Saturday, November 26, 2011

A Brief Response to Taubes's Food Reward Critique, and a Little Something Extra

It appears Gary Taubes has completed his series critiquing the food reward hypothesis of obesity (1).  I have to hand it to him, it takes some cojones to critique an entire field of research, particularly when you have no scientific background in it, and have evidently not read any of the scientific literature on it.  As of 2012, a Google Scholar search for the terms “food reward” and “obesity” turned up 2,790 papers.

The food reward hypothesis of obesity states that the reward and palatability value of food influence body fatness, and excess reward/palatability can promote body fat accumulation.  If we want to test the hypothesis, the most direct way is to find experiments in which 1) the nutritional qualities of the experimental diet groups are kept the same or at least very similar, 2) some aspect of diet reward/palatability differs, and 3) changes in body fat/weight are measured (for example, 2, 3, 4, 5, 6, 7, 8, 9).  In these experiments the hypothesis has both arms and one leg tied behind its back, because the most potent reward factors (energy density, sugar, fat) have nutritional value and therefore experiments that modify these cannot be tightly controlled for nutritional differences.  Yet even with this severe disadvantage, the hypothesis is consistently supported by the scientific evidence.  Taubes repeatedly stated in his series that controlled studies like these have not been conducted, apparently basing this belief on a 22-year-old review paper by Dr. Israel Ramirez and colleagues that does not contain the word 'reward' (10).

Another way to test the hypothesis is to see if people with higher food reward sensitivity (due to genetics or other factors) tend to gain more fat over time (for example, 11, 12, 13, 14, 15, 16).  In addition, studies that have examined the effect of palatability/reward on food intake in a controlled manner are relevant (17, 18, 19, 20, 21, 22), as are studies that have identified some of the mechanisms by which these effects occur (reviewed in 23).  Even if not all of the studies are perfect, at some point, one has to acknowledge that there are a lot of mutually buttressing lines of evidence here.  It is notable that virtually none of these studies appeared in Taubes's posts, and he appeared unaware of them. 

I'd like to briefly discuss three studies Taubes brought up, because I think they encapsulate the nature of this debate nicely.  The first study is the only sugar consumption study Taubes cited in which 1) palatability was somewhat controlled for, and 2) body fat changes were actually measured (although none of the sugar studies cited were designed to investigate the effects of reward/palatability on body fat accumulation).  Taubes suggests in his series that a more compelling hypothesis is that dietary fructose promotes fat gain, and I suppose the relevance is that if this idea is true, it weakens the food reward hypothesis (the reasoning here eludes me).  Dr. Peter Havel’s group fed volunteers fructose or glucose-sweetened beverages as 25% of their total calorie intake, for 10 weeks (24).  If fructose has some special ability to increase body fatness that glucose does not have, then the fructose group should have gained more fat.  Here’s what they observed:

Body fat mass increased by about 3% in both groups (slightly but not significantly higher in the glucose group), despite the fact that fasting insulin increased by 10.2% in the fructose group and only 2.9% in the glucose group.  It is puzzling that this piece of information did not appear in Taubes's discussion of the paper, when it is the only element of the study that is relevant to the question at hand.  The fructose group gained more fat in the abdominal (belly) region, and less in other places, and experienced negative metabolic changes, which is why I discussed this paper in 2009 (25).  But if we’re trying to figure out what causes obesity, aren’t we talking about body fat accumulation?  This study shows that sweetened beverages, regardless of fructose content, and regardless of effects on circulating insulin, cause body fat accumulation in humans when added to a typical diet.  I'm not sure how that argues against the food reward hypothesis of obesity, but it certainly poses a challenge for the fructose and insulin hypotheses of obesity. 

The second article I'd like to discuss is a paper reviewing the effects of food palatability/variety on appetite and food intake (26).  Taubes took issue with my statement that "Many human studies have shown that people eat more food at a sitting if the food is higher palatability than if it is lower palatability", claiming that the review I cited did not support that conclusion (27).  Let's see what the paper says:
All reviewed studies have shown increased intake as palatability increased...
Studies also measuring the effect of palatability on energy intake (the ‘within-meal’ effect) show increased intake as palatability increases, no matter what the effect of palatability on the subjective appetite sensations is.
Taubes quoted other parts of the review which stated that subjective appetite and subsequent food intake are not consistently higher after eating a high-palatability meal, which is true but beside the point.  What I wrote is that within a single meal, if you actually measure food intake, people eat more if the food is higher palatability even if it is nutritionally identical, and according to the authors, "all reviewed studies" supported this effect.  This is clearly stated both in the abstract and the text body (26).  The effect has been consistently demonstrated by a number of studies (28, 29, 30, 31, 32, 33), and it is simply considered a fact at this point. Taubes would have known this if he had taken the time to read past the paper's abstract, or at least read the abstract carefully.

The third study I'd like to discuss is the weight loss study I introduced in previous posts, in which obese people (but not lean people) dramatically reduced their calorie intake and lost body fat when restricted to a bland and repetitive liquid diet consumed through a straw (34).  Taubes objected that the liquid diet was not low in palatability/reward value because it was sweet, which is the same objection he brought up after my talk at the Ancestral Health Symposium.  This truly strains the imagination.  Let's do a thought experiment here.  What would you rather eat for two weeks straight, this:


Nestle Nutrament, the modern version of the formula that was used in the study.  Ingredients: Skim milk, sugar, corn syrup, canola oil, high oleic sunflower oil, calcium caseinate, soy protein isolate, corn oil, sodium caseinate, artificial flavour, magnesium phosphate, magnesium chloride, carrageenan, soy lecithin, sodium ascorbate, ferrous sulfate, zinc sulfate, vitamin E acetate, niacinamide, calcium pantothenate, cupric sulfate, manganese sulfate, vitamin A palmitate, vitamin B6 hydrochloride, thiamine hydrochloride, riboflavin, chromium chloride, folic acid, vitamin D3, biotin, sodium molybdate, sodium selenite, vitamin K1, vitamin B12.

Or a typical varied diet?  If you ate nothing but Nutrament, described by the investigators at the time as a "bland liquid formula", day in and day out, would you find it delicious?  Would you wake up excited to drink it every morning?  Would you choose a meal of this liquid over a steak, baked potato and salad?  How about scrambled eggs, hash browns and coffee?  Amazingly, Taubes argues that this would not have been a low-reward/palatability situation (35).

Furthermore, he does not seem to be bothered by the fact that two (out of two where weight changes were reported) obese patients rapidly lost body fat on a diet that was 50 percent highly refined carbohydrate, including a high proportion of sugar, even though they were asked to drink the liquid to fullness.  I thought refined carbohydrate and sugar were supposed to drive insulin, hunger and body fat accumulation?  Taubes attempted to reconcile this by suggesting that all five obese patients (out of five where calorie intake was described) were deliberately restricting calories to lose fat during the study (35b).  If all five of these people had the desire and stoic determination to eat 400 calories a day for an extended period of time, why hadn't they already done so prior to the study?  Not to mention the fact that the subjects reported not being hungry.  According to Taubes, this was because their low calorie intake meant they weren't consuming much carbohydrate, therefore their insulin dropped, their fat was "unlocked" and they burned it instead of needing food (35b)!  So all we have to do is go on a 400-calorie diet, our insulin will drop, and the pounds will melt off without any hunger?  Eureka!  I find these logical contortions highly entertaining.

This study demonstrates that in a low-palatability/reward context, refined carbohydrate and sugar can actually allow substantial fat loss, suggesting that they are not inherently fattening, but rather that their ability to cause fat accumulation depends on their palatability/reward value.  This is probably a central reason why people who get most of their calories from white rice (e.g., large parts of Asia) are typically lean, not obese as one would expect if refined carbohydrate were inherently fattening. 

I could keep going, but I think you get the point.  In his critique, Taubes demonstrated neither a knowledge of the relevant literature, nor a willingness to accurately interpret the papers he did encounter.  It was simply not a serious scientific critique.  Therefore, I don't see any need to respond in a more comprehensive manner.  However, I did compose something that I think will be more useful to the readership, which is a deconstruction of the core argument that Taubes uses to brush aside 60 years obesity research that would otherwise falsify many of his ideas (below). It is also the same argument he uses to attempt to discredit obesity researchers who hold ideas that are not consistent with his own (i.e., nearly all of them). 

The evidence supporting the food reward hypothesis continues to speak for itself:

The Case for the Food Reward Hypothesis of Obesity, Part I
The Case for the Food Reward Hypothesis of Obesity, Part II
Food Palatability and Body Fatness: Clues from Alliesthesia
Food Reward, a Dominant Factor in Obesity, I, II, III, IV, V, VI, VII, VIII
Humans on a Cafeteria Diet
Losing Fat With Simple Food-- Two Reader Anecdotes

The evidence arguing against the carbohydrate-insulin hypothesis of obesity also continues to speak for itself:

The Carbohydrate Hypothesis of Obesity: a Critical Examination
Hyperinsulinemia: Cause or Effect of Obesity?
Does High Circulating Insulin Drive Body Fat Accumulation?  Answers from Genetically Modified Mice 
Fat Tissue Insulin Sensitivity and Obesity
Clarifications About Carbohydrate and Insulin

The "Energy Balance Paradigm" Argument: Poor Logic and Revisionist History

Rather than compose a full rebuttal to Taubes's recent posts, I thought it would be more productive to discuss one of the core elements of his position, which has arguably been one of his greatest influences on the public.  This is the "paradigm shift" he promotes, away from thinking about obesity as a problem of energy imbalance (energy in vs. out), and toward thinking about it as a "disorder of excess fat accumulation" where energy imbalance is the result rather than the cause of fat tissue expansion (36).  He seems to believe that thinking about energy balance at all is a distraction, and framing obesity in those terms is enough to send a paper to the dustbin (37).  He uses this argument to brush aside much of the last 60 years of obesity research, and the opinions of many seasoned researchers, arguing that they are largely irrelevant because they operate under the wrong paradigm (logical framework).

Maybe I'm a little slow, but only recently did I realize just how nonsensical this argument is.  It has generated a lot of confusion and ill will toward researchers over the years, and it's time to have a close look at it. 

Calorimetry is the science of measuring energy release in the form of heat, often from living organisms.  The first documented attempts to quantify energy expenditure in a living animal were likely performed by Dr. Antoine Lavoisier and colleagues in the 18th century, according to an excellent review paper on calorimetry by my friend Dr. Karl Kaiyala (38).  Calorimetry tools improved greatly in the late 19th century, including calorimeters of sufficient size to measure human energy expenditure, and it has been a staple technique in a number of fields, including obesity research, since then.  Calorimetry also permits the measurement of the energy content of foods, so it provides information about both the "in" and the "out" side of the equation.

The first law of thermodynamics states that energy cannot be created or destroyed, only shuttled between different forms (e.g., chemical energy and heat).  In this context, what it means is that changes in the energy content of a human body depend strictly on the amount of energy entering it, minus the amount leaving it.  This was empirically confirmed by a series of extraordinary experiments by Dr. Wilbur Atwater and colleagues in the late 1800s, a summary of which was published in 1899 and is freely accessible online (39).  Since body fat is by far the main modifiable energy storage site in the human body (i.e., other organs don't have the ability to change their energy content very much), one would predict that the long-term balance between energy in and energy out would determine fat mass stores.  This is indeed the case (40, 41, 42, 43). 

When researchers discovered that fat mass depends tightly on energy balance in humans, they realized that they has discovered the cause of, and solution to, obesity.  Obesity is caused by energy entering the body at a greater rate than it leaves, and fat loss occurs when this is reversed.  This is simply a fact at this point, and it has been repeatedly confirmed (44, 45, 46, 47, 48).  However, it is an incomplete explanation, because it doesn't tell us why the energy imbalance is present (therefore, it is the proximal, rather than the ultimate cause), and it does not necessarily imply that simply asking people to eat less and move more is a practical solution to obesity.  This is where I agree with Taubes-- 1) the key thing to understand is what is causing the energy imbalance, and 2) the idea that "eat less, move more" is a practical fat loss strategy does not necessarily follow from the first law of thermodynamics.  Taking in less energy and expending more does cause fat loss, but the problem is that it's difficult to maintain-- the body opposes changes in its fat stores.  However, this is where the usefulness of his idea ends. 

It has been made clear by countless studies that body fat stores can be manipulated by changing food intake and energy expenditure.  For example, overfeeding reliably increases fat mass in humans and can produce substantial body fat accumulation, regardless of whether the excess calories come from carbohydrate or fat, and regardless of changes in circulating insulin (49, 50, 51, 52).  Similarly, underfeeding reliably decreases fat mass by a predictable amount, also regardless of macronutrients and changes in circulating insulin (53, 54, 55).  "Exceptions" to this rule only seem to occur in studies where food intake is not measured accurately.

To some extent, changes in fat mass are opposed by the body (under the direction of the brain), for example, energy expenditure decreases with fat loss and this is largely dependent on the reduction in circulating leptin that accompanies fat loss (56).  Not everyone gains the same amount of fat mass when overfed, because certain people can ramp up energy expenditure to some degree, but this is fairly limited and the effect remains controversial.  These adaptive changes in energy expenditure depend on the location of the body fat "setpoint" (or whatever you want to call it), as I have discussed in previous posts.  However, all of this can be accounted for by changes in energy expenditure, and thus none of it violates the first law of thermodynamics.

The primary role of fat tissue is to buffer body energy stores, absorbing excess energy and storing it for when it is needed and keeping it away from the other tissues where it would do damage, and that is exactly what it does in response to changes in energy balance.  Regardless of the hormonal milieu of the body (with the exception of a few rare and severe disorders), when energy balance (in vs. out) is experimentally altered, it is reflected tightly in fat mass stores.

To review the key points so far:
  • Energy balance tightly determines changes in body fat stores
  • This does not necessarily imply that "eat less, move more" is a practical fat loss strategy
  • It also does not tell us what is driving changes in energy balance that cause obesity
Since fat mass is determined by changes in energy balance, it makes perfect sense why this has been viewed as important to obesity researchers.  It is a critical piece of the puzzle, and it is simply not correct to suggest that thinking in these terms is misleading or not useful, when it is clearly an extremely useful research framework.  That is the first reason why Taubes's argument is illogical.

Since energy balance is by far the main factor that determines body fat stores, naturally obesity researchers have been interested in what determines energy intake and energy expenditure, the two control points of energy balance, and there has been a tremendous amount of research into this in the last century.  Now we come to the second reason why Taubes's argument is illogical.  He suggests that obesity researchers are in the wrong paradigm because they are focused on energy balance rather than the determinants of energy balance (e.g, they have the causality backward), but this is simply not true.  Taubes states (57):
If the post-WW2 generation of researchers had simply defined obesity as a disorder of excess fat accumulation rather than one of energy balance, I argued, they would have naturally asked the question, what hormones and enzymes and other factors regulate fat accumulation. And that’s what they would have and should have been studying for the past sixty years.
Someone should tell Gary Taubes about leptin.  And after that, tell him about melanocortins, neuropeptide Y, dopamine, opioids, endocannabinoids, amylin, ghrelin and all the other factors that researchers have determined regulate body fat accumulation since WWII.  Then, all of the brain regions that respond to these factors and have well-defined roles in body fat regulation (e.g., the arcuate nucleus, ventromedial hypothalamus, lateral hypothalamus, paraventricular nucleus of the hypothalamus).  Just because these mechanisms involve the brain doesn't mean we get to pretend they don't exist, and then complain that no one is studying the question. 

Most obesity researchers view energy imbalance as a link in the causal chain between environmental factors and obesity, and view the whole process as being driven by upstream causal factors, just as Taubes does.  That may not be reflected on TV or in the newspaper, but I can assure you it is a common sentiment in my field.  There is no "paradigm shift" necessary here, because most obesity researchers already share Taubes's view on this-- in fact, they had already studied it in detail long before he came to town.  And his statement that obesity researchers don't define obesity as a disorder of excess fat accumulation is simply absurd.  There is no rational justification for brushing aside 60 years of obesity research on these grounds, but of course, agreeing with people doesn't help you stand out.

The remaining two questions are, 1) where do the control points for energy intake and energy expenditure reside? 2) what causes energy imbalance?

The efforts of many dedicated researchers over the last century have uncovered a complex control system in the brain that adjusts energy intake and expenditure both in the short and long term to try to achieve stability (homeostasis) of body energy status over time.  This system is composed of negative feedback loops between the digestive system and the brain for the control of meal-to-meal energy intake, and negative feedback loops between fat mass and the brain for the control of long-term energy balance and thus fat mass (58).  This makes sense, since energy intake obviously involves the brain directing food seeking and ingestion, and energy expenditure involves the brain moving the body and controlling the sympathetic nervous system and thyroid signaling.  There is no known system in fat tissue that would allow it to intrinsically regulate its own size with any degree of precision, nor is there any known system in the insulin-secreting pancreas that could do so.  These organs do not appear to be a control point of energy balance or total body fat mass.

Now we are left with the question of what causes energy imbalance.  We are looking for factors that influence the control systems in the brain that regulate energy balance and fat mass.  Some good candidates have been identified, and I posted a summary of my thoughts on them recently (59).

To summarize the key points of this post:
  • Energy balance tightly determines fat mass
  • Energy balance is an extremely useful logical framework for obesity research
  • This does not necessarily imply that "eat less, move more" is an effective fat loss strategy in practice
  • The control point for energy balance appears to reside in the brain
  • It is therefore likely that the causes of obesity influence this control system in the brain
Taubes likes to quote pre-WWII obesity researchers such as the Vienna physician Dr. Julius Bauer, to lend credence to his hypothesis that body fat tissue is regulated by factors acting locally on fat tissue, not by the brain.  According to Taubes's revisionist history of obesity research, this was back in the good old days, supposedly before neuroscientists and the nefarious energy balance paradigm mucked everything up.  Here's a quote from one of Taubes's recent posts (60), describing his "body rules" idea:
Here, the body is running things.  Indeed the organ in control may be the fat tissue itself in concert with the liver.  The University of Vienna endocrinologist/geneticist Julius Bauer described this fat-rules concept back in 1929 by saying that  the fat tissue of someone who’s obese (what he called “abnormal lipophilic tissue) “maintains its stock, and may increase it independent of the requirements of the organism.  A sort of anarchy exists; the adipose tissue lives for itself and does not fit into the precisely regulated management of the whole organism.”
In this scenario, the brain plays no more role in regulating the growth of the fat tissue than it would regulating the growth of any tissue.
I thought Taubes's idea is that insulin regulates fat tissue size?  That means the pancreas would be in charge ("pancreas rules"), not the fat tissue itself.  Why do I get the feeling no one has told Taubes the brain regulates insulin secretion by the pancreas?  I'm pretty sure Dr. Bauer didn't sign up for "pancreas rules".  But let's put all that aside for now.  Taubes left out a second quote by Dr. Bauer that is relevant here:
The genes responsible for obesity act upon the local tendency of the adipose tissue to accumulate fat (lipophilia) as well as upon the endocrine glands and those nervous centers which regulate lipophilia and dominate metabolic functions and the general feelings ruling the intake of food and the expenditure of energy. Only a broader conception such as this can satisfactorily explain the facts.”
Dr. Bauer was speculating here, because this was long before we had the tools to answer these questions directly-- today we know that the bold portion of his statement has received the most consistent scientific support (discussed in 61).  It appears that even during those golden years of pre-WWII obesity research, before we had discovered leptin, before we understood in detail how the brain regulates body fatness, when obesity research was still taking its first baby steps-- even then, it was clear that the brain regulates body fat mass by controlling food intake and energy expenditure.  Where did I get that quote?  A book called Good Calories, Bad Calories, page 362 (thanks Evelyn).

At this point, I feel I've already spent too much time engaging Taubes, so I won't continue to do so.  But I hope I've been able to convey some interesting obesity research to Whole Health Source readers during this process.

168 comments:

New York said...

Note 60 seems to be a mistake as it links to your posting, not Taubes

Burn said...

Wow. Epic post. Thank you for all your critiques of Taubes, you've done a lot to change my thinking on obesity. Kudos

ponder said...

Thanks Stephan for an interesting read. Based on my own experience, I lose weight when I count calories and force a calorie deficit into my diet. I've eaten Paleo for about 10 years now and if I eat too much, I gain weight. My typical diet, when I gain weight, is higher in fat with tree nuts and dark chocolate (85 or 90% cocoa with low sugar content)to excess, not sugar. It was because of listening to many of Jimmy Moore's podcasts (which promotes a higher fat diet) that I mistakenly decided to add more fat to my diet (thinking I didn't need to control the calorie intake) and within 3 or 4 months I had gained 5 pounds of fat to my body (from approximately 6.5% body fat to 8.5%). It always seemed to me that calorie intake needed to be controlled and natural carbohydrate, rather than processed sugar, would not be a problem. When I tend to lose weight I eat lots of fruits as they are satiating with a high water content and relatively low in calories. Jimmy likes to come down hard on banana's as a food because of what he says is high sugar content, but I find that banana's are a good choice for my weight loss strategy.

Hans Keer said...

To Gary and Stephan : Why don’t you guys sit around a table for let’s say one week and try to come to consensus. I’m sure the outcome (especially when approved by CarbSane :-) ) will be of invaluable value. Working together will appear to be less frustrating for the both of you and the effectiveness will be much more satisfactory.

Sanjeev said...

I'm curious if anyone knows the standard Atkins/Eades/Taubes "explanation" for the phenomenon of lipsuction patients returning to their original fat mass fairly quickly, with the adiposity distributed differently.

Also the phenomenon of after returning quickly to the pre-liposuction weight/(fat mass)/weight, thereafter resuming steady weight gain, as before the liposuction.

Scott W said...

Awesome. And Nice to have everything (all links) in one post.

Who to believe?

Two people...

One an academic researcher, one a laboratory researcher with a doctorate.

One who interprets studies and cases selectively and ignores confounding results (see Pima Indians) and one who apparently understands how to read entire studies and attempt to account for all experimental outcomes.

One who cannot ever change his mind (even a little), and one who's thinking develops over time and admits to past mistakes in a public forum.

One who is selling books and one who is selling nothing.

Who to believe, who to believe...hmm.

Scott W

FredT said...

You are both short. We need both palatable available food, reward if you like, and insulin resistance, insulin to gain weight.

When I was a young man, I worked in exploration and construction camps many winters. Most people would come in and gain 10 to 20 pounds and then get bored with the good food available. A few of us would be up 50 pounds by spring, when the job ended. When it was our nickle buying the food, it was less plentiful, and we lost weight.

To lose, the only way is to cut both hyper-palatable available food and insulin generating food.

Justin said...

It seems to me that the next logical step, study-wise, would be to determine the effect of an individual's ability to taste on fat accumulation. That is, take super tasters and whatever the opposite is, and feed them the same foods.

Would that, theoretically, have an impact?

Aravind said...

Hello Stephan,

Great post as usual. I think you know my views of FR so no need to restate my support here.

However one thing that I've mentioned before - I really wish you would drop the word "palatability" when discussing the concept. As someone who has spent a lot of time engaging/debating others trying to explain Food Reward, I find that "palatability" leads to confusion and other red herrings that distract from the essence of the concept.

That reward and palatability are correlated is not being questioned. But since reward is so much more than that and there continues to be some definitional issues that people are struggling with, this is just a suggestion.

Live long and prosper Mr Spocker!

Aravind

bjk said...

We just need to stage an epic battle of Guyenetians and Taubeslanders.

Tim said...

Stephan,

Would you acknowledge that there are cases in which people are on a caloric deficit but fail to lose weight, as well as cases in which people are on a caloric surplus and fail to gain weight?

If so, how would you account for this?

Jim said...

Thanks Stephan.

You've raised the dialogue back above the muck that's been developing on Gary's blog.

Personally, until Gary's latest series I had been giving Taubes a lot more credit than I should have.

In his latest series I have seen him to be less a scientist and more a lawyer than I had previously thought.

I can see why you want to be done with this "distraction", however, you are doing an immense public service by having enaged as much as you have.

GCBC was for me, as it has been for a lot of people, my first relatively detailed introduction to the biochemistry of obesity. In point of fact Taubes has been the only one able to bring that amount of detail to the general public and to get them to actually read it.

And, as a lay person, not being up on the current research in the field, it was difficult to see the bias in GCBC.

But Gary did open the door for a lot of people, and now you are using that open door to deliver the "good stuff".

Thank you.

Payam said...

Stephen, have you ever discussed how exercise, particularly post workout meals, fits into the food reward theory?

brec said...

What advice to an overweight person who wants to lose weight does the food reward theory imply?

Amy said...

It really concerns me that the fructose group gained weight in the waist. I've meet skinny type 2 diabetics that carry all their body fat in the waist. http://www.msnbc.msn.com/id/7259632/ns/health-diabetes/t/waistline-better-indicatorof-diabetes-bmi/
I think research is starting to show a small waist line is far more important than overall weight.

Greg said...

I appreciate the rebuttal to Taubes but am disappointed in the tone. (just as I was very disappointed by Taubes tone at AHS). "someone should tell him" and "doesn't sell" aren't the kind of rhetoric I come to this blog for.

I view the both of you as experts at critiquing existing arguments. It is much easier to criticise explanations than come up with correct explanations. Obviously this is the case with Taubes and carbohydrate, but it is very possible that reward could be overblown. If Taubes could admit that reward could account for a small percentage of obesity and Stephen could constantly remind readers that reward is only one (not the dominant) factor, there might be a lot less to argue about.

David Pier said...

Really well written. Even though it was mostly a recapitulation, I felt the same great feelings as when I am reading something revelatory.

Anoopbal said...

Can someone tell Taube to look at Randomised Clinical Trials (RCT's) first and then if they are not there go look at observational studies and 'quotes" from researchers. Taubes has it backwards.

I am surprised Taubes still has a crowd.

Unknown said...

Thank you for choosing to engage in this discussion with Mr. Taubes and attempting to set the record straight. I know how draining and distracting public debates can be, and I'll donate some $$ towards this amazing knowledge base that you've been building up here at Whole Health Source. Kudos!

BigWhiskey said...

The "Food Product" used in the experiment may be acceptable as Vegetarian Diet.....

Txomin said...

Thank you for putting the effort into this post. Some of these ideas needed to be explained properly and you have done it.

To the extent that I understand the issues, I largely agree. Unfortunately, my experience tells me otherwise. Since I gave up carbs, I eat more than before and have lost almost 20 kilos of fat (I have no more fat to lose, btw). If this is not insulin related, there must be some other carb related reason. I agree calories matter but, again, my experience requires explanations beyond your post.

Kris said...

Hello Stephan,

I'm interested in your thoughts about a blog post I wrote, where I explored the link between diet soda consumption (zero calories) and subsequent weight gain and metabolic derangement.

Diet Soda – Is it Bad For You and Can it Cause Weight Gain?

Diet soda increases weight gain, metabolic syndrome, type II diabetes, heart disease, etc. significantly and even much more than regular, sweetened soft drinks (high in sugar calories).

I'm thinking this might fit in nicely with the food reward theory.

These drinks don't contain any calories, yet they are very sweet and bring about a sense of reward.

The food reward theory would explain quite nicely how they cause these effects, because I don't believe these artificial sweeteners are that harmful in isolation.

But it is still quite a mystery to me why they would cause even more weight gain than sweetened soft drinks which are just as palatable, if not more.

bopes said...

Can someone tell me what the recommended daily allowance is for food reward and palatability?

Thomas said...

Nice Stephen!

I'm reminded of a local new story that ran here at Thanksgiving about child cancer patients and their relationship with food. Two kids were interviewed and they reported that while undergoing treatment, they lost their taste for food and simply did not want to eat anymore. They reported that it was because they couldn't taste the food anymore (they did not mention nausea or the inability to keep it down as far as I can remember). Both lost significant weight due to reduced intake. Happily, after treatment they regained their taste sense and were able to enjoy their Thanksgiving meal.

Mzlittlekitten said...

Excellent post thank you so much.If it wasn't for people like you and Evelyn there would be almost no regulation amoung the low-carb/paelo communities and people might just take everything taubes says as fact without ever questioning it.

You,Don matesz and Carbsane provide us with much appreciated alternative views.

JBG said...

With the possible exception of skim milk, there is nothing among the major ingredients of Nutrament that I would want a loved one to eat.

I sincerely hope that someone produces a formula made up of healthful ingredients that works like Nutrament.

It's a way someone could make a ton of money while doing a ton of good for the world.

Mitch Fletcher said...

Stephan,

Terrific post (and blog in general). Your writing and logic is so much clearer than Taubes'.
You could pretty easily publish your posts as a book and I hope you might at some point (as long as you don't feel that would undermine your credibility!). Kudos

Evelyn aka CarbSane said...

Hi Stephan, Wouldn't it be great if he made good on the "e" for "enough already". LOL. I agree that there's really no need for a more comprehensive refutation of his work. As Kurt Harris said recently, he can't rescue his hypothesis on the backs of refined carbs and fructose. I'd add that he also can't rescue it by trying to take down other hypotheses. Nice job!

Sam Knox said...

It isn't enough to simply declare victory in an obscure corner of the blogosphere.

Lest we forget, there are, literally, millions of human beings who suffer from the effects of obesity. It matters little which theory is "right" unless it implies a course of treatment that is both effective and practical.

There are, as far as I know, no randomized, controlled dietary trials that compare the efficacy of a low-reward vs. a low-carb diet.

Until such trials exist, if they ever do, isn't a little humility in order?

Jim said...

Stephan, I'm gratified to see you came to the same conclusion I did about "calories in/calories out" being a red herring.

I tried to push that line in my comments on Gary's first post against food reward:

http://garytaubes.com/2011/11/catching-up-on-lost-time-%E2%80%93-the-ancestral-health-symposium-food-reward-palatability-insulin-signaling-and-carbohydrates%E2%80%A6-part-iia/#comment-8651

And notice that Gary may have indicated that he sees the point in his reply to this comment -- though his "I agree with most of what you said here" is a bit vague.

Evelyn aka CarbSane said...

@Sam: I think the LC trials have been done, and produced no better result in the lasting reversal of obesity.

Evelyn aka CarbSane said...

Hi Mzlittlekitten: While directed at Stephan, I do want to thank you for including me in your comment!

Evelyn aka CarbSane said...

@Hans Keer: Have you started blogging on a new website yet? Your former cutthecarb domain is "up for sale". I would be interested in reading when you do. Perhaps just a Blogger profile update is in order.

Ela said...

Stephan, thanks so much for your rigorous work. I've been following with interest, especially since you've been engaging with Taubes.

I read GCBC a few years ago and totally bought into it, and now feel embarrassed to have done so. Cutting out carbs made my health problems worse and it took me a long time to recognize that. My history is severe anorexia and then high-fruit raw-veganism so that I was v. low weights/wasn't menstruating throughout my 20's. Now, I have thyroid and adrenal (and other endocrine) problems, some fat accumulation around my middle, and although my adrenals have recovered to where I can exercise, I seem to be unable to change my body composition despite not eating a lot.

Two questions: In this post, you insist on the first law of thermodynamics: I have felt for a while like my body is defying that--is it just that my metabolism is chronically slow from all the starvation and fruit/fructose, and I really need to cut my calories even more drastically to get back toward my ideal? (which is no longer 75lbs, or even 90, as I was all those years)

Second question: in many circles, a 'cheat' day is recommended, whereby a greater amount of food is consumed on day per week, to help keep the metabolism up. If it really is just a matter of output exceeding input, would this kind of habit actually undermine any progress made by restricting and exercising to a deficit the rest of the week?

With thanks,
Ela

RedCairo said...

I have respect for you Stephen and have always enjoyed your blog. But the personal animosity that comes through in many of these posts (for both of you) is really beneath you, or beneath the guy I'd hope you'd be.

Until one of you has the put-it-in-practice answer to save a good chunk of the planet from the horror, misery and grief of obesity and related metabolic disorders, I would think a little bit more conservative and cordial debate would be reasonable.

I have yet to see any answer or theory seem to answer to all of the real world situations for the many hundreds of obese to super obese people I have watched and talked with for years now while working on it myself.

Dr. Jeffrey Friedman said in an interview some years ago that after gastric bypass and much weight lost, many people (metabolic ward subjects) were eating 700 calories a day and their bodies simply would not lose any further weight.

Anomalies like that (which by the way I have seen plenty in real life), and anomalies like why lab animals can starve to death and die leaving plenty of fat when their organs failed, and why some people can intake food and get 'energy' and others get lethargy and more hunger--sometimes even with lowcarb -- until these questions are answered, we do NOT really have an "answer" to anything that directly helps us solve the problem.

We have good indicators from all over. That's all so far.

Also, your reward theory doesn't seem to address the many studies related to how desire for food conforms to what the animal or person needs (and changes when they don't anymore). The topic does relate to the following theory, though:

Maybe the reward theory is valid because people are chronically deficient in micronutrients, and the body by evolution is looking first for 'energy' food to give them the gumption to go hunt up or dig up something, and that energy food is what amounts to sweet/carb, which has profound hormonal effects, in which case you and Gary are both right, and both wrong, since the first driving of the nail in that case would be the chronic malnutrition of micronutrients -- not the drive for reward in the brain, or the effects of macronutrients which may overlap with reward, which follows.

PJ

harpersnotes said...
This comment has been removed by the author.
DH said...

Pay no attention to these politically correct critics on your wall who tell you to be like that and not tell it as it is. These people are afraid of anyone showing the slightest opinion/aggression and as such will remain followers. Despite their seemingly "reasonable" comments, they're actually attacking your morality and I find it offensive. "It is not the critic who counts..the credit belongs to the man who is actually in the arena." I have been following nutrition/evolutionary biology myself for a long time now and I am a former morbidly obese individual who lost weight on Paleo. I believe you have perfectly great reason to say what you have towards Taubes, whose theories are totally out of date (for those who actually follow the evolution of Paleo). He did nutrition a huge wake-up call and he deserves an award for that but now he's becoming dogmatic about his work (as expected, no one wants to find out their career's work was wrong). I totally agree with your reward theory and I am putting it into practice on myself (I've been stuck about 15lbs away from my ideal BW), I will report back to you in a month's time. I am currently a medical student and I believe you're truly onto something magnificent. I hope the results carry through and that you get credit for this innovative thought project in the future. Good luck and God bless.

Sara said...

@ScottW. I was about to say the same thing, but you said it first. Stephan has little to lose if his hypothesis falls over - and in fact, that would just be a natural part of his research, but Taubes loses credibility. I'm not saying that's WHY he is attacking Stephans hypothesis, but it would look less like it if he was taking a less journalistic approach (i.e. needs a firm angle and doesn't suffer ambiguity - probably the way he was taught to write in his journalism degree).

humoshi said...

Stephan writes:
This study demonstrates that in a low-palatability/reward context, refined carbohydrate and sugar can actually allow substantial fat loss, suggesting that they are not inherently fattening, but rather that their ability to cause fat accumulation depends on their palatability/reward value.

The study demonstrates no such thing. In fact, the study demonstrates...nothing really. As Gary points out, the methodology is so flawed by confounding factors and a small sampling size that it is about as useful as knowing my grandmother lost weight on an all meatball diet. It's irrelevant, and shouldn't have been put forth as evidence to begin with.

(and I'm sorry, but 100 flawed studies do not equal a good one. That's about as logical as saying that I should be considered competent in organic chemistry because I failed all the tests...you see, there were a lot and in total they suggested that I kind of sort of had the right idea.)

Stephan writes:
This is probably a central reason why people who get most of their calories from white rice (e.g., large parts of Asia) are typically lean, not obese as one would expect if refined carbohydrate were inherently fattening.

A defective insulin metabolism is vital here. You act as if Gary never discussed metabolic syndrome, its importance in understanding obesity, and the importance of understanding its causes.

humoshi said...

You also forgot to mention that the study by Hashim and Van Itallie cited as "evidence" showed that the weight loss subjects were always ketonuric.

So how does this study support the food reward hypothesis? Showing a can of Nutrament and saying essentially "it looks nasty" doesn't seem to reach the level of serious argument.

I for one used to enjoy drinking protein shakes daily, and I enjoy my diet even though it is very repetitive.

How can we quantify foods as being hyperpalatable?

Stephen said...

The bibliography in GCBC is 66 pages long in small type. The book itself is the result of five years of research, is comprehensive and well argued. It cannot be simply waved off with the back the hand.

Continue your research and when you think you have enough material, publish your findings. I'd love to read a competing hypothesis.

I've followed the advice in GCBC and WWGF and have lost fat and improved my blood profile. For me, the proof is always in the pudding.

Cliff said...

@humoshi
You enjoy protein shakes in the context of a varied diet. If you try to eat nothing but protein shakes eventually you will start to restrict calories in my experience(due to decreased appetite). This works with just about any food except for maybe the really rewarding stuff like fast food but I'm sure if you ate nothing but the same cheeseburgers day in and day out your appetite would probably decrease. This is my experience at least.

@Stephen
Stephan never claimed a low carb diet was bad or didn't have benefits in certain context. Having extensive references doesn't prove the validity of someones hypothesis either.

STG said...

Stephan:
In the future will you try to get funding to set up a clincial trial to test your food reward hypothesis? Would running a trial conflict with your current work schedule or is it possible?

L. Zambezi said...

What are some bland foods, anyway? Baked potato and celery probably qualify, but what about full fat cottage cheese? Plain white toast with butter? Garden salad probably, but what about garden salad with olive oil and vinegar? A post plus rec's from readers might be beneficial.

Alex said...

humoshi is right, and I think the fact that there is no real solid objective definition of palatability borders on intellectual dishonesty. It allows you to pick and choose your studies by their results and then assign them to whichever palatability category fits your theory better. Most people would call milk and soft drinks highly palatable/rewarding but now this Nutriment, which seems to be a mix of them, is not rewarding/palatable?

Is the only thing that is rewarding/palatable a cafeteria diet in the end? A useless conclusion, if so.

bopes said...

Stephan, you wrote: “If we want to test the [food reward] hypothesis, the most direct way is to find experiments in which 1) the nutritional qualities of the experimental diet groups are kept the same or at least very similar, 2) some aspect of diet reward/palatability differs, and 3) changes in body fat/weight are measured (for example, 2, 3, 4, 5, 6, 7, 8, 9).”

None of those references (at least in their abstracts) mention “food reward.”

Reference No. 2 is to a study that looks at “flavor preferences” in baboons.

Reference No. 3 is to a study that looks at effects on rats of foods of equally balanced energy composition but “varying in taste, smell and texture.”

Reference No. 4 looks at effects of the “altering the variety of sensorially distinct foods of equal macronutrient content on food intake and body weight in men.” The test subjects (6 younger “lean” men, 6 older “overweight” men) all lost weight regardless of “variety” levels, except for the lean mean on a “high variety” diet. The study authors accused the “overweight” men of deliberately “constrain[ing] their energy intake relative to expected requirements.”

Reference No. 5 looks at “The effect of flavor variety on diet selection, energy intake, weight gain and fat deposition” in rats.

Reference No. 6 looks at "taste" and "palatability" effects on rats.

Reference No. 7 looks at the effects of monosodium glutamate added to rat food.

Reference Nos. 8 and 9 look at “food texture” effects on rats.

Some questions:

Is “flavor” what you mean by “some aspect” of food reward?

Is “taste” what you mean by “some aspect” of food reward?

Is “smell” what you mean by “some aspect” of food reward?

Is “texture" what you mean by “some aspect” of food reward?

Is “variety” what you mean by “some aspect”?

Is "sensorial distinct-ness" what you mean by "some aspect"?

Is monosodium glutamate “some aspect”?

Thanks.

Stephan Guyenet said...

Hi humoshi,

I'm sorry, but Taubes's interpretation of the Hashim study does not make any sense. These people reduced their calorie intake, according to them, because they weren't hungry. Saying that they weren't hungry because they weren't eating very much, thus they were in ketosis and their appetite dropped, is circular reasoning.

What exactly is this "defective insulin metabolism" that makes people susceptible to gaining fat on white rice? This is an ad hoc hypothesis that Taubes has advanced to try to salvage his ideas, but he has presented no evidence to support it.

This is one of the things that bugs me about the

Hi Stephen,

The section in GCBC on obesity contains very few pertinent references from the obesity literature, and those that it does contain are often grossly misinterpreted. If you need some help understanding how Taubes likes to treat his evidence and sources, see this article:

http://reason.com/archives/2003/03/01/big-fat-fake/singlepage

This line of reasoning "I lost weight on a LC diet, therefore Taubes is right about insulin, food reward, and everything else he says" is really baffling to me. Weight loss on a LC diet is easily explained by the food reward hypothesis, and there is still no evidence to suggest that insulin has anything to do with the mechanism of fat loss on LC.

This is one of the things that bothers me about the carb-insulin-obesity crowd. They will nitpick anything that disagrees with them to death, but when it comes to actually having evidence to support their views, half-baked study interpretations and anecdotes seem just fine.

Hi Alex,

There is a definition of palatability, it's just that it's not exactly the same for everyone. Does that mean it's intellectually dishonest to define the word "culture" because every culture is different? There are certain aspects of palatability and reward that do not vary much between individuals.

Ho bopes,

Not sure if you read my series or not, but flavor, texture and variety are aspects of palatability and reward. These have been shown to influence fat mass, and Taubes seems blissfully unaware of the evidence.

Alex said...

Whether the definition of palatability is different for everyone or not does not change the issue I have with you (or anyone else) determining whether the food used is palatable or not by looking at the results of the study.

If this nutrament stuff is not super-palatable, then what beverage would be?

Marty K said...

That looks like check and mate. Taxi for Taubes.

And for all the little b1tches crying about this debate not being polite/cordial enough, FFS grow up. Blogging is a contact sport and if you are prepared to dish it out then there's no point whining when u get it back. If anything Stephan needs to take off the kid gloves and start sticking in a few well-placed reducers on Taubes, Nikoley and co and let them know that he's the daddy now.

There's a new sheriff in Paleotown...and he's French.

gallier2 said...

Stephan wrote:
Hi humoshi,

I'm sorry, but Taubes's interpretation of the Hashim study does not make any sense. These people reduced their calorie intake, according to them, because they weren't hungry. Saying that they weren't hungry because they weren't eating very much, thus they were in ketosis and their appetite dropped, is circular reasoning.


Wow, just wow. How one can misrepresent what Taubes wrote is just incredible.

Taubes wrote:

Two hundred calories of carbohydrates – 50 grams worth – was low enough to be ketogenic. “Ketonuria was always present,” Hashim and Van Itallie write, “ and the blood ketone levels on several occasions was 15 mg. per 100 ml.” This means insulin levels on the diet were extremely low, despite the 50 percent carbs.


He cited the original researcher who noticed the ketosis, he didn't deduce it.

I think you should apply to Penn State or to University of East Anglia, this kind of scientist are appreciated there.

Stephan Guyenet said...

Hi gallier2,

You misunderstood my comment. I wasn't claiming he deduced that they were in ketosis. Regardless of whether ketosis was measured or not, Taubes's argument is circular, because their very low calorie intake was the only reason they were in ketosis. What explains their low calorie intake to begin with, before ketosis and before their insulin (supposedly) dropped?

gallier2 said...

So, if I correctly interpret what you mean, is that the ketosis could not have been kickstarted because, at the moment the subject started the study, they were still on a high whatever diet and only the blandness or low-reward (or bad taste or whatever) was able to create the initial deficit that allowed the "setpoint" to be lowered.

Thomas said...

Hi Gallier2,

Ask yourself-can a person gain fat weight while in ketosis? Can a person lose fat weight with high basal insulin?

It is not hard to see Taubes circular reasoning here.

bopes said...

So: under the food reward theory, the closer one gets in one's diet to tasteless, odorless, flavorless, texture-less, and variety-less, the greater the likelihood one will eat less and lose weight (and/or avoid obesity)?

And this has something to do with the "setpoint" or "whatever you want to call it"? And so, we should all just eat the equivalent of pureed cardboard and/or Nutrament?

OK, since I can call it whatever I want, when and if I ever reach that point (maybe when I am toothless and bedridden in a nursing home?) I will call it the "just shoot me" point or the "do not resuscitate" point.

Thomas said...

"And this has something to do with the "setpoint" or "whatever you want to call it"? And so, we should all just eat the equivalent of pureed cardboard and/or Nutrament?"

It's not about what you are supposed to do, it's about what is.

You can lose fat weight eating highly palatable foods, you just have to be highly aware of your consumption-something nobody seems to want to do (ie. count calories or points or whatever). You may also have to suffer some hunger-another thing nobody seems to want to do. It's really your choice. None of these things (calorie counting and hunger) will kill you, but it is difficult.

bopes said...

So food reward and setpoints is just a fancy way to say "eat less, exercise more"?

What's to prove then? Just say it. Obesity is a failure of the will. Hyper-rewarding and hyper-palatable foods can't "make" anyone do anything, least of all eat them. People who are obese must choose to be so.

Sorry, all you lazy-assed fatties out there. You failed because you are weak-willed and incapable of self-restraint. But never fear, the food reward theory is here to save you with this fortified liquid wood pulp. Suck it up.

Marty K said...

No, YOU suck it up Bopes. If you want to believe the magical insulin fairy is whats making you fat and you want a nice easy miracle cure that will allow you to stuff your face with delicious Primal recipes all day long while the fat effortlessly melts away, then go and find a guru who will oblige you.

Or do you want the truth? Do you? Do you want the truth Bopes??

You can't handle the truth!

The truth hurts, Bopes, and some day everyone has to find out the insulin fairy doesn't exist. Its just something Paleo mummies and daddies tell their kids to stop them following CW.

Marty K said...

Stephan isn't telling people to suck up cardboard juice. He's simply responding to Taubes dissin' him at the AHS. Any blogger with any sort of self respect can't leave that sh1t lie without returning fire, and eye for an eye. But it seems Taubes got a little bit more than he bargained for, thats for sure. He tossed a live grenade at Stephan during his talk and thought SG wouldn't respond?? Come on mate, he had to expect a response. Unfortunately for him the French has fired back with a volley of grenades of his own - nuclear grenades.

BOOM!!!

humoshi said...

Stephan said...

I'm sorry, but Taubes's interpretation of the Hashim study does not make any sense. These people reduced their calorie intake, according to them, because they weren't hungry. Saying that they weren't hungry because they weren't eating very much, thus they were in ketosis and their appetite dropped, is circular reasoning.

I just can't locate where Taubes said anything this.

All we know is that the patient wasn't eating very much. I can't get access to the paper, but I will try when I stop by my university library later.

The authors cite possible reasons:
Whether the inhibition of food intake exhibited by obese patients represents a physiologic effect of massive stores of fat, or whether it results from psychologic factors relating to guilt about the obesity, fear of the feeding device, inability to adjust to the formula, or some other cause, is unknown. The fact that such a striking difference does seem to be present merits further investigation.

Gary then states another: maybe a patient who volunteers for a weight study is motivated to lose weight and will try to to eat less.

You state yet another: maybe the palatability of the food was so low that it changed his neurobiological set point.

All we can say is that we don't know, which is why this study is so weak and cannot be used to support any position.

And the defective insulin metabolism is metabolic syndrome, Reaves' Syndrome X, or some variant of it.

I read the blog relatively recently where you try to discredit insulin's role in obesity, but imho hyperlipid thoroughly rebutted your arguments.

And to continue being a Taubes apologist (not my day job), the Reason article you proffer to malign Taubes' journalistic ethic was also thoroughly responded to by...Taubes. You can read the emails Gary sent to Farquhar and its clear that there was no misrepresentation of what he said.

Btw. Despite my disagreements, I do enjoy your blog and appreciate the time you put into it.

bopes said...

Insulin fairies? Gurus? Mummies? Oh my!

Actually I'm just trying to understand the food reward theory.

Seems complicated.

Marty K said...

@Bopes

It's not rocket science, mate. Here's the basic jist:

http://www.bbc.co.uk/news/world-africa-15876968

Marty K said...

Sorry, wrong link. Here it is now:

http://wholehealthsource.blogspot.com/2011/10/case-for-food-reward-hypothesis-of.html

bopes said...

Marty, from your link:

"Manipulation of reward and hedonic circuits in the brain (e.g., by lesion, drugs or genetic manipulation) should impact food intake and body fatness."

Is it a goal of food reward researchers to develop a drug, gene or surgical therapy to treat obesity?

Sven-Are Bjerke said...

Hi Stephan

Somewhere in the post you mention that certain people ramps up energy expenditure in response to increased food intake, and i wonder. Has there been done some experiments to determine variations in energy expenditure in response to food intake? And secondly, what governs this ability? Thank you.

Alex said...

Yeah if you read that reason article be sure to see the thorough refutation by taubes linked at the bottom as well.

Rob said...

@Sven-Are Bjerke,

Here's a study that overfed participants 1000 cals a day and NEAT ranged from -98 cals to +692.

http://www.uoguelph.ca/hhns/grad/courses/HBNS6710/HBNS6710W04Levine.pdf

Dan said...

It's amusing to me that a supporter of the Food Reward Hypothesis would accuse another person of circular reasoning. The Food Reward Hypothesis is little but circular reasoning.

Oh, they didn't eat very much? Oh, well, it must be because the food wasn't rewarding!

So is Food Reward about "palatability" and all these evil processed hyperpalatable foods, or is it about eating a boring diet?

Stephan, would you admit that, if I lost weight on a candy bar diet because I got bored of it, that that would support your Food Reward Hypothesis, but undermine your dogmatic BS about "hyperpalatability"?

LNFAW said...

http://lnfaw.blogspot.com/2011/11/blog-post_1301.html

Thomas said...

"Stephan, would you admit that, if I lost weight on a candy bar diet because I got bored of it, that that would support your Food Reward Hypothesis, but undermine your dogmatic BS about "hyperpalatability"?"

@Dan-I don't think you get it.

Stephan Guyenet said...

Hi Folks,

Just a reminder that you are free to disagree, but I won't tolerate gratuitously insulting comments.

Hi gallier2,

Yes, the most plausible explanation for the reduced calorie intake is the low palatability/reward value of the diet. This is the same thing you see in rodent studies when obese rodents are switched back to a less palatable diet.

Hi bopes,

I'm glad you brought this up, because it highlights one of the main two misconceptions about my writing that I see around the net, which is that I'm just saying "eat less, move more", or stating that obesity is a moral failure. I'm not sure where these ideas came from exactly, but that's not at all what I'm saying. What I'm saying is that food reward influences the circuits that regulate food intake on an unconscious level. How that is construed as "eat less, move more" or "gluttony and sloth" concepts of obesity, escapes me.

Regarding drugs to treat obesity, there are already two obesity drugs developed that target reward pathways: Rimonabant and Contrave. Both cause fat loss in controlled trials but have not been FDA approved due to side effects.

Hi humoshi,

If the paper were published in a vacuum, I would agree that it doesn't suggest much because it's not controlled for other factors. However, when considered in the context of the literature as a whole, the most likely explanation is the reward/palatability change. I certainly wouldn't have interpreted the paper how I did without the context of the rest of the literature.

The point of citing the Reason article is to show that Taubes is simply not a credible source of information on obesity. When you're butting heads with practically every expert in a field you don't know very well and have no scientific background in, it should make you think twice. Taubes did a good job of legitimizing low-carb, which I think has had some positive aspects, but most of his other ideas on obesity fall apart under the most casual examination of the literature. I learned this the hard way, because I used to buy into his ideas before I knew much about obesity research.

Hi Dan,

The food reward hypothesis is not circular, I addressed that in a previous post, but maybe if people keep saying it, it will become true.

Sourpusscandy said...

Here's a good documentary on obesity, food, and why some get fat and some don't. (studying people who can't gain)

http://topdocumentaryfilms.com/why-are-thin-people-not-fat/

john said...

Why are there so many idiotic angry commenters? On one hand we have people going on Taubes' blog to "yell" about how calories matter; on the other we have people coming here and cursing the idea of "move more and eat less." I feel like these people are reading half a sentence, guessing/imagining the rest of the idea, then arguing with the part of the idea they imagined.

Princess Dieter said...

~~~To Gary and Stephan : Why don’t you guys sit around a table for let’s say one week and try to come to consensus. I’m sure the outcome (especially when approved by CarbSane :-) ) will be of invaluable value. Working together will appear to be less frustrating for the both of you and the effectiveness will be much more satisfactory. ~~~

I would pay darn tootin' good money to watch the streaming video of a debate (include the Jaminets for a lovely tri-partate go-at-em) with Evelyn-CarbSane moderating and calling shenanigans when the logic/science is bogus. OMG, yes!

And thank you for this post. It's really good stuff and I will be rereading and chasing down the links. For someone like me, who is trying to read and learn and NOT get obese again and figure this obesity thing out for lifelong weight loss maintenance, this is a gem. THANK YOU!!!!!!!!!!!!

Deirdre said...

Well done, Stephan. You're a class act - on top of everything else.

gallier2 said...


Hi gallier2,

Yes, the most plausible explanation for the reduced calorie intake is the low palatability/reward value of the diet. This is the same thing you see in rodent studies when obese rodents are switched back to a less palatable diet.


I disagree strongly that the FR is the most plausible, in fact on that specific study (afaict as I can only see what you and Gary have published of it) even if the guys had eaten strawberry cake with the same macronutrient profile, they would have lost.
As for the kickstarting of the weight loss, it is not was is the problem on any diet or change of regimen. Where the difference is made is on the hunger/appetite and cravings after a certain time. Anyone who had ever weight problems can attest to that.

However, when considered in the context of the literature as a whole, [...]

Now you sound like Colin T. Campbell. In the light of any context, a crap study is a crap study.

nothing91 said...

"I appreciate the rebuttal to Taubes but am disappointed in the tone. (just as I was very disappointed by Taubes tone at AHS). "someone should tell him" and "doesn't sell" aren't the kind of rhetoric I come to this blog for."

Concur. Stephan used to be the classiest, most respectful nutrition blogger out there. It's amazing how quickly things can change.

So far there are two well-known bloggers who have critiqued Stephan's hypothesis: Taubes and Peter @ Hyperlipid. They have both done so in a respectful, mature fashion. Rather than return the favor, Stephan has taken the exact same approach with both of them: accuse them of not playing fair, and refuse to discuss the matter with them.

This isn't how mature adults handle criticism.

Thomas said...

"So far there are two well-known bloggers who have critiqued Stephan's hypothesis: Taubes and Peter @ Hyperlipid. They have both done so in a respectful, mature fashion. Rather than return the favor, Stephan has taken the exact same approach with both of them: accuse them of not playing fair, and refuse to discuss the matter with them."

Is this some kind of joke? The bias is deafening.

The "tone" argument always comes out when people get offended. The problem here is that Stephen's tone is totally appropriate and mature in this case. Read some Anthony Colpo if you want some edgy tone.

In fact, I think Stephen could stand to be a little edgier if he wanted. His responses to some of the goofy comments are pretty restrained.

rolikman said...

Stephan wrote " I have to hand it to him, it takes some cojones to critique an entire field of research, particularly when you have no scientific background in it."

Putting aside the fact it's argument from authority, I fully agree with Stephan about Taubes' cojones. What Taubes has done is especially valuable given that this "entire field of research" has given us the obesity epidemic.

Kris said...

I for one have to agree with Stephan here, even though I wasn't quite settled on the whole insulin vs. food reward thing before.

And I'm surprised to see so many angry and rude comments from the low-carb community.

Low-carb works, for one reason or another, nothing Stephan has said has changed that. It is pretty much a fact and supported by many studies.

But the mechanism by which it causes weight loss may not be what we previously thought it to be.

Apparently, eating bland and unpalatable food causes weight loss too (not surprising, really). And I believe Stephan has made extensive arguments to prove his point.

Now we didn't really think that low-carb was the ONLY way to lose weight?

The low-carbers with the angry and idiotic comments are becoming just like the conventional wisdom folks were when low-carb was gaining ground.

Science evolves, that's just how it is and what we take as a fact today may not hold true tomorrow.

I'm pretty sure a lot of "smart guys" got really angry and defensive when someone told them that the earth wasn't really flat.

Thomas said...

@rolikman,

How has "this entire field of research" given us the obesity epidemic? Are you talking in terms of definition and diagnosis?

I get the "argument from authority" angst but really, aligning your arguments with the majority of research is hardly that. Also, remember, Taubes basically calls the obesity researchers that don't buy into his null hypothesis idiots. Unfortunately his argument from "non-authority" is one not based in good research and dare I say one that takes advantage of the possible emotional weaknesses of those who are overweight and obese.

Adam Smith said...

"Low-carb works, for one reason or another, nothing Stephan has said has changed that. It is pretty much a fact and supported by many studies.

But the mechanism by which it causes weight loss may not be what we previously thought it to be."

This x 1,000

I eat low-carb. It helped me lose weight and keep it off. I advocate on its behalf.

That doesn't mean that Taubes theory isn't full o' crap.

Low-carb works for me because it allows me to spontaneously and sustainably reduce my caloric intake, not because of the effects it has on insulin. I used to think this wasn't the case, but then I took an honest weekend of looking at old food logs and new food logs and realized that I'd cut about 1,000 cals/day from my diet when I had previously thought I was eating just as much.

Stephan's not forcing any of you to eat potatoes, he's just hilghting the fact that the mechanisms put forth by the Taubes's of the world is not supported by the evidence.

The key to wieght loss isn't "eat less, move more," it's "eat less and move more without being hungry and exhausted." Some people do this with low carb, some don't.

rolikman said...

@Thomas
I don't really care what Taubes calls these obesity researchers as long as he's doing a great job exposing their worthless theories on obesity. What I care about is that the eat-less-excercise-more advice, combined with anti SF propaganda, caused more harm than good.

To be honest I see the FR theory as the refreshed version of CICO paradigm. That's what it boils down to after all is said and done. It never ceases to amaze me how someone can miss this obvious fact.

bentleyj74 said...

"I have to hand it to him, it takes some cojones to critique an entire field of research, particularly when you have no scientific background in it."


It's easy to be confident when you are ignorant with regard to just how far out of your depth you have drifted. Especially when there is no personal accountability. It's a bad place to be. I don't envy him.

Adam Smith said...

Taubes doesn't even agree with Taubes anymore.

Remember when he wrote two books saying that eating cabs made you insulin resistant because of all the post-prandial insulin spikes?

Well, that's wholly factually inaccurate, and once Taubes caught wind of it about 30 years after obesity researchers did, he now says that fructose consumption, not pure carb consumption, causes insulin resistance.

Which is funny, because fructose doesn't even cause a post-prandial insulin response.

People continue to quote him like he's some sort of faultless authority, but he had to totally revise the cornerstone part of his theory on "why we get fat" about a year after he wrote his book of the same name.

Thankfully, he's now writing a book on sugar.

It honestly baffles me that people can look at Taubes as an authority on how people become obese, when he immediately discarded his proposed "Step One" of that process when people with actual knowledge of the subject set him straight.

I work as an attorney, one of the first things you learn is that lots of citations and excellent writing don't make someone correct. You have to actually dig into the source material.

allison said...

A recent interview with Taubes, where he seems to be moderating his dogmatic view of carbohydrates. He goes so far as to use the term "good carbs."

http://media.crossfit.com/cf-video/CrossFitJournal_TaubesBuddingInterview_PRE.wmv

Frank said...

@rolikman

That's funny because, from my point of view, LC also boils down to CICO. Why wouldn't? There can be no weight loss nor weight gain if it's not about CICO.

I believe we pretty much all once bought into the insulin hypothesis has put forward by Taubes. I for sure did. But if you keep the right attitude, if you always know that it's never the end-all answer, if you keep an open mind, keep growing, evolving, and be ready to accept that something that you believed in was wrong, someday you will also accept the idea that LC simply spontaneously reduce calorie intake and so it comes down to CICO.

I mean, do people really believe that everyone thinking that CICO is right are idiots? Do you really believe that none of us can read the evidence, weight them, and come to our own conclusion?

We all have read GCBC, Peter's blog, etc etc, and well, their arguments are weaks and not supported by the vast majority of the scientific evidence out there.

Do you guys really believe that even if Gary at some point realise he was wrong he would come out of the closet? His whole writting carrier is based on his hypothesis. He will die defending it, even if he's fully aware that it's not right. Ditto could be said for guy like Peter who has been blogging on that all along, althought in the blogosphere a turn around is always possible.

The tenacity of holding to the LC-insulin hypothesis in the face of so many contradictory evidences just shows how fanatics one can become about some ideology (as if we needed more example of that...)

FrankG said...

But Adam Smith... none of what you say explains WHY a low-carb diet allowed you to "spontaneously and sustainably reduce [your] caloric intake".

Gary Taubes might say it is because you have lowered your insulin levels with the result that you are not partitioning so much of your food directly to fat stores. In this way you are less hungry because your body has free access to the energy it needs -- unhindered by high insulin levels.

Stephan Guyenet might say it is because the low-carb diet has low-reward and/or low-palatability which spontaneously affected your brain's set-point for fat storage. So you feel less need to eat.

Maybe both of them are right... maybe neither. As Kris said above "Science evolves"... I'd add that in my view: science is more about the questions than the answers -- if it had all the answers it would stop.

My own experience as Type 2 Diabetic injecting insulin is that: I was initially using around 130 units a day of insulin to manage high Blood Glcuose, and in doing so I gained over 100lbs excess fat mass in just 12 months. After reading GC,BC I drastically cut back on carbohydrates -- especially sugars and refined starches -- not only did the constant gnawing hunger go away within a day or so but my need for injected insulin halved and then quickly, over the next few weeks and months dropped right off (as I lost excess fat mass) to where I now only use around 6 (six) units of injected insulin per day (down from 130 units). I have all this charted and logged in Excel. And YES doubtless I was eating fewer calories... I can't be certain because I no longer need to count calories nor carbs for that matter.

Over three years later and I have maintained my weight loss, my excellent Blood Glucose control and all other health markers are excellent. ALL without the feelings of hunger or deprivation as I have experienced on many, many calorie-restricted diets over the previous 25+ years -- but then perhaps I suffer with one of Thomas's "possible emotional weaknesses of those who are overweight and obese."

So I have direct personal experience of how my insulin levels are affected by my choice of what I eat and how that affects my fat mass, hunger, Blood Glucose etc...

Perhaps I am biased but I have yet to see any evidence that a low-reward and/or low-palatability diet that was NOT also low-carb could have the same effect.

Alex said...

Stephan, are you going to respond to my question about defining a food's reward by the results of the study?

Don't you see how this is what leads to the arguments about circular reasoning?

In this post http://wholehealthsource.blogspot.com/2011/10/case-for-food-reward-hypothesis-of_07.html

you state

In the research setting, food reward is measured by the ability of food or food-related stimuli to reinforce or motivate behavior (e.g., 1). In humans, palatability is measured by having a person taste a food and rate its pleasantness in a standardized, quantifiable manner

So, where are these studies showing that nutrament and the other foods used in your linked studies have low reward/palatability values?

You link studies like http://www.ncbi.nlm.nih.gov/pubmed/8937617

which is completely circular in its usage of the word palatable (if it were defined as you're stating). How do they determine that 0.27% is the most palatable amount of oregano other than by a study that is essentially the same?

rolikman said...

@Frank

Ok, but now please apply the same line of thinking you propose to all this low fat, CICO establishment and infrastructure that has now come into existence. Loads of people, reserachers, physicians, politicians have made their careers, earned their degrees and credentials, regularly recieve research funding, literally lives off the paradigm that Taubes has shown to be scientifically wrong. Do you think they will not die defending their position? Who has more to loose? Who has more resources, more intrumnents who stands a better chance of prevailing, at least in the public eye?

Having said that, I do not think this is the best way of discussing these issues.

Adam Smith said...

"But Adam Smith... none of what you say explains WHY a low-carb diet allowed you to "spontaneously and sustainably reduce [your] caloric intake"."

This thought occurred to me, so I spent several weeks on a very low fat, bland diet after reading Stephan's posts here.

I basically ate plain meat and plain, boiled potatoes.

I lost five pounds (From 150) and became noticeably leaner. I ate less and wasn't very hungry.

I, of course, did not continue with the diet, as it was unpleasant and I didn't need to lose five pounds. The experience did motivate me to be more liberal with starches, however.

I find that I definitely have "trigger foods" that cause overeating, and all of those trigger foods have carbs in them, so cutting carbs keeps me from overeating. However, not ALL carbs are trigger foods.

I can eat potatoes and rice as much as I want and my intake and weight are stable. Bread or pasta? Not so much.

If only some carbs make me raise my caloric intake, then how can it be insulin? Reward seems far more likely.

Also, as an aside, I do not feel that the experiences of a diabetic are particularly relevant to me, though obviously they should be of paramount relevance to you. I am not diabetic.

FrankG said...

Adam Smith said... "If only some carbs make me raise my caloric intake, then how can it be insulin? Reward seems far more likely."

Not all carbs are equal. To take an extreme example: I could ingest 100g or carbs from a can of cola or 100g of carbs from a very large plate of broccoli. One advantage of being a diabetic is that I regularly check my Blood Glucose (BG) so I know how different foods affect my BG and by inference (plus experience) how much insulin is required (endogenous and/or exogenous) to manage that BG back to the normal range. Suffice to say that in the above example the broccoli would cause significantly less of a BG spike and would require significantly less insulin to control.

This might help to explain why you are better able to tolerate real whole foods such as potatoes and rice as compared to processed/refined starches such as bread and pasta... not all carbs are treated the same in the body and I have never read Gary Taubes as indicting ALL carbs.

I also assume that your test of a very low fat, bland diet of plain meat and plain, boiled potatoes was AFTER you had already lost excess fat mass and stabilised your metabolism by eating a low-carb diet? If so, this is also alternately explained by a reduction in Insulin Resistance and increased tolerance for carbohydrates seen commonly as we lose excess fat mass.

I think it is shortsighted to dismiss the peripheral effects of insulin.

Alex said...

Some more issues with this post I've found after more review. You provide a good method for testing your hypothesis

If we want to test the hypothesis, the most direct way is to find experiments in which 1) the nutritional qualities of the experimental diet groups are kept the same or at least very similar, 2) some aspect of diet reward/palatability differs, and 3) changes in body fat/weight are measured

Then proceed to provide a few studies, but some of them do not seem to show 3). Now, I can only see the abstracts for most of them so I might be missing something, in which case please enlighten me.

(2) and (3) seem ok to me

(4) http://www.ncbi.nlm.nih.gov/pubmed/11303491 - This study is conflicting at best. The medium variety diet produced MORE energy intake and more weight loss than the low variety diet. But the high variety one caused more intake and less weight loss than the medium.

(5) http://www.ncbi.nlm.nih.gov/pubmed/4056941 - This one concludes that flavour is of minor importance compared to fat content!

(6) this one seems good to me, and supports your statements.

(7) http://www.ncbi.nlm.nih.gov/pubmed/15925301 - MSG makes things more palatable, unless there is fiber already there? It's confusing, but there is support for FR there :)

(8) http://www.ncbi.nlm.nih.gov/pubmed/11171658 - This one would seem to cast a lot of other research in a bad light, the palatability situation completely reversed after 3 weeks!


(9) http://www.ncbi.nlm.nih.gov/pubmed/8764282 - This study shows NO increased intake with the higher palatability. Or maybe that means it wasn't more palatable? I can't tell.

bentleyj74 said...

@ rolikman

"Ok, but now please apply the same line of thinking you propose to all this low fat, CICO establishment and infrastructure that has now come into existence. Loads of people, reserachers, physicians, politicians have made their careers, earned their degrees and credentials, regularly recieve research funding, literally lives off the paradigm that Taubes has shown to be scientifically wrong."

I'm not sure what that even means. His hypothesis is falsifiable. He himself can't defend it and has moved on to fructose which does NOT cause an insulin spike.

There's no doubt that people with a vested interest have capitalized on a marketing opportunity [using reward theory to their advantage I might add] but they put their own personal rinse on it.

Somehow using CICO as a platform EAT MORE healthy whole grains, EAT MORE fruit, EAT MORE vegetables, EAT for health, EAT MORE small meals to boost your metabolism, EAT MORE healthy snacks, it's low fat so you can EAT MORE, we've pounded spinach powder into the potato chips so they are HEALTHY now...you should EAT MORE of them.

On the other end of the spectrum there are fast food sandwiches whose calorie counts exceed what I need in an entire DAY.

How is the fact that there are corporate entities who profit from pulling every punch they can think of to keep people eating whether they need to or not an educated commentary on the accuracy or relevance of the research?

bopes said...

@Adam Smith,

you wrote: "[Taubes] now says that fructose consumption, not pure carb consumption, causes insulin resistance.

Which is funny, because fructose doesn't even cause a post-prandial insulin response."

Does that mean fructose doesn't cause insulin resistance?

Here is a 2002 review (IDK if there are other more recent ones) that suggests otherwise:

http://www.ajcn.org/content/76/5/911/T2.expansion.html

From the review:

"The effects of dietary fructose on insulin action in humans are not as well documented. In 1980, Beck-Nielsen et al (94) investigated whether the reduction in insulin sensitivity induced by sucrose consumption is related to the glucose or fructose components of the diet. They found that 7 d of high-glucose feeding induced no significant changes in insulin sensitivity, whereas high-fructose feeding was accompanied by both reductions in insulin binding and insulin sensitivity. Other investigators found that diets containing 15% of energy as fructose produced undesirable changes in glucose metabolism in both normal and hyperinsulinemic men."

The Beck-Nielsen study they reference is here:

http://www.ajcn.org/content/33/2/273.abstract?ijkey=d389122114e78bea4ac20feca8bc630046c32e3b&keytype2=tf_ipsecsha.

Alex said...

Why is a willingness to admit mistake and modify your hypothesis seen as weakness?

Adam Smith said...

"Does that mean fructose doesn't cause insulin resistance?"

No, it does not. In fact, I think it's a much more compelling argument.

The point is that Taubes "took on the establishment" with the idea that carbs per se cause insulin resistance and then, lo and behold, he immediately had to change course when he realized that researchers had debunked that notion years ago.

He gets some credit for changing his position when he was obviously wrong, but he gets no credit for writing two books on a completely false premise.

"Why We Get Fat" is almost painfully ironic now. If he releases a new addition, it should have one page with one line of text on it:

"Not the way I said before."

And that ignores the other fact that Taubes's linkage from insulin resistance to hyperphagia to obesity is tenuous at best and flat out wrong at worst.

The fructose kerfuffle shows just how much Taubes is flying by the seat of his pants on this topic. It's like watching someone live out a compressed version of all modern obesity research.

Also, if you understand anything at all about leptin, Taubes's discussion of why CICO doesn't work and insulin must be to blame is sort of stupefying. He must not have read that far yet.

FrankG said...

bentleyj74 said... "How is the fact that there are corporate entities who profit from pulling every punch they can think of to keep people eating whether they need to or not an educated commentary on the accuracy or relevance of the research?"

Is it just corporate entities? Have you ever received weight-loss or other eating advice from a Medical Doctor, Dietitian or other health expert... who supposedly is basing their advice on the very best research available?

If as Stephan Guyenet suggests above, the researchers have been on the right trail all along (a point made against Gary Taubes) then why has that advice not been coming down from the lofty ivory towers of academia? The stock advice from health care professionals is just as you say "low fat, avoid saturated animal fats, plenty of healthy whole grains, eat less, exercise more etc... etc..."

What is the relevance of research that does not appear to be having a practical impact on our current epidemic of so-called diseases of Western civilisation?

bentleyj74 said...

"Is it just corporate entities? Have you ever received weight-loss or other eating advice from a Medical Doctor, Dietitian or other health expert... who supposedly is basing their advice on the very best research available?"

No, but that's probably because I'm 5'4 and 110.


"What is the relevance of research that does not appear to be having a practical impact on our current epidemic of so-called diseases of Western civilisation?"

I have an opinion on that which really and truly is JUST my opinion. I don't know if it's relevant or welcome here but with Stephans permission I'll dish.

Aeris said...

@Justin

"It seems to me that the next logical step, study-wise, would be to determine the effect of an individual's ability to taste on fat accumulation. That is, take super tasters and whatever the opposite is, and feed them the same foods."

http://www.sciencedaily.com/releases/2010/03/100310164011.htm

"Interestingly, we also found that those with a high sensitivity to the taste of fat consumed less fatty foods and had lower BMIs than those with lower sensitivity," Dr Keast said.

"With fats being easily accessible and commonly consumed in diets today, this suggests that our taste system may become desensitised to the taste of fat over time, leaving some people more susceptible to overeating fatty foods."

I thought this may be interesting...

Obese and Overweight people show a decreased sensitivity to the taste of fat.

I'd love to hear Stephan's or Seth Roberts' thoughts on this.

Thomas said...

@rolikman,

I think you may be equating CICO with "eat less, exercise more". They are not necessarily the same thing. CICO is fact of thermodynamics-if you eat more than you expend, you store what you don't use. This is not even refutable.

"Eat less, exercise more" is a method of influencing CICO. Some may just choose to eat less. Some may just choose to exercise more. Some may choose to do both. Some think they can eat way more of a certain macro (usually fat) and still lose weight-in which case they're CO is still over their CI (yes, it still applies-it has to!!)

Disdain for "eat less, exercise more" (I get it) should not create disdain for CICO. This is where people fall off the edge of reality.

Alex said...

Thomas, just because it's not refutable (when formulated in such a way, which you haven't done), doesn't mean it's interesting or useful in any way.

FrankG said...

I'm confused by the comments that have Taubes making an about-face on carbs and is now indicting only fructose? Does anyone have a source for this as I am clearly reading in all the wrong places?

As above: I have never read Gary Taubes as indicting ALL carbs, nor even insulin per se for that matter -- both are factors in a healthy metabolism. It is only when insulin is seen in the abnormal and frequent levels resulting from a diet high in sugars are refined starches that metabolic damage can start to occur. Reportedly the Kitavans do NOT eat such a diet.

Meantime the obesity researcher Robert Lustig MD -- who brought at least, my attention to fructose -- is now quite clear about the role he sees insulin playing in obesity. Interestingly he also seems to have an understanding of letpin's role in this as well...

http://www.youtube.com/watch?v=m8dWNbEscOw

allison said...

The fructose kerfuffle is much ado about nothing. Humans eat fruit. If evolution means anything, the fact that our hominid ancestors spent about 50 million years living in trees and eating fruit must count for something.

One source notes that large swaths of humanity have consumed an average of 16-20 grams of fructose per day for thousands of years. Americans consume an average of 85-100 grams of fructose per day, mostly in the form of HFCS. Moderate quantities of fructose --from fuit!--improve glucose tolerance and have no discernible effect on TGs.

Taubes confuses fruit with fructose. Eating fruit is a normal part of the human diet. Drinking 100 grams per day of fructose from soda pop is not.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC552336/

Frank said...

@rolikman

Well, this is why you must get very familiar with the scientific method and especially with critical thinking skills. Biases are everywhere, and it's up to you to have the capacity to recognize a logical fallacy when there is one.

I apply my objective thinking to everything I read. I don't hold onto any opinion. I go with the WHOLE available evidences, knowing that my time, experience and capacity to know everything is vastly limited. But I learn a little everyday.

But there are way enough material already available on the internet if you want to look at it with a fresh eye to see why Taubes hypothesis failed on many account to reveal true.

So first, make sure you know the science, then make sure you know how to critically appraise it, read the raw data, and not the interpretation of someone of it, and then come to your own conclusion, knowing that tomorrow it might change in light of new informations.

That's my line of thinking, which I applied both to CICO and to the LC-insulin hypothesis.

I'm curious. Why don't people want to ear that willpower has something to do with it? Yes, there for sure is genetic, epigenetic, metabolic, neurologic disorder that are influencing CICO, but in most case these can be overcome by someone who truely want it. Is it because it always has to be somebody's fault? It is because it always take an easy and lazy way of doing things?

I'm not sure why ppl are so reluctant to be told that they must apply some discipline and willpower in their weight loss journey.

Thomas said...

@Alex

"Thomas, just because it's not refutable (when formulated in such a way, which you haven't done), doesn't mean it's interesting or useful in any way."

I'm not sure what you mean here?

rolikman said...

@Frank wrote:
"I'm not sure why ppl are so reluctant to be told that they must apply some discipline and willpower in their weight loss journey."

Now you sound like a preacher rather than researcher, echoeing the reverend Sylvester Graham.

I guess being a European I do not buy into that moral aspect of obesity, which, in my view, is rooted in the puritan tradition so pervasive in American scholarship. Similar arguments (obesity as a result of self-indulganece)were used by Jean Mayer in the 60ies.

FrankG said...

@Thomas...
Based upon our current understanding of the universe, the First Law of Thermodynamics is a physical law -- no-one is disputing that... least of all Gary Taubes (according to his biography on Wiki he studied applied physics at Harvard University) but what practical applications does that have to obesity?

The First Law applies to energy conservation in a closed system and free-range humans are NOT a closed system... we can only make them so by placing them in a metabolic ward where everything in and out is measured. I don't live in a metabolic ward.

There are a great many more variables in this equation than how much energy/calories we put in our mouths, and how many the machine at the gym says we have burned. Many of these variables -- such as Basal Metabolic Rate -- are outside our control. So stating and restating this physical law is as usefull/meaningless to this dialogue as restating Newton’s laws of motion... after all they inarguably apply to moving food into the mouth, or climbing onto an elliptical trainer.

Perhaps you misunderstand when a proponent of low-carb says "eat freely of natural fats" as meaning "stuff yourself silly at every opportunity!" instead of the more moderate "eat until you are satisfied". This is why it works for me and so many others... there is no need to leave the table hungry. Have you ever experienced a calorie-restricted diet.. not just for a day or two but week in and week out?

It's interesting that despite my 28+ years with excess fat mass (25 of struggle followed by 3+ of success) Adam Smith (and I assume others) is willing to wave aside my experience because I now have Diabetes... meantime it seems that lean, young folks are somehow experts on obesity??


Frank asked...

"I'm curious. Why don't people want to [hear] that willpower has something to do with it?"

I am not here looking for excuses but if you want people to take full responsibility for their choices then they need to be aware of all the facts beforehand. I'm here in an effort to find those facts.

Neither Gary Taubes nor (so far as I read) does Stephan Guyenet blame the individual for eating too much, or moving too little and lacking "willpower" -- whatever the heck that is -- in both hypotheses I see a presentation of a biochemical rationale for overeating rather than a behavioural one... physiological rather than psychological.

As above: I have struggled with significant excess fat mass for 25 years. Three years ago (having read GC,BC) I cut back on refined carbohydrates. I have lost and maintained significant fat mass, without hunger. It was almost too easy by comparison with the years of intense exercise and starving I'd endured previously for little if any reward.

Whether you think my change in diet (what I eat) resulted in this success due to reducing insulin or reducing reward/palatability, do you really think that it worked by finally giving me the long elusive "willpower" that I'd lacked for the previous 25 years?

bentleyj74 said...

@ rolikman

I agree that turning food into a moral issue is a BIG part of the problem. I saw a woman in the store [quite overweight btw] with her spouse and two small children visibly upset over making a decision about what brand of snack crackers to buy.

She was angry, frustrated, and not too many miles away from tears from the looks of things. Her H wanted the "ordinary" crackers [he wasn't obviously overweight btw and if he was being honest he'd probably say that what he wanted more than crackers was a wife who wasn't orthorexic] because they "taste better". She wanted the whole grain ones because they are "healthier".

People are confused and filled with anxiety and constantly being tugged between being "right" or being "happy". That's the paradigm that's been set up to make them vulnerable to the next wave of production. First you buy your sins, then you buy your redemption. That works out just smashingly for everyone who profits from you putting food of any kind into your mouth.

Low fat and whole grain [nutritionism aside] is just another way to eat at high volume for fewer calories. Then when they can't white knuckle it anymore people eat "real" versions of the food they like ALSO still at high volume.

cwaiand said...

frankg;

it worked by cutting your calories.you cut a complete macro group,you think that might have something to do with your calorie reduction?duh.now it may work to reduce your appetite which is all good but it sure as shit had nothing to do with reduced insulin or leptin.that,s the problem with taube,s ,he spreads disinformation..

end of the day you lost weight(fat)because you reduced your calories.whether it be weight watchers, paleo ,low carb, twinky diet ,potato diet.they only ever work because of calorie restriction.

FrankG said...

@cwaiand...

And the previous 25 years? You think I chose to be overweight? Do you really think it is fun?

All you are doing is restating the First law of Thermodynamics... NOT HELPFUL ;-) please see my comments above on that.

Obviously I was storing less energy than I was using but WHY???

Frank said...

@rolikman

Hummm... well I guess our way of seeing life is very different then.

I don't know of any athletes, or great individual ever who had not to be disciplined and work hard to give the better of themselves and acheives great things with his life. If I want to get good at the guitar, I'll have to sit down, day after day, and practice hard. Same for martial arts. Same for anything.

If I want to lose weight, I'll have to control my portion size, take my ass to the gym, make good choices in regard to what I eat, and no, I won't be able to eat anything that I want anytime that I want it. Isn't that discpline and willpower? I'm not sure what sounds like preaching in regard to this.

FrankG

What do people who lose weight do, regardless of the diet? They change their habits. This probably could be debated to some point, but I don't think habits are dicted by the physiology - most likely by the psychology of the individual. Actually, probably a mix of the two, but you cannot discard the big role of environment, social and psychological factors that can influence eating and physical activity habits. To some point, you've got to have the willpower (you had me doubt, but it is indeed a word, it means self-discipline) to say no to various things, change the way you act and think, and this ask for an active implication of the individual in the process, not a passive one (insulin will do it for me, or food reward, what ever). At some point, as you said, you need to take full responsability of your state and do action, which will probably ask for discpline, to reach the results you want. And to me, that is much more a matter of psychology than physiology.

As for your own case, first your diabetic, so cearly once diabetic LC will do good. Second, it's impossible to know what you were doing first and why it failed. The science is clear, there is no magic, at least in regard to insulin, with LC diet. If you choose not to see this, well, there nothing that can be said anymore.

rolikman said...

@bentleyj74 said:
"First you buy your sins, then you buy your redemption."

Exectly. In the catholic church it is called "indulgance"

http://en.wikipedia.org/wiki/Indulgence

The entire concept of calorie-management is based on moral and religious grounds: if you eat too much (too many calories)you have sinned. Then you have two options: either burn it off as a "penance" (e.g. working out in a gym) or you will meet the punishment (extra punds and disease).

That's also why until the end of the WWII European researchers never accepted the energy-balance theory of obesity and came up with biological causes. It had to be imported from the USA (after it became a superpower in the wake of Europe's destruction by 1945) where all science and morality is deeply interwoven. The concept of "willpower failure" as implied by overeating has always been culturally "foreign" in Europe, so to speak.

bentleyj74 said...

@rolikman

Add to that the difficulty in ever REALLY knowing how many cals you are eating and you are back to square one. Energy imbalance is the cause of obesity but what is causing the energy imbalance?

It's not an entire category of macronutrients. It's not insulin. It's not "refined" foods whatever that means. It's not micronutrients although all of these things may play a role. We just don't know what role, how, and to what degree.

What we do know is that people eat for a lot of reasons other than "hunger" and that [to me anyway] suggests that the relationship there is a little dysfunctional. I think that nutritionism contributes to that rather than resolving it. I think I'm going to run screaming into the woods next time an overweight person tells me how many grams of anything any food has in it.

As to willpower...you need direction for that. Decisiveness and executive function in good working order. You need to have a goal to apply it towards. People don't know what their goals are or even what they "should" be. They don't know who to listen to in the crowd of shouting and marketing. They don't feel entitled to like what they like without apology or want what they want without permission.

Eat whole grains for your health, no wait it's calories, no wait grains are bad and so are all carbs except for all those problems with fat, but not the right fat[and we don't agree on what fat is right], and calories don't matter except when they do, and sugar is bad except when it's fruit, but fruit is bad unless it's low sugar, so buy some stevia for your coffee, oh no caffee spikes your insulin and things that taste like sugar make you fat even if they don't have any sugar in them and if they have enough fiber except for all the times fiber is bad and will give you cancer and KILL you so I guess the best thing you can do is...

...have a cigarette for dinner?

rolikman said...

@bentleyj74

I guess this image sums up what we're talking about here ;-)

http://nowadebata.pl/wp-content/uploads/2011/08/puritans-2.jpg

bentleyj74 said...

Bwa ha haha ha. Love it.

The really sad part is that my little list could have gone on for miles. I didn't even get started on the virtues and perils of artificial sweeteners for example.

Adam Smith said...

"Adam Smith (and I assume others) is willing to wave aside my experience because I now have Diabetes... meantime it seems that lean, young folks are somehow experts on obesity??"

First off, I am only lean because I used to be obese and became lean.

Second, I did not mean to be dismissive of your story because you're diabetic, though re-reading what I wrote, I can see how it looked that way.

What I wished to say was that if I were a diabetic, I would probably eat differently than I do now. I think a LC diet is a very wise choice for people who are diabetic, and being very concerned about insulin levels is a very wise choice as well.

I do not, however, believe that carb consumption causes diabetes.

Your experience should not be waived away, however, and I would use it as another data point in favor of advocating LC diets for blood sugar control in diabetic individuals.

I think the "optimal diet" is one that puts you at a healthy weight, keeps you there, and gets you off of non-essential medications. This is low carb for many people, it is not low carb for all people.

Thomas said...

@FrankG

"There are a great many more variables in this equation than how much energy/calories we put in our mouths, and how many the machine at the gym says we have burned. Many of these variables -- such as Basal Metabolic Rate -- are outside our control. So stating and restating this physical law is as usefull/meaningless to this dialogue as restating Newton’s laws of motion... after all they inarguably apply to moving food into the mouth, or climbing onto an elliptical trainer."

Yes, there are many variables in the CO part. Some of them we have no control over. But these variables still apply to CO. The open vs. closed system argument really doesn't change the fact that if you take in more than you use, the left over gets stored-it must go somewhere.

Anyway, I'm not denying that this isn't complicated-it is, and for various reasons that are highly individual. Each person has to find a way to deal with it, a way to somehow at least be conscious of the CI part. In the distant past, there was no need to think about this for most, as food was less available and took more work to attain.

Thomas said...

How nice it is for those of us who live with so much abundance that we actually have to be aware of the type and amount of food we take in less we get fat. Sure beats not having enough, being malnourished or starving to death. Maybe we should count our blessings rather than groan about how hard it is to contain ourselves. I'll take being overweight over starving to death any day.

vladex said...

Thomas
Fasting regulates hormones and never being hungry leads to aging and degeneration. Also there is no guarantee of continous feast but ultimatelly the world will be survived by those who survive the feast and the famine.

john said...

It's incredibly annoying how so many bloggers become preoccupied with "disproving" another blogger instead of actually presenting information, and I have removed multiple from my feed as a result. Posts are filled with out-of-context nitpicking about information that is already clearly wrong or unimportant: there are tons of "Taubes-haters" who continually point out that fructose has a low postprandial insulin effect, which counters his insulin spike hypothesis...who cares anymore? Why don't we actually move forward instead of getting caught up in the useless bickering? It's a huge shame that it's actually happening to this blog.

Frank without the G,

Eat a meal of potatoes and bananas, then see how hard it is to avoid cake or whatever when placed in front of you 3 hours later; then try the same after eating 20oz of full fat Fage and unsweetened chocolate. Willpower and temptation can change, but yes, it's obviously always there because cake and ice cream taste good.

If you think Peter of Hyperlipid is entrenched in his views, you haven't read his blog thoroughly or for long enough. From my memory he has developed his views at least on fructose, glucose/carbs, vitamin D, ketosis.

cwaiand,

What you said is why people like you and carbsane will never further their knowledge: you already "know everything," and it boils down to finding tricks to lower calorie intake for the sake of lowering calorie intake. You treat variation across people the same as variation in coin-flipping simulations, never trying to understand why and how individuals can stay lean without ever counting calories or restricting foods.

bentleyj74 said...

I agree we are fortunate to live in abundance rather than lack but it isn't more fun to die of CVD than starvation. People who are about to cry in public over what can and should be a simple choice are generally also people who are being set up to fail because their failure is profittable.

The guy selling organic oatmeal hand sewn by monks from an impressively obscure origen out of one side of his coat and bacon double cheeseburgers out of the other knows he can get you to buy them BOTH if the misdirection is done right.

Frank said...

Hi John

I don't deny that some factors can make it harder, but my point would be that you still have the choice to eat the cake or not; it's not like it's going to fall in your mouth by accident. YOU will make the decision to take it and eat it. Someone with enough willpower could overcome the ''need'' to eat that cake, that is just my point.

I don't want to come across as someone who don't think that other factors come at play, some clearly do, but in the end you always make a choice.

As for Peter at Hyperlipids, I was talking about his opinion regarding insulin and weight management, not his whole blog per se.

I just wanted to add that many people say that CICO is useless because eat less move more is useless. But i'm wondering, what else is there suppose to do? Unless we find a drugs, people are pretty much left with eat less move more. There enough data to clearly see that carbs per se are not more fattening but that reducing carbs can make eating less easier, so if you need it use it. But in the end, the only solution, except using drugs, is eating less, moving more, because varying macro composition has no effect on weight loss, has shown many time already in metabolic ward studies, and insulin level does not correlate with weight gain/less.

What other concret actions can be done other than that?

bentleyj74 said...

It's funny that "eat less" automatically is assumed to be "resist the cake" rather than eat less by having ONLY the cake since it's what you really wanted anyway. A thickly frosted piece of cake or brownie is about 400 cals. A 400 cal meal isn't making anyone fat anytime soon.

But you can't eat cake to satisfy hunger [not even occasionally] because it's WRONG.

Thomas said...

@Bentleyj74,

Good point! People don't realize that they can have their cake and eat it too, as long as they don't eat the whole damn thing in one sitting. If a 2000 calorie/day diet allows you to be under maintenance, 400 of those calories can (gasp) be in the form of cake if you want. You may be more hungry later on, and you may want to have another piece right away, but one piece of cake wont make your fat and isn't WRONG.

Sue said...

Evelyn started this! How dare she make us look at the evidence more closely rather than just follow some guru!!

Rap said...

It's too bad that Stephan does not intend to continue this debate. You can't hammer away at someone for months and then, following his first real response, dismiss most of his arguments as garbage and refuse to play anymore. I'm left wondering if Taubes has in fact raised some good points that Stephan would have difficulty addressing. If Stephan can address them (or maybe has addressed them in earlier posts) wouldn't now be an excellent time to put the nail in the coffin? Otherwise, refusing to debate begins to look like a mere rhetorical device (as is STephan's overuse of the logical fallacy of appealing to authority).

Also disquieting is the fact that Taubes raises a rather clever alternative explanation for the Hashim straw-feeding study which Stephan derisively dismisses without proper refutation. Stephan wrote:
"If all five of these people had the desire and stoic determination to eat 400 calories a day for an extended period of time, why hadn't they already done so prior to the study? Not to mention the fact that the subjects reported not being hungry. According to Taubes, this was because their low calorie intake meant they weren't consuming much carbohydrate, therefore their insulin dropped, their fat was "unlocked" and they burned it instead of needing food (35b)! So all we have to do is go on a 400-calorie diet, our insulin will drop, and the pounds will melt off without any hunger? Eureka! I find these logical contortions highly entertaining."

You can't just make out that Taubes has made a silly argument and leave it at that. As someone who has experience with fasting and the significant diminution in hunger that results, it is more than conceivable that Taubes is right on the money here. The only question that remains is what kickstarted the diet. The bland food is one possibility, but I wonder if it has more to do with the apparatus from which they were feeding. Obese individuals are highly sensitive to food-related visual and olfactory cues which the apparatus completely stripped away. This massive change in environmental cues by itself could account for the result. Of course, this not inconsistent with the notion of food having addictive properties, but the taste of the food may not be the critical variable in this case.

As for the possibility that the obese subjects were motivated to lose weight, regardless of the instructions they were given, this strikes me as a rather parsimonious explanation that needs to be seriously entertained. Even the authors of the study speculated about this. Were they also being silly?

Finally, please jettison the food reward/palatability terminology. Replace it with the simple notion that certain foods predispose an individual to overeat (beyond homeostatic need). Reward and palatability are too difficult to divest of their psychological meanings and even Stephan gets mixed up at times . For example, in response to a comment, he wrote:
"Weight loss on a LC diet is easily explained by the food reward hypothesis"
But in response to Taubes' claim that Nutrament has high reward value, he wrote:
"Would you choose a meal of this liquid over a steak, baked potato and salad? How about scrambled eggs, hash browns and coffee?"
Change the last one to scrambled eggs, crispy bacon and coffee--which many would find even more tempting--and you've got a low carb meal. Or did the switch from hash browns to crispy bacon suddenly turn it into a low reward meal. It's no wonder people are confused.

jethro said...

I LMAO reading the GT v. SG battle.

They hurl studies at each other, each claiming to hold the ultimate truth.

What a joke!

These studies prove nothing. Why? The subjects are not A RANDOM SAMPLE OF THE WORLD POPULATION.

Thus, any results would be true only to the extent of the SUBJECTS IN THE STUDY!

And please, do not equate rats with humans.

jethro said...

I LMAO reading the GT v. SG battle.

They hurl studies at each other, each claiming to hold the ultimate truth.

What a joke!

These studies prove nothing. Why? The subjects are not A RANDOM SAMPLE OF THE WORLD POPULATION.

Thus, any results would be true only to the extent of the SUBJECTS IN THE STUDY!

And please, do not equate rats with humans.

Evelyn aka CarbSane said...

@Rap: It was ungentlemenly, not to mention unprofessional, the manner in which Taubes picked any perceived "fight". He then tried to frame the debate to divert from defending his own failed hypothesis. There's no CIH v. FRH dichotomy. It could be one or the other or both or none or all that and a whole kitchen sink of additional ones.

Although Stephan made clear that he didn't buy into Taubes' hypothesis anymore, he didn't go after it. It was Taubes who challenged Stephan at AHS (perfectly fine to do so, but his manner of doing so didn't help his cause). He has written a 5-part series on what's supposedly wrong with FRH. In my opinion, Stephan doesn't even need to respond at all to Taubes' flimsy often flawed-in-logic arguments. Yet he chose to and I thank him for doing so and for the time he spent.

At some point, each of us has our priorities, and I get the feeling Taubes is not one of Stephan's. Nor it would appear is falling for the framing of this debate as some competition. He doesn't owe anyone any further discussion ... would you agree?

In the end, Taubes' hypothesis is pretty sunk -- we're left with "well I lost X pounds eating 10000 calories".

Evelyn aka CarbSane said...

@FrankG: You seem to be woefully unfamiliar with the writings and stated opinions (lectures Q&A sessions, interviews) of the man/hypothesis you are defending. WWGF was all about how it is the carbs, only the carbs, and nothing but the carbs that cause hyperinsulinemia, lock your fat in your fat cells/starve your body, making you accumulate fat. An indefensible hypothesis, but he keeps on keeping on. And now he's trying to rescue it with fructose and glycemic index. Insulin is THE root of all fatty evil to Taubes. Period. (And no, the person you're jockeying back and forth with over on GT's blog is not me. I have only ever posted as CS/Evelyn. Kudos to Taubes to at least allow dissenting opinions on his blog.)

Anand Srivastava said...

Lots of comments here thought I would add my two cents.

Palatability does not remain constant. It changes. Yes sugar can make food highly palatable, but in itself it can be HIGHLY unpalatable after the first couple of spoon to MOST people.

Yes this will apply to eating cake. If you were told to eat the same cake, day in and day out, you will lose weight. Because the palatability will go down. If you don't believe me try it.

Some people are susceptible to particular foods and may be able to eat it day in and day out. But I would suspect that the diet will still become less palatable and weight will be lost.

The real culprit is the variety, which resets the palatability. Palatability of a food goes down, if nothing else is eaten.

This is also why low carb works for many people. You remove starch from the diet, which reduces the variety. Only fat and salt becomes onerous.

Ofcourse Palatability is not the only reason for obesity, there may be a lot of other reasons. Hormonal disturbances are surely a big reason, which may cause stalls, and only a healthy balanced diet will fix it.

An unbalanced unpalatable diet will fail at some point because of deficiencies and hormonal imbalance caused due to the unbalanced diet.

Yes low carb diets can also be unbalanced.

Philbert said...

Here's an open question because I'm trying figure this all out:

If insulin is not "the root of all fatty evil" ... what is it? That is: what role does it play in the whole process of fattening and weight gain (or, conversely, weight loss). Or is it completely irrelevant?

It certainly appears to be involved in the process of fat storage and liberation. It also seems to be regulated primarily (?) by the ingestion of carbs (and, yes, to a lesser degree protein).

I guess I want to know what part of science that everyone agrees on, and where in the science we find ourselves diverging and putting our selves in our different nutrition-science camps (i.e. CIH vs. FRH).

This is an honest truth-seeking question question, so limit the sarcasm and rudeness please.

Frank said...

Hi Philbert

Here's my 2 cents.

First off, there is no one roots of all evil in regard to obesity. The disease is multifactorial and many many things can influence it's progression. When you read Taubes and al, they give the impression that carbs and the insulin responses they bring is the sole reason for obesity. It surprises me that we have not learned anything from the low-fat era, as this is exactly the same mentality, with a 180 degree.

As for insulin, it plays a role in nutrients metabolism, but it's clearly not the only hormone to do so (Taubes seems to think it is), and where I think we disagree, is that some people are saying that it's not the amount of calories that matter in regard to weight gain/loss but the type of calorie (ie, carbs) whereas other, such as myself, say that it's first the amount of calories, regardless of the type, that determines if there is a weight gain or a weight loss.

Rephrase, in the face of a calorie deficit, insulin won't lock away the fat and make you starve to death. You'll lose weight, even if you eat a lot of carbs. Others would say you don't need to have a calorie deficit as long as you keep insulin low.

There also seems to be subcamp. Some people will say that there is a metabolic advatange to LC (you can eat more calorie on it than on low-fat, hence claiming that the first law of thermo is not right) but some other seems to acknowledge that LC result in eater fewer calorie, but that it would be a consequence of lower insulin and more ketone thus controlling hunger better.

I believe this is the source of disagreement, as I understand it.

Hope this helps.

Medjoub said...

To all interested, Slate has a really fantastic article series up about the ubiquity of the mouse model in research and the corresponding difficulties of interpretation and application to humans.

http://www.slate.com/articles/health_and_science/the_mouse_trap/2011/11/lab_mice_are_they_limiting_our_understanding_of_human_disease_.html

Medjoub said...
This comment has been removed by the author.
Rap said...

Anand said:
"If you were told to eat the same cake, day in and day out, you will lose weight. Because the palatability will go down. If you don't believe me try it."

This is an interesting phenomenon. Repeatedly eat one food only and consumption decreases (or "palatability goes down" if we choose to be mentalistic about it). It's almost as though we have an innate drive to seek a certain level of variety in our diet and in the absence of that variety, we naturally restrict intake. Perhaps it is evolutionarily disadvantageous for people to restrict their diet in this way.

nothing91 said...

"It's too bad that Stephan does not intend to continue this debate. You can't hammer away at someone for months and then, following his first real response, dismiss most of his arguments as garbage and refuse to play anymore. I'm left wondering if Taubes has in fact raised some good points that Stephan would have difficulty addressing."

Yep. Same goes for Peter@Hyperlipid. Both Peter and Taubes made some good points in their critiques. Stephan took his ball and went home.

We may miss out on getting closer to "the truth" because of it, but at least we've learned who's the most delicate out of the three of them. :-)

Stephan Guyenet said...

Hi nothing91,

OK, you guys want some more examples? Here are two:

Taubes claims that we don't know why rats get fat on the cafeteria diet, that it may be the refined carb/sugar content. Well, actually, we do know, because it has been tested in controlled feeding trials, as I have explained on this blog. Diets high in refined carb/sugar are not nearly as fattening as the cafeteria diet, thus refined carb/sugar can't explain the effect.

http://www.ncbi.nlm.nih.gov/pubmed/21331068

To suggest that Dr. Sclafani, the originator of the cafeteria diet, thinks carb foods are the reason they get fat, as Taubes did, is a joke. Sclafani is more focused on fat than carbs, according to one of his papers I read recently, but he thinks both act through palatability, not some magical function of insulin.

http://www.ncbi.nlm.nih.gov/pubmed/21452471

Taubes also suggested that hunger arises because the cephalic (pre-meal) insulin response clears nutrients from the circulation, creating a physiologic need and therefore hunger. Again, that has been tested directly, and it is simply false. Injecting insulin into animals in an amount equivalent to the cephalic phase insulin release does not increase food intake, if anything it decreases it. The only way to increase food intake by administering insulin is by creating hypoglycemia. This is just basic insulin biology, but Taubes seems blissfully unaware of it.

http://www.ncbi.nlm.nih.gov/pubmed/3095717

This is the problem: Taubes speculates wildly, in a manner that favors his ideas, when no speculation is necessary.

I could keep going and going and going. Virtually everything he said in his "critique" was like this, a desperate distortion of the science. The fact is, he doesn't know the obesity or insulin literature from a hole in the ground, and he substitutes speculation and shaky deductive reasoning for readily available facts. Most of his ideas fall apart with even the most casual critical examination. He is simply not a reliable source of scientifically accurate information.

The same applies to Peter's response at Hyperlipid. The reason I didn't respond to it is because it was so weak. Speculation and jokes do not replace a careful consideration of the evidence.

nothing91 said...

"To suggest that Dr. Sclafani, the originator of the cafeteria diet, thinks carb foods are the reason they get fat, as Taubes did, is a joke."

I'm going to check out your links, but this comment jumped out at me -- as I can find no such suggestion from Taubes. You may want to remove the bee from your bonnet and re-read the part where he discusses his interview with Sclafani. Arguing against straw men is too easy -- you're better than that.

Stephan Guyenet said...

Hi nothing91,

You are right, I wrote that comment too hastily. Taubes didn't claim that Sclafani said he thinks carb/sugar are the culprit, but he did relate Sclafani's anecdote to try to suggest that the carb/sugar foods are what the rats went after (how that argues against food reward eludes me). I guess his argument there is that the refined carb/sugar could be responsible for the obesity on cafeteria diets, but again that has been proven false based on the study I linked to.

Another clarification: Sclafani doesn't think it's solely palatability, he also thinks obesity involves post-ingestive factors (satiation, metabolic effects, etc), but as far as I know insulin is not among the factors he thinks is involved.

Jared M Johnson said...

@Stephen

You're a little over 30, you just got your PhD and you think that Taubes has no room to talk? I think that's a pretty silly idea and you should probably stop the Ad hominen bs. No one is forcing you to respond. If you do so, you're not going to win any points by talking trash.

Also, I've read your posts about the insulin. You are always attacking a straw man. It's pretty ridiculous how you talk about these things. You keep doing this in your response as well, talking on and on about irrelevant, inconsequential issues.

Taubes is arguing that to get a broken metabolism, you need maybe years of sugar/high-GI carbs. None of the studies you cite directly contradict this. Also, you continually ignore the elephant in the room that is the superior performance of low-carb diets to weight loss vs. other diets that are probably even more bland, and instead talk about irrelevant issues that are not in dispute and have no relevance to which hypothesis is more likely.

Argue against taubes' causes for obesity taking years and also being only a necessary condition for metabolic derangement, not a sufficient one. Stop thinking that you've shown anything by showing that people eat more when a meal is tasty or that people can drink fructose for a few months and not get fat (neither of these things are incompatible with what Taubes is talking about).

Taubes is as expert as anyone else alive at finding bad science. It's pretty damn silly to claim that he has no room to talk on this issue.

Rap said...

Thanks Stephan for the further examples. I look forward to seeing if Taubes (or Peter at Hyperlipid) can provide effective answers.

Stephan Guyenet said...

Hi Jared,

Taubes doesn't even have an undergrad degree in the biological sciences. I've been training for 14 years in the field. That argument isn't going to fly. Undergrad is where you learn about things like how cells work. You can't just wake up one morning, decide you're an expert, and start challenging people who have been doing research for 40 years. You will just fall down, as Taubes has. The fact that he is older than me is irrelevant.

Taubes has some nice speculations about how once your metabolism is "broken", insulin starts to matter. But where's the evidence? I have seen no convincing evidence for that from him, only moving goalposts.

Evelyn aka CarbSane said...

FrankG said: "The First Law applies to energy conservation in a closed system and free-range humans are NOT a closed system... we can only make them so by placing them in a metabolic ward where everything in and out is measured. I don't live in a metabolic ward."

This is one of the more absurd arguments I've seen yet. I think you mean a metabolic chamber, but do you really think that human metabolism actually CHANGES when you take a human and put them in a sealed room and measure everything? Technically even the chamber is not a closed system if used for sufficient time because w/o adding O2 and/or removing CO2 the human lab rat would expire.

Methinks you need to read this post of mine: Of Thermodynamics, Complexity, Closed Systems & Equilibrium

Evelyn aka CarbSane said...

@Stephan: It seemed to me that Taubes was referring to that Sampey paper you linked to here in the comments ... then diverted the conversation to Sclafani. That's what makes his "we don't know" nonsense that much more aggravating to anyone interested in a genuine debate. There is NO excuse for his not being aware of that study and ALL of its implications. The food list you rattled off in his quotation is from Sampey not Sclafani.

@nothing91: The LF diet was actually matched to the HF diet replacing 35% fat with sugar. This blows his hypothesis, and the new fructose version out of the water. Because the LF rats ate 2.5X the simple sugars v. HF rats, and even ate a few more calories, yet gained the same amount of weight. Geez, it can't get much more plain as day than that! http://carbsanity.blogspot.com/2011/11/taubes-rat-problem.html

And please, Peter's rebuttal or whatever that was, wasn't even a serious post. What did it add to the conversation?

FrankG said...

Stephan said... "Taubes claims that we don't know why rats get fat on the cafeteria diet, that it may be the refined carb/sugar content. Well, actually, we do know, because it has been tested in controlled feeding trials, as I have explained on this blog. Diets high in refined carb/sugar are not nearly as fattening as the cafeteria diet, thus refined carb/sugar can't explain the effect.

http://www.ncbi.nlm.nih.gov/pubmed/21331068"

Abstract of that study says... "Several animal models of obesity exist, but studies are lacking that compare high-fat diets (HFD) traditionally used in rodent models of diet-induced obesity (DIO) to diets consisting of food regularly consumed by humans, including high-salt, high-fat, low-fiber, energy dense foods such as cookies, chips, and processed meats. To investigate the obesogenic and inflammatory consequences of a cafeteria diet (CAF) compared to a lard-based 45% HFD in rodent models, male Wistar rats were fed HFD, CAF or chow control diets for 15 weeks. Body weight increased dramatically and remained significantly elevated in CAF-fed rats compared to all other diets. Glucose- and insulin-tolerance tests revealed that hyperinsulinemia, hyperglycemia, and glucose intolerance were exaggerated in the CAF-fed rats compared to controls and HFD-fed rats."

So the "Cafeteria diet" either consisted of or mimicked cookies, chips etc... How is that not high in sugars and refined starches?

And yet when compared to the High Fat and control diets, the CAF exaggerated "hyperinsulinemia, hyperglycemia, and glucose intolerance". All this after less than 4 months.

How does this not support the Carbohydrate Insulin Hypothesis, let alone debunk it?

If your position (somehow) is that CAF wasn't high in sugars and refined starches then where is the high-carbohydrate control which allows you to use this study in support of your assertion that "Diets high in refined carb/sugar are not nearly as fattening as the cafeteria diet..." ?

FrankG said...

...or put another way, the study you provided is further evidence that an high-fat (so "low-carb") diet is preferable for insulin levels, blood glucose, excess fat mass etc... etc... when compared to what most kids are eating these days.

But hey... what do I know..? I'm just an ignoramus who never even went to University.

FrankG said...

...and why were these particular researchers even interested in insulin, blood glucose and glucose tolerance if these are not considered to be diet-driven factors in obesity and metabolic syndrome?

Evelyn aka CarbSane said...

@FrankG: I wonder if you're even being serious or just trying to muck up the waters. The Sampey cafe rat study is available in full for free online. Or you can look at just the charts and graphs in my post here: http://carbsanity.blogspot.com/2011/02/why-we-get-fat-lessons-from-cafeteria.html
Taubes is actually commenting on that study, though diverting the issue with Sclafani.

Why are they looking at all those things? They are the effect of the diet along with obesity, and not the cause of the obesity maybe.

Rap said...

Medjoub said...
"To all interested, Slate has a really fantastic article series up about the ubiquity of the mouse model in research and the corresponding difficulties of interpretation and application to humans.
http://www.slate.com/articles/health_and_science/the_mouse_trap/2011/11/lab_mice_are_they_limiting_our_understanding_of_human_disease_.html
"
Interesting. I just had a glance at the cafeteria diet study that Stephan referenced above in his additional critique of Taubes. It turns out that the rats were being fed ad lib. Is this common in cafeteria diet studies? If so, it could represent a significant problem.

The comparison in these studies isn't just between a normal diet and a highly varied diet; it is between a one-item only diet (which virtually no one eats unless their doing a potatoes-only experiment or happen to have a severe addiction to purina monkey chow) and a several-item diet (which virtually everyone follows regardless of whether they're on a low carb or low fat or whatever diet). Moreover, the animals are in the presence of food day, in day out for the duration of the experiment. Imagine what it would be like to be confined to a small room with virtually nothing to do but eat and the food being constantly in front of you. It's a perfect set-up for inducing long-term habituation to the food, and I wouldn't at all doubt that habituation would occur much more profoundly to the one-item diet than the several item diet. Personally, I would be desperate to have varied food items in front of me, the more the better, rather than just one item. I would also be desperate for more tasty items. It's also possible that if the rats were not being fed ad lib, but were instead given separate meals a day, then the tendency to habituate would again be alleviated.

If it hasn't already been done, someone should investigate the possibility of these kinds of effects from ad lib feeding. Even if there is a food-reward effect associated with a varied diet, it may be that it is being greatly exaggerated by the ad lib feeding regimen in these rat studies.

Just a thought.

Marc Brazeau said...

The sharp elbowed tone of the exchange between Stephan and Taubes didn't bother me in a "can't we all just get along?" sort of way. What bothered me was a sense that both sides had dug in and were more interested in out-lawyering each other than in using the exchange to further their (and our) understanding.

They each seem to be clutching their hypothesis rather than holding it gingerly. Unfortunate, since neither hypothesis seems particularly robost to me at this point.

Rosemary said...

Does food-rewards theory make long-term predictions of weight gain/loss.

I think it is quite straight-forward that palatable food encourages you to eat more, and hence put on weight. I understand most people who become vegans usually lose weight!

But, are these weight changes maintained? After 3-5 years (the point at which most diets fail) would having only access to low palatable foods keep you lighter, or would the body just up the ante and give you more reward for your efforts?

I suspect that, providing the calories and nutrition are available, the body will eventually adapt to any regime? long-term weight loss will be insignificant on a low-palatability diet - is there any evidence to the contrary?

Gordon Rouse said...

Oops - apologies to my wife - the comment from "Rosemary" should be from "Gordon".

jaylen watkins said...

Good food habits can keep the fat away from you.


Weight gain

comrade_stalin said...

Mr. Guyenet, you and your cronies are engaged in the most ferocious attack on Mr. Taubes' ideas and credentials.

However, it is Mr. Taubes who writes for the New York Times, the greatest newspaper in the world.

It is Mr. Taubes that has published numerous books, some of them becoming best sellers.

For which newspapers do you or your cronies write for?

What books have you and your cronies published?

Your attacks seem to be nothing more than jealousy and sour grapes.

comrade_stalin said...

Mr. Guyenet, you and your cronies are engaged in the most ferocious attack on Mr. Taubes' ideas and credentials.

However, it is Mr. Taubes who writes for the New York Times, the greatest newspaper in the world.

It is Mr. Taubes that has published numerous books, some of them becoming best sellers.

For which newspapers do you or your cronies write for?

What books have you and your cronies published?

Your attacks seem to be nothing more than jealousy and sour grapes.

Stephan Guyenet said...

Hi comrade,

I write for a publication called "the scientific literature". Popular books are all well and good, but what has Taubes written that has gone through a scientific peer review process? Nothing. That's why he can sling around these wild ideas with no accountability.

Jeff said...

With all due respect Stephan...You haven't necessarily peppered the scientific literature with first or senior authored peer reviewed manuscripts (in my opinion that should not be used to invalidate you ideas, btw). Your getting to point of invalidating Carbsane, Kurt Harris, Chris Kresser and others with these views of Taubes and lack of credentials hindering his interpretation of the scientific literature.

Stephan Guyenet said...

Hi Jeff,

My intent was not to invalidate people who don't have a scientific publication record. I was simply responding to the previous commenter's opinion that Taubes's books and articles give him more credibility than I have. I have the utmost respect for people, degree or not, publication record or not, who make a good faith effort to learn about and communicate science. What boils my blood is science abuse, where gurus mix fact with fiction and take advantage of the general public's ignorance.

Your point is well taken that I'm not a well-established researcher with a lab and a bunch of high-impact obesity papers under my belt. But the difference between me and Taubes is that I listen to people who do. If you're going to butt heads with seasoned researchers, particularly an entire field of them, you need to have a damn good reason to do so. What I do is communicate research that other experienced scientists are doing-- without calling them idiots, without distorting or selectively citing their work.

I have a first author review paper coming out soon in a high-impact journal that will be on the mechanisms of obesity. I'll announce it when it's published.

Jeff said...

That's fair enough. Didn't want it to sound like I was disregarding your thoughts and ideas by bringing up these sort of issues. I highly respect the intellect and contributions made by people in the blogosphere on these topics that are so hotly debated here and elsewhere. Just want to point out a perceived dichotomy in your referenced comment. I know, all to well, slogging through those early post-doc years and totally relate. Congrats on the upcoming publication. Look forward to ready it.

Ollie said...

As usual Stephan a brilliant post, I think the only positive I could take from Gary Taubes putting a critique on food reward is, it will actually attract more readers to your blog and increase awareness of some real scientific links to obesity.

I can see why you would also not want to spend anymore time putting up responses to Gary Taubes as he seems to be on his own planet speaking a different language with his fingers in his ears. As the chinese proverb says, "his cup is already full and will take no more water".

Keep being a great voice of reason.

Ollie

Flowerdew Onehundred said...

Oh my goodness. For you folks who think Nutrament isn't bland, you aren't really thinking it through.

Sweetened skim milk would be OK the first time you had it, maybe OK for a day. When faced with nothing but that, believe me, you'd eat to your needs and that's it. No vanilla, no cocoa, no malt extract that came off your cereal? No flavor.

The real question in all of this is why monotony OR blandness causes people's appetite to adjust to meet their needs and no more.

Having lots of tasty food available seems to derange appetite in many people. WHY??

vladex said...

Flowerdew Onehundred ,
There is a world of difference between tasty natural food and chemicalised, processed , mass marketized easy to use #$#$ that passes for food. It's the same difference as a hot lover and internet porn . We are built to be satiated after a while by a natural thing whereas these synthetic things are never meant to be satiating and the body expects something natural to come along so it's seeking that something and develops addiction to food and/or porn. In the real world this means that we always get satiated if we taste enough of good food or even have enough of a good sex partner. This serves a purpose of survival and procreation.
Abstaining from palatable food as SG suggests is not the answer anymore than Taubes extremist carb and insulin phobia. All that does is tries to misleadingly curb the symptoms while excerbating fear and misunderstanding.
In that sense SG has missed the target as far as the food reward goes, it's not the reward that is the problem, it's the intnetional and/or unintentional fooling of the brain that disrupts tne natural senses and sends the natural homeostasis into confusion . Also when combined with real or imagined stress attack from modern society which fools the brain to think it's under attack along with fear mongering from media and authorities and even people you know who may not know better , this also increases stress response which increases feeding and fat storage while decreasing energy and mental clarity.

yolio said...

I tried to read all the comments, but it was just too much! So sorry if I am retreading covered territory.

"Most obesity researchers view energy imbalance as a link in the causal chain between environmental factors and obesity, and view the whole process as being driven by upstream causal factors, just as Taubes does. That may not be reflected on TV or in the newspaper, but I can assure you it is a common sentiment in my field."

Here is my comment: I think that you have a much easier time than most people separating the energy balance model from the prescription to "eat less/move more." I do not doubt what you say, that those who are well informed on the biology have no trouble seeing that one of these does not follow from the other. But there is a reason that so many of your commenters make this link: It is the dominant public narrative. And, I am not just talking about fluffy journalism pieces, diet books or blogs. I have personally sat through plenty of harangues from medical professionals (nurses/doctors/nutritionists) who consider themselves to be very well authoritative on the subject of obesity. Let me assure you, they believe in the "eat less/move more" prescription and they point to the energy balance model/laws of thermodynamics as a reason why.

There is a war going on between the people who feel that the energy balance model is necessary and fruitful and those who think that it is doing us more harm than good. I think that both sides have important points to make, and should stop squabbling and try a little harder to integrate each other's contributions.

I acknowledge that, ultimately, obesity cannot happen without an excessive intake of calories. But, by over-focusing on this fact, we have generated a very, very strong narrative that "calories-in" is entirely under our personal control. I.e., controlling obesity is strictly a matter of self-discipline. This message has done a great deal of harm to human health and well-being (understatement!). There are people who are trying to undo the harm that this narrative has caused. I concede that sometimes they go too far in the "calories don't count" direction. But disarming the self-discipline narrative is good and necessary work (IMO).

I would love to see you help the "calories don't count" crowd find a more nuanced and accurate way of expressing their concerns. This would be a very positive contribution. But you first have to acknowledge that people aren't just being crazy or ignorant when they link the energy balance model to the harmful "self-discipline" prescription for obesity.

GK said...

Re the energy-blance "red herring":

Stephan writes that he agrees with GT that it is important to know what is driving energy imbalance. He also agrees on the first law of thermodynamics. However, he then goes on to write as if he's just forgotten it: "..fat mass depends tightly on energy balance...; fat mass is determined by changes in energy balance.." This paradigm introduces causality into the first law, which is what GT is railing against, that it is also possible that changes in fat mass determines energy balance (reverse causality). All we can say is that changes in energy balance equals changes in fat stores.


SG: "It has been made clear by countless studies that body fat stores can be manipulated by changing food intake and energy expenditure." This is a second sore point of GT: if obesity researchers have made such progress in understanding the biochemistry of fat regulation, then why have "countless studies" been done diddling around with energy balance?! These are the very studies that operate under the "wrong paradigm" and certainly the ones which go on to influence public health recommendations.

And that brings up a third point of GT: the research community is so specialized and fragmented that they rarely talk to each other. SG may be a fantastic boichemist, but the NIH certainly is not listening, as they still recommend "eat less, move more".

Samson said...

link no. (38) is broken.

i guess its this paper?
http://www.ncbi.nlm.nih.gov/pubmed/20427023

Todd I. Stark said...

Finally someone has provided a reasonable explanation of the reason so many veteran researchers still support the calorie balance model, and in a way that doesn't just reject the lipophilic hypothesis (fat causes lowered activity and increased intake) out of hand. This is one of the most useful posts on obesity models that I've seen in a long time. Thank you very much! I was persuaded from my own experience and various articles that the carb-insulin hypothesis of obesity was correct but your articles have given me new ways of looking at the evidence. Great educational service you are doing here.

Ben Kennedy said...

Taubes is correct on Nutrament - it does seem like a typical example the marketing-driven high reward food that is criticized elsewhere on this site