Why We Get Fat: Diet Trends and Food Policy

Why We Get Fat: Diet Trends and Food Policy

August 4, 2019 100 By William Morgan


Welcome to the stanford Health Policy
Forum I’m Dan Kessler
I’m a professor in the business and
law schools here at Stanford and a
member of the Advisory Council of the
Stanford Health Policy Forum that’s why
I’m here today. I’d like to make just
a couple of brief opening remarks and
then introduce our panelists. First, most
important, please turn off your cell
phones and pagers put them on silence
mode. Second,
Gary’s books are for sale out front
along with some complementary
publications from Chris Gardner who I’ll
introduce also in a moment.
And third, you can see all of our events,
this one included, on the web
filmed at HealthPolicyForum.
stanford.edu.
But before I introduce our panelists I’d
like to just take a moment to thank Dean
Philip Pizzo for his
leadership and commitment to our
Stanford Health Policy Forum. And I’m not
just saying this because I’m a member of
the advisory board.
I’m saying this is a member of the Stanford
community and someone who’s really
enjoyed coming to these things. We’ve
covered a wide array of topics of broad
importance to health policy and I think
it’s been a wonderful service to the
University and to the community as a
whole. So now let me just
move right to introducing our speakers
today.
First is Gary Taubes. Gary is a science
journalist, the author and co-founder
of the Nutrition
Science Initiative. His two books of
which I own multiple copies and suggest
you guys do — why we get fat and what to
do about it,
and Good Calories, Bad Calories. He’s also
a contributing correspondent for Science
and recipient of a the Robert Wood
Johnson Independent Investigator Award
in Health Policy.
He’s won numerous awards for his
journalism including the International
health reporting award, and the
National Association of Science Writers
in Society Journalism award three times,
the only print journalists ever to do so.
He’s also the co-founder as I said of
the nonprofit nutrition science
initiative. Taubes has argued and will
today
explain to us how our diets overemphasis
on certain kinds of foods, carbohydrates,
has led directly to the obesity epidemic
that we’re facing with us also today. With us
also today is Chris Gardner.
Chris is an associate professor of
medicine and director of the Nutrition
Studies at the Stanford Prevention
Research Center.
He serves on the nutrition committee of
the American Heart Association and the
Education Committee of the Obesity
Society. Chris is actively involved in
research focused on dietary intervention
trials designed to test the effects of
food components and food eating patterns
on chronic disease factors, including
body weight lipids and inflammatory
markers. Moderating our discussion
today is Paul Costello. Paul is the
chief communications officer for the
Stanford University Medical School
he leads the medical schools
communication and public relations
efforts, and will be serving as the as
the ringleader from now on.
So with that, I’ll turn it over to you Paul. Thank you Dan and thank you everyone for
joining us today.
I want to begin by asking you how many
of you have ever been on a diet?
Okay, how many have been on a low-fat diet? How many had been on a low carb diet?
Okay. I want to begin by asking the two
people here on stage
what did you have for Thanksgiving
dinner and how what does what you had
for Thanksgiving dinner
tell us about your beliefs about food
and nutrition. [Gary] Or what does it tell us
about my family’s beliefs? [Paul] Either way. If you
can’t control your family that’s another
issue, but what does it tell us about
food that you chose. [Gary] So what we
have is what everyone has when I
actually put on my plate yep was mostly
the turkey and some and green beans and
brussel sprouts and yeah I had a little
dessert,
a little bit of sweet potatoes and my
wife insisted I tried the mashed
potatoes. The stuffing didn’t look that
appetizing I have to say so I had it
look better I had a little.
Thanksgivings is a lousy
example for what it says about the my
nutritional beliefs but I do you know I
obviously believed that they could see
the carbohydrate content for the diet
that’s problematic
i’m in for reasons I hope to explain
tonight and so that the less
starch, the less refined
grains and sugar, the better I
feel and the lighter I am. I think
this is possibly a universal phenomenon
which will also talk about Christopher
well I’m not everyone is that’s not
that so and i love the part about the
family the family is enormous in this
so my father-in-law has a history of
heart disease and his family he’s been a
vegetarian for years I’ve been a
vegetarian for 30 years
we had a little bit of duck for the
mother in law but the rest of us
what I made was Jesse tools butternut
squash soup and a vegetable broth with
figs and pine nuts and white wine and a
splash of maple syrup
i also baked up some acorn squash and I
put an onion for color red bell pepper
mixture on top
sauteed and mixed with a little rice and
apples and raisins grand i’m going to
interrupt for one second
if my wife had her way we would be
eating at his house next Thanksgiving
that’s a given and part of that that I
want to emphasize is I cook and I think
that’s a big issue that we have to deal
with today
my father knocked this amazing green
bean dish with pearl onions and they
made a fabulous salad that has
everything and the kitchen sink on the
salad
so it’s not just a green leaf lettuce
salad it’s a work of art you know
interesting that that one of the things
that I’ve just heard you both say is you
can eat well eat well and and do it
within a confines of you know not
feeling that sure abstaining or not
feeling that your restraining and that
you can also have a day or a week or or
a moment that you celebrate something
very different than keeping yourself
restrain from food is that right is that
basically the way you approach food
well yeah
in general but i also think that
everybody is different so you could make
the argument for instance that on this
day of thanks we could have all had a
few cigarettes
and we could have all had a few drinks
and that would be true for many of us
and not true for some of us who are more
or less tolerant of these and perhaps
for whom these foods are more than these
substances are more addictive
so I think one of the mistakes we make
is that there’s a spectrum of assuming
that you again something that we talked
about that a calorie is not a calorie is
not a calorie these foods have different
metabolic hormonal and cognitive effects
then there’s a spectrum a maybe a
bell-shaped curve of how we respond to
them and most of us can do exactly what
you said but some of us might be better
off if they don’t
and those are the kind of questions that
haven’t been answered what are the
biggest misconceptions and that the
Americans particularly Americans have
about food diet and nutrition today
Christopher
well they think a lot of food like
substances are food and they’re not
really
if they’re packaged processed
manipulation so that would be the
biggest food but it what does that mean
it
so we’ve taken what was food and we
packed it and brought added value to it
so the farmers out there growing stuff
and getting six cents on the dollar for
it and the middle people took it and
added fat and sugar and coloring and a
label on the front of the package that
says it’s got this and it’s absolutely
fabulous
despite all the other junk that we put
in it and you should buy it for the
fabulous thing that we put in it so i’ll
be my comment on the food like substance
the wait
I’m not sure people have misconceptions
it
we have really interesting studies where
people look at different shapes of body
you ask them what’s normal and
culturally it’s very different
what’s a normal body size what’s
acceptable and then was less food wait
and generate the misconception about
food waiting diets and diets Indiana
well yeah
so the term diet actually means whatever
dieter on weight loss time where you
gain diet habitual diet
I think the American public theme thanks
diet is a time of deprivation and a time
of change that you will soon go off and
that’s the worst part about how many of
you agree with that diet is something
you do and then you go off of here so
educated thank you
we always get overeducated people at
these so it’s America’s misconception
but not yours
thank you what about you hear what are
what are the biggest misconceptions
about food diet and weight
well i paid more attention to what the
research community and the public health
authorities have been telling us I don’t
know if how many of us agree on to me
the greatest misconception out there is
that the reason we get fat is because of
this idea that we just take in more
calories and we expend if you read the
literature you’ll see this phrase all
the time that obesity is an energy
balance disorder it is otay
thermodynamics or physics issue and arm
I think that’s just that is kind of the
original sin in obesity research and
nutrition and so everything we’ve done
since then that was embraced in the
nineteen fifties in the United States
everything we’ve done since then has
been misconceived an attractive but it’s
been based on this idea so when you go
on a diet the primary thing you want to
do on the diet is eat less or if you’re
too heavy want to exercise more and eat
less and some combination of
manipulating your energy and take an
output in a way that you go into what we
call negative energy balance and now
you’re losing weight and by the same
token you know this idea that when you
get down to the way you like
you can now just move into energy
balance and stay that way
although nobody really understands what
that means but that also feeds into this
idea that we go on diets we lose a
certain amount of weight and then we
could go back to eating the way either
we used to eat or the way other people
around us seem to eat to maintain their
weights and we end up you know going on
and off diets our whole lives in part
because this concept is simply
misconceived you you pretty much
attacked the department of agriculture
food pyramid
would you say that’s fair it’s one of
the the institutions like pretty much
attack
what why what’s wrong with the food I
mean the major issue is you know until
the nineteen sixties the
conventional wisdom where that
carbohydrate-rich foods had some
characteristic that we call fat night
so bread pasta potatoes grains of any
kind for anything from flower sweets had
this magical quality of being fattening
and so we avoided them and then in the
1960s we began to embrace the idea that
dietary fat caused heart disease heart
disease and obesity are so intimately
associated you can’t tell people to
lower fat need more carbohydrates
if carbohydrates are going to be
fattening so dietary fat had to become
fattening as well
and between the sixties and the nineties
when the food guide pyramid was
instituted we took this concept of the
fattening carbohydrate and turned it
into the heart healthy carbohydrates
diet food
so by the late nineteen eighties all of
I remember when baked potatoes became a
diet food my life and suddenly we were
all waiting baked potatoes every night
because the idea was it was a sour cream
and the butter that was really fattening
and the potato was you know not with
somehow a diet food words in the 1960s
my mother would believe that a baked
potato was fat night and all of this
would be meaning what wouldn’t be a
problem with the food pyramid if it was
correct this transition but again the
argument i’ve been making that then
that’s taken beyond some of my argument
that I think that’s in my books is that
these carbohydrate-rich foods really are
fanning that they do have this
characteristic of being family and we
should know why that is because of their
effect on the hormone that regulates fat
accumulation and so what we ended up
doing was embracing you know building a
food pyramid where we were all supposed
to eat fattening foods is this tape over
diet those exact foods that my mother’s
generation and like no French woman and
brother certain age would ever be seen
eating
by the foods were supposed to eat all
the time and then we can begin their
heart healthy
so if we get off them are doctor tells
us we’re going to call it give ourselves
a heart attack and we have a serious
problem in all of this coincides with an
obesity and diabetes up to them
what about the food pyramid I mean it’s
the Department of Agriculture US
government is that was tested i’m sure
they didn’t come up with it out of you
know thin air
what about the if you go into a
historically it was tested less than you
would believe testing it requires long
follow-up of people and randomization to
prove cause and effect and it was a lot
of common sense that was built into it
and i would suggest a lot of it that
came into the fat vilification had to do
with some earlier trials that tried to
look at diet and decided what you know
waiting for somebody to deliver guy get
cancer heart disease that’s going to
blow the whole nih budget
I tell you what let’s go for something
like lowering blood cholesterol which we
know from drug trials has been shown to
save lives and saturated fat raises the
bad cholesterol and that was a proxy for
this so if you were on a high fat diet
and was high saturated fat
you raised your LDL and that should have
been bad so what was the counter to that
it would have been carved you would have
lowered your fat and have to replace it
with something so you replaced it with
card but it’s seriously a case of
perhaps good intentions know certainly
good intentions gone awry because of
what the food industry did without
health message so some of my favorite
examples are low-fat organic yogurt
I mean what could be more heartwarming
than low fat or can I ask who’s had low
fat organic yogurt in the last week
now how many of you had plane and how
many of you had raspberry or peach or
apricot or raspberry peach apricot as
the raspberry peach apricot has almost
no fruit in it it’s got some sweetener
before the berries that it doesn’t even
have enough Barry to color the yogurt
so they add coloring and flavor and
sugar and then the berry and you’ve got
a low-fat product but it’s yo turn it
out going to be bad
because it’s full of sugar so what
happened is when we push this low-fat
thing we made a lot of foods that
technically were low fat but when they
took the fat out the mouth taste is gone
the field was gone and they replaced it
with various forms of sugar high
fructose corn syrup being the worst
offender not any worse than sugar but
cheaper so easier to add and slip into
almost everything so I mean food
companies are there to make money so
they test pant they use test panels to
see what people like oh the fat was gone
you don’t like it as much how about to
put a little more sugar little more sure
I got that
ok so now we can do the low-fat version
and what we ended up with was a lot of
simple carbohydrates that are quickly
absorbed and have done us in
I want to get to sugar and add in a
little bit but I want to go back to
something you’ve written about in your
book
gary is it we really began this this
obesity surge in the late eighties or in
the eighties
what happened in the eighties that this
will be it was it was it portions became
larger was at the addition of the sugar
into everything was it additives what
happened to you but this is what
actually got me into this research but
yeah I started actually around 2001 when
I pitch an article in The New York Times
which is what caused the obesity
epidemic because back then it was new
and i had done a year-long investigation
for the journal Science on the dietary
fat beliefs and I knew two things had
changed in the the the nineteen eighties
or from nineteen seventy-seven in
nineteen eighty-four we could localize
the beginning of the obesity epidemic
between two national health
you know I examination in Haines
national health and nutrition
examination survey days and
and so it sometime between the late
nineteen seventies and the very early
nineteen nineties and in that time . but
we introduce high fructose corn syrup in
1977
and by 1984 did pretty much taken over
the soft drink market and replace sugar
sucrose in Coke and Pepsi and then we
instituted this low-fat diet is a
healthy diet dogma that process was
institutionalized beginning in 1977 by a
Senate committee run by George McGovern
and then by 1984 the national institutes
of health that had a consensus
conference on declaring that the entire
country over the age of two should be on
a low-fat diet and Time magazine ran
this very famous cover which was a
dinner plate with their breakfast plate
with two fridays is the eyes and a piece
of bacon for the frowning mouth and it
was cholesterol now the bad news and I
was working at time inc at the time and
I remember that cover and how our diets
literally changed from that day so the
two three prime suspects would be this
introduction of high fructose corn syrup
and then this belief that I said that a
low-fat diet where you replace the fat
with carbohydrates and simple
carbohydrates is a healthy diet and when
we brought in high fructose corn syrup
is chris there is some evidence that
it’s a little bit worse and sugar
maybe ten percent worse if we assume
that sugars bad high fructose corn syrup
is maybe maybe ten percent worse or five
percent worse and some evidence may or
may not be true on but we get no high
fructose corn syrup was sugar and
actually the corn refiners i find it
very amusing because the quarter finals
went out of their way to present that
they would refer to it is fructose to
differentiate it from sucrose and then
they were group would prefer to fructose
is a naturally occurring fruit sugar and
sucrose is a 50-50 it’s a molecule of
glucose bonded to a molecule fructose
it’s a 50-50 mixture and high fructose
corn syrup as we were consuming it in
soft drinks and tease is 55 fructose 45
glucose
so they’re effectively identical but
when you see in the the food
availability data is the consumption of
all caloric sweeteners which is about
ninety-five percent sucrose and high
fructose corn syrup starts turning
upward in the nineteen eighties and my
contention is it just because we didn’t
know that high fructose corn syrup sugar
so that the primary ingredients in
whatever we were drinking didn’t have to
say sugar and water
they could have this sort of naturally
occurring fruit sugar and sugar
consumption then collects weiner
consumption climb steadily to the end of
the the century and then it starts to
turn over around 1999-2000 and again
that pretty much parallels the obesity
epidemic it’s very hard to make sense of
this kind of observational data because
a lot of other things also change
yeah chime in so the the data set that
he was referring to this national health
and nutrition examination survey has
been done over time and there may be
some methodological issues but if you
track calories over time they were
fairly stable and then they jumped in
nineteen eighty by about two or three
hundred calories in men and women and
then they were stable again it and i
happen to really like Marion Nestle’s
take on this which doesnt contrast your
years at all it just complements it and
it has to do is very initial marion
Nestle is at New York University
she’s written a book called food
politics she’s written
what we eat she’s got a great new book
have you seen the calorie book
oh I guess you don’t like it okay I like
a great new border
not that I don’t like it actually blocks
you step-by-step through
uh-huh so to complement what Gary said
it’s fascinating
whoever was head of General Electric in
1981 and I’m gonna blank and I think
it’s james welt came up with the idea is
that and Jack Welsh Jack wells came up
with the idea of shareholder value and
started this movement that you can’t
just have profit from year to year and
not even near to your quarter quarter
you need a short show growth and that
was about the time that people started
supersizing things and so that was part
of that I think what they were super
super sizing win which fits with your
discussion is more sugary packaged
processed food so I mean to say don’t
eat so much sugar won’t work if wall
street is totally geared up to super
size and show growing profits on a
quarterly basis to investors which I I
think it’s part of the complexity that
underlies this
how much of this low-fat mantra that
we’ve been consumed with an obsessed
with sense the eighties nineties how
much of that is responsible for obesity
today
well this is one of the interesting
points I would like to make on
I you could argue a lot of it you could
see in the data that we did embrace this
these dietary beliefs to some extent so
industry is putting more and more sugar
refined grains processed food out there
was simultaneously we are eating
healthier the USDA is telling us to eat
so we’re lowering our fat consumption
little red meat consumption comes down
significantly
sugar consumption goes up significantly
but something I point out my books that
i think is crucial is that you can find
populations with high levels of obesity
as open as as high as we have in the
United States today that had none of
this toxic food environment in which we
kind of want to blame our obesity
problem
so beginning with the Pima Indians and I
the native american tribe the Pima 1902
a Harvard anthropologist comes to visit
the spot this this population on their
reservation south of Phoenix in 1902 and
comments that all the other women seem
to be obese on and they just gone
through a 20-year period of family which
is Caillou could think of was like 20
years on a very low calorie diet and yet
then there’s a photo in the book that
was published in nineteen 6068 fat
people woman he calls fat Louisa 1928 a
couple university of chicago economist
study the Sioux on the crow creek
Reservation in South Dakota and they do
they describe the unbelievable almost
unimaginable both poverty on this
reservation and yet they point out that
a quarter the women are what they call
distinctly fat while they’re obviously
children who are starving and not
getting enough food and this is an
observation that you see on throughout
history of in the fifties and the
sixties and central on a Caribbean
island populations in African
populations and South Pacific Islanders
arm and what’s called the double double
burden of obesity and malnutrition there
was recently a paper published of
western sahara refugees and Algerian
refugee camps right if I remember the
numbers correctly
twenty-five percent of the families had
obese mothers and starving children and
they don’t have this toxic food
environment that we have there something
obviously toxic about their environment
that’s the issue but they don’t
mcdonald’s or burger kings or the
process food we’re talking about they
had some processed food and so the
question is why were those populations
fat because we can now start ruling out
well what do we know why are they fat
well the two things is far as i can tell
they all have in common is then
something is true of virtually all
impoverished populations you live in a
carbohydrate rich diet sugar is a
primary rice right although you have
Southeast Asian
who live on carbons diets lot Bryce who
are not obese and not diabetic so the
Grand you could ask a question what’s
the difference between the southeast
asian populations and these other
populations I’ve been describing like
trinidad and women in the early nineteen
stranded at the early nineteen sixties
is having a malnutrition crisis the US
government sends a team a nutritionist
down to help out and they come back
saying look the other people have the
other vitamin deficiency diseases are
right if you can see all these signs of
malnutrition and yet obesity’s in a
quote explosive medical problem and the
next year at MIT nutrition is comes back
and reports that the average diet is
less than 2,000 calories
twenty one percent fat so you can ask
what’s the difference between that
population in the southeast asians and
it sugar in the diet sugar is usually
relatively new to the diet is a
population on we have to sue the Native
Americans who would not have had either
refined flour or sugar until the mid
19th century and then arm you know so
that’s a kind of getting the prime
suspect for what’s driving obesity in
these populations
you could have an extremely poor
population eating a carbohydrate rich
diet with refined grains and sugars and
that’s enough to cause obesity even if
there’s not enough calories to
constitute any degree of gluttony is we
would describe you raised the issue of
heredity and I wonder if you could both
talk about heredity and genetics what we
know about the different populations
which you said in Asia they are
carbohydrate-rich rice at an example but
relatively thin
what we know so far in terms of science
heredity food and a bay city
so you can look at different populations
will never be cause and effect so that a
lot of other differences that go on
I mean interestingly to cherry pick some
populations the New York Times just had
that the longevity group and the island
of I carry i see they quoted you a
little
if they ask you what you thought this is
a very plant-based diet but they live to
a hundred they also sleep till 11 every
day then they work for a while then they
take an afternoon nap and then they all
get together for a really small dinner
and the Tarahumara Indians survive
almost all on corn and being but their
ultra marathoners filled with know about
the ultra marathoners so there is some
genetic predisposition you could look
from population the population that’s
why it’s valuable to look at pacific
islanders or south asians clogged with
chard to this amazing study in 1990
you got 15 monozygotic twins and he /
fed them a thousand calories a day for
something like 80 days now it if that if
that math had worked out regardless of
what size you were that excess excessive
caloric intake should have been about
eight kilos of added weight by the time
you’re done
so among the monozygotic twins there was
a significant correlation there were
differences between groups of twins but
within twins it was smaller than between
different groups of twins but
interestingly one of the twins gained
four kilos and one gained eight in one
pair won game six and one game 12 and
the whole group of 30 individuals won
Game four kilos and one gained 13 kilos
with the same thousand calories so
there’s clearly some genetics there and
it’s clearly not entirely genetics so
that this is a I don’t know that’s a
scary
well no this is as early as in nineteen
thirty german-austrian research had
established that obesity is a huge
genetic component and we all know this
is you know identical twins don’t just
have the same faces they have the same
bodies on obesity runs in families
although there have been arguments over
the years that runs in families because
some parents just like to cook too much
food and everybody in the family eats
too much food and other parents don’t so
you could argue that one way or the
other but it’s always been a well known
that this is a huge genetic component a
quick question is the jeans are
obviously being triggered by something
in the environment because we know we
have populations where there is simply
not a lot of obesity and one of the
observation that was made beginning in
the nineteen sixties on is that you have
populations that immigrated from what
for instance in the 1930s 1940s obesity
was virtually unknown in Africa and yet
physicians who work in Africa hospitals
would come to the United States for year
and work in an inner say one example was
a South African name George Campbell
came to work in philadelphia for a year
and he was stunned when he went to
diabetes clinic in south africa where he
had virtually zero case of diabetes in
the black African population and then he
gets to Philadelphia and the hospitals
are full of diabetic
you know african-americans are only 300
years or 200 years removed from Africa
so what’s the difference what’s
triggering this obese what you could
call the obese and diabetic phenotype in
the environment and the obesity epidemic
is another example because the 30 or 40
years of the epidemic has been happening
is too short to have been any
significant genetic changes there could
have been epigenetic issues are changes
in the in utero that suddenly tip their
ways to explain that without evoking a
new factor in the environment but most
likely thing is something in the
environment changed and triggers obesity
and type 2 diabetes in a greater
proportion of the population
I wonder if one way to ask a question
about obesity and is that it’s so easy
to get fat and obese and overweight
especially as one moves into middle age
perhaps the better question is why are
some people slim
yes that is a great question i mean if
you look at what it would take to put on
pounds
let’s try some simple math here these
numbers don’t actually work
if you do this in real life but it’s a
3500 calories is the equivalent of a
pound of battle
so if you can access the 3500 calories
you would gain a pound
there’s 365 days in a year you had 10
extra calories a day for a year
that would be a pound x 20 years is 20
pounds that’s all it would take 10 extra
calories a day
it’s off by at least a factor of 2 I
know you have a chapter that’s 20
calories so let’s use that 20 calories a
day
if you can imagine how many Eminem’s
that is it’s only a few Eminem’s and
it’s probably one or two chips a day
couldn’t I mean couldn’t you just have
that many fewer chips that just seems
insane
the challenge in all this is most of us
are daily caloric intakes shifts from
day to day by hundreds of calories
sometimes a thousand calories from one
day to the other
I would think that people might find it
hard so to explain that more how does it
shift so dramatically
you woke up late you skipped breakfast
you ran the work you thought there was
going to be something offered there
wasn’t and then the next day after
having an enormous breakfast and a
good-sized lunch
you walked in there was a surprise party
for you had cake and after your surprise
part of your office mate had a surprise
party
and you had to have another piece of
cake just to be polite and at the end of
the day you’ve eaten a thousand calories
differently than you did the day before
so it what’s amazing is that people are
slim there is food everywhere all the
time now and how do some people do if
you do the map
roughly a million calories a year that
you eat and if you’re in theory off by
3500 one way or the other
you gain or lose a pound how do you do
that i mean you’re not even being
conscious of this and most of you
maintain a fairly stable wait so you’re
right
what’s more amazing is that more of us
aren’t overweight given the ubiquitous
availability of food
let’s use the example used clock with
shards study on so he was a population
where they go again they measured their
energy expenditure and then they force
them to 2,000 calories more a day and
yet some of them still remained
relatively lean and some didn’t there
was a wide variation and how much weight
they gained even when they were going
having the two surprise birthday parties
a day
so the question is in one way you could
ask that question is what’s the
difference between the ones who only
gained four pounds i don’t remember then
ones who gained 20 pounds kilos on the
same amount access eating now these
studies are flawed to begin with because
they assume that the way people get fat
is by eating too much so they feed them
too much and that’s not necessarily true
but you can see that even under those
circumstances
some people have the ability to let’s
say upregulate for at least the length
of the study their energy expenditure
maybe even feel more physically active
there used to be this concept of the
impulse of physical activity so maybe
some of the twins thought I’ve got to go
for run
you know man it could have been behavior
or could have been psychological someone
just thought I’m not gaining all this
weight i don’t care how much they are
going for a run even though I feel like
taking a nap like my twin brother
uh-huh
but they’re all these you know there’s
what you want to know why is it that
some of them when force-fed gained only
a little bit of weight because we could
assume those are the ones we’re going to
stay lean when they’re not force fed and
the others gain so much weight their fat
just gonna inflate to embrace these
calories
you wrote a piece for The New York Times
Magazine not long ago that i would say
was pretty controversial and it’s based
on the u.s. ucsf researcher Robert low
sticks work and it charge that sugar is
toxic and I wonder if you could first of
all what does it mean
the sugar is tossed toxic and what we do
about it i mean what do you do we
regulated to we have it is Mayor
Bloomberg a hero of yours who is really
setting policy in place to control what
we drink
what what do we do knowing the
implications the health implications and
that that sugar is such a significant
contributor to obesity
ok i’m actually going to start with the
easy question i remembered is not a hero
of mine but i do wish she would move to
oakland run from air and then band juice
boxes at birthday parties
that’s like more than my primary
fantasies in life on it
I know it’s yeah
oh he ever wanted to show there and go
to a birthday party
are they the article actually didn’t
wasn’t based on dr. al agua la rambla
Lustig’s work it
they did use him as the lead of the
article because Rob loves to give ucsf
has really put themselves out there
attacking sugar in the diet and making
this argument that sugar is toxic and so
I got to use our Rob to as kind of
launch into this argument that’s been
around for arguably maybe a hundred
thirty hundred forty years that there’s
something unique about the way we
metabolize sugar that’s uniquely
deleterious to our body so the way Rob
lusting does describe it like it is it
you know a hundred calories of sugar are
metabolized entirely differently than a
hundred calories of the glucose from
starch or the fat or protein from some
other food and so something can be isoka
Laura
it could be the same amount of calories
but have a different be metabolized
differently to have a different hormonal
response in your body and create a
different hormonal sort of enzymatic
milieu in the body that could be
deleterious it could lead to the chronic
diseases we suffer from today and one of
the fundamental observations on which my
books are built is that there’s a kind
of a cluster of chronic diseases that
are common in western populations eating
Western diet containing western
lifestyle she’s our obesity diabetes
heart disease cancer neurodegenerative
diseases possibly including Alzheimers
and so you see these pop you see these
diseases in westernize populations and
at least from the mid to late 19th
century through the Second World War
when their world at british colonial on
missionary physicians had spread around
the world running hospitals all around
the world you didn’t see these diseases
in the isolated populations whether they
were the marathon runner
is in the Mexican hills or a pastoralist
like the Maasai that we’re living on the
other blood milk and meat from the
cattle they raised or the Inuit or you
know any baseline population simply
didn’t seem to have these diseases and
then when Western foods became available
or when these populations moved into
urban centers and began eating Western
diets you started to see these diseases
and when you say Western diets are used
significantly is the major contributing
factor there sugar and fructose
well and this is the question what is it
about the western lifestyle right so
this is not a very controversial idea
although it’s embraced a little more by
some than others I embrace it and I
built it you know an effect these books
on it
so what is it about the western
lifestyle if you don’t like you know if
you think we’re all too sedentary and
your marathon runner you blame it on
sedentary behavior is one of the
problems that could be the vegetable
oils it could be the refined grains and
sugars it could be that we just eat too
much
it could be that you know you could
again it’s one of these observations
that it’s bounded only by your
imagination again the simplest possible
hypothesis i would argue and it’s backed
up by what we’ve learned about metabolic
syndrome and insulin resistance a lot of
work done by Gerald R even here at
Stanford is that it is indeed the sugar
and refined grains that are the problems
and so on and then you have these
obesity and diabetes epidemic since
we’ve talked about one of the things i
pointed out this is sugar toxic piece in
The New York Times Magazine is there was
a diabetes epidemic that followed the
civil war in the united states and from
the eighteen seventies through the
nineteen twenties on diabetes rates
skyrocketed they went up 10 15 fold in
some American cities and in fact i got
the data for a book i’m supposed to be
writing on sugar and high-fructose corn
syrup
I got the inpatient data from
Pennsylvania Hospital in Philadelphia
from date and they had years in the
eighteen seventies when they had zero
cases of diabetes
which is unimaginable today now a lot of
the increase is due to diagnostic
factors life insurance came in suddenly
middle-aged men who are prone to
diabetes were getting checked for a test
to measure blood sugar and sugar in the
urine came in so that used to be that
the physicians assistant had to taste
the urine and so you could imagine there
are a lot of reasons diabetes would be
diagnosed but the numbers were so large
that as late as in nineteen twenties and
people arguing the leading public health
authority of columbia university was
saying like sugar is the culprit it
should be the prime culprit and this
argument was made over and over and over
again that we would not have type 2
diabetes if we didn’t have significant
amounts of sugar in the diet
so Christopher debrie is sugar toxic
sure
yes in the amount that we eat right now
yeah we should cut down and what is
toxicity mean and what what he did to me
next to her
the half its fructose and the amount
that we eats it go specifically to the
liver doesn’t go to the bloodstream to
the liver clears it in excess amounts to
get fatty liver disease which mirrors
alcoholism and contributes to this
insulin resistance that we’re probably
going to get into a little more
as part of this debate and in the
amounts we eat it it still appears to
our health
almost impossible to separate out if the
sugar board or on the stage with us from
calories you’re eating too many it’s not
the sugar it’s the calories
okay well I cut back on the sugar well
then you cut back on the calories add
something that no no then you’re so you
get stuck in these arguments anytime you
change one thing and I you have to
change something else at the same time
which is my ear and some of what
gary is promoting in terms of shifting
everybody from fat carbs so I agree the
low-fat message had unintended
consequences if I can go back to that
just four minutes so that I can work my
way back to carbs the bottom of the food
pyramid
it is bread cereals rice and pasta right
those are the four groups
well most Americans just deep breath and
they just eat white bread and the health
professionals forever have been
promoting whole grains or a lot of
people that means i’m going to switch
from white Wonder Bread the whole wheat
flour bread which is not a whole grain
that’s a highly refined grain
it’s pulverized into flour gets absorbed
like that as the same glycemic index
which is how fast the glucose ends up in
your blood as white bread does the whole
grain is wheat berry
i’m guessing almost everybody in this
room has had a serving of bread in the
last week and I’m guessing a small
proportion of you have had wheat berries
wheat berries are the whole grain so if
we were to take the bottom part of the
food pyramid and eat whole grains
it might be a different story but we’ve
been eating lots and lots of bread or
we’ve been taking pasta which could have
been the basis of this massive thing of
pasta and a little sauce on top or we
have a big tortilla and a little bit of
cheese on top
I mean the base of a lot of those meals
it was like holding the meal but too
much of it was holding the meal
just to remind you remember i talked
about populations that had high levels
of obesity and did not have huge
platters and pasta and did not have you
know huge tortilla so this whole concept
of eating too much is actually
tautological is present
you know you eat too much if you’re too
fat right
Michael Phelps can eat three times as
much as any of us but he’s not eating
too much because he’s perfectly lean so
the question is if you can have obese
populations without too much without the
amount of sugar that we today for
instance the Pima 1902 would have been
eating about five to 10 pounds of sugar
per year per capita maximum actually one
of the our articles i found in my
research was a doctor and 17 15 in the
united kingdom
an article is called the vindication of
sugar and people have been attacking
sugars an oxygen part of the british
diet and 1715 this British doctor takes
it upon himself to say sugar is
perfectly healthy is just as healthy as
tobacco and alcohol
uh-huh but then he says in 1715 when the
per capita consumption of sugar in the
UK was probably five to ten pounds per
year or say one twentieth of what we’re
eating today or 140th then he says but
it makes young women fat
so question is what does too much mean
and if you are getting fat than whatever
the amount you’re eating is too much
let me ask one question just in on how
many of you doing it
you know we asked how many been on a
diet how many of you in here are
actually happy with your weight
okay and how many of you make a real
effort me this is palo alto and Stanford
how many of you make a real effort to
eat healthy
ok so how many of you eat that platter
of spaghetti and the huge you know the
junk
there’s there’s a there’s a
disassociation between how people think
they do you think they are eating
healthy and yet they’re overweight and
or obese
anyway so the question is what’s
happened what what what it has
what do you want to get in there
Christopher well yeah i got interrupted
i get to go back and finish my story so
sorry
the problem was that we vilified fat and
it
we tried to simplify the public health
message and it had unintended
consequences weight from the bottom of
the pyramid in ways that people didn’t
anticipate
I think that the signers of the food
pyramid wanted us to eat more leafy
greens and acorn squash with that
wonderful onion for color red bell
pepper thing and I put on top of it and
instead they ate white Brad
so we can shift it now and this would be
a really I think exciting discussion to
get in between the two of us because we
agree on some level three different
disagree on others about a calories of
calories so if it’s really the carbs and
if it’s really the sugar then we should
shift gears
get out of the low fat and go to
low-carbon we’ll be all set
and the problem with that Gary is I’ve
gotta study going on
right now I random I 60 people to go
Louis fat humanly possible
lowest card humanly possible six months
later the average weight loss is 20
pounds in both groups in both groups
somebody lost 0 and somebody lost 50 and
it’s an absolute continuum in both
groups so the issue is if you just say
low carb or low-fat what you’re missing
out on is the amazing heterogeneity
that’s what this is hard of your
metabolism everyone out there
so if we I think insulin resistance and
carbs is a big issue for a proportion of
the population and if you in over
simplified and exaggerated too much
you’re going to get people mad at us
again that oh they said low fat and now
they said low carbon that doesn’t work
either so i’m going to eat whatever I
want to give up
ok it’s actually in charge because one
of the arguments you I heard since 2002
when i first wrote this very
controversial new york times magazine
article is
I mean you’re not making this but I
understand the argument is it on
we all must agree because otherwise
we’re going to get this and RK and
everyone is going to give up the
argument I’m making isn’t that we should
all eat high-fat diets
isn’t that you know and then the
question is what fundamentally causes
obesity and type 2 diabetes
we as we said we know that it’s
triggered by the environment
so what is it we can figure this is a
scientific issue i mean this is a
scientific institution that can be
established and yet everybody responds
whatever it is there are people are
going to respond differently but it’s
pretty clear that this has been
triggered by something in the
environment and what I’m arguing is the
sugar and the refined grains the high
glycemic index grains and i would argue
on both your diets the low fat and the
very low fat in the very low carb
they’re probably avoiding to hide i see
make index carbohydrates and sugars
so the question is you know is that why
they’re both groups are getting
healthier or is it because something
about maybe dietary fat is bad for
someone maybe for some of us maybe this
you know there’s arguments that
vegetable oils polyunsaturated fats
could be a problem omega-6 fatty acids
could be triggering it
but the fundamental issue here is that
it is a something is triggering this
problem but how do people dig through
this
I mean what if there’s can great
confusion if the science is so poor
if you have many different still
variations
how does the average person dig through
this and have a sensible diet keep their
weight in control what do they do
what’s the what’s the path to to sort of
a a healthy lifestyle have to cook more
sorry you have to cook more I need to go
out buy food and get back in touch with
your food and not get swayed
every time the scientists which their
mind and go out and buy the latest
greatest food product because they don’t
work so we’ve become so disconnected
with our food and it’s such a
complicated problem
it’s going to require some policy
because some of these things are beyond
our control so we are some of us are
addicted to food and literally can’t
stop it was that old lays potato chip
add can eat just one
it’s true they know you can t just one
they had test panels and they made it
addictive
if you read David Kessler’s book and
it’s not your brother is it
No ok anyway David caster from the ad a
who identified the addictive properties
of nicotine has gone on to write a book
called the end of overeating and he’s
gone around the world to see all the
evidence for food addictions which he
covers in Chapter after Chapter 1 i
think it’s called fat salt and sugar one
is called sugar salt and fat one is
called fat sugar salt chef sugar fat fat
sugar salt and his whole point is that
the food industry is relying on us to be
confused and manipulating our taste buds
so that we eat more calories
ok back to you what about these
populations that I keep mentioning that
didn’t have the opportunity to eat more
calories so it didn’t matter how
addictive their food may or may not have
been there are total amount was capped
by the availability of food in their
environment
why were they obese we would have to go
back there’s a lot of complex things if
you look at those icarians that eat a
plant-based low-fat diet their whole
culture about so many different factors
that would impact this
so are our bigger issue is helping
people Americans
well it’s becoming global now to lose
weight and i will agree i mean–
actually one of the more interesting
publications that’s come out lately is
in developing countries
there’s a simultaneous rise in
malnutrition and obesity in the same
populations so I
I do agree that something is there and
part of its the Western diet again but
at you can see that combination as early
as 1928 but so and part of this is so
what were they eating was there only a
tuber around provided almost all their
calories and nothing else which may be
the part where we get into this
there’s carbs insulin puts away your car
if you have if you’re continually
challenging your system your insulin
level goes higher and higher you become
instant resistant it goes higher and
higher and higher and then you’re
diabetic and that would parallel some of
this rising obesity and diabetes that
you’re talking about so it is one
important factor but i think it’s being
overplayed here and the difference to
see I’m a huge believer and Occam’s
razor
ok which is never simplified never
complicated hypotheses beyond necessity
so this is a fundamental tenet of all
science it’s what we need to make
progress in one thing that’s happened in
obesity and in what you have to
understand the argument I’m making in my
books is that prior to world war two in
Europe where all the major clinical
medical research was done actually all
of the best science in the world
pre-world war two was done in science in
Europe and when i was writing about
physics which i started my career the
physicist you say the best thing that
ever happened American science was
Hitler because he chased all these
brilliant Europeans with their culture
of science to the US and to Israel and
that’s why these universities countries
have such great science in specific
fields but pre World War two in Europe
obesity was perceived as a hormonal
regulatory disorder not a energy balance
this order not an eating too much
disorder not a food addiction disorder
but literally a hormonal regulatory
defect on all of that was lost with the
war and I document this in my books was
fascinating the lingua franca of science
went from being German to English pre
post war and in nutrition and public
health we simply stop citing the german
literature and I say imagine what would
happen in physics if we decided that
none of the physics done pre-world war
two was important
to pay attention to Heisenberg because
he was a Nazi with his silly uncertainty
principle and and you know any of these
guys with their accents and literally
this is what happened in medicine and
public health and nutrition so the
post-war understanding of obesity is a
hormonal regulatory defect was replaced
pre-war with the simplistic idea of
obesity is gluttony and sloth energy
balance and everything went off the
rails from there
and so today what we have is this idea
that obesity is a complex multifactorial
disorder
if you think of it in terms of trying to
understand the solar system if you think
that the Sun rotates around the earth
instead of vice versa or you think that
the orbits of the planets have to be
perfect circle this is what historians
of science philosophers of science would
call epicycles we have to keep
complicating everything to make to
somehow understand what we’re seeing but
one very simple possibility is that when
we lost this concept of obesity is a
hormonal regulatory disorder and
replaced it with obesity is an eating
disorder by the nineteen sixties the
major figures in obesity research for
psychologists and imagine any other
FISMA imagine if diabetes was treated by
psychologists how many dead diabetics we
have and yet this is what we did with
obese today and so by today we have all
these ideas it’s a cultural thing is a
food addiction thing it’s a you know
there are about complex cultural factors
whereas you have somebody’s walking
around with 200 pounds of excess growth
on his body in any sane world this would
be perceived as a growth defect
like if somebody walked in the store
right now and he was eight feet tall
you wouldn’t think about all the complex
things that made him eat that much you
if you’re a physician you think that
fellow had a tumor in his pituitary
gland and when he’s over secreting
growth hormone and even if he weighs 500
pounds we don’t care we know the cause
it’s a simple hormonal defect but if its
twin brother walks in and he’s five foot
ten and weighs 500 pounds
we’re going to blame it on eating too
much the addictive nature of food the
culture in which he grew up the fact
that he wasn’t on this Greek island
and the argument is you know simplest
possible hypotheses it is conceivable
that most people argue this amateurs
like myself are wrong
usually were quacks who say look the
establishment missed everything
and that’s the real difficult thing is
how do you tell you know how do you tell
whether I’m a quacker not i mean all
quacks sound reason to hold out detail
i’m going to ask Cristen a second yeah
anyway but they did the fundamental
argument here is that when we lost the
pre-world War to learning how many
obesity are there any obesity
researchers in the audience
12 you guys did the name is carbon or
didn’t mean anything to you
Lewis newburgh are you read my book ok
there are figures pre-world War two who
are the equivalent of the Heisenberg’s
and the boars and the directs and your
major figures in your peace in medicine
who have just been their careers have
been forgotten it’s been blamed down
like a 50-year period
that’s been erased from the medical
public health and what I’m saying is if
you bring this back then you end up with
if obesity is a hormonal regulatory
defect then it’s the carbohydrate
content to the diet that’s driving it
through this hormone insulin
it should have been solved in the
nineteen sixties when we worked out the
accumulation that insulin regulates the
accumulation of fat and fat cells for
all intents and purposes and we have a
simple hypothesis doesn’t mean that
every individual will be able to reverse
30 or 40 years of metabolic disturbance
by removing the cards from the diet but
it does mean that if we never started
eating these foods which are in the
process foods that presses talking about
we would never have these obese it this
issue to deal with this epidemic would
never have happened
it could be right it could be wrong and
it can be tested and one of the things
I’m hoping to do is get this tested
through this not-for-profit we found
them but it’s a simple argument and it
you know there’s very few epidemics in
the history of it
modern medicine that are caused by
simple cure your lung cancer
cigarettes it’s not cigarettes and
cultural issues its tobacco and so it’s
not that out of the question that this
doesn’t have a simple cause
Christopher I’m it gives you for this
portion and then we’re going to take
questions from the audience the final
work
ok so first I want to applaud you in all
your writing you have done this amazing
investigative work of all of history and
pulled lots of things together you
really have a very rational hypothesis
absolutely and it’s compelling and it’s
fascinating that you are revered and
vilified for what you’re doing and
you’re vilified by some of the people
that you’ve scared that have banked on a
low-fat thing working and your revered
by the folks who thought they were wrong
let me turn this into something a little
more simple because a lot of your
history
there’s a lot of complexity to it that
culture that you found these
observations in i’m going to give you
the head of news I eighty eight hundred
million dollars to run this study
ready ok the average person has died is
2500 calories higher for men and women
who let’s say average twenty twenty-five
hundred
I want it to caloric regiments 1,500
today or 3500 today you should lose
weight I think on 1500 you should gain
weight and 3,500
hang on now there’s two . to caloric
levels but there’s two diets one is
twentylow fat and
one istwentylow
carb
okay and they’re both going to be about
twenty percent protein we can argue that
the one that’s the higher fat will have
more protein but protein never gets with
real food much higher than thirty
percent so keep the protein fairly
constant to locale diets one over low
carbon will have had to high fat too
high calorie diets
same difference now there’s another
level of whose insulin resistant or not
but forget that for the moment on the
four diets who gains weight and who
loses wake clean
that’s a very good question Chris and
thank you for not answering how do we
know if I’m a quack or not
question
earlier no this depends on how you
answer it
now let me get that why i asked um and
i’ll tell you that the problem with that
. right now and see what we want to test
this hypothesis that obesity is caused
by positive energy balance by eating too
much or is it a hormonal regulatory
defect that in turn causes positive
energy balance
so if I start driving calories into your
face is a drug magical drug that could
make you fatter
excuse me on and I give you this drug
and you start accumulating fat you’re
fat tissue and by the way there any type
2 diabetics and in here
okay you probably know what this drug is
because we have one it’s called insulin
if you start expanding your fat tissue
because we’ve changed the hormonal
milieu in which your fat tissue is
living to it so it’s now accumulates
being told to take up fat and it’s doing
it
you will then start you will then move
into positive energy balance you’re not
taking in more calories you expand and
see the problem with your hypothesis is
you are on your your study is you’re
assuming off the get-go that if we make
people with a thousand calories more
doesn’t matter what the constant with
the the dietary composition is you’re
going to get fatter and if we make me
2,000 calories less doesn’t matter what
the dietary compositions are going to
get on
they’re going to get leaner but how much
they want to eat is also biologically
regulated
ok and it’s going to be regulated think
of growing children
this is the example that the pre-world
War two Germans and Austrians use when a
child is going through a growth spurt
right how many of you have young kids
okay they eat voraciously right they lie
around the house all day long
ok so growth is a side effect so they
you know it’s not that
and this how the Europeans but they said
the kids don’t grow because they are
eating voraciously you’re lying around
the house all day long
they’re eating voraciously and lying
around the house their gluttony and
sloth is a side effect of their drive to
growth and the growth is caused by a
hormonal you know they start growth
hormone secretion
that’s stimulating insulin-like growth
factor that’s driving them to grow the
same thing could be happening with their
fat tissue but their appetite is going
to respond and if you have small kid
again this is anecdotal but sometimes
the kids are going through a growth
spurt to eat everything you give them
and more and then complain that they’re
hungry and sometimes they’re not going
through a growth spurt or so it seems
and they’d only half of what you give
them and then wander off to watch
spongebob
um here’s the experiment i would do this
is the first experience it’s not fair
I asked you to tell me what’s going to
happen in my experience and I guess I
can go lad and I gave you my question i
don’t think your experiment is
physiologically reasonable and we don’t
actually know what will happen
well they’re going to get this question
i would argue that on 33 again you can
argue that on the 1500 calorie a day
diet huh
ok people might lose weight but then
their energy expenditure you know your
semi starving people and we know that we
send my star either lean or obese people
their energy expenditure will come down
oh yeah some people remember the 3500
calories a day mimics the club which our
experiment but without the variation on
arm on dietary composition which and the
interesting thing is because the
experiment i would like to describe to
you if I get a few minutes we’re gonna
go to what we’re going to go to where it
is an experiment that i described at the
Pennington Biomedical Research Center
that Claude Bouchard runs and clubs
shard told us what he thought would
happen in that experiment and i would
like to tell that story if I could on
but again so you don’t know the
questions you’re assuming off the get-go
I don’t like the experimental design so
it is the co-founder of news you were
not going to spend the 800 million i was
giving you the 800 million that was part
of the deal were refusing it because we
have a better way to spend
okay i’m gonna add a robbery and answers
out of questions from the audience thank
you for a great discussion
I think I think . I’ve been curious
since we started as a fructose in that
drink you know this is pure black coffee
at caps I don’t flip out halfway through
we’re gonna go right here to there is a
microphone coming to you
hi thank you so much that was great so I
read a couple months ago this study that
said once you get to a certain weight
and then you try to come down your body
now thinks it’s starving
so if you’ve got to that way to begin
with the dieting or cutting down your or
increase cutting down you your energy
intake is going to be harder and harder
because the heavy you were to begin with
the more of your body thinks it’s
starving
absolutely true the simple thing you’re
resting energy expenditure goes down it
thinks you’re starving it’s trying to
compensate and be more efficient and if
you want to lose that way you shouldn’t
be thinking six months you should be
thinking three years minimum
so how long did it take someone to put
on that way they didn’t put it on and
six months it’s not coming off in six
months if it does come off and six
months going to come right back on
because your body is going to work
against you and make it harder and
harder every extra pound you lose is
going to make it that much harder to
lose the next pound so I like a term
that somebody’s using we have a term
called set . and you may have reset your
set . i can remember who said this but
there’s another one called settling . so
you have settled up there and if you
want to resettle at a lower rate it will
take a lot of time
it’s not simple um and this is again we
have two competing paradigms here
so what you just heard is sort of the
conventional wisdom explanation for what
happens when people get fatter so the
ideas we don’t really know why you got
fatter but once you get that higher way
again if you lose weight your energy
expenditures in part the determined by
your body mass your surface area so it
goes down and you have to compensate the
argument that we’ve made
is that the weight gain is driven by the
carbohydrate content of the dying the
problem is most people they lose weight
they go on low-calorie low-fat diets
it’s a traditional way of doing it
and so when you do that you would affect
starve yourself and I just said if we
start leaning individuals they’ll have
the exact same response which is their
metabolic expenditure will go down even
before they lose any significant way
this was shown back in nineteen
seventeen
ok so the question is why is it if
you’re thirty or forty or fifty or a
hundred pounds overweight you are an
energy balance if your weights table
so what you want to know is why are you
an energy balance at a hundred pounds
overweight or 50 pounds overweight
because it doesn’t matter whatever way
you are and you could college you’re set
. if you try to send my starve yourself
you will lose weight now if you flip
your paradigm that the problem the
reason you’re fatter is because of the
carbohydrate content of the diet and its
effect on this hormone insulin
so instead of putting you on a low-fat
low-calorie diet a low-fat diet keeps
the carbs kind of constant
ok probably improves the quality of the
carbs
we’re going to put you on a very low
carbohydrate diet and you can eat as
many calories as you want this is
classically an Atkins diet and one of
the reasons the medical community has
such trouble embracing this is because
we’ve thought of Atkins is a quack for
so long
we don’t like to think otherwise but now
we have a diet that’s arguably triggered
just to mobilize fat from your fat
tissue when you lower in some levels to
send the text books you mobilize fat
from your fat tissue and you oxidize
that fat
can you burn it for fuel so that’s the
only thing you wanted you want to get
insulin as low as possible now in theory
you can lose weight and your energy
expenditure will go up
ok the opposite of what Chris decided
then this can be tested and in fact this
past summer David lugging and and his
colleagues from the Harvard Medical
School published a study in the Journal
of the American Medical Association
where they did just this is a semi
starve people overweight will be subject
so that they lost i think it was ten
percent of their fat
masts and then they measured their
energy expenditure and they randomized
them to three diet where they kept they
gave them match their intake exactly to
their expenditure so calories than or
equal to calories out what was a low-fat
diet was a low glycemic index tire which
is lower in carbohydrates and the
carbohydrates in them are less refined
and higher quality and one was a very
low fat arguably an Atkins diet matched
energy expended to the intake so if you
believe it’s all about calories
then you believe that these people’s
weight won’t change in their intake
their expenditure won’t change what they
found they only did it they did it for
months at a time
it’s a very short period but the fewer
the carbohydrates in the diet
the greater the energy expand the chart
so in the atkins like diet energy
expended to one up three or four hundred
calories despite these people
maintaining a weight reduced state
so the argument would be if what I’m
arguing is right if this carbohydrate
insulin hormonal defect hypothesis is
correct
the reason that you see the wood
reduction and energy expenditure on the
typical diet when people lose weight is
because it diet is the wrong diet
it’s a low Kat a low-calorie low-fat
high-carbohydrate diet if they merely
remove the cause of the obesity the
carbohydrates and you wouldn’t see that
reduction and expand the chart and it’s
actually one of the things that we are
going to be testing with this nutrition
science initiative with the money we
have been given because if we can
demonstrate is David Ludwig arguably
already did but we’ll do it in a much
more rigorous well controlled manner if
we can demonstrate that people can lose
weight
the other end energy expenditure goes up
it’s contrary to one of the fundamental
tenets of the obesity sort of our
understanding of obesity Christopher let
me give you a minute
we got another question to respond just
a tree man whose wait while your energy
intake goes up
not as your energy expenditure of energy
expenditure will well actually I
arguably one of the interesting
experiments have always wanted to do is
already no no I get to go now
all right you you have a lot of answers
let’s go to another question over here
what do you think about types of carbs
you mentioned the rice paradox in
eastern Asia and also whether the
glycemic index of carbs matters as
opposed to the total amount of carbs
it’s a great question and i’m working on
a carbohydrate pyramid I know that the
pyramids out of fashion now we have my
plate but just because it’s so ingrained
in a lot of people’s heads
love some feedback here so in my
carbohydrate pyramid the bottom of my
carbohydrate . pyramid is legumes and
leafy greens and then after that is some
whole fruits and then after that is some
whole grains so really the wheat berries
not the bread and some pasta and some
rice especially brown rice and after
that is white red and white donuts and
white bagels and after that is fruit
juice and sugar and candy and I think
part of the issue is and I think Gary
would agree to some extent here if we
locked off the top of that pyramid in
our diet you’re getting at the quality
of the carbohydrate and the biggest
portion of our diets right now in carbs
is really simple
poor quality carbs and in that regard we
would both agree so Gary’s right in this
trial that we’re doing right now
both groups the low fat and the low-carb
of wiped out all fruit juice all sugar
all coat all simple carbs all white
bread all white rice and both groups eat
a lot of vegetables and when we do that
on both groups
some people lose weight on both diets
and some lose no weight so your answer
might be right for her if we figured out
how insulin resistance and whether or
not we’re we’re just have seven minutes
left so yeah I’m gonna get some more
questions
you don’t Chris said I do basically
agree with it but the issue is that you
could look at it is there
there are several things were looking at
the quality of the carbohydrates in the
diet
so how quickly they are digested the
quantity of carbs and how quickly the
digested so the green vegetables have
actually very few digestible
carbohydrates in them and that
carbohydrate is bound up with fiber so
it’s very slowly digested as a low
glycemic index then you have the sugar
content
so how much fructose is in it is another
issue which doesn’t reflect the glycemic
index but it is also important
and then there could be other issues
like gluten and glycoproteins and breads
that are less well-armed art with you
know we just don’t really know about how
serious and how widespread that problem
is but the fundamental difference like
if every 18
um if we went back in time a hundred
fifty years and we always chris is
carbohydrate pyramid we locked off the
top
I think we’d be a wonderfully healthy
population actually I wonder what would
we die up if i’m blaming heart disease
diabetes cancer and everything on these
the top but the pyramid we just lopped
off the problem is we’ve been eating
these foods for a long time
so now if you’re obese or overweight
type 2 diabetic
can you is it enough to lop off the top
of the pyramid and eat at the base of
the pyramid or do you have to perhaps
minimize it all in one of the things i
come back with single anecdotal
observation the nineteen fifties by a
research who arguably should have been
perceived as like the Einstein of
obesity and instead it was also
forgotten and he was a doctor and upon 2
is putting obese diabetic obese to Pont
executives on it effectively and all
meat diet with some green vegetables and
he said he had one obese dupont
executive lost 50 pounds effortlessly
but if you need a single apple a day
his weight-loss stopped and I have no
reason to doubt that that was true and
so the question is
if you’re already if you’re overweight
or obese as we’re talking about two
separate issues what causes obesity both
individuals on a population-wide level
which is the top of that pyramid and
what you have to do to be as healthy as
possible once you become metabolically
disturbed by the top of that pyramid
being in your population and your diet
and your mother’s diet and her mother’s
diet for a hundred some-odd years and
what you now have to do to be as healthy
as possible which are two different
things
in the second case the whole pyramid
except for the base the green leafy
vegetables could be problematic even the
wonderful wheat berries and looking at
we don’t know
we do not know what okay we’re going to
take a question over here do studies
show or not show a difference in caloric
intake between obese and non-obese
people
that’s fascinating often not so part of
but part of it is energy expenditure
something that Gary was alluding to so
if you’ve changed your diet
have you changed it does that caused you
to change your physical activity not
physical activity changing your weight
so TV you do you become more sedentary
so it’s really complicated attract the
different pieces down so part of it is
digesting your food that’s a tiny part
part of it is just what it takes for
your heart and lungs to work all day
long and part of it is your physical
activity which is the most variable
between people and the hardest to
measure
we’re all so horrible at measuring how
many calories you eat unless we stick
you in these really contrived places
where you can’t leave and there’s a
camera on you and we feed all your food
and that’s not really the general
population so if you tell us which we’d
is honest and scientific as you are you
will mislead us
unintentionally and trying to tie the
calories you took into the calories you
expended is so crude that it looks like
in many cases the obese are eating the
same amount as the lead but there’s
wiggle room for error
even if they’re not here’s the point of
fighting suddenly gained 50 pounds for
whatever reason so instead of being 259
out 265 pounds
I have a larger body to move around i
have more surfacer i am going to expend
more energy than i did it – 15 i have
some relatively sedentary
right now so it’s hard to imagine that i
will be less sedentary on are more more
sedentary
but the point is on so i’m going to want
to eat more because my expenditure is
greater
and so if you look at the curves as best
we can tell us as Christians very hard
to measure these things but curves of
intake versus I’m expenditure they
overlap between lean and obese people
the interesting thing is the people in
the Middle where overlap so you could
have
and again there was a study done and not
nineteen thirties where they looked at
this
how much energy people expend that women
and their women who weighed a hundred
seven pounds would spend the same amount
of energy as women away 280 pounds
so if their weight stable they would be
taking in the same amount of calories
and yet tho be an energy balance at 70
pounds different
so one of the arguments that I’ve been
making is that this paying attention to
how much people are eating and
exercising is not what you should be
doing what we have here is a disorder of
fat accumulation
ok people are overweight and obese have
too much fat you should be paying
attention who cares how much they
exercise just as a growing child you
don’t care how much they exercise you
care that they’re growing because you
know so what you want to do with study
the hormone Oh enzymatic regulation
central nervous system regulation of
their fat tissue and pay attention to
that and if you doing that you’ll solve
the problem if you pay attention to
eating and exercise you want I really
want to reframe that for 10 seconds part
of my argument for them maybe not eating
so differently as the obese get
victimized and that’s not fair
some of this is really beyond their
control they are not overeating
they are not slothful they are really
frustrated and we are not doing enough
to help them and that’s I had a
conversation yesterday with a reporter
from both where the tension if you tend
to think like there’s this obese
population out there that’s eating at
McDonald’s every day and they should
know better but they’re not they’re all
around us there are friends and our
relatives in ourselves and they’re doing
they’re trying just as hard as every
lean person and probably harder is if
you lean you can usually whatever you
want probably harder and the
determination is extraordinary over here
one last question
coming to you too is warring factions
and I’m wondering if we can come to a
common ground that you to share and what
I’m hearing from you and correct me if
i’m wrong and summarizing where you
might have common ground
one is my favorite phrase eat your fruit
don’t drink it
so perhaps the elimination of all juice
and two is decreasing our amount of
fluffy white carbohydrates so the other
is pushing
I believe in the plane model where only
a quarter of your plate should be
carbohydrate half of the plate should be
fruits and vegetables and a quarter of a
protein how valid do you feel that is
and then I just watched a movie and I’m
a carnivore but i just watched forks and
knives and the China Study and that has
just totally flipped me out so I would
love to hear your comments
oh you really don’t want to get into the
China Study there’s actually a lot of
assumptions that that may not be true
and it’s filling in some blanks between
the science
i would say they are not coming around
did you not rap out a common ground the
pyramid that i described which isn’t a
real pyramid i hope you understand that
i’m making this pyramid up a
carbohydrate pyramid
there’s no meat or dairy or anything
it’s really the carbs here and i would
totally agree on the top section and
then as you move to the white bread and
the fruit juice
sonia set we would keep agreeing and
then we would start to divert so our
common ground is the amount of calories
that come from high fructose corn syrup
sugar refined carbs breakfast cereals I
mean it’s ubiquitous donuts bagels
everywhere and it served all the time
marion Nestle favorite line for me is we
eat more places more frequently and
larger portions and the simplest things
that stay well our breaths
they don’t really go there easy to put
out donuts bagels those things so if
we’re eating them more frequently in
more places in our car and that we would
agree there are we do but remember i’m
concerned about those populations it
didn’t didn’t have the opportunity to
frequently more places and still have
high levels of obesity on so yeah we
agree on this carbohydrate pyramid
I think a fundamental area
making with this plate and I don’t know
what to do but to assume that every you
know what we have it i mean you could
imagine i just did a thought experiment
on my mind and my seasonal blog entry i
get around the blog about once every
three months and I just said let’s
assume we have identical twins and they
we put them in our laboratory we measure
their energy expenditure and we find out
there each expanding 2,500 calories a
day and then we feed them identical diet
accept 300 calories are from sugar and
one diet and the other twin gets 300
calories from glucose from fat and then
because it’s a thought experiment we
could keep them in our laboratory for 20
years and run it out and end up
are they going to have the exact same
body types are they going to still be
identical for 20 years with the only
difference in their diet is at 300
calories of sugar versus from and you
can do the same thing with the
population you can imagine we have two
identical populations we have 5,000
identical twins and a half of them live
in one village and the other their
siblings live in the other village and
we feed them the exact same diet but 300
calories from sugar and one village and
not the other we’re gonna have the same
number of obese and diabetic subjects
and the answer is I don’t think we will
okay i think that one change independent
of calories is going to have a
significant difference on how they
evolved and how it affects their health
and for all I know the sugar people
sugar industry would say that sugar
group might be healthier and that’s but
the point is you can’t assume that
something like you can turn and say look
here’s this person is a hundred pounds
overweight they have been eating exactly
like you have
ok exactly the problem is
whatever it is something in that died
and made them fat wasn’t cuz i went to
mcdonalds any more than you did it
wasn’t that they ate more white bread
than you did to diet you can eat keeps
you relatively lean the diet they makes
them fat the same food so you can say i
love the MyPlate it should be a quarter
carbs it should be this much food this
much vegetable because that could be a
perfectly healthy diet for sixty percent
of the population
forty percent will keep them fat or make
them fatter and one of our problems with
government guidelines as we don’t
differentiate so we say we should all we
prove you know and fruit i don’t i don’t
die
I think they’re basically chris and i
agree on everything if we were all in
population
the only thing we disagree on are some
ethical issues about meeting and I
haven’t seen force versus nice and maybe
if i watch it like swing but we don’t
have a healthy population anymore and so
what the overweight obese diabetic
population eat is may not be the same
you know the same thing that a lean
person eats and tolerates is likely to
make them fatter keep them that we’re
going to wrap up
I met and we’re going to lunch
afterwards I might be really watching
with these guys
thanks everyone
the preceding program is copyrighted by
the Board of Trustees of the Leland
Stanford junior University
please visit us at med.stanford.edu