Detail from Pieter Bruegel's The Triumph of Death

The Dark Ages were an inglorious period of human history bounded on the one side by the Classical Age and by the Renaissance on the other.   These grim times began when a classical empire was savaged by barbarians plunging the world into a long era of darkness ruled by ignorance, superstition and fear, and ended finally by the intellectual stirrings of the Italian Renaissance.

I believe that the latest dietary study published in the New England Journal of Medicine is an early indicator that our own era of dietary darkness may be coming to an end.

Loud have been the cries of all the low-carb bloggers, dieters, and practitioners about this paper, which purports to show that macronutrient consumption doesn’t really matter.  Low-carb, high-protein, low-fat, high-carb, it makes no difference, say the authors, it’s just the calories that count, not the composition of those calories.   As expected, all the major media picked up on the story.

Opined Jennifer Levitz of the Wall Street Journal:

You aren’t what you eat. You’re how much.

That’s the message from a two-year National Institutes of Health-funded study that assigned 811 overweight people to one of four reduced-calorie diets and found that all trimmed pounds just the same. It didn’t matter what foods participants ate, but rather how many calories they consumed.

Tara Parker-Pope of the New York Times writes:

For people who are trying to lose weight, it does not matter if they are counting carbohydrates, protein or fat. All that matters is that they are counting something.

The study has been written about and dissected by so many others that I don’t see any need to go into it in any detail myself.   Everyone with good sense who has read it understands what the deal is.  The researchers, old-school low-fatters one and all, constructed the study in such a way as to ensure the outcome they wanted, which was that all that really counted was the total caloric intake.  They did this by making sure that the diet with the lowest carb content – over 150 g per day – couldn’t possibly be called a low-carb diet by anyone who really understands what a low-carb diet is.   But the authors did call it a low-carb diet and the media perpetuated the myth.

There are a couple of ways this old fudgaroo can be brought off.

First, the way this New England Journal study did it.  If diets of similar but slightly different macronutrients are compared, the likely outcome is that calories, not macronutrient composition, is what correlates with weight loss.  In terms of carbohydrate, it’s only if intake drops significantly that a difference is seen, based on macronutrient composition.  None of the diets tested in this study qualified as a real low-carb diet.

There is a second way the effects of macronutrient composition can be minimized, leading the unwary or the unintelligent (or those who have an agenda) to misunderstand.  If you keep subjects on very-low-calorie diets, you find that the weight lost is virtually all a function of the caloric intake.  Why? Because if subjects don’t get enough calories to meet even the most basic caloric needs, all calories go to keep the body alive.  The hormonal influences of these calories don’t matter.  So, if you want to have weight loss be strictly a function of how many calories are consumed, put subjects in metabolic units to they can be observed closely, keep them on 500 calories per day of any mixture you want, and watch the weight come off about the same no matter what the macronutrient composition.    This is the trap that Anthony Colpo fell into when he decided that macronutrient composition didn’t matter and wrote a book listing a bunch of metabolic studies proving his point.   Virtually all of the studies fell into this extremely-low-calorie category, and would be expected to show weight loss strictly as a function of calories and not macronutrient composition.  But, as we all know, this idea doesn’t hold up in the real world of more normal calorie consumption.  (I suspect that Anthony has even figured this out by now since he’s pretty much vanished from the face of the earth.)

These researchers – Stark, Bray, et al – from the low-fat, it’s-only-calories-that-count school set up a low-carb straw man, then knocked it down with this study.  And a lot of people got the message.  In fact, while we were in Seattle over the past few days, I heard no fewer than three people mention that a new study had shown that only calories really counted.  So how can I write that this is the last gasp of the dark ages of nutrition?

Easy.    Think about where we’ve been and what has happened.

Petrarch (1304-1374), the Italian genius and man of letters, who started the process of dragging the world from the recesses of the Dark Ages wrote:

Each famous author of antiquity whom I recover places a new offence and another cause of dishonour to the charge of earlier generations, who, not satisfied with their own disgraceful barrenness, permitted the fruit of other minds, and the writings that their ancestors had produced by toil and application, to perish through insufferable neglect. Although they had nothing of their own to hand down to those who were to come after, they robbed posterity of its ancestral heritage.

Now, consider the history of the low-carb movement.    Gary Taubes laid it all out in Good Calories, Bad Calories.  Up until the late 1950s/early 1960s scientists the world over were homing in on the fact that excessive carbohydrate intake makes people fat.  There were international conferences, symposia and numerous papers published tying carbohydrate intake to fat accumulation.   The metabolic pathways involved were worked out in detail.   Physicians were prescribing reduced carb diet to their patients for weight loss.  It was the classical age of low-carb. Then the barbarians struck.

Ancel Keys published his Seven Countries study and began to demonize fat. The nutritional dark ages began.  For the past forty years we’ve languished in this wilderness of idiocy.  Just as there were a handful of great works of art produced during the Dark Ages, there have been a few prophets crying out during this time of low-fat, high-carb error, but the mainstream has ignored them or ridiculed them and forged ahead advocating whole grains and complex carbs while besmirching fat, especially saturated fat. During these times, obesity, diabetes, GERD and other disorders of excess carb intake have skyrocketed to epidemic proportions, a fact the main stream appears oblivious to. More carbs and less fat – that’s how you solve the problem, we’re told.  And the people get fatter and more diabetic. These mainstream pushers of carbs have forgotten the “writings that their ancestors had produced by toil and application” and have allowed it “to perish through insufferable neglect.”

“Although they had nothing of their own to hand down to posterity,” they instead filled the medical and scientific journals of their time with insipid studies designed to prove their own ill-derived hypotheses.  These are studies that will be laughed at in generations to come.

But it has all been changing.  Think about it.  When I first went out on the stump in 1989 promoting a low-carb diet, I was attacked almost everywhere I went.  Robert Atkins was, too, when he went out 15 years earlier.  We both described our clinical experiences with low-carb diets and were met with derision. “All anecdotal,” they said. “Where are the studies?  Show us the studies.”  We couldn’t really show them the studies because recent studies hadn’t been done. I countered by asking, “Where are the studies showing low-fat diets prevent anything?”  But that question was usually shrugged off with a condescending smirk.

Look at the progression over just the past five years.  Thanks to a ton of research comparing low-fat diets to low-carb diets, the mainstream thinking has first gone from the low-fat, high-carb diet is the best for weight loss, lipids, reducing cardiovascular risk, and good health in general to Okay, maybe the low-carb diet does bring about more weight loss, but at the price of clogging your arteries.   Then to Well, the low-carb diet may bring about quicker weight loss and at least an equal reduction in cardiac risk as low-fat diets do in the short term, but where are the studies showing safety over the long term?  (One could of course counter with Where are the studies showing the low-fat diet is safe over the long run?  And one often does.)  As the long term data has started to trickle in showing no problems with low-carb diets for the long haul, the mainstream has been left with pretty much no place to hide.  So, now, as a last ditch effort, they are resorting to the calorie defense.  It’s all calories.  It has nothing to do with macronutrient composition.

If you think about it, this is a pretty amazing admission for them.  Could you imagine any one of these clowns making such a statement during the height of the low-fat frenzy? They are basically saying, Low-fat, low-carb, high-protein, high-fat: it doesn’t really matter.  They all work. It’s simply a function of calories. This is a huge admission for them.  It’s the last step before actually admitting that the low-carb diet is superior across the board.

And this admission will come.  But probably not for a few more years because it won’t come from any of these guys.  This is as close as it gets.  But these are the guys who were training when Keys and his idiocy held sway. That’s what they learned and that’s what they built their careers on.  But they are old and ready to move on.  When they do, the younger people with a different outlook will come to the fore.

As the great physicist Max Planck said

A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.

The old generation is waning and this study is one of its last gasps.   Granted, they had to fiddle with the experimental design yet again to get the results that they wanted, but this study puts low-carb on par with any other diet, including the low-fat diet beloved by them all.  No longer can they cast aspersions on the low-carb diet.

I think a nutritional renaissance is on the way.