch direction correlates directly with the rise in obesity that coincided with the adoption of the government's dietary guidelines, guidelines now seen as not based on clear evidence. (Again, review the latest report, which is one of many in recent years - there is no difference in mortality between those consuming low fat versus high fat diets. Also see the January 2008 study that finds there was never any evidence that recommending low fat diets would be beneficial.)

Nutritionists discovered that "if their research failed to support the government position the funding would go to someone whose research did." To be a skeptic of the now politicized dietary recommendations meant a loss of research funding as "the peer review system rewards conformity and excludes criticism". Government authorities tried to get journals to censor reports that conflicted with the "consensus" since contrary articles diluted the government's policy message and confused the public.

The book details the flawed process that led to the dietary recommendations we have today - and for which the supporting evidence is weak to non-existent. A main message of the book is that we lack evidence to make the expansive claims made for low fat diets (but this does not mean that low fat diets are necessarily bad either). We must be far more open minded and recognize the lack of evidence for most dietary recommendations. We should be concerned that beginning with the government issued low-fat declaration, average weight in the U.S. steadily climbed, as has the per capita consumption of sugar.

The book is vast and highly detailed. I will not try to summarize more of it. You should read it for yourself to understand how bad science collides with self interest, ulterior motive driven organizations, politicians, corporations and large egos. As documented in this book, when science enters the sphere of politics, the issue is no longer science but politics.

Once the public mind has been set and the train has left the station, even significant contrary evidence may be unable to bring the train back on track to truth. The train is now barreling towards the destination known as obesity and there may be no way to stop it as so many vested interests strive to protect their turf.

I am reminded of reading a professor at the University of Minnesota who noted, a decade ago, that government nutrition recommendations were questionable at best, pointing out that the USDA made significant changes to their recommendations every five years. To him, that suggested that little was really understood about nutrition.

Without sound skepticism and an open mind you do not have science - you have politics and consensus building. The scientific method is built upon falsifying hypotheses - without sound skeptical inquiry, the method fails.

Why do policy processes become broken?
One person I spoke with, seeing parallels between this 30 year old process and contemporary public policy processes wondered if the "powers that be" were going by a "playbook" to achieve pre-determined outcomes. I do not think so. I think the process itself is defective and will always lead to these outcomes. These same mistakes are repeated for most public policy efforts. The process itself produces biased results regardless of the policy issue under discussion - whether the process produces correct policy recommendations is largely a random result. The recommendations have more to do with the faith and beliefs of those in the driver's seat than the underlying evidence.

Examples of muddled policy decision-making caused by abused process include banning children's cold medicines (after being approved by expert panels and used for decades - now they say the meds never worked?), WMD in Iraq, questions about the use of ADHD and anti-depressive medication in children, government health care planning, the over selling of bystander CPR which achieves about a 1% survival-to-hospital-discharge rate, that many anti-depressant medications have been significantly hyped and may not actually work, corn-based ethanol (makes food cost more, may cause more pollution, consumes enormous quantities of water in drought stricken areas and makes little new energy), ozone hole theory recently fell apart (see chemistry explanation) and with it the policy to deal with it, climate policy and so on.

A key attribute of many policy disputes is policy arguments based on an appeal to authority rather than data. Powerful authority-like figures emerge (whether in science or politics) who are in a position to steam roll and marginalize those who present contrary evidence. The result is that important policy decisions are perhaps mostly based on the biases and beliefs of those in power positions and not based upon the totality of the evidence. And sometimes, authorities misquote assumptions to magically manufacture facts out of thin air to support their thesis and use their position of authority to drive a falsehood forward as fact. No one goes back and looks at the original data upon which the entire argument is based - that data is just assumed to be correct and high quality, although as we learn more and more, its often bad quality and inaccurate and never reviewed by anyone.

Most science research results are quite fuzzy, especially when considered with the published caveats, the weak statistical associations, the contrary studies and so forth. But the media leaps upon the latest study as fact, never seeming to notice that the latest study refutes the previous "facts" of another study trumpeted by the media. (I do intend to sometime write a Part 6 on the media series regarding how fuzzy results, media hype, hired gun AstroTurf public relations firms, disease marketing, profit-seeking businesses, stacked expert panels and other factors contribute to the creation of fads. Remember the "low salt" fad? That's mostly disappeared now. Remember the "high fiber fad"? Gone too. "Low fat" - per the Harvard SPH, is fading. Remember tryptophan from meats like turkey supposedly putting you to sleep? Nope. Wasn't true. Remember when ulcers were caused by stress and/or what you ate? False too. Complex carbohydrates are better than simple carbs, right? Well, not any more - that advice turned out to be badly flawed; potatoes raise your blood glucose level faster and higher than table sugar. Eating eggs raises your cholesterol levels? Nope, that was wrong too. And it is hardly just health science - this occurs across the full spectrum of science, especially when science intersects with public policy.)

There is very interesting discussion on Taubes' book and how it applies to other fields of science and policy making here. This forum discussion took place after I wrote the above.

Buy the book and read it. As one reviewer wrote:

"I highly recommend the book, for those who firmly hold carbohydrate restriction is scientifically valid and for those who firmly hold limiting dietary fat is scientifically valid.

At the end of the day our quest isn't to prove what is believed right, it's to discover what is rightly to be believed."

As I have written about in the past, there are many arguments about the health effects of MSG, sugar and sugar concentrates like high fructose corn syrup, and salt. Without getting into the alleged health effects, there is one area for which there is no dispute: these are food additives that enhance the taste and encourage us to eat more than we need. Food manufacturers like that since their goal is to get us to buy more of their food product. Eating too much (and not all calories are the same) will likely lead to obesity. Obesity appears to be associated with various diseases including high blood pressure, joint injuries, heart disease, diabetes and others. (Whether obesity affects overall mortality is subject to debate. And see the latest government study - the results unexpectedly show that obese people have a lower mortality rate than thin people. Go figure?)

We are undoubtedly better off eating "real foods" that have not been modified and tweaked to encourage us to eat more. Whether we eat low fat or low carbohydrate is probably a personal decision based on what works for each individual. Many will likely find that a variety of foods work best, provided they are not tweaked to encourage you to eat too much.

It seems likely that diets that actually work all end up restricting calories to create a caloric deficit whether the diet is low fat, low calories, high fiber, low glycemic index, low carbohydrate or just massive exercise.

There is little evidence favoring any weight loss method over any other. Traditional calorie restriction approaches work for some but are difficult to follow such that they are often abandoned. Low calorie high carbohydrate diets (recommended by the government, the AHA and so on) cause feelings of hunger and few people withstand constant hunger for long periods of time.

Other plans produce such slow weight loss that dieters give up in frustration.

Some diets provide limited food choices that result in abandonment of the diet.

Some diets only slim your wallet by providing over priced pre-packaged manufactured food.

Some, like Atkins or Stillman high protein (low carb) diets tend to produce slow weight loss without starvation due to eliminating carbs; the body is allegedly forced to consume its own fat and appetite decreases but there remain concerns over nutritional balance long term (but note that actual large-scale studies have shown no difference in mortality between low fat and low carb diets). Extreme low carb eating (a la Atkin's strict induction phase) is difficult to do for longer periods due to limited food choices, the need to cook all food, and the practical problem of creating numerous dirty pans and dishes.

There is evidence that the appetite suppression of low-carb diets leads the dieter to consume fewer calories too. Some suggest that the appetite suppression of high protein consumption coupled with limited food options to eat results in a low calorie diet.

About 40% of dieters on either low fat or low carb diets end up quitting early. Finally, each approach has benefits and risks to health. However, any diet that does not work for an individual has the risk of the individual remaining obese. Whether that causes overall health risks to increase is less certain, says the latest government research (and more here).

There are claims that "90 (or 95) percent of dieters who lose weight regain all or part of it within five years" (probably because after dieting, they return to the eating style that caused their original weight gain.) There are also indications that claims of diet ineffectiveness are flawed and that people can and do truly lose weight and keep it off.

Others claim that over a 5 year period, all weight loss programs fail as nearly everyone regains weight, even when subsequently eating fewer calories and exercising more. They say that diet and exercise do not work on a long term basis (and almost no one can credibly follow the U.S. government's recommendation to get 90 minutes of exercise per day). As in "Good calories, Bad calories", there are others who say there is no evidence that exercise leads to weight loss or weight maintenance.

The newest research now suggests glycemic index - the GI measures how real people process food into blood sugar - is key. High glycemic index foods, like potatoes, turn into blood sugar spikes. Low glycemic foods, like carrots and whole grains, gradually increase blood sugar, with a gradual decrease later. Rapid spikes in blood glucose levels seem to be a factor in causing both diabetes and obesity (tends to encourage eating too much throughout the day). Read The New Glucose Revolution (or Good Calories, Bad Calories) and you'll learn that fundamentals about nutrition taught for fifty years turned out to be false.

There seem to be plenty of studies pro- and con on every dietary recommendations (see for example or this). Probably best for dieters to try a variety of methods until finding one that works.

And that's the last memo at this blog.

Minor updates:
Another myth shattered: The Science Education Myth. For decades we have been told repeatedly that the U.S. is falling behind in math and science education and that we have a shortage of scientists, technologists, engineers and mathematicians, with the made for the media and Congressional lobbying acronym "STEM".

Except that a major new study reveals that its not just a little wrong, it is flat out wrong.

For two decades U.S. colleges have been graduating almost three times more science and engineering students than we have new jobs available each year.

But we've been consistently told we have a shortage of science and engineering graduates in the U.S. and must import those workers from abroad. Dr. Norm Matloff (in his email distribution list), responding to frequent accusations that U.S. students lag in math notes that the "country" in second position to Singapore's highest math scores is .... Nebraska! The skill surveys are, as I reported on the old blog, using poor methodologies that often exclude entire populations in some countries to bump up their average, or exclude entire countries that do not permit measurement (such as India and China).

Just like with the government's misguided nutrition recommendations leading to obesity, the U.S. government's attempt to solve a non-existent STEM worker shortage is leading to students abandoning engineering and science in favor of health care, business and law careers.

Related Myth: Around the year 2000, the Information Technology Association of America (ITAA - a lobbying group) published an estimate that in the coming year 1.2 million IT workers would leave their current job (and go to another IT job) and that 400,000 new jobs would be created. This was translated by the ITAA, the media morons and some advertisers like ITT Tech into making the false claim that there were be 1.6 million new IT jobs created in 2001! This did not pass the giggle test since the U.S. was forecast to create only 2 million new jobs per year - in total. The original report shows they actually forecast 400,000 new jobs. And in that one year - 2001 - subsequent data showed that less than 200,000 actual new IT jobs were created. We went from the urban legend "1.6 million new IT jobs" to an actual growth of less than 200,000 new IT jobs. But the ITAA accomplished its goal of expanding the importation of temporary tech workers from outside the U.S. to help keep salaries down.

Astronomical model of the universe may be totally wrong but no one yet knows for sure. Like so many modern studies, the critique relies on statistical associations which means this will be argued until the end of the universe is reached.

Another myth? Does daylight savings time actually save energy? The conclusion that it does is based on very old data (from 1974) that no longer apply as new appliances (computers, VCRs, widescreen TVs) now account for much more power as lighting accounts for less. There is newer - and conflicting data that suggests daylight savings time may not be the best way to reduce electricity demand - and may not be reducing demand today.

The FBI used a scientific analysis method to investigate crimes for 40 years after which it was discovered to be completely invalid and may have sent hundreds or thousands of innocent people to jail. The underlying science was fake - it was based on a belief system that went unchallenged for 40 years. Ten years after finding the method didn't work, the FBI still has not notified many convicted criminals that they may, in fact, be innocent. Bad science can have devastating effects for decades.

An emerging consensus says scientists are losing the publics' trust - some, including me - blame the media for its moronic and incompetent reporting on technical subjects that often involve numbers.

Are you feeling a bit manipulated yet?