What causes health?

What causes health? It’s such a simple question, but it’s complex. The causes are many and the direction of causality not always clear. There has been a particular challenge to dietary ideology that shifts our way of thinking. It has to do with energy and motivation.

The calorie-in/calorie-out (CICO) theory is obviously false (Caloric Confusion; & Fung, The Evidence for Caloric Restriction). Dr. Jason Fung calls it the CRaP theory (Caloric Reduction as Primary). Studies show there is a metabolic advantage to low-carb diets (Cara B. Ebbeling, Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial), especially ketogenic diets. It alters your entire metabolism and endocrine system. Remember that insulin is a hormone that has much to do with hunger signaling. Many other hormones are involved as well. This also alters how calories are processed and used in the body. More exercise won’t necessarily do any good as long nothing else is changed. The standard American diet is fattening and the standard American lifestyle makes it hard to lose that fat. Even starving yourself won’t help. The body seeks to limit energy use and maintain energy stores, especially when it is under stress (NYU Langone, Researchers Identify Mechanism that May Drive Obesity Epidemic). All that caloric restriction does is to slow down metabolism, the opposite of what happens on carbohydrate restriction.

We associate obesity with disease and rightly so, but that isn’t to say that obesity is the primary cause. It too is a symptom or, in some cases, even a protective measure (Coping Mechanisms of Health). The body isn’t stupid. Everything the body does serves a purpose, even if that purpose is making the best out of a bad situation. Consider depression. One theory proposes that when there is something wrong we seek seclusion in order to avoid further risks and stressors and to figure out the cause of distress — hence the isolation and rumination of depression. It’s similar to why we lay in bed when sick, to let the body heal. And it should be noted that depression is a symptom of numerous health conditions and often indicates inflammation in the brain (an immune response). Insulin resistance related to obesity also can involve inflammation. When the cause of the problem is permanent, the symptoms (depression, obesity, etc) become permanent. The symptoms then become problems in their own right.

This is personal for me. I spent decades in severe depression. And during that time my health was worsening, despite struggling to do what was right. I went to therapists and took antidepressants. I tried to improve my diet and exercised. But it always felt like I was fighting against myself. I was gaining weight over time and my food cravings were persistent. Something was missing. All that changed once I got into ketosis. It’s not merely that I lost weight. More amazingly, my depression and food addictions went away, along with my tendencies toward brooding and compulsive thought (The Agricultural Mind). Also, everything felt easier and more natural. I didn’t have to force myself to exercise for it now felt good to exercise. Physical activity then was an expression of my greater health, in the way a child runs around simply for the joy of it, for no other reason than he has the energy to do so. Something fundamentally changed within my body and mind. Everything felt easier.

This touches on a central theory argued by some low-carb advocates. It’s not how many calories come in versus how many go out, at least not in a simple sense. The question is what is causing calories to be consumed and burned. One thing about ketosis is that it forces the body to burn its own energy (i.e., body fat) while reducing hunger, but it does this without any need of willpower, restraint, or moral superiority. It happens naturally. The body simply starts producing more energy and, even if someone eats a high-calorie diet, the extra energy creates the conditions where, unless some other health condition interferes, increased physical activity naturally follows.

It’s not merely that being in ketosis leads to changed activity that burns more energy. Rather, the increased energy comes first. And that is because ketosis allows better access to all that energy your body already has stored up. Most people feel too tired and drained to exercise, too addicted to food that trying to control it further stresses them. That is the typical experience on a high-carb diet, mood and energy levels go up and down with the inevitable crashes becoming worse over time. But in ketosis, mood and energy is more balanced and constant. Simply put, one feels better. And when one feels better, one is more likely to do other activities that are healthy. Ketosis creates a leverage point where health improvements can be made with far less effort.

In the public mind, diet is associated with struggle and failure. But in its original meaning, the word ‘diet’ referred to lifestyle. Diet shouldn’t be something you do so much as something that changes your way of being in and relating to the world. If you find making health changes hard, it might be because you’re doing it wrong. Obesity and tiredness is not a moral failing or character flaw. You aren’t a sinner to be punished and reformed. Your body doesn’t need to be denied and controlled. There is a natural state of health that we can learn to listen to. When your body hungers and craves, it is trying to tell you something. Feed it with the nutrition it needs. Eat to satiety those foods that contribute to health. Lose excess weight first and only later worry about exercise. Once you begin to feel better, you might find your habits improving of their own accord.

This is a challenge not only to dietary belief systems but an even more radical challenge to society itself. Take prisons as an example. Instead of using prisons to store away the victims of poverty and inequality, we could eliminate the causes and consequences of poverty and inequality. We used to treat the mentally ill in hospitals, but now we put them into prisons. This is seen in concrete ways, such that prisoners have higher rates of lead toxicity. As a society, it would be cheaper, more humane, and less sociopathic to reduce the heavy metal poisoning. Similarly, studies have shown the prison population tends to be extremely malnourished. Prisons that improve the diet of prisoners result in a drastic reduction in aggressive, violent, anti-social, and other problematic behaviors. A similar observation has been made in studies with low-carb diets and children, as behavior improves. That indicates that, if we had increased public health, many and maybe most of these people wouldn’t have ended up in prison in the first place (Physical Health, Mental Health).

We’ve had a half century of unscientific dietary advice. Most Americans have been doing what they’ve been told. Saturated fat, red meat, and salt consumption went down over the past century. In place of those, fruits and vegetables, fish and lean chicken became a larger part of the diet. What has been the results? An ever worsening epidemic of obesity, diabetes, heart disease, autoimmune disorders, mood disorders, and on and on. In fact, these kinds of health problems were seen quite early on, following the fear toward meat that followed Upton Sinclair’s 1906 muckraking journalism on the meatpacking industry in The Jungle. Saturated fat intake had been decreasing and seed oil intake had been increasing in the early 1900s, in the decades leading up to the health epidemic that began most clearly around the 1940s and 1950s. The other thing that had increased over that time period were grains, sugar, and carbs in general. Then the victims who followed this bad advice were blamed by the experts for being gluttonous and slothful, as if diet were a Christian morality play. We collectively took the hard path. And the more we failed, the more the experts doubled down in demanding more of the same.

Do we want better lives for ourselves and others? Or do we simply want to scapegoat individuals for our collective failures? If you think we can’t afford to do the right thing, then we really won’t be able to afford the consequences of trying to avoid responsibility. The increasing costs of sickness, far from being limited to healthcare, will eventually bankrupt our society or else cause so much dysfunction that civil society will break down. Why choose such a dark path when an easier choice is before us? Why is the government and major health institutions still pushing a high-carb diet? We have scientifically proven the health benefits of low-carb diets. The simplest first act would be to change our dietary guidelines and all else would follow from that, from the food system to medical practice. What are we waiting for? We can make life hard, if we choose. But why not make it easy?

* * *

I’ve long wondered why we humans make life unnecessarily hard. We artificially construct struggle and suffering out of fear of what would happen if people were genuinely free from threat, punishment, and social control. We think humans are inherently bad and must be controlled. This seeps into every aspect of life, far from being limited to demented dietary ideology.

We are even willing to punish others at great costs to ourselves, even to the point of being highly destructive to all of society. We’d rather harm, imprison, kill, etc millions of innocents in order to ensure one guilty person gets what we think they deserve. And we constantly need an endless parade of scapegoats to quench our vengeful natures. Innocence becomes irrelevant, as it ultimately is about control and not justice.

All of it is driven by fear. The authoritarians, social dominators, and reactionaries — they prey upon our fear. And in fear, people do horrific things or else submit to others doing them. Most importantly, it shuts down our ability to imagine and envision. We go to great effort to make our lives difficult. Struggle leads to ever more struggle. Suffering cascades onto suffering. Worse upon worse, ad infinitum. As such, dietary ideology or whatever else pushed by the ruling elite isn’t about public good. It’s social control, pure and simple.

But let all of that go. Let the fear go. We know from science itself that it doesn’t have to be this hard. There are proven ways to do things that are far simpler and far easier and with far better results. We aren’t bad people who need to be punished into doing the right thing. Our bodies aren’t fallen forms that will lead us into sin. What if, instead, we looked to the better angels of our nature, to what is inherently good within us?

Here is some of what I’ve written before about the easy versus the hard, about freedom versus social control:
Public Health, Public Good
Freedom From Want, Freedom to Imagine
Rationalizing the Rat Race, Imagining the Rat Park
Costs Must Be Paid: Social Darwinism As Public Good
Denying the Agency of the Subordinate Class
Capitalism as Social Control
Substance Control is Social Control
Reckoning With Violence
Morality-Punishment Link
Unspoken Connection: Fundamentalism and Punishment
What If Our Economic System Conflicts With Our Human Nature?
An Invisible Debt Made Visible

About imagining alternatives, I’ve been reading Edward Bellamy’s Looking Backward. It’s a utopian novel, but in many ways it isn’t all that extreme. The future portrayed basically is a Nordic-style social democracy taken to the next level. That basic model of governance has already proven itself one of the best in the world, not only for public good but also wealth and innovation.

In reading about this fictionalized world, one thing stood out to me. The protagonist, Julian West, was put into trance to aid his sleep. He was in a sealed room underground and apparently the house burned down, leaving behind an empty lot. As a leap of imagination for both author and reader, this trance state put him into hibernation for more than a century. His underground bedchamber is discovered by the Leete family who, in the future world, lives on his old property although there house was built on a different location.

The father is Doctor Leete who takes particular interest in Julian. They have many conversations about the differences between the late 19th and early 21st centuries. Julian struggles to understand the enormous changes that have taken place. The world he fell asleep in is no longer recognizable by the world he woke up in. When he questions something that seems remarkable to him, Doctor Leete often responds that it’s more simple than it seems to Julian. The contrast shows how unnecessarily difficult, wasteful, and cruel was that earlier society.

The basic notion is that simple changes in social conditions can result in drastic changes in public good. The costs are miniscule in comparison to the gains. That is to say that this alternative future humanity chose the easy path, instead of continually enforcing costly punishment and social control. It’s quite amazing that the argument I make now was being made all the way back in 1888 when Bellamy began writing it. From the novel, one example of this other way of thinking is the description of the future education system in how it relates to health:

I shall not describe in detail what I saw in the schools that day. Having taken but slight interest in educational matters in my former life, I could offer few comparisons of interest. Next to the fact of the universality of the higher as well as the lower education, I was much struck with the prominence given to physical culture, and the fact that proficiency in athletic feats and games as well as in scholarship had a place in the rating of the youth.

“The faculty of education,” Dr. Leete explained, “is held to the same responsibility for the bodies as for the minds of its charges. The highest possible physical, as well as mental, development of everyone is the double object of a curriculum which lasts from the age of six to that of twenty- one.”

The magnificent health of the young people in the schools impressed me strongly. My previous observations, not only of the notable personal endowments of the family of my host, but of the people I had seen in my walks abroad, had already suggested the idea that there must have been something like a general improvement in the physical standard of the race since my day ; and now, as I compared these stalwart young men and fresh, vigorous maidens, with the young people I had seen in the schools of the nineteenth century, I was moved to impart my thought to Dr. Leete. He listened with great interest to what I said.

“Your testimony on this point,” he declared, “is invaluable. We believe that there has been such an improvement as you speak of, but of course it could only be a matter of theory with us. It is an incident of your unique position that you alone in the world of to-day can speak with authority on this point. Your opinion, when you state it publicly, will, I assure you, make a profound sensation. For the rest it would be strange, certainly, if the race did not show an improvement. In your day, riches debauched one class with idleness of mind and body, while poverty sapped the vitality of the masses by overwork, bad food, and pestilent homes. The labour required of children, and the burdens laid on women, enfeebled the very springs of life. Instead of the these maleficent circumstances, all now enjoy the most favourable conditions of physical life ; the young are care fully nurtured and studiously cared for ; the labour which is required.of all is limited to the period of greatest bodily vigour, and is never excessive ; care for one’s self and one’s family, anxiety as to livelihood, the strain of a ceaseless battle of life, all these influences, which once did so much to wreck the minds and bodies of men and women, are known no more. Certainly, an improvement of the species ought to follow such a change, In certain specific respects we know, indeed, that the improvement has taken place. Insanity, for instance, which in the nineteenth century was so terribly common a product of your insane mode of life, has almost dis appeared, with its alternative, suicide.”

* * *

Bonus Article:
Here’s What Weight-Loss Advice Looked Like Nearly 100 Years Ago
by Morgan Cutolo, Reader’s Digest

I’m throwing this in for a number of reasons. It is showing how low-carb views are basically the same as dietary advice from earlier last century. Heck, one can find advice like that going back to the 1800s and even 1700s. Low-carb diets were well known and mainstream until the changes at the AHA and FDA over the past 50 years or so.

The return of low-carb popularity is what inspires such articles from the corporate media. Reader’s Digest would’t likely have published something like that 10, 20, or 30 years ago. Attitudes are changing, even if institutions are resistant. Profits are also changing as low-carb products become big biz. Corporate media, if nothing else, will follow the profits.

Here is what really stood out to me. In the article, two major dietary experts are quoted: Dr. Jason Fung and Dr. Robert Lustig. Both of them are leading advocates of low-carb diets with Dr. Lustig being the most influential critic of sugar. But neither of them is presented as such. They are simply used as authorities on the topic, which they are. That means that low-carb has become so acceptable as, in some cases, to go without saying. They aren’t labeled as low-carb gurus, much less dismissed as food faddists. No qualifications or warnings are given about low-carb. The article simply quotes these experts about what the science shows.

This is a major advance in news reporting. It’s a positive sign of changes being embraced. Maybe we are finally turning off the hard path and trying out the easier path instead. Some early signs are indicating this. The growing incidence of diabetes might be finally leveling out and even reversing for the first time in generations.

Diabetic Confusion
Low-Carb Diets On The Rise
American Diabetes Association Changes Its Tune
Slow, Quiet, and Reluctant Changes to Official Dietary Guidelines
Official Guidelines For Low-Carb Diet
Obese Military?
Weight Watchers’ Paleo Diet

A Century of Dietary and Nutritional Trends

At Optimizing Nutrition, there is a freaking long post with a ton of info: Do we need meat from animals? Let me share some of charts showing changes over the past century. As calories have increased, the nutrient content of food has been declining. Also, with vegetable oils and margarine shooting up, animal fat and dietary cholesterol intake has dropped.

Carbs are a bit different. They had increased some in the early 20th century. That was in response to meat consumption having declined in response to Upton Sinclair’s muckraking of the meat industry with his book The Jungle. That was precisely at the time when industrialization had made starchy carbs and added sugar more common. For perspective, read Nina Teicholz account of the massive consumption of animal foods, including nutrient-dense animal fat and organ meats, among Americans in the prior centuries:

“About 175 pounds of meat per person per year! Compare that to the roughly 100 pounds of meat per year that an average adult American eats today. And of that 100 pounds of meat, more than half is poultry—chicken and turkey—whereas until the mid-twentieth century, chicken was considered a luxury meat, on the menu only for special occasions (chickens were valued mainly for their eggs). Subtracting out the poultry factor, we are left with the conclusion that per capita consumption of red meat today is about 40 to 70 pounds per person, according to different sources of government data—in any case far less than what it was a couple of centuries ago.” (The Big Fat Surprise, passage quoted in Malnourished Americans).

What we forget, though, is that low-carb became popular for a number of decades. In the world war era, there was a lot of research on the ketogenic diet. Then around the mid-century, low-carb diets became common and carb intake fell. Atkins didn’t invent the low-carb diet. Science conferences on diet and nutrition, into the 1970s, regularly had speakers on low-carb diets (either Gary Taubes or Nina Teicholz mentions this). It wasn’t until 1980 that the government began seriously promoting the high-carb diet that has afflicted us ever since. Carb intake peaked out around 2000 and dropped a bit after that, but has remained relatively high.

The inflammatory omega-6 fatty acids combined with all the carbs has caused obesity, as part of metabolic syndrome. That goes along with the lack of nutrition that has caused endless hunger as Americans have been eating empty calories. The more crap you eat, the more your body hungers for nutrition. And all that crap is designed to be highly addictive. So, Americans eat and eat, the body hungering for nutrition and not getting it. Under natural conditions, hunger is a beneficial signal to seek out what the body needs. But such things as sugar have become unlinked from nutrient-density.

Unsurprisingly, Americans have been getting sicker and sicker, decade after decade. But on a positive note, recently there is a slight drop in how many carbs Americans are eating. This is particularly seen with added sugar. And it does seem to be making a difference. There is evidence that the diabetes epidemic might finally be reversing. Low-carb diets are becoming popular again, after almost a half century of public amnesia. That is good. Still, the food most American have access to remains low quality and lacking in nutrition.












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Caloric Confusion

In human biological terms, there is no such thing as a calorie. It’s an abstraction measured by machines, in breaking down matter to determine the energy it contains. That isn’t how the body functions. It’s similar to the view of nutritionism where chemical analyses determines the amounts of specific vitamins and minerals found in any given food. None of this, however, tells us how the body absorbs, processes, and uses them.

Take sugar, for example. It is worse than empty calories. Rather, we are talking about actively toxic calories. It also interferes with nutrient intake and so can contribute to malnourishment. In the 1890s in Britain and by 1940 in the United States, a shockingly high number of recruits and draftees were being rejected because of malnourishment and tooth decay. This had been preceded by decades of rising levels of sugar and carbs in the diet, combined with processed vegetable oils that were replacing saturated fat.

A commonly discussed example of this is how more vitamin C is required on a high-carb diet because glucose competes with it, whereas on a low-carb diet very little vitamin C is needed to avoid scurvy. Sugar is causing harm simultaneously on multiple levels. That it is fattening is bad enough, especially considering all that is involved: dental caries, diabetes, heart disease, fatty liver, depression, etc — no minor set of health consequences and that list could go on much longer. Yet sugar was exonerated while saturated fat was scapegoated, which is rather inconsistent in that saturated fats have never been treated as mere empty calories equal to anything else.

It turns out calories aren’t all equal and on some level everyone probably always knew that was true, but in its simplicity it was an easy way of describing nutrition to the public. The problem is that it is so simplistic as to be fundamentally wrong. It is meaningless to speak of calories-in/calories-out. That doesn’t explain anything. We are still left with the issue of why the body burns some calories while turning others into fat. Recent research has shown that there is a metabolic advantage to low-carb diets in that more calories are burned in ratio to calories consumed. This is particularly true in a ketogenic state where the body efficiently burns fat. Fat easily turns into fat when eaten with carbs, but this is not true to the same degree when carbs are limited.

It is understandable how this all came about. We study what we can perceive and we ignore what we can’t. Scientific researchers early on learned how to measure calories with machines and it was assumed that the body was like a machine, burning a fuel in the way an engine burned coal and released heat. It became not only one model among many but a defining paradigm to explain human behavior and even morality, with the sins of gluttony and sloth taking key roles. Calories-in/calories-out created a perfect moral calculus. If you were fat or whatever, it was your fault. It couldn’t possibly have anything to do with the severely health-destroying food system, demented nutritional advice, and sub-par healthcare.

Other models of dietary health developed such as the endocrinological study of hormones and the hormonal systems, but the calorie model was already established. Besides, most of this other early research was done in Europe, much of it in German. The World Wars scattered the European research communities and their scientific literature mostly remained untranslated. When the US became the new center of nutritional research, English-speaking researchers were largely ignorant of all that previous researchers had already figured out.

Until this past decade or so, this state of affairs has remained that way, more than a century after that early research was done. Only now has the American-dominated nutritional research begun to return to old knowledge long forgotten.

* * *

The Curious History of the Calorie in U.S. Policy:
A Tradition of Unfulfilled Promises
by Deborah I. Levine

The Progressive Era Body Project:
Calorie-Counting and “Disciplining the Stomach” in 1920s America
by Chin Jou

Forget Calories
by James Hamblin

Death of the Calorie
by Peter Wilson

How Do We Gain Weight? – Calories Part I, II, IIIIV, V, VI, VII, VIII, IX, X, & XI
Historic Perspective on Obesity – Hormonal Obesity Part I, II, III, IV, & V
The Myth about Exercise – Exercise Part I, II, III, & IV
by Jason Fung

11 Experts Demolish the “Calories-In-Calories-Out” (CICO) Model of Obesity
9 More Experts Lay Waste to the “Calories-In-Calories-Out” (CICO) Model of Obesity
by Adam Kosloff

* * *

The Case Against Sugar
by Gary Taubes
pp. 23-25

Meanwhile, the latest surge in this epidemic of diabetes in the United States— an 800 percent increase from 1960 to the present day, according to the Centers for Disease Control—coincides with a significant rise in the consumption of sugar. Or, rather, it coincides with a surge in the consumption of sugars, or what the FDA calls “caloric sweeteners—sucrose, from sugarcane or beets, and high-fructose corn syrup, HFCS, a relatively new invention.

After ignoring or downplaying the role of sugars and sweets for a quarter-century, many authorities now argue that these are, indeed, a major cause of obesity and diabetes and that they should be taxed heavily or regulated. The authorities still do so, however, not because they believe sugar causes disease but, rather, because they believe sugar represents “empty calories” that we eat in excess because they taste so good. By this logic, since refined sugar and high-fructose corn syrup don’t contain any protein, vitamins, minerals, antioxidants, or fiber, they either displace other, more nutritious elements of our diet, or simply add extra, unneeded calories to make us fatter. The Department of Agriculture, for instance (in its recent “Dietary Guidelines for Americans”), the World Health Organization, and the American Heart Association, among other organizations, advise a reduction in sugar consumption for these reasons primarily.

The empty-calories argument is particularly convenient for the food industry, which would understandably prefer not to see a key constituent of its products—all too often, the key constituent—damned as toxic. The sugar industry played a key role in the general exoneration of sugar that took place in the 1970s, as I’ll explain later. Health organizations, including the American Diabetes Association and the American Heart Association, have also found the argument convenient, having spent the last fifty years blaming dietary fat for our ills while letting sugar off the hook. […]

This book makes a different argument: that sugars like sucrose and high-fructose corn syrup are fundamental causes of diabetes and obesity, using the same simple concept of causality that we employ when we say smoking cigarettes causes lung cancer. It’s not because we eat too much of these sugars—although that is implied merely by the terms “overconsumption” and “overeating”—but because they have unique physiological, metabolic, and endocrinological (i.e., hormonal) effects in the human body that directly trigger these disorders. This argument is championed most prominently by the University of California, San Francisco, pediatric endocrinologist Robert Lustig. These sugars are not short-term toxins that operate over days and weeks, by this logic, but ones that do their damage over years and decades, and perhaps even from generation to generation. In other words, mothers will pass the problem down to their children, not through how and what they feed them (although that plays a role), but through what they eat themselves and how that changes the environment in the womb in which the children develop.

Individuals who get diabetes—the ones in any population who are apparently susceptible, who are genetically predisposed—would never have been stricken if they (and maybe their mothers and their mothers’ mothers) lived in a world without sugar, or at least in a world with a lot less of it than the one in which we have lived for the past 100 to 150 years. These sugars are what an evolutionary biologist might call the environmental or dietary trigger of the disease: the requisite ingredient that triggers the genetic predisposition and turns an otherwise healthy diet into a harmful one. Add such sugars in sufficient quantity to the diet of any population, no matter what proportion of plants to animals they eat—as Kelly West suggested in 1974 about Native American populations—and the result eventually is an epidemic of diabetes, and obesity as well.

pp. 117-121

The second pillar of modern nutritional wisdom is far more fundamental and ultimately has had far more influence on how the science has developed, and it still dominates thinking on the sugar issue. As such, it has also done far more damage. To the sugar industry, it has been the gift that keeps on giving, the ultimate defense against all arguments and evidence that sugar is uniquely toxic. This is the idea that we get obese or overweight because we take in more calories than we expend or excrete. By this thinking, researchers and public-health authorities think of obesity as a disorder of energy balance,” a concept that has become so ingrained in conventional thinking, so widespread, that arguments to the contrary have typically been treated as quackery, if not a willful disavowal of the laws of physics.

According to this logic of energy balance, of calories-in/calories-out, the only meaningful way in which the foods we consume have an impact on our body weight and body fat is through their energy content—calories. This is the only variable that matters. We grow fatter because we eat too much—we consume more calories than we expend—and this simple truth was, and still is, considered all that’s necessary to explain obesity and its prevalence in populations. This thinking renders effectively irrelevant the radically different impact that different macronutrients—the protein, fat, and carbohydrate content of foods—have on metabolism and on the hormones and enzymes that regulate what our bodies do with these foods: whether they’re burned for fuel, used to rebuild tissues and organs, or stored as fat.

By this energy-balance logic, the close association between obesity, diabetes, and heart disease implies no profound revelations to be gleaned about underlying hormonal or metabolic disturbances, but rather that obesity is driven, and diabetes and heart disease are exacerbated, by some combination of gluttony and sloth. It implies that all these diseases can be prevented, or that our likelihood of contracting them is minimized if individuals—or populations—are willing to eat in moderation and perhaps exercise more, as lean individuals are assumed to do naturally. Despite copious reasons to question this logic and, as we’ll see, an entire European school of clinical research that came to consider it nonsensical, medical and nutrition authorities have tended to treat it as gospel. Obesity is caused by this caloric imbalance, and diabetes, as Joslin said nearly a century ago, is largely the penalty for obesity. Curb the behaviors of gluttony (Shakespeare’s Falstaff was often invoked as a pedagogical example) and sloth (another deadly sin) and all these diseases will once again become exceedingly rare.

This logic also served publicly to exonerate sugar as a suspect in either obesity or diabetes. By specifying energy or caloric content as the instrument through which foods influence body weight, it implies that a calorie of sugar would be no more or less capable of causing obesity, and thus diabetes, than a calorie of broccoli or olive oil or eggs or any other food. By the 1960s, the phrase a calorie is a calorie had become a mantra of the nutrition-and-obesity research community, and it was invoked to make just this argument (as it still is). […]

The energy-balance idea derives ultimately from the simple observation that the obese tend to be hungrier than the lean, and to be less physically active, and that these are two deviations from normal intake and expenditure: gluttony and sloth. It was first proposed as an explanation of obesity in the early years of the twentieth century, when nutrition researchers, as we discussed, were focused on carefully quantifying with their calorimeters the energy content of foods and the energy expended in human activity. At the time, the application of the laws of thermodynamics and particularly the conservation of energy to living creatures—the demonstration that all the calories we consume will either be burned as fuel or be stored or excreted—was considered one of the triumphs of late-nineteenth-century nutrition science. Nutrition and metabolism researchers embraced calories and energy as the currency of their research. When physicians began speculating as to the cause of obesity, they naturally did the same.

The first clinician to take these revelations on thermodynamics and apply them to the very human problem of obesity was the German diabetes specialist Carl von Noorden. In 1907, he proposed that “ the ingestion of a quantity of food greater than that required by the body, leads to an accumulation of fat, and to obesity, should the disproportion be continued over a considerable period.”

Noorden’s ideas were disseminated widely in the United States and took root primarily through the work of Louis Newburgh, a University of Michigan physician who did so based on what he believed to be a fundamental truth: “All obese persons are alike in one fundamental respect—they literally overeat.” Newburgh assumed that overeating was the cause of obesity and so proceeded to blame the disorder on some combination of a “perverted appetite” (excessive energy consumption) and a “lessened outflow of energy” (insufficient expenditure). As for obese patients who remained obese in spite of this understanding, Newburgh suggested they did so because of “various human weaknesses such as overindulgence and ignorance.” (Newburgh himself was exceedingly lean.) Newburgh was resolutely set against the idea that other physical faults could be involved in obesity. By 1939, his biography at the University of Michigan was already crediting him with the discovery that “ the whole problem of weight lies in regulation of the inflow and outflow of calories” and for having “undermined conclusively the generally held theory that obesity is the result of some fundamental fault.”

The question of a fundamental fault could not be dismissed so lightly, however. To do that required dismissing observations of German and Austrian clinical researchers who had come to conclude that obesity could only be reasonably explained by the existence of such a fault—specifically, a defect in the hormones and enzymes that served to control the flow of fat into and out of cells. Newburgh rejected this hormonal explanation, believing he had identified the cause of obesity as self-indulgence.

Gustav von Bergmann, a contemporary of Noorden’s and the leading German authority on internal medicine, * 1 criticized Noorden’s ideas (and implicitly Newburgh’s) as nonsensical. Positive energy balance—more energy in than out—occurred when any system grew, Bergmann pointed out: it accumulated mass. Positive energy balance wasn’t an explanation but, rather, a description, and a tautological one at that: logically equivalent to saying that a room gets crowded because more people enter than leave. * 2 It was a statement that described what happens but not why. It seems just as illogical, wrote Bergmann, to say children grow taller because they eat too much or exercise too little, or they remain short because they’re too physically active. “ That which the body needs to grow it always finds, and that which it needs to become fat, even if it’s ten times as much, the body will save for itself from the annual balance.”

The question that Bergmann was implicitly asking is why excess calories were trapped in fat tissue, rather than expended as energy or used for other necessary biological purposes. Is there something about how the fat tissue is regulated or how fuel metabolism functions, he wondered, that makes it happen?

The purpose of a hypothesis in science is to offer an explanation for what we observe, and, as such, its value is determined by how much it can explain or predict. The idea that obesity is caused by the overconsumption of calories, Bergmann implied, failed to explain anything.

p. 129

These revelations led both directly and indirectly to the notion that diets restricted in carbohydrates—and restricted in sugar most of all—would be uniquely effective in slimming the obese. By the mid-1960s, these carbohydrate-restricted diets, typically high in fat, were becoming fashionable, promoted by physicians, not academics, and occasionally in the form of hugely successful diet books. Academic nutritionists led by Fred Stare and Jean Mayer of Harvard were alarmed by this and denounced these diets as dangerous fads (because of their high fat content, particularly saturated fat), suggesting that the physician-authors were trying to con the obese with the fraudulent argument that they could become lean without doing the hard work of curbing their perverted appetites. It is a medical fact that no normal person can lose weight unless he cuts down on excess calories,” The New York Times would explain in 1965.

This battle played out through the mid-1970s, with the academic nutritionists and obesity researchers on one side, and the physicians-turned-diet-book-authors on the other. The obesity researchers began the 1960s believing that obesity was, indeed, an eating disorder—Newburgh’s “perverted appetite”—and the ongoing revolution in endocrinology, spurred by Yalow and Berson’s invention of the radioimmunoassay, did little to convince them otherwise. Many of the most influential obesity researchers were psychologists, and much of their research was dedicated to studying why the obese failed to restrain their appetites sufficiently—to eat in moderation—and how to induce them to do a better job of it. The nutritionists followed along as they focused on the question of whether dietary fat caused heart disease and perhaps obesity as well, because of its dense calories. (A gram of protein or a gram of carbohydrate has four calories; a gram of fat has almost nine.) In the process, they would continue to reject any implication that sugar had fattening powers beyond its caloric content. That it might be the cause of insulin resistance—after all, something was—would not cross their radar screen for decades.

pp. 199-201

In 1986, with the perceived FDA exoneration of sugar, the public-health authorities and the clinicians and researchers studying obesity and diabetes had come to a consensus that type 2 diabetes was caused by obesity, not sugar, and that obesity itself was caused merely by eating too many calories or exercising away too few. By this logic, the only means by which a macronutrient could influence body weight was its caloric content, and so, calorie for calorie, sugar was no more fattening than any other food, and thus no more likely to promote or exacerbate diabetes. This was what the sugar industry had been arguing and embracing since the 1930s. It was what Fred Stare of Harvard had in mind when he said publicly that he would prefer to get his calories from a martini than from a dessert.

A more nuanced perspective, one nourished by scientific progress, would be that if two foods or macronutrients are metabolized differently—if glucose and fructose, for instance, are metabolized in entirely different organs, as they mostly are—then they are likely to have vastly different effects on the hormones and enzymes that control or regulate the storage of fat in fat cells. One hundred calories of glucose will very likely have an entirely different effect on the human body from one hundred calories of fructose, or fifty calories of each consumed together as sucrose, despite having the same caloric content. It would take a leap of faith to assume otherwise.

Nutritionists had come to assume that a hundred calories of fat had a different effect from a hundred calories of carbohydrate on the accumulation of plaque in coronary arteries; even that a hundred calories of saturated fat would have an entirely different effect from a hundred calories of unsaturated fat. So why not expect that macronutrients would have a different effect on the accumulation of fat in fat tissue, or on the phenomena, whatever they might be, that eventually resulted in diabetes? (Insulin resistance and hyperinsulinemia, as Rosalyn Yalow and Solomon Berson, among others, had suggested in the 1960s, seemed to be a very likely bet.) But obesity and diabetes researchers, as we’ve seen, had come to embrace the mantra that “a calorie is a calorie”; they would repeat it publicly when they were presented with the idea that there was something unique about how the human body metabolizes sugar that sets it apart from other carbohydrates. The long-held view was based on the state of the science in the early years of the twentieth century, and to cling to it required a willful rejection of the decades’ worth of relevant revelations in the medical sciences that had come since.

By the 1980s, biochemists, physiologists, and nutritionists who specialized in the study of sugar or in the fructose component of sugar had come to consistent conclusions about the short-term effects of sugar consumption in human subjects, as well as the details of how sugar is metabolized and how this influences the body as a whole. The glucose we consume—in starch or flour, or as half of a sugar molecule—will be used directly for fuel by muscle cells, the brain, and other tissues, and can be stored in muscles or the liver (as a compound called glycogen), but the fructose component of sugar has a much different fate. Most of it never makes it into the circulation; it is metabolized in the liver. The metabolic pathways through which glucose passes when it is being used for fuel—in both liver and muscle cells—involve a feedback mechanism to redirect it toward storage as glycogen when necessary. This is the case with fructose, too. But the metabolism of fructose in the liver is “unfettered by the cellular controls,” as biochemists later put it, that work to prevent its conversion to fat. One result is the increased production of triglycerides, and thus the abnormally elevated triglyceride levels that were observed in many research subjects, though not all, when they ate sugar-rich diets.

While cardiologists and epidemiologists were debating whether elevated triglycerides actually increased the risk of heart disease (in the process, challenging their own beliefs that cholesterol was key), biochemists had come to accept that sucrose was “the most lipogenic” of carbohydrates—as even Walter Glinsmann, author of the FDA report on sugar, would later acknowledge—and that the liver was the site of this fat synthesis. * 2 The Israeli biochemist Eleazar Shafrir would describe this in the technical terminology as “the remarkable hepatic lipogenic capacity induced by fructose-rich diets.” It was also clear from the short-term trials in humans that this happened to a greater extent in some individuals than others, just as it did in some species of animals and not others. In human studies, subjects who had the highest triglycerides when the trials began tended to have the greatest response to reducing sugar intake, suggesting (but not proving) that the sugar was the reason they had such high triglycerides in the first place. These same individuals also tended to see the greatest drop in cholesterol levels when they were put on low-sugar diets.

A Food Revolution Worthy of the Name!

“Our success with carbohydrates, however, has had a serious downside: a worldwide plague of obesity, diabetes and other diet-related diseases.”
~Gerald C. Nelson

The conventional view on diet promoted by establishment figures and institutions is based on the idea that all calories are equal. In dieting and fat loss, this has meant promoting a philosophy of calorie-in/calorie-out which translates as calorie counting and calorie restriction. Recent research has brought serious doubt to this largely untested hypothesis that has for so long guided public health recommendations.

There is also a larger background to this issue. The government has spent immense money promoting and subsidizing the high-carb diet. For example, they’ve put decades of funding into research for growing higher yield staples of wheat, corn, and rice. But they have never done anything comparable for healthy foods that are nutrient-dense and low-carb. This promotion of high yield crops with industrialized farming has denatured the soil and the food grown on it. This is problematic since these high-carb staples are low in nutrient-density even when grown on healthy soil.

This mentality of obsessing over food as calories is severely dysfunctional. It ignores the human reality of how our bodies function. And it ignores widespread human experience. Calorie-restricted diets are well known to have one of the lowest rates of compliance and success. It doesn’t matter how many or how few calories one tries to eat, as long as the food one is eating is of such low quality. Your hunger and cravings will drive you in your body’s seeking nutrition.

As I’ve eaten more nutrient-dense foods as part of a diet that is ketogenic and paleo, my hunger decreased and my cravings disappeared. I certainly don’t consume more calories than before and possibly far less, not that I’m counting. I no longer overeat and I find fasting easy. Maybe too many people eat so much making them fat because the food system produces mostly empty calories and processed carbs. It’s what’s available and cheapest, and the food industry is brilliant in making their products as addictive as possible. The average person in our society is endlessly hungry while their body is not getting what it needs. It’s a vicious cycle of decline.

I remember how I was for most of my life until quite recently, with decades as a sugar addict and a junk food junky. I was always hungry and always snacking. Carbs and sugar would keep my blood sugar and serotonin levels on a constant roller coaster ride of highs and lows, and it wrecked my physical and mental health in the process. It wasn’t a happy state. And anyone having told me in my deepest and darkest depressive funk that I should count and restrict my calories would not have been helpful. What I needed was more of the right kinds of calories, those filled with healthy fats and fat-soluble vitamins along with so much else. My body was starving from malnourishment even when I was overeating and, despite regular exercise, eventually gaining weight.

We don’t need to grow more food to feed the world but to grow better food to nourish everyone at least to a basic level, considering how many diseases even in rich countries are caused by nutrient deficiencies (e.g., Dr. Terry Wahls reversed multiple sclerosis symptoms in her self, in patients, and in clinical subjects through increasing nutrient-density). The same amount of food produced, if nutrient-dense, could feed many more people. We already have enough food and will continue to have enough food for the foreseeable future. That of equal and fair distribution of food is a separate issue. The problem isn’t producing a greater quantity for what we desperately need is greater quality. But that is difficult because our industrial farming has harmed the health of the soil and denatured our food supply.

The U.S. gov pays some farmers to not grow anything because the market is flooded with too much food. At the same time, U.S. gov pays other farmers to grow more crops like corn, something I know from living in Iowa, the corn capital of the world. Subsidizing the production of processed carbs and high fructose syrup is sickening and killing us, ignoring the problems with ethanol. Just as important, it also wastes limited resources that could be used in better ways.

We have become disconnected in so many ways. Scientific research and government policies disconnected from human health. An entire civilization disconnected from the earth we depend upon. And the modern mind disconnected from our own bodies, to the point of being alienated from what should be the most natural thing in the world, that of eating. When we are driven by cravings, our bodies are seeking something essential and needed. There is a good reason we’re attracted to things that taste sweet, salty, and fatty/oily. In natural whole foods, these flavors indicate something is nutrient-dense. But we fool the body by eating nutrient-deficient processed foods grown on poor soil. And then we create dietary ideologies that tell us this is normal.

What if we could feed more people with less land? And what if we could do so in a way that brought optimal and sustainable health to individuals, society, and the earth? Now that would be a food revolution worthy of the name!

* * *

The global food problem isn’t what you think
by Gerald C. Nelson 

Here’s what we found:

Under even the worst conditions, there will be enough food, if we define “enough” as meaning sufficient calories, on average, for everyone — with 2,000 calories per day as the standard requirement. . . [T]he post-World War II Green Revolution efforts to boost the productivity of staples such as wheat and rice have been so successful that we are now awash in carbohydrates. And because so much has already been invested in improving the productivity of these crops, solid yield gains will likely continue for the next few decades. The productivity enhancements have also made them more affordable relative to other foods that provide more of the other needed nutrients.

Our success with carbohydrates, however, has had a serious downside: a worldwide plague of obesity, diabetes and other diet-related diseases. The World Health Organization reports that in 2014, there were 462 million underweight adults worldwide but more than 600 million who were obese — nearly two-thirds of them in developing countries. And childhood obesity is rising much faster in poorer countries than in richer ones.

Meanwhile, micronutrient shortages such as Vitamin A deficiency are already causing blindness in somewhere between 250,000 and 500,000 children a year and killing half of them within 12 months of them losing their sight. Dietary shortages of iron, zinc, iodine and folate all have devastating health effects.

These statistics point to the need for more emphasis on nutrients other than carbohydrates in our diets. And in this area, our findings are not reassuring.