Low-Carb Diets On The Rise

I’ve been paying close attention to diet this past year. It’s something I’ve had some focus on for decades now, but new info has recently changed the public debate going on. For example, a few years back, the research data from Ancel Keys was reanalyzed and an entirely different conclusion was found to be more plausible — instead of blaming saturated fat, the stronger correlation was to sugar. So much of what mainstream dietitians and nutritionists asserted as fact was based on Keys’ work, but it has since come under a dark cloud of doubt. Simply put, it was horrible science and even worse public health policy.

My own recent interest, though, was piqued in watching the documentary The Magic Pill. It came out in 2017 and several other great documentaries have come out in the last few years, with Nina Teicholz’s documentary in the works. In playing around with diet in the broad sense, I didn’t find much that helped, beyond limiting added sugar and throwing in a few healthy traditional foods (e.g., cultured dairy). It’s not that I ever was much interested in formal diets — some combination of laziness, apathy, and being too independent-minded, hence figuring something out for myself or else failing on my own terms, no doubt plenty of failure was involved and long periods of depressive despair and frustration. I’ve always been more about experimenting and finding what works or doesn’t work for me, if for no other reason than being stubborn in going my own way.

The problem was that nothing fundamentally had worked for my depression that plagued me my whole life nor for the weight gain that hit me as I approached my 40s. It is damn hard struggling to be healthy while depressed, but I did try such things as exercising regularly for it had some immediate palpable effect. Still, it was strange to exercise and yet not lose weight, even if aerobics did lift my mood ever so slightly. I was literally running to stay in place.

That is where The Magic Pill came in. I randomly came across it and watched it out of passing curiosity. Something about the case made was compelling to me, a blend of science and personal experience that rang true to my decades of reading and experimentation. It brought many pieces together: the whole foods emphasis on quality, the vegetarian emphasis on plant foods, the traditional food emphasis on nutrient-density, the low-carb emphasis on avoiding grains, legumes and sugar, the ketogenic emphasis on shifting metabolism, mood and much else, the alternative health emphasis on eliminating processed foods and additives, and the holistic/functional medicine emphasis on seeing the body as a system and part of larger systems.

So, what miraculous diet brings all of this diversity of views together under the umbrella of a coherent understanding? It’s the paleo diet, although some prefer to call it a lifestyle or a philosophy as it isn’t a singular dietary regimen or protocol. It’s about learning how to be healthy by following the examples of traditional societies in combination with the best science available, not only research in diet and nutrition as narrow fields but also research from dentistry, anthropology, archaeology, etc — any and all info that helps us understand the evolution of human health, specifically in explaining what has gone so terribly wrong in industrialized societies with the diseases of civilization. Diet is important, but only one part. Through an alliance with functional medicine, there is a greater focus on what makes for a healthy lifestyle: exercise, stress reduction, toxicity elimination, forest bathing, sun exposure, learning new things, etc… and don’t forget about play, something lost to so many modern adults.

Despite that greater focus of concern, it is the dietary angle that draws people in. Simply put, a lot of people feel better on the paleo diet, often in healing numerous conditions or at least reversing some of the worst symptoms, from conditions like obesity and diabetes to autism and depression to Alzheimer’s and multiple sclerosis, and much else. The paleo diet, as with traditional foods (both inspired by the work of Weston A. Price), is a good introduction to an alternative way of thinking not only about diet but health in general. It seems to be a gateway diet for many who go on to try related diets: primal (paleo plus dairy), Whole30, ketogenic, ketotarian, pegan, pescatarian, carnivore, etc. Primal, as one common example, demonstrates how paleolists have a tendency of drifting toward the similar traditional foods. Paleo is more of a framework than anything else, to the extent that it requires or promotes a paradigm change in one’s attitude.

The greater issue at hand is a potential paradigm change of society. That is the battle going on right now, those promoting that shift and those defending the status quo. Most figures and institutions of authority attack diets like paleo and keto because they are threatening. And the reason they are threatening is because of their growing popularity which in turn comes from their being highly effective for their intended purposes, while also being followed and sometimes promoted by many famous people, from media figures to politicians, including plenty of athletes (according to various sources, and in no particular order):

Bill Clinton, Madonna, Drew Carey, Renee Zellweger, Katie Couric, Al Roker, Halle Berry, Kim Kardashian, Kourtney Kardashian, Vinny Guadagnino, Jordan Peterson, Vanessa Hudgens, Megan Fox, Adriana Lima, Jessica Biel, Blake Lively, Channing Tatum, Eva La Rue, Phil Mickelson, Aisha Tyler, Matthew McConaughey, Edgar Ramirez, Jeb Bush, Kanye West, Christina Aguilera, Jack Osbourne, Kelly Osbourne, Sharon Osbourne, Miley Cyrus, Ursula Grobler, Becca Borawski, Aaron Rodgers, Andrew Flintoff, Jenna Jameson, Savannah Guthrie, Chris Scott, Tamra Judge, Grant Hill, Uma Thurman, Kobe Bryant, Gwyneth Paltrow, LeBron James, Alicia Vikander, Tim McGraw, Kristin Cavallari, Tom Jones, Grant Hill, Mick Jagger, Melissa McCarthy, Jennifer Lopez, Robin Wright, Cindy Crawford, Jennifer Aniston, Guy Sebastian, Elle Macpherson, Courteney Cox, Catherine Zeta Jones, Geri Halliwell, Ben Affleck, Joe Rogan, Brendan Schaub, Shane Watson, Tim Ferris, Jessica Simpson, Rosie O’Donnell, Lindsey Vonn, Alyssa Milano, Kendra Wilkinson, Christina Aguilera, Britney Spears, Joe Manganiello, Tom Kerridge, Jessica Alba, Mariah Carey, Tobey McGuire, Jennifer Hudson, Shania Twain, etc.

These low-carb diets work. People feel better, lose weight, go off their meds, have a lot of energy, and on and on. It’s a paradigm change with a real kick and so the change is largely coming from below, from probably hundreds of thousands of individuals experimenting similar to what I’ve done, including individual doctors who decide to buck the system and sometimes are punished for it (a few key examples are: John Yudkin, Tim Noakes, and Gary Fettke). And every individual this works for ends up being an inspiration to numerous others, even if only to the people they personally know such as family members, friends, neighbors, and coworkers. Other people see it works and so they try it themselves. This is how it went from a minor diet to its present growing momentum and did so in a fairly short period of time.

As I was saying at the beginning of this piece, I’ve been observing this shift. And I’ve come to realize it might be a seismic change going on. Every now and then, I see hints of the impact in the world around me. These alternative views are taking hold and won’t remain alternative for long. They are forcing their way into mainstream awareness. Unsurprisingly, there is backlash.

There is the corporate media, of course, with their typical attack pieces on “fad diets”, ignoring the fact that the keto diet has been medically researched since the early 1900s, the low-carb diet having been the first popular diet starting back in the 1800s, the traditional foods diet based on thousands of years of shared human experience, and the paleo diet as the diet hominids have thrived on for millions of years. The corporate media prefers to ignore what is threatening, until the point it no longer can be ignored, and so we are in that second phase right now, maybe a bit beyond since the mainstream authorities have already adopted some of the alternative views without acknowledging it (e.g., AHA quietly lowering its recommendations of carb intake after pushing a high-carb diet for a half century, as if hoping no one would notice this implicit admission to having been wrong, and wrong in a way that harmed so many). Local media is sometimes more open to new views, though.

The whole EAT-Lancet issue demonstrates the sense of conflict in the air. The authors of the report frame the situation as a crisis for all of humanity and the earth. And they use that as a cudgel to bash the new low-carb challengers, to nip them in the bud, even to the extreme of pushing for international regulations that would force conformity with the high-carb approach of conventional diets that have risen to prominence these past decades — mainstream versions of: vegetarianism, veganism, and Mediterranean (the modern Mediterranean diet as studied after World War II, not the traditional one with high levels of animal foods that existed for millennia before 20th century industrialization of the food system, no noodles or tomatoes prior to modern colonial trade, and surprisingly not much if any olive oil since according to ancient texts it was mainly used for lamp fuel, with animal fat being preferred for cooking). We’ve seen this push with such things as “Veganuary”.

It has become an overtly ideological fight, but maybe it always was. The politicization of diet goes back to the early formalized food laws that became widespread in the Axial Age and regained centrality in the Middle Ages, which for Europeans meant a revival of ancient Greek thought, specifically that of Galen. And it is utterly fascinating that pre-scientific Galenic dietary philosophy has since taken on scientific garb and gets peddled to this day, as a main current in conventional dietary thought (see Food and Faith in Christian Culture ed. by Ken Albala and Trudy Eden with an excerpt to be read here; I made this connection in realizing that Stephen Le, a biological anthropologist, was without awareness parroting Galenic thought in his book 100 Million Years of Food).

But the top-down approach to pushing dietary regimens hasn’t been all that successful in more recent years, maybe because of growing cynicism about past failures. Even with it being heavily promoted by well-funded organizations and government agencies, the high-carb plant-based diets are beginning to find it hard to maintain their footing in the tides of change. According to various data, it’s easy to get people to try veganism for a short period, but few maintain it. Vegetarianism is less restrictive, of course, but consistent adherence is still rare. The vast majority who start veganism or vegetarianism either occasionally eat meat or fish or else eventually give up on the diet. There is big money, including corporate money, behind the campaigns promoting it (most processed foods, including junk food, are technically vegan and big food has come to realize this is an effective way of marketing unhealthy food as healthy). Still, it doesn’t seem to be catching on with the general public, not that I doubt there will be those who continue their games of propaganda, persuasion, and perception management.

People have gotten the message that a plant-based diet is good. That part of the official messaging machine has been successful. Indeed, for decades, most Americans have been increasing their intake of fruits and vegetables and that is a good thing, but as far as that goes the paleo diet and many related diets also tend to recommend high levels of fruits and vegetables. The main advantage the low-carb diets have is that it’s easier to give up bread than to give up all animal foods (including eggs and dairy), though vegetarianism is a decent compromise since it allows some animal foods and that increases availability of the key fat-soluble vitamins. It’s not that low-carb, keto, or paleo vegetarianism is hard to do — so it isn’t an either/or scenario, but many pushing a so-called “plant-based” diet for some reason want to portray it in such dualistic terms, maybe as a way of falsely portraying low-carb as an anti-plant caricature in order to make it seem ridiculous and extremist.

Despite the ideological reaction, there is the growing realization that maybe there is some profit to be had in this emerging trend, as most businesses ultimately don’t care about dietary ideology and will go where the wind blows. New products cater to these alternative diets (paleo creamer, keto supplements, etc) or else old products are repackaged (“Keto Friendly!”). This is why it gets called a “fad diet”. But if being heavily marketed makes a diet a fad, then the same label applies to conventional diets as well that are more heavily marketed than any alternative diet. I’ve also begun seeing paleo and keto magazines, guides, and recipe booklets in grocery stores. Even when dismissed by experts such as in rankings of recommended diets, these “fad diets” nonetheless get mentioned, albeit usually tossed to the bottom of the list. As all this demonstrates, we are long past the silent treatment.

Furthermore, it goes beyond the products specifically marketed as paleo or keto or whatever. Demand has been increasing for organ meats, coconut products (from coconut milk to coconut oil), cauliflower, etc; consumption of eggs is likewise on the rise — all favorites on the paleo diet, in particular, but also favorites for similar diets. Prices have been going up on these items and, because demand sometimes exceeds supply, they can go out of stock at stores. Why are they so sought after? Organ meats are nutrient-dense, coconut milk is a good replacement for dairy and coconut oil for unhealthy vegetable/seed oils, and cauliflower can be used as a replacement for rice, mashed potatoes, tater tots and pizza crust (“The weird thing about cauliflower, though, is that while it has allies, it doesn’t really have adversaries.” ~Rachel Sugar); as for eggs, their popularity needs no explanation now that the cholesterol and saturated fat myths are evaporating.

Even Oprah Winfrey, though financially invested in the conventional Weight Watchers diet (in owning 8% of the company) and a self-declared lover of bread (actual quote: “I love bread!”), has put out a line of products that includes a low-carb pizza with cauliflower crust. This is interesting since, as low-carb diets have gained popularity, the stock of Weight Watchers has plunged 60% and Oprah lost at least 58 million dollars in one night and a loss of 500 million over all, putting Oprah’s star power to a serious test — maybe Oprah decided it is wise to not put all her eggs in one basket, in case Weight Watchers totally tanks. The company is finding it difficult to gain and retain subscribers. Those profiting from established dietary ideology are feeling the pinch.

It’s amusing how Weight Watchers CEO Cindy Grossman responded to the low-carb threat: “We have a keto surge,” she said. “It’s a meme, it’s not like a company, it’s people have keto donuts, and everybody on the diet side look for the quick fix. We’ve been through this before, and we know that we are the program that works.” And that, “We’ve lived through this [competition from fad diets] for 57 years and we’re not going to play a game and we never have.” Good luck with that! Maybe in reassuring stockholders, she also stated that, “We’re going to be science informed and we’re sustainable for the long term.” That is great. Everyone should be science informed. The problem for those trying to hold onto old views is that the science has changed and so has the public’s knowledge of that science.

Most people these days aren’t looking for complicated diets with eating plans and paid services, much less pre-prepared meals to be bought. A subscription model is becoming less appealing, as so much info and other resources are now available online. Besides, the DYI approach (Do It Yourself) is preferred these days. Diets like paleo and keto are simple and straightforward, and they can be easily modified for individual needs or affordability. But even for those looking for a ready-made system like Weight Watchers, there are other options out there that are looking attractive: “Wall Street is clearly nervous, too. JPMorgan analyst Christina Brathwaite downgraded the [Weight Watchers] stock to “underperform” last week and slashed her price target. One of the reasons? She was worried about competition from rival weight-loss service Diet Doctor, which is a proponent of keto.”

In whatever form, like it or not, low-carb diets are on the rise. Even among vegans and vegetarianism, the low-carb approach will probably become more common. Maybe that is why we’ve suddenly seen new low-carb, plant-based diets like Dena Harris’ paleo vegetarianism (2015), Will Coles’s ketotarianism (2018), and Mark Hyman’s peganism (2018). Do a web search about any of this and you’ll find numerous vegans and vegetarians asking about, discussing, or else praising low-carb diets. The same is true in how one sees broad interest in thousands of websites, blogs, and articles. Hundreds upon hundreds of organizations, discussion forums, Reddit groups, Facebook groups, Twitter alliances, etc have sprouted up like mushrooms. More and more are jumping on the low-carb bandwagon, as apparently that is what a large and growing part of the public is demanding. Whether or not it ever was a fad, it is now a movement and it isn’t slowing down.

Spartan Diet

There are a number well known low-carb diets. The most widely cited is that of the Inuit, but the Masai are often mentioned as well. I came across another example in Jack Weatherford’s Genghis Khan and the Making of the Modern World (see here for earlier discussion).

Mongols lived off of meat, blood, and milk paste. This diet, as the Chinese observed, allowed the Mongol warriors to ride and fight for days on end without needing to stop for meals. Part of this is because they could eat while riding, but there is a more key factor. This diet is so low-carb as to be ketogenic. And long-term ketosis leads to fat-adaptation which allows for high energy and stamina, even without meals as long as one has enough fat reserves (i.e., body fat). The feast and fast style of eating is common among non-agriculturalists.

There are other historical examples I haven’t previously researched. Ori Hofmekler in The Warrior Diet, claims that Spartans and Romans ate in a brief period each day, about a four hour window — because of the practice of having a communal meal once a day. This basically meant fasting for lengthy periods, although today it is often described as time-restricted eating. As I recall, Sikh monks have a similar practice of only eating one meal a day during which they are free to eat as much as they want. The trick to this diet is that it decreases overall food intake and keeps the body in ketosis more often — if starchy foods are restricted enough and the body is fat-adapted, this lessens hunger and cravings.

The Mongols may have been doing something similar. The thing about ketosis is your desire to snack all the time simply goes away. You don’t have to force yourself into food deprivation and it isn’t starvation, even if going without food for several days. As long as there is plenty of body fat and you are fat-adapted, the body maintains health, energy and mood just fine until the next big meal. Even non-warrior societies do this. The meat-loving and blubber-gluttonous Inuit don’t tolerate aggression in the slightest, and they certainly aren’t known for amassing large armies and going on military campaigns. Or consider the Piraha who are largely pacifists, banishing their own members if they kill another person, even someone from another tribe. The Piraha get about 70% of their diet from fish and other meat, that is to say a ketogenic diet. Plus, even though surrounded by lush forests filled with a wide variety of food, plants and animals, the Piraha regularly choose not to eat — sometimes for no particular reason but also sometimes when doing communal dances over multiple days.

So, I wouldn’t be surprised if Spartan and Roman warriors had similar practices, especially the Spartans who didn’t farm much (the grains that were grown by the Spartans’ slaves likely were most often fed to the slaves, not as much to the ruling Spartans). As for Romans, their diet probably became more carb-centric as Rome grew into an agricultural empire. But early on in the days of the Roman Republic, Romans probably were like Spartans in the heavy focus they would have put on raising cattle and hunting game. Still, a diet doesn’t have to be heavy in fatty meat to be ketogenic, as long as it involves some combination of calorie restriction, portion control, narrow periods of meals, intermittent fasting, etc — all being other ways of lessening the total intake of starchy foods.

One of the most common meals for Spartans was a blood and bone broth using boiled pork mixed with salt and vinegar, the consistency being thick and the color black. That would have included a lot of fat, fat-soluble vitamins, minerals, collagen, electrolytes, and much else. It was a nutrient-dense elixir of health, however horrible it may seem to the modern palate. And it probably was low-carb, depending on what else might’ve been added to it. Even the wine Spartans drink was watered down, as drunkenness was frowned upon. The purpose was probably more to kill unhealthy microbes in the water, as was watered down beer millennia later for early Americans, and so it would have added little sugar to the diet. Like the Mongols, they also enjoyed dairy. And they did have some grains such as bread, but apparently it was never a staple of their diet.

One thing they probably ate little of was olive oil, assuming it was used at all, as it was rarely mentioned in ancient texts and only became popular among Greeks in recent history, specifically the past century (discussed by Nina Teicholz in The Big Fat Surprise). Instead, Spartans as with most other early Greeks would have preferred animal fat, mostly lard in the case of the Spartans, whereas many other less landlocked Greeks preferred fish. Other foods the ancient Greeks, Spartans and otherwise, lacked was tomatoes later introduced from the New World and noodles later introduced from China, both during the colonial era of recent centuries. So, a traditional Greek diet would have looked far different than what we think of as the modern ‘Mediterranean diet’.

On top of that, Spartans were proud of eating very little and proud of their ability to fast. Plutarch (2nd century AD) writes in Parallel Lives “For the meals allowed them are scanty, in order that they may take into their own hands the fight against hunger, and so be forced into boldness and cunning”. Also, Xenophon who was alive whilst Sparta existed, writes in Spartan Society 2, “furnish for the common meal just the right amount for [the boys in their charge] never to become sluggish through being too full, while also giving them a taste of what it is not to have enough.” (from The Ancient Warrior Diet: Spartans) It’s hard to see how this wouldn’t have been ketogenic. Spartans were known for being great warriors achieving feats of military prowess that would’ve been impossible from lesser men. On their fatty meat diet of pork and game, they were taller and leaner than other Greeks. They didn’t have large meals and fasted for most of the day, but when they did eat it was food dense in fat, calories, and nutrition.

* * *

Ancient Spartan Food and Diet
from Legend & Chronicles

The Secrets of Spartan Cuisine
by Helena P. Schrader

Obesity Mindset

There is a piece from The Atlantic about weight loss, The Weight I Carry. It’s written from a personal perspective. The author, Tommy Tomlinson, has been overweight his entire life. He describes what this has been like, specifically the struggle and failure in finding anything that worked. One has to give him credit for trying a wide range of diets.

It was sad to read for a number of reasons. But a point of interest was a comment he made about carbs: “I remember the first time carbohydrates were bad for you, back in the 1970s. The lunch counter at Woolworth’s in my hometown of Brunswick, Georgia, sold a diet plate of a hamburger patty on a lettuce leaf with a side of cottage cheese. My mom and I stared at the picture on the menu like it was a platypus at the zoo. We pretended to care about carbs for a while. Mama even bought a little carbohydrate guide she kept in her pocketbook. It said biscuits and cornbread were bad for us. It didn’t stay in her pocketbook long.”

That is what I’ve read about. Into the 1970s, it was still well known that carbs were the main problem for many health problems, specifically weight gain. This was part of mainstream medical knowledge going back to the 1800s. It was an insight that once was considered common sense, back when most people lived on and around farms. Everyone used to know that how cattle were fattened for the slaughter was with a high-carb diet and so the way to lose weight was to decrease carbs. There was nothing controversial about this old piece of wisdom, that is until the government decreed the opposite to be true in their 1980s dietary recommendations.

The sad part is how, even as this guy knew of this wisdom, the context of understanding its significance was lost. He lacks an explanatory framework that can sift through all the bullshit. He writes that, “I’ve done low-fat and low-carb and low-calorie, high-protein and high-fruit and high-fiber. I’ve tried the Mediterranean and taken my talents to South Beach. I’ve shunned processed foods and guzzled enough SlimFast to drown a rhino. I’ve eaten SnackWell’s cookies (low-fat, tons of sugar) and chugged Tab (no sugar, tons of chemicals, faint whiff of kerosene). I’ve been told, at different times, that eggs, bacon, toast, cereal, and milk are all bad for you. I’ve also been told that each one of those things is an essential part of a healthy diet. My brain is fogged enough at breakfast. Don’t fuck with me like this.”

His frustration is palpable and reasonable. But I notice all that gets left out from his complaints. A low-carb diet by itself very well might feel impossible. If you aren’t replacing carbs with healthy fats and nutrient-dense whole foods, you will be trying to swim upstream. Carbs is used by the body as a fuel. Take it away and you better give the body a different fuel. And after a lifetime of nutrient deficiency as is common in modern industrialization, you’d be wise to rebuilding your nutritional foundations.

That is the failure of the deprivation model of diets. They eliminate without offering any good advice about what to add back in. The advantage of traditional foods and paleo is that they are less diets in this sense. They are simply seeking scientific knowledge based on how humans live in traditional communities in the world today and how humans have lived going back to the ancient world and beyond. The point is finding what naturally works for the human body, not forcing restrictions based on ideological demands. If a diet feels like a constant struggle, then you are doing something wrong. For most of human existence, the vast majority of individuals maintained a healthy body weight with no effort whatsoever. The epidemic of obesity is extremely and bizarrely abnormal. Obesity indicates something is seriously out of balance, specifically with insulin sensitivity and the related hormonal hunger signals. Deprivation simply antagonizes this state of disease.

We already know that the ketogenic diet is the most effective diet for weight loss. Not only in the losing part but also in maintaining one’s optimal weight. No other diet decreases hunger and eliminates cravings to the same extent. More generally, a recent study showed that a low-carb diet beat a low-fat diet in burning fat, even when protein and calories were exactly the same in both groups. This possibly indicates that, as some have speculated, a diet low enough in carbs may increase metabolism in burning more calories than one is consuming. Then when you reach your preferred weight, you can add back in some calories to attain an equilibrium. This is apparently the one thing the author didn’t try. He did try the South Beach diet, but it is only moderately low-carb and unfortunately is also low-fat, a bad combination — this diet, for example, recommends low-fat milk which is not only eliminating the needed fats but also the fat-soluble vitamins, especially in the form of dairy from cows that are pastured/grass-fed.

The author is trapped in the dominant paradigm. He doesn’t need to “Eat less and exercise.” And he recognizes this is bad advice, even as he can’t see an alternative. But he should look a bit further outside the mainstream. On a ketogenic diet, many people can lose weight while eating high levels of calories and not exercising. It’s more of a matter of what you eat than how much, although in some cases where there are serious health problems as is typical with lifelong obesity more emphasis might need to be given to exercise and such. But the point is to find foods that are satisfying without overeating, which generally means healthy fats. Your body gets hungry for a reason and, if you don’t feed it what it needs, it will remain hungry. Calorie counting and portion control won’t likely help anyone with long term weight issues. It will just make them frustrated and hangry, and for good reason. But when the old patterns repeatedly fail, it is best to try something new. Sadly, the author’s conclusion is to more fully commit to the old way of thinking. His chances of success are next to zero, as long as he continues on this path.

It’s an obesity mindset. The individual blames himself, rather than blaming the bad advice. He just needs more self-control and less gluttony. This time, he tells himself, it will work. I doubt it. I hope he doesn’t spend the rest of his life on this endless treadmill of self-defeat and self-blame. Life doesn’t need to be so difficult. Rather than losing weight, he should focus on what it takes to be and feel healthy. But it is hard to convince someone of that when their entire identity has become entangled with obesity itself, with their appearance as judged by the same society that gave the bad advice.

* * *

The Weight I Carry
What it’s like to be too big in America

by Tommy Tomlinson

I remember the first time carbohydrates were bad for you, back in the 1970s. The lunch counter at Woolworth’s in my hometown of Brunswick, Georgia, sold a diet plate of a hamburger patty on a lettuce leaf with a side of cottage cheese. My mom and I stared at the picture on the menu like it was a platypus at the zoo. We pretended to care about carbs for a while. Mama even bought a little carbohydrate guide she kept in her pocketbook. It said biscuits and cornbread were bad for us. It didn’t stay in her pocketbook long.

I’ve done low-fat and low-carb and low-calorie, high-protein and high-fruit and high-fiber. I’ve tried the Mediterranean and taken my talents to South Beach. I’ve shunned processed foods and guzzled enough SlimFast to drown a rhino. I’ve eaten SnackWell’s cookies (low-fat, tons of sugar) and chugged Tab (no sugar, tons of chemicals, faint whiff of kerosene). I’ve been told, at different times, that eggs, bacon, toast, cereal, and milk are all bad for you. I’ve also been told that each one of those things is an essential part of a healthy diet. My brain is fogged enough at breakfast. Don’t fuck with me like this.

Here are the two things I have come to believe about diets:

1. Almost any diet works in the short term.
2. Almost no diets work in the long term.

The most depressing five-word Google search I can think of—and I can think of a lot of depressing five-word Google searches—is gained all the weight back. Losing weight is not the hard part. The hard part is living with your diet for years, maybe the rest of your life.

When we go on a diet—especially a crash diet—our own bodies turn against us. Nutritional studies have shown that hunger-suppressing hormones in our bodies dwindle when we lose weight. Other hormones—the ones that warn us we need to eat—tend to rise. Our bodies beg us to gorge at the first sign of deprivation. This makes sense when you think about the history of humankind. There were no Neanderthal foodies. They ate to survive. They went hungry for long stretches. Their bodies sent up alarms telling them they’d better find something to eat. Our DNA still harbors a fear that we’ll starve. But now most of us have access to food that is more abundant, cheaper, and more addictive than at any other time in human history. Our bodies haven’t caught up to the modern world. Our cells think we’re storing up fat for a hard winter when actually it’s just happy hour at Chili’s.

Even worse, when people succeed at losing a lot of weight, their bodies slam on the brakes of their metabolism. […] Other studies had already shown that the body’s metabolism slows down as people lose weight, which means they have to eat fewer and fewer calories to keep losing. But this study showed that, for the contestants who lost weight quickly, their metabolism kept slowing even when they started gaining weight again. Basically, however fat they had been, that’s what their bodies wanted them to be. […]

“Eat less and exercise.”

That’s what some of you are saying right now. That’s what some of you have said the whole time you’ve been reading. That’s what some of you say—maybe not out loud, but you say it—every time you see a fat person downing fried eggs in a diner, or overstuffing a bathing suit on the beach, or staring out from one of those good-lord-what-happened-to-her? stories in the gossip magazines.

“Eat less and exercise.”

What I want you to understand, more than anything else, is that telling a fat person “Eat less and exercise” is like telling a boxer “Don’t get hit.”

You act as if there’s not an opponent.

Losing weight is a fucking rock fight. The enemies come from all sides: The deluge of marketing telling us to eat worse and eat more. The culture that has turned food into one of the last acceptable vices. Our families and friends, who want us to share in their pleasure. Our own body chemistry, dragging us back to the table out of fear that we’ll starve.

On top of all that, some of us fight holes in our souls that a boxcar of donuts couldn’t fill.

My compulsion to eat comes from all those places. I’m almost never hungry in the physical sense. But I’m always craving an emotional high, the kind that comes from making love, or being in the crowd for great live music, or watching the sun come up over the ocean. And I’m always wanting something to counter the low, when I’m anxious about work or arguing with family or depressed for reasons I can’t understand.

There are radical options for people like me. There are boot camps where I could spend thousands of dollars to have trainers whip me into shape. There are crash diets and medications with dangerous side effects. And, of course, there is weight-loss surgery. Several people I know have done it. Some say it saved them. Others had life-threatening complications. A few are just as miserable as they were before. I don’t judge any people who try to find their own way. I speak only for myself here: For me, surgery feels like giving up. I know that the first step of 12-step programs is admitting that you’re powerless over your addiction. But I don’t feel powerless yet.

My plan is to lose weight in a simple, steady, sustainable way. I’ll count how many calories I eat and how many I burn. If I end up on the right side of the line at the end of the day, that’s a win. I’ll be like an air mattress with a slow leak, fooling my body into thinking I’m not on a diet at all. And one day, a few years down the road, I’ll wake up and look in the mirror and think: I got there.

Clearing Away the Rubbish

“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue”
~Richard Horton, editor in chief of The Lancet

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor”
~Dr. Marcia Angell, former editor in chief of NEJM

Back in September, there was a scientific paper published in Clinical Cardiology, a peer reviewed medical journal that is “an official journal of the American Society for Preventive Cardiology” (Wikipedia). It got a ton of attention from news media, social media, and the blogosphere. The reason for all the attention is that, in the conclusion, the authors claimed that low-carb diets had proven the least healthy over a year period:

“One-year lowered-carbohydrate diet significantly increases cardiovascular risks, while a low-to-moderate-fat diet significantly reduces cardiovascular risk factors. Vegan diets were intermediate. Lowered-carbohydrate dieters were least inclined to continue dieting after conclusion of the study. Reductions in coronary blood flow reversed with appropriate dietary intervention. The major dietary effect on atherosclerotic coronary artery disease is inflammation and not weight loss.”

It has recently been retracted and it has come out that the lead author, Richard M. Fleming, has a long history of fraud going back to 2002 with two FBI convictions of fraud in 2009, following his self-confession. He has also since been debarred by the U.S. Food and Drug Administration. (But his closest brush with fame or infamy was his leaking the medical records of Dr. Robert Atkins, a leak that was behind a smear campaign.) As for his co-authors: “Three of the authors work at Fleming’s medical imaging company in California, one is a deceased psychologist from Iowa, another is a pediatric nutritionist from New York and one is a Kellogg’s employee from Illinois. How this group was able to run a 12-month diet trial in 120 subjects is something of a mystery” (George Henderson). Even before the retraction, many wondered how it ever passed peer-review considering the low quality of the study: “This study has so many methodological holes in it that it has no real value.” (Low Carb Studies BLOG).

But of course, none of that has been reported as widely as the paper originally was. So, most people who read about it still assume it is valid evidence. This is related to the replication crisis, as even researchers are often unaware of retractions, that is when journals will allow retractions to be published at all, something they are reluctant to do because it delegitimizes their authority. So, a lot of low quality or in some cases deceptive research goes unchallenged and unverified, neither confirmed nor disconfirmed. It’s rare when any study falls under the scrutiny of replication. If not for the lead author’s criminal background in the Fleming case, this probably would have been another paper that could have slipped past and been forgotten or else, without replication, repeatedly cited in future research. As such, bad research builds on bad research, creating the appearance of mounting evidence, but in reality it is a house of cards (consider the takedown of Ancel Keys and gang in the work by numerous authors: Gary Taubes’ Good Calories, Bad Calories; Nina Tiecholz’s The Big Fat Surprise; Sally Fallon Morrell’s Nourishing Diets; et cetera).

This is why the systemic problem and failure is referred to as a crisis. Fairly or unfairly, the legitimacy of entire fields of science are being questioned. Even scientists no longer are certain which research is valid or not. The few attempts at determining the seriousness of the situation by replicating studies has found a surprisingly low replication rate. And this problem is worse in the medical field than in many other fields, partly because of the kind of funding involved and more importantly because of how few doctors are educated in statistics or trained in research methodology. It is even worse with nutrition, as the average doctor gets about half the questions wrong when asked about this topic, and keep in mind that so much of the nutritional research is done by doctors. An example of problematic dietary study is that of Dr. Fleming himself. We’d be better off letting physicists and geologists do nutritional research.

There is more than a half century of research that conventional medical and dietary opinions are based upon. In some major cases, re-analysis of data has shown completely opposite conclusions. For example, the most famous study by Ancel Keys blamed saturated fat for heart disease, while recent reappraisal has shown the data actually shows a stronger link to sugar as the culprit. Meanwhile, no study has ever directly linked saturated fat to heart disease. The confusion has come because, in the Standard American Diet (SAD), saturated fat and sugar have been conflated in the population under study. Yet, even in cases like that of Keys when we now know what the data shows, Keys’ original misleading conclusions are still referenced as authoritative.

The only time this crisis comes to attention is when the researcher gets attention. If Keys wasn’t famous and Fleming wasn’t criminal, no one would have bothered with their research. Lots of research gets continually cited without much thought, as the authority of research accumulates over time by being cited which encourages further citation. It’s similar to how legal precedents can get set, even when the initial precedent was intentionally misinterpreted for that very purpose.

To dig through the original data, assuming it is available and one knows where to find it, is more work than most are willing to do. There is no glory or praise to be gained in doing it, nor will it promote one’s career or profit one’s bank account. If anything, there are plenty of disincentives in place, as academic careers in science are dependent on original research. Furthermore, private researchers working in corporations, for obvious reasons, tend to be even less open about their data and that makes scrutiny even more difficult. If a company found their own research didn’t replicate, they would be the last in line to announce it to the world and instead would likely bury it where it never would be found.

There is no system put into place to guard against the flaws of the system itself. And the news media is in an almost continual state of failure when it comes to scientific reporting. The crisis has been stewing for decades, occasionally being mentioned, but mostly suppressed, until now when it has gotten so bad as to be undeniable. The internet has created alternative flows of information and so much of the scrutiny, delayed for too long, is now coming from below. If this had happened at an earlier time, Fleming might have gotten away with it. But times have changed. And in crisis, there is opportunity or at very least there is hope for open debate. So bring on the debate, just as soon as we clear away some of the rubbish.

* * *

Retracted: Long‐term health effects of the three major diets under self‐management with advice, yields high adherence and equal weight loss, but very different long‐term cardiovascular health effects as measured by myocardial perfusion imaging and specific markers of inflammatory coronary artery disease

The above article, published online on 27 September 2018 in Wiley Online Library (wileyonlinelibrary.com), has been withdrawn by agreement between the journal Editor in Chief, A. John Camm and Wiley Periodicals, Inc. The article has been withdrawn due to concerns with data integrity and an undisclosed conflict of interest by the lead author.

A convicted felon writes a paper on hotly debated diets. What could go wrong?
by Ivan Oransky, Retraction Watch

Pro-tip for journals and publishers: When you decide to publish a paper about a subject — say, diets — that you know will draw a great deal of scrutiny from vocal proponents of alternatives, make sure it’s as close to airtight as possible.

And in the event that the paper turns out not to be so airtight, write a retraction notice that’s not vague and useless.

Oh, and make sure the lead author of said study isn’t a convicted felon who pleaded guilty to healthcare fraud.

“If only we were describing a hypothetical.

On second thought: A man of many talents — with a spotty scientific record
by Adam Marcus, Boston Globe

Richard M. Fleming may be a man of many talents, but his record as a scientist has been spotty. Fleming, who bills himself on Twitter as “PhD, MD, JD AND NOW Actor-Singer!!!”, was a co-author of short-lived paper in the journal Clinical Cardiology purporting to find health benefits from a diet with low or modest amounts of fat. The paper came out in late September — just a day before the Food and Drug Administration banned Fleming from participating in any drug studies. Why? Two prior convictions for fraud in 2009.

It didn’t take long for others to begin poking holes in the new article. One researcher found multiple errors in the data and noted that the study evidently had been completed in 2002. The journal ultimately retracted the article, citing “concerns with data integrity and an undisclosed conflict of interest by the lead author.” But Fleming, who objected to the retraction, persevered. On Nov. 5, he republished the study in another journal — proving that grit, determination, and a receptive publisher are more important than a spotless resume.