I’m going to tell you about the best low-carb book I’ve ever read. In fact, it’s exactly the book I wish I had written myself.  And I’ll tell you why I didn’t in a bit, but first I want to clear up a few misconceptions I may have spread in my last post.

I get feedback on the posts I write from three sources.  First, MD looks at them and tones them down if I’ve gone off on some sort of political tangent or if I’ve scattered in a bit of too colorful language.  After she gives me the go, I put the posts up and wait to see what the commenters have to say.  The third source for feedback is my friends, some MDs and/or PhDs and some not, who pick up the phone and call me.

MD okayed what I wrote. The readers who commented seemed to realize what I was trying to say.  But the phone calls were a different story.

One friend called to say she had been low-carbing since Jan 1, and when she read my post she became so depressed she almost quit.  “How can you tell people it’s hard,” she said.  “It’s the easiest thing I’ve ever done. I can eat till I’m full.  I’m losing weight; I’m losing the water I’ve been retaining; I feel great.  What a downer that post was.”

I heard different versions of that rant from three other people.  They all wanted to know why I would be idiotic enough to put up such a post right at the time everyone was trying to commit or recommit to losing weight.  Depressing was a word everyone used.

I guess I got off easy with the written comments on the blog.

I didn’t really mean for the post to be a downer.  Really.  I wanted to tell people who might be struggling to lose that MD and I fall prey to all the same problems.  We gained weight over the holidays.  We are back on the straight and narrow.  I was trying to say that we were right in there with everyone else working away to reestablish our own thinner selves.  (In fact, we’ve made great progress in the week or so we’ve been on the plan.)  I just wanted people to be aware that long-term weight loss requires effort and constant vigilance.  And to view the process as a life change and not a quick one-time fix. My goal was to get people to recommit seriously, not to depress them.

Obesity is a medical problem caused by a damaged metabolism, which is why one person, without the damage, can eat the same foods without gaining weight that pack the pounds on someone else.  Once you realize you have the underlying problem that leads to obesity, you simply have to recognize that you have to deal with it for the long term.

Let’s look at it in terms of another medical problem: high blood pressure.  For argument’s sake, let’s ignore the fact that about 80 percent of cases of high blood pressure can be reversed with a low-carb diet, and let’s just assume that the case we’re talking about is responsive only to high blood pressure medication.  If you were the patient with the high blood pressure, and I gave you a pill that brought your blood pressure down to normal, you would consider the medication effective.  Would you then say, Hey, my blood pressure is normal, yippee! now I can quit taking the medicine?   I doubt it.  You would say, Great, the medicine is working.  Furthermore, if you quit taking the medicine and your blood pressure went back up to what it was before you started taking the medicine, would you say the medicine didn’t work?

Of course not.  Your high blood pressure was kept in check with the medicine, and your BP, not surprisingly, went back up when you quit taking the medicine.  The medicine itself was effective.

Same thing with dieting.  If you have an obesity problem that responds to a low-carb diet and you lose to your target weight, then go back to your old way of eating and gain your weight back, it isn’t the low-carb diet’s fault.  You have a problem that responds to a low-carb diet, and you pretty much have to stick with a low-carb diet (although not in nearly as extreme a structure as when you are trying to lose) for the long haul.

Having said all that, I can tell you that in my experience there is nothing that helps people lose weight more quickly and with less deprivation than a good quality, whole food low-carbohydrate diet.  You don’t have to be hungry.  You can eat rich, delicious foods, you’ll get rid of heartburn, drop your blood pressure, ditch excess fluid, and feel remarkably better.  You’ve just got to hang in there until you lose what you need to lose (which process you can speed along if desired with a little Metabosol), then you can loosen up and start adding some of the foods you’ve been foregoing.  And continue to eat them in moderation on maintenance.

Virtually all the studies in the medical literature show that at worst the low-carbohydrate diet equals the low-fat diet in all parameters and at best completely leaves it in the dust.  As far as I’m concerned, there is no faster, safer, more delicious way to lose weight. Hell, a study was just presented recently showing that women who did low-carb just two days a week lost almost twice as much weight as women following a calorically-restricted Mediterranean diet daily.  So, to be clear: Is weight loss tough?  Sure.  Is it easier when you cut the carbs? Absolutely! Low carb rocks!

Which brings me to the book that started this post.  In my opinion, The Art and Science of Low Carbohydrate Living is simply the best how-to book on low-carb dieting ever written.  As I wrote above, it is the book I wish MD and I had written.

The reason we didn’t write it is because a) some of this information wasn’t available when we last wrote a book (much of it is now available thanks to the work of Drs. Volek and Phinney), and b) no mainstream publisher would pay an author for this book.  If a mainstream publisher would buy it, the editor would force the authors to change it.  What do I mean by that?

All books fall into different genres, as they’re called in publishing.  One genre is diet/nutrition books.  So if you come to a publisher offering a diet/nutrition book, it gets pigeonholed into that genre and has to conform structurally to that genre’s standardized format.  Editors of mainstream publishing houses believe that the great mass of readers of nutritional books are not very bright and so have to be served real scientific information in small, small bites and not very many of them at that.  So the genre formula for a diet book is to have the actual diet regimen way up front because these editors don’t believe the readers of these books are smart enough or patient enough to wade through the explanations of why a particular diet works in order to get to the plan.  They want the plan up front within the first couple of chapters so people can get started without really having to read the book.  They also want a ton of recipes and meal plans to fill up the last half of the book.  Squeezed in between the plan and the recipe section is where they want to meat of book cubbyholed, and, in their view, with as little science as possible.

MD and I fought this structure tooth and toenail with Protein Power and ended up beating our editor down by agreeing to write a summary of each chapter called The Bottom Line that explained what each chapter said in non-scientific terms.  (Fortunately, we’ve been able to use this strategy in most of our books.) We worked well with our first editor, but we ended up in the hands of another editor when the paperback came out.  Editor Number Two hated all the stuff on the Paleolithic diet and the data from the ancient Egyptians.  This info was the first time in the popular press that the pre- verses post-agricultural diet was used as an argument for low-carb dieting.  And she wanted to ditch it from the book.  We went postal on her, so she ended up agreeing to leave it but only if we buried it in the very back of the book as an Epilogue.  That was one of the chapters of the book I wrote, and I thought it was pretty exciting information.  So, apparently did many others. But not this editor.  Sadly, she is not unusual.  Most want to conform to the genre.

Drs. Volek and Phinney self-published their book, and, as a consequence, could write it however the flip they wanted.  It is extremely well written and suffers none of the usual flaws of a self published book.  And it lays out the rationale for a low-carb diet as the treatment of obesity and other related disorders in a linear fashion instead of adhering to the typical diet book format.

As I finished writing the above paragraph, I clicked over and checked for comments on my latest post and found one with the following line:

This low-carb world can be a lonely place if one needs a navigator…

I can think of no better navigators than the authors of this book. Both of them have done a large part of the hardcore research on low-carb dieting that is in the medical literature today.  Go to PubMed and enter Volek JS or Phinney SD in the search window, hit ‘Search,’ and you will be rewarded with more peer-reviewed scientific papers on low-carb dieting than you will have time to read.  Many of the experiments described in these papers are explained in easy to understand language in their book.

Disclosure: Both Dr. Volek and Dr. Phinney are friends and colleagues of mine.  But they did not send me a copy of their book for review.  I purchased it from Amazon and paid the full price of $29.95 (it is now $19.95).  I bought it months ago and carried it with me all over Europe and on a half dozen other trips since but didn’t have time to even crack it until I was on the last leg back from our holiday trek.  It sounds cliché, but I couldn’t put it down.  I read and annotated the entire book over the course of two long flights.  Virtually anything anyone could want to know about the science behind low-carbohydrate dieting can be found in this book.

I’ll give you just one example.  It is common knowledge among many nutritionist, doctors and journalists that saturated fats are bad for us.  Most believe eating saturated fats leads to higher levels of saturated fats in the blood, which they inevitably describe as ‘artery-clogging saturated fat’.  Drs. Volek and Phinney, who certainly don’t believe this nonsense, understand adaptation to a low-carbohydrate diet changes the way the human body metabolizes different fats.  Eating more fat on a low-carbohydrate diet speeds up the burning of fat in general and saturated fat in particular.

There are only three things the body can do with saturated fat from the diet (or saturated fat made from dietary carbohydrate — and, yes, the body can and does make saturated fat from dietary carbohydrate).  It can burn them, store them, or convert them to a mono-unsaturated fat.  When people go on low-carbohydrate diets, they reduce their insulin levels, which in turn allows fat to escape from the fat cells to become the body’s primary fuel.

But what happens when a person increases saturated fat intake as part of a low-carbohydrate diet?  Drs. V & P knew that saturated fat burning would increase, but would enough burn to offset the extra amount of saturated fat coming in as part of a high-fat, low-carbohydrate diet?

To find out, they put 20 subjects on a low-carbohydrate diet for 12 weeks and another 20 subjects on a low-fat, high-carbohydrate weight loss diet for the same length of time.  The subjects in the low-carb group consumed three times the saturated fat per day (36 g vs 12 g) as did those in the low-fat group.  The blood from the subjects in both groups was then tested to determine total triglyceride level and specific fatty acid composition.

What did the good docs find?

In the serum samples done at baseline and again after 12 weeks, serum triglycerides  in the low fat group went from 187 to 151 mg per 100 ml, a tidy 19% reduction.  But in the low carb group, the before and after values were 211 and 104, a whopping 51% fall.  Both visually (just looking at the numbers) and statistically, the low carbohydrate group had a much greater (better) reduction in serum triglycerides.

The above should come as no surprise, because everyone knows that a low-carb diet reduces triglyceride levels.  But what about the amount of saturated fat in the blood?

As a proportion of the total, the low carb group had 33% saturates [saturated fatty acids] at baseline and 29% after 12 weeks, whereas the low fat group started at 30 and ended at 29%.  So after 12 weeks of dieting, the proportion of saturated fats in the blood triglycerides was the same for both groups despite the fact that the low carb group was eating three times as many grams per day of saturated fat in their diet.

But there’s more.  Because the low carb group ended up with blood triglycerides of 104 mg per 100 ml compared to the low fat group’s 151, they actually had about 30% less total triglycerides circulating in their serum.  So although the two groups had similar relative proportions of saturates, this means that the absolute serum content of saturates in the low-carb group was 30% lower than the low fat diet group.  So what we found, in a nutshell, is that despite a higher intake of saturated fat, the proportionate blood level of saturated fats did not increase, and their absolute levels fell dramatically with the low carbohydrate diet.

The bottom line on this point is that when our metabolism adapts to a low carbohydrate diet, saturated fats become a preferred fuel for the body, and their levels in blood and tissue triglyceride pools actually drops.

To summarize, a three times higher intake of saturated fats leads to a 30% drop in saturated fats in the blood of those following a low-carb diet as compared to those following a low-fat, high-carb diet.

Which means, of course, that if you want to decrease the artery-clogging saturated fats (should that be what you want to call them) in your blood, a low-fat, high-carb diet, the very diet almost every health care professional recommends for the job, isn’t the way to do it.  All you have to do is simply follow a low-carb diet.

The description of what happens to saturated fats in the blood during a low carb diet took two pages out of a 300 page book, so you can imagine how much content the entire book contains.

There is so much invaluable information in this book that I’m having to fight back the impulse to quote the whole thing.  You’ll learn

why you need more sodium on a low-carb diet and why the sodium prevents lean tissue loss,
why you need to increase fat intake during maintenance,
why a low-carb diet decreases inflammation,
why the low-carb, high-fat diet improves gall bladder function,
why excess carbohydrate converts to saturated fat and how,
what all the lipid parameters mean and how they’re affected by a low-carb diet,
and what the Paleolithic evidence tells us about diet.

And this list is just scratching the surface.  As I read this book, I kept marking parts that I needed to use for this blog.  In going back through, I would have to practically reprint the whole thing to give you just the important parts because the entire book is a gem.

Unlike most traditional diet books, The Art and Science of Low Carbohydrate Living doesn’t contain a lengthy section on how to execute a low carb diet.  There are plenty of books out there – some written by MD and me – that do that.  The book does have about 10 pages of the authors’ favorite recipes for low-carb foods and a seven day meal plan incorporating many of these recipes. (Another disclosure:  The authors recommend Protein Power as a good book on low-carb dieting, but I would have written this review the same had they never mentioned our book.)

The strength of this book isn’t in its meal plans and recipes, although those are delicious, it is in the wealth of information about all aspects of low-carb dieting.  If you have a question, almost any question, about any facet of low-carbohdyrate dieting, this book will have the answer.  And the answer will grounded in science, and in many cases from work done by these two scientists on the front lines of low-carbohydrate research.

As far as I am concerned, if you are planning on going on a low-carb diet and can afford only one book, make The Art and Science of Low Carbohydrate Living that one book.  If you are a long time low-carber, this is the one essential reference book you should have on your shelf.

If you are getting going on a low-carb diet the first part of this year, grab this book before you do another thing.  Once you see the world of benefits that will accrue to you from following such a diet, you will probably be able to overcome any depression that may have been inflicted on you from my last post.  So don’t hold off, grab a copy of this book today.  You will be very glad you did.

Over a half decade ago Professor Jared Diamond, in his Pulitzer Prize-winning book Guns, Germs, and Steel, famously wrote

“The adoption of agriculture, supposedly our most decisive step toward a better life, was in many ways a catastrophe from which we have never recovered.”

Dr Diamond was referring, of course, to the devolution of human health that took place as mankind suffered the corporal transformation driven by the mismatch between hunter-gatherer genes and an agricultural diet and lifestyle. Smaller stature, decreased cortical bone thickness, obesity, increased incidence of infectious diseases, dental caries, periodontal disease, vitamin deficiencies, and even famine – all common in agriculturists – were not, for the most part, the lot of pre-agricultural man.

Humanity doubtless gained more than it lost in this hunter to farmer changeover when viewed in a big-picture sort of way.  Farming made possible larger communities filled with workers, workers who, for the first time, made specialization of labor a possibility.  And fewer people could till the fields and provide food for the many, freeing the others to pursue the arts, business, politics, and warfare.

Stephen Budiansky, author of one of my favorite books, Covenant of the Wild, describes how domestic animals formed a pact with humans in which the animals traded a period of safety and survival for their lives.  Had this covenant not been made, it is highly likely – virtually a certainty – that cows would now be extinct.  Big, slow, stupid and tasty, had they not been amenable to domestication and entered into the covenant with their domesticators, cattle would have been hunted to extinction long, long ago.  But they did – however unwillingly – make the covenant and so exist by the tens of millions today.  The deal they cut was a phenomenal deal for cattle as a species, but not a particularly good deal for the individual cow when the time comes to pay up at slaughter.

Homo sapiens entered an almost mirror image of this same covenant when they domesticated cereal grasses.*  We gave up our independence and mobility for the promise of a constant and plentiful food supply.  But, as with our covenant with domestic animals, there is a catch.  And this time it’s with us.  Humans emerged from this deal with the short end of the stick.  In the same way as did cattle, we made a good-for-humans-as-a-species/bad-for-the-individual-human trade.  Like it or not, we traded the health of the individual human for the overall good of mankind and the development of civilization.

We traded a diet based primarily on fat and protein with a little carbohydrate thrown in from roots, shoots and tubers for one centered predominantly on carbohydrate.  The main source of the carbohydrate was cereal grains, chiefly ancient forms of wheat, the predecessor of the wheat that now occupies a large part of the human diet everywhere.  Ancient forms of wheat didn’t do our forebears a lot of good, and, according to Dr. William Davis’s new book Wheat Belly, the modern forms of the grain do us even less good.

Before we get to the problems modern hybrid wheat causes us, let’s take a look at the afflictions a diet of primitive wheat visited upon our predecessors.

The ancient Egyptians consumed a diet that would be considered optimal by many people today.  Both wealthy and poor Egyptians consumed primarily bread and a type of cloudy, almost gruel-like beer.  To these staples were added a variety of vegetables (mainly onions), and a small selection of game, fish and meat.  The bread was made from coarse ground, whole grain emmer wheat, a primitive, high-protein wheat.  Sugar didn’t come on the scene until about 1000 AD, so the Egyptians used honey sparingly (it was expensive) as a sweetener along with figs.  In short, these people consumed a diet the vast majority of modern nutritionists would prescribe to people to prevent obesity, heart disease, obesity and the rest of the diseases associated with the Western diet.

But, as their mummified remains and their contemporary artwork demonstrate, the ancient Egyptians were often fat and were riddled with heart disease, dental caries, bad periodontal disease and no doubt diabetes and hypertension.  Many people have argued that since only the wealthy were mummified, the mummy data applies only to them, and since the wealthy ate more red meat, the rates of obesity, heart disease and the other disorders common to them didn’t apply to the rest of the population.  Even the common man, however, was often portrayed as obese in Egyptian artwork, and despite greater consumption of meat, the main staple of even the wealthy was bread and beer. And it didn’t do them a lot of good.

The 5,300 year old mummy of Ötzi the Iceman found in the Italian Alps showed a bad case of dental caries and periodontitis along with a stomach-full of einkorn wheat (another primitive variety). Said the researchers who examined Ötzi:

Although the Iceman did not lose a single tooth until the his death at an age of about 40 years, he had an advanced abrasion of his teeth, profound carious lesions, and a moderate to severe periodontitis.

In particular, the molars of the upper jaw showed loss of alveolar bone as a sign of periodontitis (inflammation of the ligaments and bones that support the teeth), while evidence of “mechanical trauma” was found on two teeth.

…the most surprising find is the high frequency of cavities.

These dental pathologies are a sign of change in the Neolithic diet.

We already know that he was eating grains, such as einkorn or emmer. The contained carbohydrates clearly increased the risk of developing dental diseases

One would assume these findings would be common among the rest of Ötzi’s contemporaries, who doubtless consumed a similar diet.

Sadly, these same findings are also common among modern man who consumes a more malign version of primitive wheat.

Until I read Dr. Davis’s book Wheat Belly, I didn’t really think much about wheat other than its being a major source of carbohydrate in the American diet.  It never had occurred to me that the wheat we eat today is not the same wheat of our great-grandmothers cooked with nor probably even our grandmothers.  And it really hadn’t dawned on me how pervasive wheat is in the diet.  Since reading Michael Pollen’s The Omnivore’s Dilemma I had been conscious of the amount of corn in our modern diet, but I hadn’t thought much about wheat.  As Yogi Berra supposedly said, “You can see a lot just by looking.”  So I went out and looked.  And I can tell you that we are much more Children of the Wheat than we are Children of the Corn.

In most grocery stores, an entire aisle is devoted to nothing but bread in all its forms.  Then there is typically another large aisle full of cakes, cupcakes, cookies, pies, tarts, sweet rolls, bagels, croissants, brownies, and other sweet baked goods.  The vast majority of the cereal aisle displays products containing primarily wheat.  And if you look at processed foods of all kinds, you’ll find wheat in there.  If you make or buy gravy, roux, or just about any kind of sauce, you’ll find it’s thickened with wheat flour. (MD bought some demiglace a few days ago, and noticed as she was removing it from the container that even it had added wheat.) Then there is the aisle full of different beers, many of which are made with wheat.  These are just a few of the items you can find containing wheat in a grocery store; don’t even get me started on restaurant fare.  Wheat is everywhere – corn should be so lucky.

When I was roaming around looking for pictures of dwarf wheat (more about which later), I came upon the website for the Kansas Wheat Commission that listed a few facts about wheat.  Here are several that caught my eye.

Wheat is the primary grain used in U.S. grain products.  Approximately three-quarters of all U.S. grain products are made from wheat flour.

More food is made with wheat than any other cereal grain.

U.S. Farmers grow nearly 2.4 billion bushels of wheat on 63 million acres of land.

About half the wheat grown in the United States is used domestically.

A little back-of-the-envelope calculating using the above statistics tells us that each of us in the United States consumes about four bushels of wheat per year.  Another statistic from the linked website states that each bushel of wheat makes about 90 one-pound loaves of whole wheat bread.  So, we all eat the equivalent of 360 loaves of bread per year, or approximately one loaf per person per day. That’s a lot of wheat, in fact, it’s almost approaching ancient Egyptian levels. (Moreover, since MD and I don’t eat any, that means two other people out there are each eating two loaves per day.)

It would be bad enough if we consumed all this wheat as emmer or einkhorn or other primitive varieties, but we don’t.  We get most from a hybrid of Triticum aestivum – our great grandmother’s wheat – called dwarf (or semi-dwarf) wheat, which now comprises more than 99 percent of all wheat grown worldwide.

As Dr. Davis tells it, the hybridization of wheat came about in an effort to improve yield, which is now about tenfold greater per acre than it was a century ago. Older strains of wheat were taller and more prone to damage from wind and rain.  And

When large quantities of nitrogen-rich fertilizer are applied to wheat fields, the seed head at the top of the plant grows to enormous proportions.  The top-heavy seed head, however, buckles the stalk.  Buckling kills the plant and makes harvesting problematic. A University of Minnesota-trained geneticist…is credited with developing the exceptionally high-yielding dwarf wheat that was shorter and stockier, allowing the plant to maintain erect posture and resist buckling under the large seed head.  Tall stalks are also inefficient; short stalks reach maturity more quickly, which means a shorter growing season with less fertilizer required to generate the otherwise useless stalk.

In the photos below you can see the difference between wheat grown in the Middle Ages and the dwarf wheat grown today.

Dr. Davis writes that modern wheat is approximately 70 percent carbohydrate by weight.  The carbohydrate is in the form of a starch called amylopectin A.

The most digestible form of amylopectin, amylopectin A, is the form found in wheat.  Because it is the most digestible, it is the form that most enthusiastically increases blood sugar.  This explains why, gram for gram, wheat increases blood sugar to a greater degree than, say, kidney beans or potato chips.  The amylopectin A of wheat products, “complex” or no, might be regarded as a supercarbohydrate, a form of highly digestible carbohydrate that is more efficiently converted to blood sugar than nearly all the other carbohydrate foods, simple or complex. [Italics in the original.]

But what about the much vaunted whole grains.  Won’t ‘whole grain’ bread or wheat products be better?  Not according to Dr. Davis:

…the degree of processing, from a blood sugar standpoint, makes little difference: Wheat is wheat, with various forms of processing or lack of processing, simple or complex, high-fiber or low-fiber, all generating similar high blood sugars.  Just as “boys will be boys,” amylopectin A will be amylopectin A.  In healthy, slender volunteers, two medium-sized slices of whole wheat bread increase blood sugar by 30 mg/dl (from 93 to 123 mg/dl), no different from white bread.  In people with diabetes, both white and whole grain bread increase blood sugar 70 to 120 mg/dl over starting levels.

And aside from the blood sugar and, consequently, insulin problems caused by the consumption of too much wheat, there are other problems.  As with almost any food, the newer the food, the greater the likelihood that it will be problematic to some humans who consume it.  Since dwarf wheat has been around for less than 50 years, it should come as no surprise that it does indeed cause it’s share of problems.  Dr. Davis spends the better part of his excellent book detailing many of these problems and describing his clinical experience in helping many of his patients shuck their wheat habit.  He describes the increase in celiac disease over the past 50 years and believes, as I do, that celiac disease is a continuum.  The severe form of it that is recognized as celiac disease is pretty easy to diagnose (if a doctor has sense enough to look for it), but there are milder forms that manifest themselves as anything from mysterious rashes that come and go to diarrhea and other GI disturbances to arthritic aches and pains. And we can’t forget a number of other afflictions that may well have their basis in wheat intolerance that include osteoporosis, acne (bagel face?), neurological disorders, and the creepily- dubbed ‘man boobs.’

It’s good to learn in Wheat Belly that Dr. Davis has finally shucked his bred-in-the-bone cardiologist’s antipathy toward fat in general and saturated fat specifically and has come over to what most of his peers must view as the dark (read: low-carb) side:

The fat phobia of the past forty years turned us off from foods such as eggs, sirloin, and pork because of their saturated fat content — but saturated fat was never the problem.  Carbohydrates in combination with saturated fat, however, cause measures of LDL particles to skyrocket.  The problem was carbohydrates more than saturated fat.  In fact, new studies have exonerated saturated fat as an underlying contributor to heart attack and stroke risk. [Italics in the original.]

Dr. Davis wraps up his meticulously researched book with a straightforward plan to help free the reader from the tyranny of wheat, while at the same time providing instructions for a delicious and satisfying wheat-free diet.  He furnishes an extensive list of wheat-containing foods that should be avoided and imparts his caveats about going facedown in products advertised as being gluten-free.  And best of all, he provides a short section filled with matchless wheat-free recipes for many meals that would otherwise be wheat-laden. (MD and I have tried a few of these recipes and found them to be superb.  I especially enjoy his wheat-free granola recipe even though I go a little easy on the rolled oats part of it.)

Wheat Belly hit the New York Times Bestseller list shortly after it came out (and has been there for two weeks now), which I can tell you from experience, is not an easy thing to do.  As a result (because being on the NY Times list means a book has had big sales numbers), the wheat producers have not taken their hits lying down.  They’re fighting back with full venom, because a book like this one can do them serious economic damage. Expect it to get worse. (Remember all those shelves in the grocery stores stuffed with wheat-containing products? They don’t want to see that go away.)  You can read about some of their tactics here and read Tom Naughton’s interviews with Dr. Davis here and here.

I can’t recommend this terrific book highly enough.  Wheat Belly is fully referenced and indexed (unless you somehow got the little freebee paperback review version that I received from the publisher), and is a must have for the library of any serious low-carber or anyone concerned about health.

*MD and I wrote about this domestication of humans by grains in The Protein Power LifePlan.  In that book we referenced an interesting paper by a couple of Australian researchers on the hypothesis that the addictive nature of cereal grains helping this domestication along.

Of all the dangerous ideas that health officials could have embraced while trying to understand why we get fat, they would have been hard-pressed to find one ultimately more damaging than calories-in/calories-out. That it reinforces what appears to be so obvious—obesity as the penalty for gluttony and sloth—is what makes it so alluring. But it’s misleading and misconceived on so many levels that it’s hard to imagine how it survived unscathed and virtually unchallenged for the last fifty years.

It has done incalculable harm. Not only is this thinking at least partly responsible for the ever-growing numbers of obese and overweight in the world—while directing attention away from the real reasons we get fat—but it has served to reinforce the perception that those who are fat have no one to blame but themselves. That eating less invariably fails as a cure for obesity is rarely perceived as the single most important reason to make us question our assumptions, as Hilde Bruch suggested half a century ago. Rather, it is taken as still more evidence that the overweight and obese are incapable of following a diet and eating in moderation. And it puts the blame for their physical condition squarely on their behavior, which couldn’t be further from the truth.

Gary Taubes from Why We Get Fat

While trying to catch up on my reading before piles of Financial Times, New York Times and Wall Street Journals consume our living space, I came across a review of Donald Rumsfeld’s book, Known and Unknown.  The title of which was taken from one of his orotund responses to a reporter about the various kinds of knowledge we have.  Said he:

There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.

Mr. Rumsfeld believes the last of the above, the things we don’t know we don’t know, is the most problematic.  I disagree.  I think the first gets most people in trouble most of the time.  And this includes Rummy himself.

It ain’t so much the things we don’t know that get us into trouble. It’s the things we know that just ain’t so.

So opined Henry Wheeler Shaw (AKA Josh Billings), who said it a lot more memorably well over a century ago in a quote often misattributed to Mark Twain, Will Rogers and others.

One of the things countless people ‘know’ that just ain’t so – or at least that ‘just ain’t so’ as they think they know it – is that people get fat because they eat too much or exercise too little.  In the minds of many, it’s all a matter of calories in versus calories out.  Which is a really meaningless statement of the problem, but which leads inexorably to the conclusion that people get fat because they are either gluttonous or lazy or both.  The so-called Gluttony and Sloth model for obesity.

Why is the calories in vs calories out notion so meaningless?  If more calories come in than go out, you gain weight, and if more calories are expended than come in, you lose weight.  Seems reasonable.  It’s a bewitching notion, because it is absolutely true but at the same time absolutely meaningless.  It tells us nothing.  Let me digress to explain using a painful example from my own past.

Almost 20 years ago I singlehandedly dragged my family into the restaurant business.  I bought a franchise for a Mexican food place. (If you’re interested, you can read more about it here.) I recruited (read: dragooned) all our children to operate it, and despite all our best efforts, the venture ended in disaster.  But during the run, I spent a lot of time in the restaurant.  And one of the constant conversational threads was why it was or wasn’t busy at any given time.  We would have a Saturday afternoon during which few people came in.  As a consequence, the next Saturday we would schedule a skeleton crew, and we would be slammed.  Then someone would realize that there was a Razorback football game in Little Rock that weekend, which would explain it.  Or so we thought. Sometimes for no apparent reason we would have people swarm in.  There would be a line out the door with more showing up by the minute.  We would all be working like dogs to get everyone served, all the while saying to ourselves and to one another: What the #$&**!!# is going on? Why are we so packed?

Now imagine if during one of these rushes, one of us had said, It’s really quite simple:  we’re so crowded because there are way more people coming into the restaurant than there are people leaving.  We all would have looked at the person uttering such nonsense as if he/she were the village idiot.  But the statement is absolutely 100 percent correct.  That’s why we were so busy.  More people coming in than going out.  But it doesn’t really answer the question at hand.  What we want to know is why so many people are coming in?  A Razorback game? A big sale at the department store next door? A good review in the paper that we weren’t aware of? A bus full of people broken down outside the front door?  Why are there so many more people coming in than going out? If we could figure out the why, then we would have an easier time scheduling staff.*

It’s the same with the calories in/calories out notion.  If you’re fat, you’ve been taking in more calories than you’ve been expending.  No one would argue that.  At least no one with good sense.  But the question is, why?  Why have you been taking in more than you’ve been expending?  That’s the question you want to have answered, because only when you discover the answer can you figure out why you’re fat and what to do about it.

Gary Taubes has done the figuring and writes about it in his new book, Why We Get Fat And What To Do About It (WWGF).  As most readers of this blog know, a few years ago Gary wrote a long, detailed book on what we can call the Carbohydrate Theory of disease, titled Good Calories, Bad Calories (GCBC).  Now he has come out with what many think is a slimmed-down version of GCBC, called by some GBGC-Lite. But it’s not really a lite version of GCBC – it’s something much different.  I call it GBGC-Fat.  I would append the term ‘fat’ because it’s about fat – adipose tissue – and why so many of us struggle so mightily to rid ourselves of superfluous wads of it.

WWGF is a great primer on fat gain, fat loss and just about everything having to do with obesity.  I read GCBC three times, starting with the first manuscript version and ending with the actual book.  I’ve done the same with WWGF, so I can assure you that it is not a rewrite of GCBC, but is mainly new material presented in a much easier to assimilate way.  As many people have discovered, trying to get their doctors or other non-believers to read GBGC is a tough sell.  Few, who aren’t already converts, can summon the will to dig in to a book that large.  The new book is much less intimidating than GCBC, but just as compelling.  Even the title is better and more seductive.  Who wouldn’t want to know why we get fat?

In his efforts to ferret out why we do get fat, Gary, an obvious follower of the Samuel Johnson admonition that we more often need reminding of old truths than instruction in new ones, looks to the pre WWII scientific literature for the ‘old truths’ that are still valid. One of which is that carbohydrates fatten both livestock and people.  If you think about it, it’s difficult for the current crop of academics to intuitively grasp this notion, because they have been inculcated from the time they entered kindergarten with the ‘dietary fat is bad’ mantra.  That kind of deep-seated learning is hard to shake.  Especially so, since when today’s academics were students, their mentors, who had built their own careers (all way post WWII) on the very same mistaken notion about fat, wouldn’t likely have provided much inspiration for their young charges to change.

So, why do people get fat?  Let’s look at it as Gary does and start from the beginning.

When we talk about obesity, we’re talking about the excess accumulation of fat.  The excess fat is stored in the fat cells (adipose cells), which, collectively make up the adipose tissue.  With that as our starting point, where do we go?

If we ask how the fat gets into the fat cells, we will discover that all the pathways of fat storage were worked out years ago and are so uncontroversial that they’re described in detail in every biochemistry and physiology textbook currently in use.  It’s well known that the metabolic hormone insulin stimulates an enzyme on the surface of the fat cell that moves the fat into the cell.

So if insulin moves fat into the fat cells, it would seem that a lot of insulin would move a lot of fat into the fat cells.  And indeed it does.  Given this, the rational person trying to figure out the previous step in our progression would ask What causes a lot of insulin?  Or the rational person, should he/she have been steeped for a lifetime in the marinade of ‘fat is bad’ might ask, What about fat?  If there is a lot of fat in the blood as a result of fat in the diet, wouldn’t that fat get into the fat cell?  If so, then doesn’t dietary fat lead to fat?

A good question, but the answer is no.  Type I diabetics can have a lot of fat in their diets and in their blood, but if they have no insulin, they can’t store that fat.  In fact, most pre-diagnosis type I diabetics lose enormous amounts of weight despite eating ravenously because without insulin they can’t store the fat.  So dietary fat itself – even large amounts of it – won’t find its way into the fat cell without the help of insulin.

When you hack through the thicket of all the biochemical pathways involved in the metabolic process, you find that insulin is the primary force involved in the storage of nutrients.  Insulin is the body’s storage hormone: it puts fat in the fat cells, protein into muscle  cells and glucose into it’s storage form, glycogen.  Insulin, along with its counter-regulatory hormone glucagon (the Yin and Yang of metabolism), are involved in nutrient partitioning – the process of stashing nutrients away in different parts of the body and/or harvesting them for the body to use as energy.

If we have a lot of insulin, the insulin dominant-pathways (the storage pathways) hold sway, and fat is partitioned away in the fat cells; if insulin is low, then the glucagon-dominant pathways (the energy-release pathways) take over and start moving fat out of the fat cells, so it can be consumed by the body as fuel.  This is how it is supposed to work.  We eat.  Insulin comes out and stores away the energy.  We go for a while without eating, insulin goes down and glucagon comes out to retrieve our stored fat so we’ll have a continuous energy supply.

Problems arise when this system goes off the rails, which most commonly happens when people develop insulin resistance, a problem of disordered insulin signaling.  Insulin talks, but the cells don’t listen.  So insulin keeps talking louder until the cells finally get the message. In other words, the pancreas keeps producing insulin and the blood levels continue to rise until the cells finally get the message.  But it’s a message that has taken a lot of insulin force to deliver.

If all the different types of cells developed resistance to insulin at the same rate, we wouldn’t have as much of a problem.  But they don’t. Different cells develop insulin resistance at different rates.  Typically the first cells to become insulin resistant are the liver cells.  The liver cells are continuously producing sugar and dumping it into the blood.  Insulin shuts this process down.  If the insulin level drops to zero, as it does in type I diabetes, the liver dumps a huge load of sugar in the blood causing all the blood sugar problems associated with this disease.  Under normal circumstances, just a little insulin stops the liver cells in their tracks.  But if these cells are resistant to insulin, much more is required to get them the message to turn off the sugar spigot.

In most people, the fat cells develop insulin resistance later, which creates the problem.  If insulin levels are high to control the liver’s sugar factory output, then these elevated insulin levels are sending a strong message to the non-insulin-resistant fat cells.  The message is take this fat and store it.  High insulin not only drives fat into the fat cells, it prevents it from getting out.  Fat is packed into the fat cells and kept there.

Between meals when insulin levels would normally fall, allowing the liberation of fat to feed all the body’s tissues, insulin remains high in an effort to keep the liver in check.  Fat can’t get out of the fat cells, and the tissues begin to starve.  Even though there is plenty of stored fat, the body can’t get to it because elevated insulin is preventing its release.

Starving tissues send a message to the brain, saying ‘we’re hungry.’  The brain responds by increasing the drive to feed.  We eat, and the carbs we eat are consumed by the cells for immediate energy, and insulin stimulated by the dietary carbohydrate drives the fat into the fat cells where it is trapped with the rest of the fat already there.  The fat cell mass gets larger and larger, and we become obese.

The above scenario explains a lot.  Why can some people eat like crazy and not get fat?  Perhaps because they develop insulin resistance in their fat cells just as they do in their liver cells.  They don’t get fat, but they typically have all the other insulin-driven problems of the obese: high blood pressure, elevated triglycerides, increased risk for heart disease, etc.  And all while staying skinny.

How about morbid obesity?  Easy.  Those people don’t develop insulin resistance in their fat cells until late in the game, if ever.  They continue to push fat into the fat cells and become more and more obese until they weight 400-500 pounds or even more.  The average person will finally develop fat cell insulin resistance before the morbid obesity stage.  When this happens, weight and level of obesity stabilize and stay the same, almost irrespective of how much is eaten.

We now know why we get fat.  Excess insulin drives fat into the fat cells increasing the fat cell mass, ultimately leading to the state we call obesity. If we keep walking this progression back, the next question has to be, Why do we make too much insulin?

We make too much insulin because we eat too many carbohydrates, especially sugar and other refined carbohydrates.  With that statement, we’re starting to edge into controversial territory, but it’s only territory populated by the ignorant.  The hard science is emphatic that carbs are a pure insulin play.  Eat them and your insulin goes up.

Some people with a little learning may be quick to point out that protein drives insulin up as well.  This is true, but with a catch.  Protein drives both insulin and glucagon up, so you don’t have the pure insulin effect.  Only carbs will give you that.  With carbs, insulin goes up while glucagon goes down.  With meat and other proteins, the effects of the elevated insulin are muted by the concomitant rise in glucagon. (Glucagon isn’t called insulin’s counter-regulatory hormone for nothing.)

As Gary lays out the progression, carbs increase insulin, excess insulin drives excess fat into the fat cells, the fat cell mass grows, and we become fat.  This chain of cause and effect leads to the ineluctable conclusion that excess carbohydrate intake leads to obesity.  And each and every link forged in this chain is scientifically unimpeachable.

So if you are fat and want this progression to reverse itself, wouldn’t it make sense to reduce your carbohydrate intake?  All the science is valid.  But don’t just take my word for it. Gary writes of a former Harvard professor responsible for much of the early work in the field of the regulation of fat accumulation who summed it up like this:

Carbohydrate is driving insulin is driving fat.

If you put that in reverse, you should cut the carbs, reduce the insulin and lose the fat.  Seems simple, but here is where all kinds of controversy rears its head. Even the very smart Harvard professor who did the original work and uttered the above quote, when asked by Gary why there is so much obesity, responded that people didn’t exercise enough. Which also proves true what Saul Bellow wrote years ago:

A great deal of intelligence can be invested in ignorance when the need for illusion is deep.

As I’ve written numerous times in the pages of this blog, food is made of three things: fat, protein and carbohydrate.  When you decrease one, you typically increase the other.  If you cut the carbs, you’re going to increase the fat and protein in your diet.  And it’s the increased fat in particular that leads to all the controversy.

The current zeitgeist is that dietary fat, especially saturated fat, is bad.  And not just bad, but extremely bad.  So, even though they may understand that carbs drive fat storage, the ingrained fear of fat keeps many otherwise smart people from accepting the merits of the low-carbohydrate diet.  To escape the cognitive dissonance, they default to the calories in/calories out argument, which, as we’ve seen, is meaningless.  But they feel safe taking refuge in what they believe is a known known. More’s the pity since it will end up doing them about as much good as it did Rummy in the Iraq war.

Most rational people will find the above argument understandable and be able to connect the dots showing that carb intake leads to excess insulin leads to obesity.  The difficult concept for many to grasp, however, is the other problem with too much insulin: it prevents the stored fat from being accessed for energy. Normally adipose tissue acts as a reservoir of energy.  We eat, we convert the food we don’t immediately use into fat, and the body – acting via insulin – stashes it away for later.  When later comes, insulin falls, glucagon rises, and the body starts harvesting it’s stored fat to provide energy for all the cellular functions.  Then we eat, and the process starts anew.

In obese people it’s different.  They eat, they use the food for immediate energy needs and store the rest away.  In other words, they store excess energy away in their fat cells just like non-obese people do.  It’s the second part of the formula that is different.  In obese people, insulin is almost always elevated – even when they haven’t just finished a meal.  These chronically elevated insulin levels trap the fat in the fat cells, and, in fact, turn the fat pathway into the fat cell into a one-way street.  Fat can get in, but it can’t get out. If the fat does get out, the excess insulin tells the mitochondria not to burn it anyway, so it just gets sent back to the fat cells.

What does this mean for an obese person?

Let’s look back at the non-obese person to explain.  A non-obese person eats, uses the energy from the food and stores the rest.  During the time between meals and during sleep, the non-obese person draws on the stored fat to provide energy.  When the fat cell mass decreases to a certain critical point, the body signals the brain that the fat cells need a refill, so the brain initiates the hunger response.  The non-obese person eats, uses some energy for immediate needs, fills the fat cells with the rest, uses the stored energy as needed, and then the cycle repeats.

It doesn’t work that way in the obese.  Obese people eat, use the energy required for immediate needs and store the rest.  But–and this is the extremely important ‘but’– during the time between meals and during sleep, obese people can’t access their fat stores because their baseline insulin is too high.  When they can’t get to their stored fat, the lack of access to energy sets in motion all the same biochemical signals in the obese person that get sent in the non-obese, who have depleted the energy storage in their fat cells.  And these signals are converted by their brains into the drive to feed, i.e., intense hunger.  They have to eat to provide for their immediate energy needs because, thanks to chronically elevated insulin levels, they can’t get into to their own stored fat, even though it’s there waiting in massive quantities.

To use an analogy, it would be like being out of cash when you desperately needed it yet having a huge amount of money in the bank.  You hustle to an ATM machine and find your card won’t work.  It’s the same with the obese – they have plenty of energy to go without eating for months, but their fat ATM cards don’t work.  And since their fat ATM cards don’t work, the only option they have for immediate energy is to eat.

So fat people are fat not because they overeat – they overeat because they’re fat.

A real debt of gratitude is owed Gary for combing the old literature and ferreting out this notion.  As early to mid-twentieth century, researchers both in Europe and America had determined obesity is a disorder of fat accumulation, not a problem of ‘perverted appetite,’ self control, or gluttony and sloth.  Louis Newburgh, Ancel Keys, Jean Mayer and a few others were responsible for turning the herd thinking of academia in a different direction, and the ‘eat less, exercise more’ paradigm has been with us since. It’s doubtless not a coincidence that the obesity and diabetes epidemics have flourished as a consequence.  As I say, Gary deserves a lot of credit for resurrecting this old work and starting to turn opinion in the other direction.

In addition to the chapters describing and discussing the mechanisms by which we get fat, Gary has included other important material in his book.  One of my favorite chapters is the one titled “The Nature of a Healthy Diet.”  Although you wouldn’t know it from this title, the chapter fairly presents most of the arguments against low-carbohydrate diets and refutes them.  I’m sure many will find these refutations helpful in their dealings with naysayers, who seem compelled to point out non-existent problems with carb-restricted dieting.  There is one in particular that I plan to deploy at the next opportunity.  Since I have my own arguments against the rest of the anti-low-carb idiocy, it annoys me greatly that I didn’t think of this one myself.

Here is a scenario I often endure at a party or other get together after my identity as a diet book writer and low-carb expert has been revealed:

Other person, OP (typically an overweight female): I tried a low-carb diet once.

Me: (Dreading what’s sure to follow.) Oh, really.

OP: Yes, and it worked for a while, but I couldn’t stick to it.

Me: Oh, really?  Why not?

OP: Well, I felt tired and spacey headed.

Me: People sometimes experience those symptoms early on, but they usually resolve after a couple of weeks.  And there are steps you could’ve taken to prevent or minimize them.

OP: No, I don’t think so in my case.  I know my body, and I know what it’s telling me.  I’m just one of those people whose body needs carbs.  As soon as I started eating carbs again, I felt much better.

Me: (Fighting down the impulse to point out that she’s still fat…) Hmmm.  Maybe so.
Now, thanks to WWGF, I’ll know just what to say.  I’ll leave you with the relevant paragraph from the book along with my highest recommendation to grab a copy and read it.  I can promise you won’t be disappointed.

The more technical term for carbohydrate withdrawal is “keto-adaptation,” because the body is adapting to the state of ketosis that results from eating fewer than sixty or so grams of carbohydrates a day.  This reaction is why some who try carbohydrate restriction give it up quickly. (“Carbohydrate withdrawal is often interpreted as a ‘need for carbohydrate,’ ” says Westman.  “It’s like telling smokers who are trying to quit that their withdrawal symptoms are caused by a ‘need for cigarettes’ and then suggesting they go back to smoking to solve the problem.”)

* Full disclosure:  In the first draft of WWGF I read, Gary had used the crowded restaurant example to explain why the calories in/calories out explanation was so ridiculous.  It reminded me of our dismal times in the restaurant business, and I thought it was a brilliant way to demystify the problem.  In one of the later drafts I read, the restaurant example was missing.  I asked Gary about it, and he told me he and his editor had decided it wasn’t the best way to describe the situation.  I disagreed (probably because my financial wounds from the restaurant biz, though long past, were still painful) and told Gary I thought it was a terrific way to explain it and that if he didn’t use it, I would rip it off and use it as my own.  Although he has used the examples in lectures, Gary didn’t use it in the book, so, true to my word, I ripped it off as my own.

This post is going to be one of those potpourri posts that allows me to catch up on a few issues that aren’t significant enough to require a post for each one.

Lubricant

I want to start out with a funny Q & A that I can across while catching up on my The Spectator reading on one of the countless flights I’ve been on lately.  As most of you who are regular readers of this blog doubtless know, I am a huge The Spectator fan.  I love the writing, the book reviews, the movie reviews, and even the advice column.  Said column is written by a woman named Mary Killen who deals with the social conundrums of the British gentry class.  Her columns are not of the ‘Me and my uncle got in a fight after I yelled at him for crushing my cigarettes during sex. He ran off but I still love him. What can I do to get him back?’ variety that are more typical over here.  Those Mary routinely deals with are of a more genteel variety, and she typically dispenses invaluable advice as she does to the questioner below:

Q. Please can you advise on a matter that, although seemingly trivial, is causing some tension in our household. Like many families, rather than spreading butter on our toast at breakfast time, we have switched to one of the supposedly healthier alternative low-fat spreads. Our problem is by what name should we refer to this new product? My wife continues to ask if I’d please pass the butter, but as it isn’t butter, I find this irksome. If I refer to it as margarine, she is annoyed by the implication that we are using some inferior low-quality butter substitute. To request that someone passes the low-fat spread is hardly elegant. Please, Mary, can you advise on the correct terminology?

C.S., Woodbridge, Suffolk

Why not use the word ‘lubricant’? The products to which you refer are, technically, lubricants, and when you have guests they will enjoy laughing at your use of this term.

Hilarious, no?’  And a great idea.  We never, ever use margarine or its low-fat equivalent, but now I wish we did just so I could call it ‘lubricant.’  Perhaps from now on I’ll start asking: Is this butter or is it lubricant?’  The possibilities are endless. I encourage everyone to start using the term.’  Makes this schlock sound like what it really is.

New shipping policy

As many of you may know, we have a products page on our website that can be accessed from the tab at the top of this blog labeled, appropriately enough, Products.  We never intended to be in the ‘products’ business, but when our first book Protein Power came out, our clinic in Little Rock was inundated with phone calls from readers wanting to know how they could purchase the specific supplements we used with our patients.  We began providing these supplements to readers who called from all over the place.

When we moved our clinic to Boulder, Colorado in 1998, we changed our practice from a local one to a more national one since, thanks to the success of Protein Power, people began coming to us from all over.  We put up a website listing the supplements we used so that people could purchase them directly instead of having to go through our receptionist, who wasn’t always available.  We have maintained some kind of online presence since.   But we have never really sold enough product to make it worth our fooling with.   We’ve always done it kind of as a service to those people who wanted to use the very supplements we used ourselves and used with our patients.

Since we never really paid much attention to the products or how many we sold, we simply set the price at whatever the different manufacturers recommended and added whatever the shipping and handling actually was to that price.  The shipping and handling fees were pretty high, but that’s what they actually were.  We backed up and looked at the whole operation a few weeks ago and discovered we were selling more product than we thought we had been, even with the high shipping.  When we figured our costs, we decided that we could underwrite some of the shipping and still pay expenses, including paying the outfit actually doing the warehousing and shipping.

We instituted new pricing for our shipping.  It is now $5.00 on any orders from $0.01-$100.00.  $3.00 for orders between $100.01 to $200.00.  And free shipping on orders over $$200.00. As those of you who have previously purchased from our website know, this is a huge decrease in the $10-$20 it used to cost.

For those who do purchase through this site and for those who enter through Amazon.com, a heartfelt thanks.  Virtually everything we make goes back into the site in upgrades and tech work.  These two sources of income are the only ones we have for this site since I decided that all the Google ads I used to have on the site were tacky and ditched them.

Just another reason I hate the government

Again, most readers of this blog know my libertarian leanings and sentiments, so I’m against vastly more government policies than I’m for.  One that really ticks me off to the max, however, is that governments (local, state and federal) all pass laws that they themselves don’t have to obey.  If congress had to abide by the laws congress passed, there would be a whole lot fewer passed.

On October 15 I had to mail in my tax return that I had to get extended because I had’t received all the documentation I needed to complete it.  When I got my completed tax return from my accountant, I discovered that I owed an extra $48 above and beyond what I had already forked over.  I was traveling and filed my return electronically but I had to somehow pay the $48.   My accountant sent me information on how I could pay electronically, which I did.   Of course I ran afoul of one of the many rules that the government plays by that it prevents others from playing by.   I don’t know how many people know this, but when you purchase goods or services on a credit card, the merchant who accepts the credit card has to pay a fee on each transaction.  This fee is typically about 2 percent.  So, if you buy $200 of groceries on your credit card, the grocer has to pay $4.00 to the credit card company.

Some clever merchants figured out long ago that they could avoid paying this fee by simply adding it to the price for anyone who paid by credit card.  So there would be two fees for any given product: one fee for payment by cash or check and another (about 2 percent higher) for those paying with credit cards.

Can’t have that, says the government.  Laws are passed so that no one can charge more to those who purchase via credit card.  (One wonders how much lobbying the big banks, MasterCard, Visa, Discover and American Express did to get these laws passed?)  So now, if you pay by credit card, you get the same price as someone paying by cash or check.  And the merchant eats the 2 percent.

But not the government, the same government that mandates that those in the private sector can’t charge more for credit card purchases.

As you can see below from the screen shot of my payment to the IRS, they charged me a ‘convenience fee’ of $3.89 on my $48.00 tax payment, which calculates to a little over 8 percent.  Just let a merchant try to squeeze a paltry (in comparison) convenience fee of 2 percent out of a buyer, and the same government is all over them.

What’s probably worse, is that I’ll bet the government beats the credit card companies into a much lower rate than the 2 percent most merchants pay.

Blog Comments

Once again, it’s time for me to whine about the comments.  Only this time it’s not a whine, I’ve solved the problem.  I think.  I’ve started just posting the comments pretty much as they come in.  I don’t know if I’ve developed a greater readership lately or what, but each post seems to generate about 200 comments, all of which I read.  But if I had to comment on each one, it would take me vastly longer than it took to write the post.  And I’m assuming that most people would rather read new posts than plow through the comments looking for my answers to specific questions.  I’ll continue to answer a comment here or there, but don’t feel ill used if your comment isn’t one of the ones answered because I simply don’t have the time to answer them all.

I had coffee a week or so ago with Richard Nikoley of Free The Animal.  He suggested I set up the comments to auto-post as they come in, which is how he does it on his blog.  He says it makes for a better dialogue among readers because they get instant feedback.  I’m tempted to do this, but I’m afraid if I do, I won’t read all the comments myself.  They’ll just hit the blog, and I wont know what’s going on.  Plus, nasty comments and spam (of which I get plenty despite a great spam filter) could make their way in.  If my new method doesn’t work, I may give Richard’s suggestion a try.  Any folks out there have a preference?

Finally, and once again, for the zillionth time for those who haven’t read it yet, I can’t make diagnoses and recommend treatment over the internet, so please don’t ask.  Thanks.

My nightstand, real and electronic

I realized in looking through the last few posts that I’ve fallen down on listing the books I’ve been reading. I’ve been traveling a huge amount lately (in fact, I’m writing this post at 37,000 ft between Dallas and Phoenix), so I’ve cut back a bit on my reading.  I usually stack up all my magazine reading and read it on a plane so I can jettison it along the way and lighten my load.  Since I’ve been traveling as much as I have lately, I still bring the magazines, but my book reading has suffered.

I’ve been reading most of my books on the Kindle app on my iPad simply because I don’t have the room to bring books on my carry-on along with all the magazines.  I’m somewhat limited in the books I get on Kindle because I absolutely refuse to pay more than $9.99 for an electronic book.  MD thinks I’m unreasonable, but I don’t care.  That’s my cutoff.  So, if any of the books discussed below can be had on the Kindle for less than ten bucks, that’s probably how I read them.  If they’re more than that, I got a real copy of the book.  We’re talking fiction here.  When I get non-fiction books, I almost always get the real thing so I can mark them up and go to the index and page back to what I’ve already read or check footnotes – all of which are difficult to do with a Kindle.

I’ve been working my way through The Paleo Solution by Robb Wolf, who graciously sent me a copy.  Since I have the hard copy and since I’ve been on the road so much, I haven’t finished it because I haven’t had it with me.  I very much like what I’ve read so far and plan to review it here when I’m finished.

I’m also reading Steven Johnson’s Where Good Ideas Come From in fits and starts because I have it in the hardcover version as well.  Steven (who is an avid golfer) and I have been trying to figure out when we can get together and play on one another’s home course.  He’s on a brutal (scheduling-wise) book tour and I’m all over the place myself.  The book, like all his books, is excellent, and I highly recommend it.  If you haven’t read his The Ghost Map, you should.

I just finished Christopher Hitchens’ Hitch-22, which I loved.  It starts out with his ruminating on his own death, which is kind of creepy since he found out he has terminal esophageal cancer in the early days of  his book tour.  And I’m sure it was growing away as he wrote the very words contemplating his own demise.  (If you haven’t read of his discovery of his disease, you can read about it in his own words here.) I especially enjoyed the last chapter of the book because it describes Hitchens’ changing his mind politically as he gained more experience and wisdom with aging. His description of the creeching that burst forth from his former political cronies and allies who felt he was a traitor to their liberal causes is something to behold.  I didn’t enjoy it because of Hitchens turn from liberalism because his politics and mine certainly aren’t the same, but because his description of what he went through is pretty much the same thing long time vegans go through when they publicly renounce their religion and begin eating meat. Most of you know the tough road that Lierre Keith has been tredding.

Reading Hitchens’ book inspired me to pick up copies of Martin Amis’s Money and his father, Kingsley Amis’s book Girl, 20.  I’ve just started both and they’re both hardcover so are sitting on my nightstand while I’m all over the place.

I’m slowing picking my way through a difficult but worthwhile and enlightening book called Bureaucracy in Representative Government.  It’s an older book published in 1971 (and recently republished, I noticed when checking Amazon) when economists, in a fury of jealousy at physicists, all thought they could prove economic laws with equations.  The book is equation and math heavy, but despite that is a thought-provoking read.  The author’s thesis is that bureaucrats running big government departments (including those at the very top, i.e., secretary of agriculture, treasury and all the rest) have the same goals and aspirations as all of us.  They want to increase their income, authority and prestige.  In business, one does this by being a better business person, negotiating deals with suppliers (which I’m learning all about now that I’m in the appliance business), pricing product correctly and running a profitable operation with good growth.  If you are the head of a bureaucratic agency, you achieve these goals – more income, authority and prestige – by increasing the number of people in your agency and increasing your agency’s budget.  As a consequence, no one in a position of bureaucratic authority wants to see his/her agency diminish in size, scope or budget.  Therefore, due to human nature as applied to bureaucracies, the size will always grow, making governments at all levels larger and larger.  It’s the natural state of things.  An interesting but sobering book that, due to its complexity, probably won’t be everyone’s cup of tea.

I read Peter Robinson’s latest book, Bad Boy, which I enjoyed much more than his last.  If you enjoy Brit detective fiction, any of Peter Robinson’s books are worth a read.  If you’ve been put off of Brit detective fiction because you have trouble understanding the British police hierarchy, try Robinson.  He grew up in England, but has spent the last 30 years in North America, so his books are much more accommodating to American readers than those of many other UK mystery authors.

Speaking of Brit authors, I just finished Quintin Jardin’s Death’s Door, a convoluted novel with a plethora of police characters that are all either married or are ex-spouses of one another.  It was okay, but it will be a while before I pick up another of his.

I recently read Long for this World, a semi-jaundiced view of the anti-aging movement and Aubrey de Grey, one of its leading proponents.  Some halfway decent science and a lot of really great insight into de Grey, who apparently consumes almost nothing but beer and constantly floats around in an alcohol-induced, semi-conscious state.  If you’re interested in the anti-aging movement, I recommend this book.  If you really want to read the best book on anti-aging I’ve ever read (and I’ve read them all), pick up a copy of Stephen Austad’s Why We Age.  It’s one of the best written and most interesting books I’ve ever read.  Pick it up and you’ll find out how Paleo man lived as long as we do.  You will then be prepared when you present the health benefits of the Paleo diet to someone and he/she responds inanely with, yes, but they all died in their 20s.

Last night I had one of those wonderful experiences that can be experienced only by book freaks such as I (plus it tells you a lot about the dullness of my everyday life that I can get worked up by something like this).  I was laying in bed at about 1 AM, wide awake reading between three different electronic books on my iPad, none of which could really hold my attention.  I was reading on The Dark Vineyard, an acclaimed mystery set in the French countryside, Billy Boyle, a mystery series that has promise, set in WWII (Billy Boyle is a Boston cop who ends up in the army and acting as a sleuth in various WWII settings), and All the Dead Voices, a mystery set in Dublin.  (BTW, Billy Boyle is free on the Kindle.) None of these were really grabbing me, and I was wanting to read the latest Michael Connolly book The Reversal, but at $14.99 it violated my never-over-ten-bucks-for-an-electronic-book rule.  I was sorely tempted, but I held off.  I was searching for all manner of mysteries and everything violated the ten-dollar rule.  As I was looking at one (can’t remember which one now), I noticed a John Lawton book down in the section in Amazon that shows what other people liked who had read the book in question.  I about broke my finger navigating to the page and found that a new John Lawton Inspector Troy novel, The Lily of the Field, was available on Kindle, and that the price was only $9.99.  My lucky night.  I downloaded that sucker and read until 3 AM when I finally forced myself to put it down and try to sleep.

(Despite my wallowing in euphoria at having found the latest Lawton book, I couldn’t help but reflect on the technology advances that had made it possible.  Here I was, propped up in bed in the middle of the night in pitch darkness (except for the glow of my iPad), my beloved wife sacked out next to me, and I was able to search the entirety of books available, select the one I wanted, and had it sent to me wirelessly, and in just a few seconds I was reading away. Couldn’t have happened just a few years ago.  Ain’t technology grand?)

If you want a great mystery series set circa WWII, you can’t do any better than John Lawton’s books.  Start with his first in the Inspector Troy series, Black Out.  You won’t be disappointed.

I can’t end this book discussion without giving you a couple more recommendations of books I’ve finished that I’ve found to be excellent.  Michael Lewis’s The Big Short provides a look at some of the people who were smart enough to make fortunes during the recent financial crash by betting against the supposed ‘smart’ guys.   They were able to see through the government obfuscation and the PR of those who ran the big investment banks and come out the other end many millions of dollars richer.   I love real life David verses Goliath stories where the small, smart people conquer the big, bluff idiots.  As always, Michael Lewis knows how to tell a tale and keep it funny and engaging.  His description at the end of the book of his lunch with John Gutfreud, Lewis’s former boss at Salomon Brothers, whom Lewis wrote about in his first giant bestseller Liar’s Poker, is alone worth the price of the book.  A brief sample:

Hard as it was for him to enjoy my company, it was harder for me not to enjoy his:  He was still tough, straight, and blunt as a butcher.  He’d helped to create a monster but he still had in him a lot of the old Wall Street, where people said things like “a man’s word is his bond.” On that Wall Street people didn’t walk out of their firms and cause trouble for their former bosses by writing a book about them.  “No,” he said, “I think we can agree about this: Your fucking book destroyed my career and made yours.”  With that, the former king of a former Wall Street lifted the plate that held his appetizer and asked, sweetly, “Would you like a deviled egg?”

The most profound book I’ve read in a long while is Washington Rules by Andrew Bacevich.  This book has answered a question I’ve been wrestling with for ages, which is why other countries that don’t have the same economic engine we do are doing so much better.  If you wonder why the vastly more socialistic Brits, Germans and French have stronger currencies than do we Americans despite their having inferior economic systems and massive government intervention, taxation and regulation, the author of this book provides the answer.  This is an unusual book in that all the people I’ve recommended it to love it.  That includes liberals, Tea Party members, true libertarians and fiscal conservatives.  I haven’t given it to any hardcore, social conservatives yet simply because I don’t really know any. (Or if I do know them, they’re keeping their views secret.) The message of the author – who is a West Point graduate and retired army colonel with 23 years service – appeals across ideological lines because it is so obviously on point.  Here is the introduction to Washington Rules, a chapter titled “The Unmaking of a Company Man,” which has been online in a number of places, gives the real flavor of the book and tells why the author wrote it.  Read it and become hooked as I was, then get the book.  You won’t regret it.

So, there you have it: lubricants, shipping, comments, our government, and books all in one post.  I’ll be back to more traditional nutritional posting next time out.

..man, proud man,
Dress’d in a little brief authority,
Most ignorant of what he’s most assur’d…

From Measure for Measure by Wm Shakespeare

The web has been alive with commentary the past few weeks since Denise Minger lobbed her first cannonball of a critique across the bow of The China Study, the vessel T. Colin Campbell, Ph.D. rode to fame and bestsellerdom.  Seems like everyone is now jumping into the fray and gunning for poor Dr. Campbell, who early on in the fracas made a few halfhearted attempts to fight back but has now fled the scene.  I’ve been laying low watching it all play out, and so now figured it’s about time I add my two cents worth to the debate. But first a little history.

I met Dr. Campbell about ten years ago (five or so years before the publication of the popular book The China Study) when we both spoke at the same conference.  He was a nice enough man who spoke about the work he and his team had done in China gathering the data published in the massive 894 page monograph Diet, Life-style and Mortality in China (pictured above left).  As Dr. Campbell presented his data ‘demonstrating’ the superiority of a plant-based diet and demonizing protein of animal origin, I didn’t think much about it because the data was all in the form of observational studies, which, as all readers of this blog should know by now, despite often showing correlation don’t prove causation.  My lecture, which followed Dr. Campbell’s, was, as you might imagine, a lecture of a different sort.  Then we both sat on a panel after our talks and fielded questions.  And were both cordial to one another.

A few years ago, I became vaguely aware that Dr. Campbell had written a popular book on his work in China titled, appropriately enough, The China Study.  I assumed it pretty much mirrored his presentation I had watched, so didn’t rush out and grab a copy.  Over the past few years a number of people have asked about The China Study through the comments section of this blog, and I’ve typically answered that the data are all observational and so not really meaningful in terms of causation.

(Note: Throughout this post whenever I refer to the popular book Dr. Campbell wrote, I’ll call it by it’s title The China Study, and when I refer to the large study Dr. Campbell was involved with in China and was the basis for the monograph Diet, Life-style and Mortality in China, I’ll call it the China study.)

About a year ago, I wrote a guest post for Tim Ferriss’s The Four Hour Workweek blog.  It actually wasn’t a guest post as much as it was an excerpt of a chapter from our book The Six-Week Cure for the Middle-aged Middle extolling the virtues of saturated fat.  It was a popular post that has garnered to date 520 plus comments, many of them fairly spirited.  I agreed to answer a number of the comments and did so.  I noticed as I sifted through them that a handful were absolutely fawning of Dr. Campbell and The China Study.  Here is a sampling:

The number one study of diet and disease is the China Study. All other data points are slivers compared to the volume of data and statistical correlations that came from the China Study.

Have you read The China Study? Dr. Campbell points out repeatedly that none of the weight loss studies such as Atkins or South Beach diet follow any type of peer reviewed scientific method.

Tim…and to think I was such a big fan of yours. This is by far the weakest (and least cited) argument I have ever read on diet–especially increasing saturated fats. Half knowledge is a scary thing in the hands of influential people. Maybe it’s another genius marketing ploy (like the myth riddled protein Atkin’s diet)–people love to feel good about their personal yet poor decision making–and diet is very personal. Check out researchers that actually meant to study nutrition–like Dr. T. Colin Campbell’s The China Study comes to mind.

It was pretty apparent that the disease of non-critical thinking was at epidemic proportions.

After reading a number of these, I decided I had better take a look to see what Dr. Campbell had going on that had attracted such devotees.  I pulled up his book on Amazon and read through a few comments, most of which were even more nauseatingly gushing than the above.  I ordered a copy of The China Study.

I knew that both Anthony Colpo and Chris Masterjohn had done their own critiques of the original data, so I figured, what the hell, I’ll take a look at the ‘real’ China study (as opposed to the popular book of that name) and do one too.  And I’ll critique the popular book, which I figured was a rehash of the China project, while I’m at it.

I tracked down a copy of the 894 page book in a bookstore in the UK and forked over $240 to purchase it and have it shipped.  As I was awaiting its arrival I told Gary Taubes what I had done, and he replied that he had done the same thing himself a few years earlier.  And that I could have borrowed his.  And, even worse, that most of the data was available online for free.

When the book arrived, I was amazed at the size of it.  Not only was it the 894 pages as advertised, it was in a large format.  Much larger than a volume of the Enclyclopaedia Britannica.  It wasn’t at all what I thought it would be.

Here are a couple of photographs shamelessly using our own book to show the size of this behemoth

Of the 894 pages, the first 82 are a study overview, description of methodology and author commentary.  It is written in the form of a scientific paper with half the page in English and half in Chinese (which, presumably, is a translation of the English half).  The remainder of the 894 pages are raw data and correlations.  Page after page after page of correlations.  I didn’t bother counting them, but Dr. Campbell says there are 367 variables, each of which is compared with every other variable.  I don’t doubt him.  This study was a massive undertaking, requiring thousands upon thousands of man hours and God only knows how much money.  No one can possibly accuse the team members of not giving it their all.

Here is one page of correlations.  This one between stearic acid and all the other variables studied.

But in the end it is still only an observational study.  And even though – again, according to Dr. Campbell – there are over 8000 statistically significant correlations, correlations are not causation.  Any scientist worth his/her salt will tell you that all you can do with data from observational studies is use them to form hypotheses that can be rigorously tested in randomized, controlled trials.  Then and only then (assuming the study results show it) can you even begin to talk about causation. The whole enterprise, costly and time consuming though it was, was described perfectly by Shakespeare in the words of MacBeth:

…it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.

Once I saw that the original China study was nothing but a huge number of correlations, I quickly lost interest.  What is the point in going through the brain damage of ferreting around in these to see if Dr. Campbell interpreted them correctly when he tries to make his case that a plant-based diet is optimal.  It doesn’t really matter whether he interprets them correctly or not, they are only correlations.  Repeat after me one last time: Correlation is not causation, correlation is not causation, correlation is not causation…

I wondered why Dr. Campbell and his group didn’t spend a fraction of the time and money they spent on this behemoth of a spreadsheet full of correlations on a real study that could provide hard evidence.  Why not randomize subjects into two groups and provide one a plant-based diet and the other a meat-based diet or something similar.  Lock them down as Ancel Keys did if they had to.  Surely the money spent on the China study could’ve covered that.  Get some real data.  I discovered later that I wasn’t the only one who wondered that.  Even some of Dr. Campbell’s own colleagues abandoned him to this study and told him it would be worthless.  More about this later.

So enough for me.  I stuck my copy of the $240 book of correlations in my library and forgot about it.  Until Denise Minger’s critique hit the net.

Upon reading her blog post, my first reaction was This is great; someone took the time to do what I was going to do. I figured Dr. Campbell had cherry picked his correlations to  make the case he wanted to make, and I had seen Colpo and Masterjohn catch him on it.  Ms. Minger went even further and really caught Dr. Campbell with his pants down, correlation-misinterpretation speaking.  I continued to read with mounting glee Ms Minger’s successive critiques and a few other bloggers who had critiques of their own.  (Believe me, there is no dearth of material here for people to attack without any two attacking the same data twice.)

After this went on for a while, I had my second reaction to the whole affair.

Which was that I had fallen victim to the confirmation bias.  My bias was that Dr. Campbell was wrong, so I was more than happy to uncritically accept evidence confirming his error without lifting a finger to double check said evidence myself.  I knew that if a blogger somewhere had come out with a long post describing an analysis of the China study demonstrating the validity of all of Dr. Campbell’s notions of the superiority of the plant-based diet, I would’ve been all over it looking for analytical errors.  But since Ms. Minger’s work accorded with my own beliefs, my confirmation bias ensured that I accepted it at face value.

Once the fact that I had succumbed to my confirmation bias settled in around me, I became suffused with angst.  I had tweeted and retweeted Ms. Minger’s analysis a number of times, giving the impression that I had at least minimally checked it out and had approved it.  I had emailed it to a number of people, many of whom, I’m sure, had forwarded it on.  I’m sure I played a fairly large role in the rapid dissemination of the anti Campbell/China study info.

(It didn’t really make me feel better to know I wasn’t alone in falling into the confirmation bias quicksand.  Take a look at this post from Richard Nikoley’s Free the Animal blog.  I doubt that all these people checked Ms. Minger’s calculations before posting.)

My angst wasn’t because I had possibly fed the flames of a misinformation wildfire – I wasn’t particularly worried about that because mountains of other data (including first hand data from my own clinical practice) have persuaded me that Dr. Campbell is dead wrong in his ideas about the superiority of a plant-based diet.  No, my angst arose for two other reasons: first, because I was distressed that I so easily fell prey to the confirmation bias, and, second, because I felt I needed to go through all the calculations  myself to make sure Ms. Minger and others whose work I had circulated were truly correct in their analyses.

As I was wallowing in self pity over all this, I didn’t realize that salvation was at hand. And that my savior was none other than Dr. T. Colin Campbell himself.

Yep, his first response to Denise Minger’s critique of his work appeared on the Tynan.net website and rescued me from my pit of self-loathing.  In it, Dr. Campbell wrote:

But she suffers one major flaw that seeps into her entire analysis by focusing on the selection of univariate correlations to make her arguments (univariate correlations in a study like this means, for example, comparing 2 variables–like dietary fat and breast cancer–within a very large database where there will undoubtedly be many factors that could incorrectly negate or enhance a possible correlation). She acknowledges this problem in several places but still turns around and displays data sets of univariate correlations.

In other words, the China study is an observational study comparing one variable to another (univariate correlations) and, as such, meaningless.  And this from the man’s own pen.

Since these observational studies are meaningless in terms of causality, it doesn’t really matter how one slices and dices the data because meaningless correlations by any other names are still just as meaningless.  All this falderal over whether or not Dr. Campbell had his interpretations right was tantamount to the medieval theological argument over how many angels could stand on the head of a pin.  And my participation certainly wasn’t required.

I’d known this all before, of course, but somehow had lost my focus on it.

I was ready to wash my hands of the whole affair when I came across another statement Dr. Campbell made in his response to Ms. Minger’s critique.  Writing of her, he said:

One further flaw…is her assumption that it was the China project itself, almost standing alone, that determined my conclusions for the book (it was only one chapter!). She, and others like her, ignore much of the rest of the book.

Only one chapter? As I mentioned above, I always figured The China Study was simply Dr. Campbell’s tale of the China study and the conclusions he had drawn from it.  Now he says that only one chapter is about the China study, leaving me to conclude that the rest must be about something else.  I found the book, which I hadn’t yet taken from the pack it came in from Amazon, opened it and started reading.

Wow!

In 1976 author Mary McCarthy famously said live on the Dick Cavett show of her rival Lillian Hellman:

Every word she writes is a lie, including ‘and’ and ‘the’.**

I feel much the same way about The China Study.  Except it’s not really a lie, it’s an obfuscation.

In fact, in my studied opinion, The China Study is a masterpiece of obfuscation.

It is obfuscatory in so many ways it could truly qualify as a work of obfuscatory genius. It would be difficult for a mere mortal to pen so much confusion, ambiguity, distortion and misunderstanding in what is basically a book-length argument for a personal opinion masquerading as hard science.

Let me take just one tiny section of the book, one that is in no way atypical, and show you what I mean.

In Chapter 3 titled Turning Off Cancer, Dr. Campbell is starting to hit his stride in his anti animal protein jihad.  He has described the three stages of cancer – initiation, promotion and progression – and is setting the stage for his description of his laboratory work implicating animal protein in all three stages.

Here is his setup paragraph starting on page 50:

At the start of our research, the stages of cancer formation were known only in vague outline.  But we knew enough about these stages of cancer to be able to structure our research more intelligently.  We had no shortage of questions. Could we confirm the findings from India that a low-protein diet represses tumor formation?  More importantly, why does protein affect the cancer process?  What are the mechanisms; that is, how does protein work?  With plenty of questions to be answered, we went about our experimental studies meticulously and in depth in order to obtain results that would withstand the harshest of scrutiny.

The “findings from India that a low-protein diet represses tumor formation” were the results of a rodent study published in the Archives of Pathology in 1968 that Dr. Campbell wrote about 14 pages earlier in the book.  He mysteriously refers to the Archives of Pathology as an obscure journal when it is anything but.  It was published then by the American Medical Association and still is today under the new name Archives of Pathology & Laboratory Medicine.  But the notion of the paper initiating his quest being discovered by Dr. Campbell in an “obscure medical journal” fosters the impression of him as a leave-no-stone-unturned kind of guy.  Even the little throw away but incorrect phrase “obscure medical journal” is part of the greater picture of obfuscation that maintains throughout the book.

The study from India showed that rats given aflatoxin along with a high-protein diet got liver cancer while rats given the same amount of aflatoxin while consuming a low-protein diet didn’t.  Aflatoxin is a substance released from a fungus often found in peanuts, corn, other grains and even hay. It is converted in the liver to a much more toxic compound and is often used in laboratory experiments with animals to induce cancer and other problems.

Moving on, here is what Dr. Campbell has to say about protein and cancer initiation:

[I] How does protein intake affect cancer initiation?  Our first test was to see whether protein intake affected the enzyme principally responsible for aflatoxin metabolism, the mixed function oxidase (MFO).  This enzyme is very complex because it also metabolizes pharmaceuticals and other chemicals, friend or foe to the body.  Paradoxically this enzyme both detoxifies and activates aflatoxin.  It is an extraordinary transformation substance.

[II] At the time we started our research, we hypothesized that the protein we consume alters tumor growth by changing how aflatoxin is detoxified by enzymes present in the liver.

[III] We initially determined whether the amount of protein that we eat could change this enzyme activity.  After a series of experiments, the answer was clear (Chart 3.2).  Enzyme activity could be easily modified simply be changing the level of protein intake.

[IV] Decreasing protein intake like that done in the original research in India (20% to 5%) not only greatly decreased enzyme activity, but did so very quickly.  What does this mean?  Decreasing enzyme activity via low-protein diets implied that less aflatoxin was being transformed into the dangerous aflatoxin metabolite that had the potential to bind and to mutate DNA.

These four little paragraphs and accompanying chart take up less than a page in space, and are tiny glittering gems of obfuscation.  Let’s deconstruct.

First, take a look at how subtly these four paragraphs are written, especially II.  Note how he writes “the protein we consume”?  I’m sure many people took these paragraphs to mean that the studies were done on humans.  That’s almost the implication.  Reread them to see if they indicate anywhere that the author is talking about rat studies.

As Dr. Campbell progresses through this chapter, he does ultimately tell the reader he is talking about rat studies and not human studies, but he doesn’t mention the word rat for another two pages after the above paragraphs. By this time it’s probably implanted in the minds of many readers that he’s talking about human studies.

He describes experiments showing that rats getting diets high in casein (a milk/animal protein) develop more cancer at the same dose of aflatoxin than do rats getting a lower-casein diet.  The implication: animal protein causes cancer.

Dr. Campbell then gave his rats diets of varying amounts of plant protein (wheat gluten) and found that they did not get cancer after exposure to aflatoxin irrespective of protein dose.  Same thing happened with soy.  Implication: plant protein protects against cancer.

If you’re worried about cancer – and who isn’t – you’re now starting to look at animal protein a little differently.  Which is what Dr. Campbell wants.  But he hasn’t told you the complete story.

As I’ve written often in these pages, rodents aren’t just furry little humans.  They are a distinct species separate and apart from humans.  The rodents usually used in lab experiments are Sprague-Dawley rats, and inbred strain that has a tendency to develop cancer easily. (See Abelson, PH. (1992) Diet and Cancer in Humans and Rodents, Science 255(5041); Jan 10: 141)  In fact, these rats can develop cancer just from a change in diet.  I ran quick checks on a bunch of the studies referenced in The China Study, and all checked used Sprague-Dawley rats.

And think about this.  If you were to visit a farm and search for rodents, where do you think you would be most likely to find them?  In the grain or in the milking area?  Like Dr. Campbell, I grew up in a rural area and spent a lot of time on a farm.  Rats and mice are in the hay and in the grain.  You have a helluva time keeping them out of the animal feed, which they eat, too.  Grain and hay are common places for growth of the fungus that produces aflatoxin.  Since rodents spend most of their days in this stuff (grains), and since they eat it as well, I would bet that most have adapted over the generations to  the combination of plant protein and aflatoxin.  If this did them in regularly, there wouldn’t be the rodent problem on farms that there is.  So, in my opinion, making a huge issue of the fact that rats didn’t get cancer after dosing with aflatoxin irrespective of how much plant protein they ate is pretty disingenuous.

Most disingenuous of all in the above four paragraphs and chart is the lack of full disclosure in these paragraphs of the very study Chart 3.2 is made from. Let me explain.

Certain enzymes in the liver convert aflatoxin into a more toxic substance that Dr. Campbell claims can initiate the formation of cancer.  He demonstrates in rat studies that giving the rats a lower protein diet decreases the activity of this enzyme, meaning that the lower the protein intake, the less conversion of the aflatoxin into the really nasty stuff.  Chart 3.2 above and on page 52 of his book shows this graphically.

When I pulled the study from which this chart was adapted (Mgbodile MUK and Campbell TC. (1972) Effect of protein deprivation of male weanling rats on the kinetics of hepatic microsomal enzyme activity, J Nutr, 102: 53-60.) and read it, I found a little disclaimer Dr. Campbell didn’t bother to mention in The China Study.  You can read the last paragraph of the study (highlighted in yellow) below:

Nice, eh?  He hits the nail on the head.  Protein utilization may be influenced by what is eaten along with the protein.  Sucrose (table sugar) was eaten along with the protein used in this experiment.  In other experiments corn starch was used instead of sugar and the effect of the protein on the enzyme was diminished, meaning that the protein along with starch did not have nearly the same effect as protein with the sugar.  Who knows whether or not it’s even the protein that has the effect and not the sugar?  It can’t be shown from this study. That caveat certainly didn’t make in into The China Study.

See what I mean about a masterpiece of obfuscation?

I could go on and on, but I’ll quit after I give you just a couple more examples.

On page 107 of The China Study Dr. Campbell writes:

At the end of the day, the strength and consistency of the majority of the evidence is enough to draw valid conclusions.  Namely, whole plant-based foods are beneficial, and animal-based foods are not.

Then one inch below (literally) he writes the following:

The China Study was an important milestone in my thinking.  Standing alone, it does not prove that diet causes disease. [Italics in the original]

So, the China study produces valid conclusions as to causality, i.e., “whole plant-based foods are beneficial, and animal-based foods are not.”  Yet the China study “does not prove that diet causes disease.”  Say what?

Don’t believe me, take a look at a scan of my copy:

On page 73 Dr. Campbell dons the mantle of prestige conferred by one of America’s most august newspapers.  Writes he referring to the China study:

We had a study that was unmatched in terms of it’s comprehensiveness, quality and uniqueness.  We had what the New York Times termed “the Grand Prix of epidemiology.”

A quick search of that phrase in the online version of the NY Times reveals that it came from an opinion piece by none other than Jane Brody, a kindred spirit to Dr. Campbell.  Brody, a lipophobe of the deepest hue, has written a number of low-fat cookbooks and is a believer in the plant-based diet. So she hardly qualifies as an unbiased commenter.

And speaking of the so-called plant-based diet, when Dr. Campbell responded to Ms. Minger’s critique, he took her to task for mentioning the words ‘vegan’ and ‘vegetarian’ as it applied to his work.

One final note: she repeatedly uses the ‘V’ words (vegan, vegetarian) in a way that disingenuously suggests that this was my main motive. I am not aware that I used either of these words in the book, not once. I wanted to focus on the science, not on these ideologies.

Just for grins, I turned to the index of The China Study to see if ‘vegan’ or ‘vegetarian’ were indexed.  Here’s what I found on page 417:

vegetarianism or veganism. See plant-based diet

When I flipped over  to ‘plant-based diet’ on page 414, I found a long grocery list of references.

Even in his online response to his opponents, Dr. Campbell apparently can’t resist obfuscating.

Okay, just one more, then I’ve got to draw this to a close.  Let’s go back to the bottom of page 52, the page the paragraphs above and Chart 3.2 appear on.  Dr. Campbell shows in Chart 3.2 how protein is involved in stimulating the liver to convert aflatoxin to the toxic product that he implies is involved in cancer initiation.  He then reports how he wanted to see if animal-based protein was involved in the other phases of the cancer progression cascade.  So he and his grad students started to look.  He writes:

As time passed, we were to learn something quite remarkable. Almost every time we searched for a way, or mechanism, by which protein works to produce its effects [on cancer formation and progression], we found one!

That, my friends, is almost the dictionary definition of the confirmation bias summed up in one sentence.

This tiny bit of the book that I’ve chosen to lay bare is truly the tip of the iceberg.  I could go on and on and on, but I’m sure you get the picture.

Before I finish, I want to get back to something I mentioned earlier about how one of Dr. Campbell’s own colleagues bailed out from the China study because he recognized it for what it was: a giant observational study that was meaningless.  Here is how Dr. Campbell describes it on page 105-106:

When we first started this project we encountered significant resistance from some people.  One of my colleagues at Cornell, who had been involved in the early planning of the China Study, got quite heated in one of our meetings.  I had put forth the idea of investigating how lots of dietary factors, some known but many unknown, work together to cause disease.  Thus we had to measure lots of factors, regardless of whether or not they were justified by prior research.  If that was what we intended to do, he said he wanted nothing to do with such a “shotgun” approach. [i.e., a big, meaningless observational study]

This colleague was expressing a view that was more in line with mainstream scientific thought than with my idea [i.e., a randomized, controlled trial that might demonstrate causality would be a better use of the funds.] He and like-minded colleagues think that science is best done when investigating single – mostly known – factors in isolation. [He and like-minded colleagues are correct.] An array of largely unspecified factors doesn’t show anything, they say. [They are right.] It’s okay to measure the specific effect of, say, selenium on breast cancer, but it’s not okay to measure multiple nutritional conditions in the same study, in the hope of identifying important dietary patterns.

I prefer the broader picture, for we are investigating the incredible complexities and subtleties of nature itself…

So I say we need more, not less, of the “shotgun approach.” We need more thought about overall dietary patterns and whole foods.  Does this mean that I think the shotgun approach is the only way to do research?  Of course not.  Do I think that the China Study findings constitute absolute scientific proof?  Of course not.  Does it provide enough information to inform some practical decision-making? [No.] Absolutely.

Dr. Campbell uses an impassioned written speech to persuade the scientifically untrained that the China study carries vastly more scientific value than it actually does. Once again, it’s a large observational study, but an observational study nonetheless.  And as such, it is useful only in developing hypotheses to be tested with randomized, controlled trials.  The entire 894 page study proves not a shred of causality.

What saddens me about all this is that hundreds of thousands (probably millions) of people who can’t (or won’t) read critically have fallen for the premise of The China Study without even thinking about it.  Believing that the entire book is based on the greatest and most important nutritional study ever completed.  What happened to the ability to read critically?  Has it vanished from the populace?  Based on the comments on The China Study on Amazon it would seem so.

In my opinion, there really isn’t much of substance in the entire 400 plus page book.  But I encourage you to buy it and read it to test your own critical reading skills.  If you don’t want to test your critical reading skills, you’ll at least enjoy coming across some real howlers such as this one believed only by the vegetarian/vegan zealots out there (oh, sorry, plant-based diet followers):

As you will see in this book, there is a mountain of scientific evidence to show that the healthiest diet you can possibly consume is a high-carbohydrate diet. [italics in the original]

I wonder if Gary Taubes, who wrote a vastly more scientific book, would agree?

Lest you think I’m being too hard on poor Dr. Campbell, let me tell you a few things.  First, as I mentioned earlier, the few sections of The China Study I dissected are just a tiny fraction of the whole.  I could go on and on. Second, Dr. Campbell mentions Protein Power by name on page 19 and labels it a modern protein fad diet that “continue[s] to inflict a great variety of dangerous health disorders.”  Third, he is absolutely and unnecessarily brutal in his treatment of Dr. Robert Atkins.  He has an entire section on Dr. Atkins starting on page 95 that runs for almost three pages.  After quoting from one of Dr. Atkins’ books, he writes the following about the deceased diet doctor:

There are snake oil salesman, who have no professional research, professional training or professional publications in the field of nutrition, and there are scientists, who have formal training, have conducted research and have reported on their findings in professional forums. Perhaps it is a testament to the poser of modern marketing savvy that an obese man with heart disease and high blood pressure [here he inserts a citation for an article discussing Dr. Atkins’ death] became one of the richest snake oil salesmen ever to live, selling a diet that promises to help you lose weight, to keep your heart healthy and to normalize your blood pressure.

A way below-the-belt commentary when you consider that Dr.Atkins was a trained cardiologist who took care of thousands of real, live patients throughout his career – he wasn’t, like Dr. Campbell, a bench scientist doing rat studies in a lab.  Bob Atkins and I have had our differences, but were he still alive, I would vastly prefer to put my own care in his hands than I would those of Dr. Campbell, who has never treated a patient in his life.

You may ask if I took anything of value from my reading of this book?  I did.  On page 107 Dr. Campbell writes the following:

The results of this study…convinced me to turn my dietary lifestyle around. I stopped eating meat fifteen years ago, and I stopped eating almost all animal-based foods, including dairy, within the past six to eight years, except on very rare occasions,  MY cholesterol has dropped, even as I’ve aged; I am more physically fit now than when I was twenty-five; and I am forty-five pounds lighter now than  was when I was thirty years old.  I am now at an ideal weight for my height.

I have no reason to doubt Dr. Campbell’s own medical and dietary history (except maybe for the part about being more physically fit than he was at age 25 – that’s a tough act for someone who is 73), so I’ll assume it’s all true.  As I recall, he had a trim physique when I met him 10 years ago, which, assuming nothing has changed, is probably the same.  And I’m going to take Dr. Campbell at his word about what he eats.

Granted, I’m younger than Dr. Campbell, but I follow almost the opposite diet as he does yet I, too, have low cholesterol, very low blood pressure and am ideal weight for my height.  What this all tells me is how wonderfully adaptive the human species is where diet is concerned.  It’s no wonder we took over the earth.

** Lillian Hellmann was predictably furious over McCarthy’s comment and adopted the typical American response: she sued.  In one of those turns in which the law of unintended consequences jumps up and bites one, many of her untruths came to light in the courtroom as McCarthy was forced to defend her statement.  Hellmann disengaged by dying during the proceedings.

“If I had to give you a single secret ingredient that could apply to the prevention — and treatment, in many cases — of heart disease, common cancers, stroke, infectious diseases from influenza to tuberculosis, type 1 and 2 diabetes, dementia, depression, insomnia, muscle weakness, joint pain, fibromyalgia, osteoarthritis, rheumatoid arthritis, osteoporosis, psoriasis, multiple sclerosis, and hypertension, it would be this: vitamin D.”

During the whirlwind that has been my life of late, I managed to make my way through Dr. Michael Holick’s terrific book The Vitamin D Solution from which the above quote comes.  Before I get started on my review, in the interest of full disclosure, I’ve got to tell you that of all the books I’ve reviewed on this blog since its inception, this is the first and only one that I’ve been sent gratis by the publisher.  It was strange how it came about.  I learned of this book long before it was published and had pre-ordered it through Amazon.  A few weeks or so after my pre-order, I received an email from the publisher’s PR agent for this book asking if I would like a pre-publication copy for possible review.  I sure would, said I, and promptly canceled my Amazon order.

I’ve been a fan of Dr. Holick’s for years now, reading every paper he publishes, which is a considerable job given his prolific output.  I’ve corresponded with him a time or two on a few issues and he has always been very generous with his advice.  I consider him THE authority on vitamin D.  So, I was eager to dig into his book.

I wasn’t disappointed.

I figured that somewhere along the way, Dr. Holick had gotten intrigued with vitamin D, had pursued his interest and had become sort of a guru.  But in reading his book, I learned that he is much more than that.  He began studying vitamin D as a graduate student and ended up being the person who actually discovered 1,25 (OH)D, the major circulating form of vitamin D in humans.  This was back in the early 1970s, and he’s been studying vitamin D without letup since.  His book is the most up-to-date source of all the science available about this amazing nutrient.

Dr. Holick sums up the importance of vitamin D to human well being in this single sentence from early in the book:

The sun is as vital to your health and well-being as food, shelter, water and oxygen.

Which seems reasonable since every morsel of energy we consume originates with the sun.  No sun, no plants.  No plants, no animals.  No plants and animals, no us.  As Sir Karl Popper noted, we eat the sun. We evolved in the sunlight, so it makes sense that the sun offers other benefits as well food.

Dr. Holick begins his book with a fascinating comparison of a ten-year-old girl growing up somewhere along the equator to a ten-year-old girl growing up in the United States or Europe.  The former will probably never learn how to use a computer, never go to a mall, never learn to drive a car and will probably end up spending most of her life outside tilling the soil as did her parents and grandparents.  She will probably experience periods in her life of poverty and poor nutrition.  By contrast, her US or European counterpart will always have plenty to eat, will learn to shop, order pizza, operate a computer, Game Boy, Wii, and God only knows what other kinds of electronics.  She will have her doting parents slather sunscreen on her to protect her skin from birth until she’s old enough to do it herself.  She will come of age in a different world, filled with the latest in medical technology.

And she will pay for it with her health.

Her equatorial counterpart will be only half as likely to get cancer in her lifetime.  She will have an 80 percent reduction in risk of developing type I diabetes before the age of 30.  And she will live longer.  If she can avoid trauma or an untreated severe medical condition, the girl growing up in the more primitive but sunny circumstances will have an overall 7 percent greater longevity than her US/European counterpart.  She will have stronger bones, lower blood pressure, fewer cavities in her teeth, a greatly reduced risk for heart disease, type II diabetes, obesity, arthritis and most of the other diseases that will plague her more Westernized sisters.

Why the difference?  According to Dr. Holick, the equatorial girl has vastly more exposure to natural sunlight over her lifetime than does the other.

But, you might ask, why don’t the children in the US and Europe play outside more in the sunshine and reap its many benefits?  A couple of reasons.  Most of the US and Europe are too far north to get enough sun exposure to generate the production of adequate vitamin D during a large part of the year.  And, second, most parents are so fearful of sunburn that they slather their kids with sunscreen if and when they let these children play outside during the part of the year they can make adequate vitamin D.  Since a sunscreen with an SPF of only 8 reduces the synthesis of vitamin D by 95 percent, think of how little vitamin D children with sunscreens of SPF 30 or 45 are making.  Zero.

Why?

Heliophobes.

Readers of this blog know that I refer to people who have an unreasoning fear of fat as lipophobes, fat fearers.  Well, since Helios was the Greek god of the sun, I’ll call those who have an unreasoning fear of the sun heliophobes.

Why do people become heliophobes?  Same reason they become lipophobes: they refuse to think.

Just as lipophobes see a heart attack in every morsel of fat, heliophobes see skin cancer in every ray of sunshine.

To give them their due, the heliophobes have at least a smidgen of data to bolster their point of view.  Unlike the lipophobes, who have no reliable data demonstrating that saturated fat causes heart disease, the heliophobes can point convincingly at the data showing sun exposure causes problems for the skin.

Unquestionably, excess sun exposure causes premature aging of the skin and a couple of types of skin cancer.  Of this there is no doubt.  But, lack of adequate vitamin D appears to be related to an entire host of serious problems including melanoma, the most dangerous and deadly form of skin cancer.  The most common type of skin cancer from overexposure is basal cell carcinoma, which is just about the least malignant of all cancers, and if treated (by removal) results in virtually no mortality.  The same can’t be said for prostate, breast and colon cancers, all cancers thought to be sun (or, more correctly, lack of sun) related.  These cancers are much more prevalent the farther north one goes and almost non-existent at the equator.

The trade off, in my opinion, is well worth it.  Especially when it’s possible to have the best of both worlds and avoid both the premature aging, minor skin cancers AND the breast, prostate and colon cancers (not to mention multiple sclerosis, osteoporosis, and the host of other disorders laid at the doorstep of too little vitamin D) by sensible sun exposure.

Dr. Holick tells you how.  He provides charts and tables telling you how much sun exposure you require for adequate vitamin D synthesis depending upon where you live in the world.  And he describes how you can make up any difference by taking vitamin D supplements.

Why not just take the supplements and forget about the sun?

Vitamin D made in the skin lasts at least twice as long in the blood as vitamin D ingested from the diet.  When you are exposed to sunlight, you make not only vitamin D but also at least five and up to ten additional photoproducts that you would never get from dietary sources or from a supplement.

Old Mother Nature is pretty parsimonious with her creations, and I suspect she wouldn’t have five to ten photoproducts circulating around if they didn’t do something good for us.  Just because we aren’t advanced enough yet to figure out what it is they do, doesn’t mean they don’t do something.  Thus Dr. Holick’s recommendation to hit the sun if at all possible instead of the supplement bottle.

Plus, there are some downsides to indiscriminately throwing back the supplements without monitoring your 25 (OH)D levels.  See here and here, for example.

One of the few criticisms I have of this exceptional book is that Dr. Holick goes way overboard in his obvious worry about the opinion of the heliophobes.  Throughout, he repeatedly warns against overexposure as if getting a little too much sun from a day at the beach could lead to one’s body becoming wrinkled and having skin cancers the size of buboes popping out all over within a week.  But we can’t be too hard on the poor Doc because the water in which he swims professionally has a high SPF indeed.  His colleagues are primarily dermatologists and Dr. Holick works hard not to gain their total opprobrium.  As cardiologist wage their misguided war against fat, dermatologist wage theirs against the sun.  And just as many cardiologists haven’t figured out that fat can be a good thing, dermatologists apparently haven’t learned of the good sunshine can do.  Or if they have learned it, they’ve chosen to ignore it to their patients’ detriment.

The dermatologists are a pretty vocal group and are constantly issuing press releases about the dangers of sun exposure.  So sun phobic are dermatologists that in their minds, the perfect place to vacation would be inside a cave.  I’m not really exaggerating – they are heliophobes of the deepest dye.  And they don’t tolerate dissent.  Ask Dr. Holick.

In 2004 I was forced to give up my position as a professor of dermatology at Boston University Medical Center, a position I had held for nearly ten years.  My stalwart support of sensible sun exposure just didn’t jibe with the views of the chair of the department.

Since this time the scientific literature has exploded with articles about the benefits of vitamin D and the widespread epidemic of vitamin D deficiency.  (I just ran a PubMed search for vitamin D and found 48,552 citations.) I wonder if this silly woman who fired him and was so pompous and cocksure now feels any sense of remorse?  Especially since she still labors in obscurity while Dr. Holick is an academic rock star.

Another point I would take issue with is Dr. Holick’s statement in the book that there is no difference between vitamin D2 and vitamin D3.  He says he’s performed studies looking at these two versions of vitamin D and found both of them to maintain vitamin D levels in the appropriate range.   Since he’s done the studies and seen the data, I don’t have any reason to disagree with him on his findings.  But, there have been a number of anecdotal reports showing that people with problems due to vitamin D deficiency seem to have better symptomatic improvement if they take vitamin D3 (the real vitamin D) than if they take equivalent doses of vitamin D2.

Since these are anecdotal reports, we can’t put absolute faith in them, but I would still recommend vitamin D3 over vitamin D2.  In these situations where one supplement is supposed to perform better than another, usually the one that allegedly performs better, costs more.  So you end up in a risk reward situation: Do I want to pay more to get a better effect or do I want to pay less and hope for adequate results?  In the vit D3 versus vit D2, we don’t have this circumstance.  Both are dirt cheap, and, if anything, vitamin D3 is less expensive.  So if they both create the same blood levels, but one engenders more anecdotally positive reports, why not go with it.  My advice is to buy vitamin D3 and avoid the D2.

One more criticism I have of the book (might as well get ‘em out early) is Dr. Holick’s aligning with the mainstream in criticizing saturated fat.  I’m sure he hasn’t looked at the literature on saturated fat, because if he had, he wouldn’t have written what he did.  But I can’t really hold that totally against him since he is, after all, a mainstream guy (in all but his defense of sunshine), and, as such, would be expected to be marinated in the mainstream biases.

Unfortunately, for a century now, the American diet has been getting higher in fat–especially in the extra-unhealthy saturated fats.  This may partly explain why skin cancer rates have gone up, as well as diabetes and heart disease.  The average American diet is about 16 percent saturated fat, whereas most qualified dieticians [sic] will tell you it should be no more than one third of that.  To make matters worse, there has been a trend toward fad weight-loss programs advocating high fat content (the Atkins diet is probably the best known of these).

Leaving aside whether these diets actually work in the long term to help people keep weight off, diets high in saturated fat may cause a variety of life-threatening health problems and probably contribute to skin cancer, not to mention all other types of cancer.  But you don’t necessarily have to go on a traditional ‘diet’ to achieve the results you’re looking for.  You just need to start moving toward foods lower in saturated fat and try to limit or evict those foods that contain excessive amounts of fat–which is typically found in processed products (which also usually contain lots of salt and sugar) and marbled meats.  There are several excellent eating plans out there that advocate eating this way.

It’s beyond the scope of this book to offer specifics on the perfect diet, but I’ll say that a healthy eating regimen calls for plenty of fresh fruits and vegetables, high-quality proteins (“high-quality” meaning they are low in saturated fat but can be high in healthy monounsaturated fats, as is the case with wild salmon), and whole grains.

Jesus wept.

Fortunately, aside from a few small mentions here and there, this is about the extent of his saturated fat bashing.

For a while now, I have been worried about the long-term effects that will come about from the heliophobes and their constant sunshine bashing. (In fact, MD and I wrote a whole chapter about it in The Protein Power LifePlan back in 2000.)  But after reading The Vitamin D Solution, I’m greatly concerned.  Conscientious parents have no idea of the future damage they may be causing by never letting their children play outside without slathering them with sunscreen.  Today’s children have weaker bones are are much more prone to fracture than children of a few decades ago.  As Dr. Holick reports

Even more alarming is a new epidemic in which bone formation in children appears normal but is actually much softer than is should be.  Girls today break their arms 56 percent more often than did their peers forty years ago.  Boys break their arms 32 percent more often.

I’m sure the girls and boys of forty years ago were much more rough and tumble than the ones of today, yet the kids of today suffer more fractures.

While writing this post I got an email notifying me of a recent study showing that melanoma, a virulently malignant form of skin cancer is occurring with frighteningly high frequency in today’s teens.  These are the adolescents at the leading edge of the great heoliophobe movement, the very ones whose parents, in an effort to protect them, coated these kids liberally with sunscreen every time they walked out of doors.  Did their well-meaning parents set them up for this terrible disease?  Are the chickens coming home to roost?  It’s difficult to say for sure, but, in my opinion, it’s more than likely.  Here’s what happened.

When I was a kid, I played outside all the time.  So did all my friends.  We were outside, especially during the summer, from the time we got up until it was dark.  Since we played outside most all the time, as summer approached and the suns rays became more direct, we had already developed the base of tan from being outside all during the spring when it was difficult to get sunburned.  Our tans protected us from the effects of the sun, blocking both UVA and UVB light.

UVB rays are those that burn the skin and the ones that drive the synthesis of vitamin D.  UVA rays are those that mobilize the melanin (the pigment in the skin) and bring it to the surface.  When enough melanin comes to the surface, our skin gets darker, i.e., we develop a tan.  The tan then protects us from the harmful effects of the sun, allowing us to stay out all day without getting a sunburn and without getting too much UVA, which is important since excess UVA exposure is thought to be the cause of melanoma.

Although many sunscreens available today claim to block both UVB and UVA, when today’s teens were young children, virtually all of the sunscreens on the market then blocked UVB only.  Which is probably the root cause of the increase in melanoma in adolescents today.  Here’s what happens.

People who don’t use sunscreens and who have good sense get out of the sun when they begin to burn.  Avoiding the sun limits the exposure to both UVB, the burning rays, and UVA, the melanoma-stimulating rays.  When people slather on sunscreen that blocks UVB only, they can then stay out in the sun for a long time without burning.  The price they pay for this is that they end up with an extremely large dose of UVA, which doesn’t cause pain but sows the seeds for later melanoma development, a fate that has in the past befallen many a vacationer to the sunny areas of the world.

Many people labor away in offices for 50 weeks of the year then escape for a couple of weeks of fun in the sun.  Since they have limited time, they don’t want to spend it with graduated sun exposure while they develop a tan.  They pile on the sunscreen in copious amounts, hit the beach and stay out all day, stopping only long enough to put on more sunscreen.  During this process, they accumulate the effects of huge exposure to UVA and often pay the price years later by developing melanoma.  Those hardy folk who work outdoors all year long and have constant sun exposure almost never develop melanoma.  Why?  Because they develop a tan that blocks the UVA.  Plus, thanks to their constant sun exposure, they receive the benefit of plenty of vitamin D synthesis, which has been shown to be protective against melanoma.  The poor schmucks on vacation who broil in the sun while basting themselves with sunscreen get way too much UVA and don’t get any vitamin D because sunscreen blocks virtually all of the vitamin D synthesizing rays.  They are the victims of a true double whammy.

And that is what I suspect is driving the increase in melanoma in teens today: their poor misguided parents attempting to do the right thing.  Very sad, indeed.

Along with the increase in melanoma, the huge epidemic of fibromyalgia we are seeing today is in great measure a consequence of vitamin D deficiency.  Without enough vitamin D, bone doesn’t harden as it should.  It grows, but is softer and mushier and less supportive than it should be.  The body continues to make more bone to try to remedy the problem and the bones actually enlarge.  This enlargement presses against the periosteum, the fibrous sheath that surrounds the bone and through which the nerves run.  As the pulpy bony growth presses against the periosteum, it stimulates the nerves in the periosteum and causes the deep bone pain common to sufferers of fibromyalgia.  Doctors who are up to date on their vitamin D knowledge will press the breastbone to try to elicit pain.  And if they do, their patient is probably suffering from a vitamin D deficiency.  If that’s what the blood test shows, then the fibromyalgia can be treated with a course of sunshine and/or vitamin D supplementation.

A couple of weeks ago, I was reading The Vitamin D Solution on a plane, and the guy sitting across the aisle from me was reading Predictably Irrational, which I had read and enjoyed a while back.  I kept looking to see where he was in his book, and he kept glancing at mine.  After we had landed and were taxiing in, he asked me if I had ever known anyone who had responded medically to vitamin D.  He then told me that he had been experiencing severe, debilitating pains in the bones in his chest, back and legs.  He went to his doctor, who checked his vitamin D levels, found them way low, and started my new friend on a course of vitamin D supplements, which, in due course, had gotten rid of his problem.  He was a pretty tan guy, so I asked him about his sun exposure and wondered why he would be vitamin D deficient.  He then told me he was a kidney transplant patient, which explained everything.  As you will learn when you read Dr. Holick’s book, the kidney converts the inactive form of vitamin D circulating in the blood to the active form.  This gentleman’s transplanted kidney obviously wasn’t doing it for him.  Vitamin D supplements did the trick, however, and his pains had vanished.

The subject matter I’ve covered in this post barely scratches the surface of what’s there in Dr. Holick’s new book.  I heartily recommend it to all.

Before I sign off here, though, I want to relate a funny story.  Funny to me at least.  It involves a character who was a running dog of mine back when I was in medical school.  Any of you who read The Protein Power LifePlan already met this guy in another humorous adventure of his I related in the section on iron overload.  He’s the guy who dated the pig lady.

This guy was, in Billy Bob Thornton’s memorable words to Woody Harrelson in the movie Indecent Proposal, a “real poon hound.”  This guy would relentlessly go after anything with a skirt.  And, as often happens with those types, he came down with a bad case of herpes.  As soon as he got his diagnosis he went into a depression for about a week and then began reading everything he could read on herpes.  He discovered that herpes was typically a local infection but that in some patients (mainly immunocompromised ones) herpes could go systemic, which means it could spread through the bloodstream and and create a hellish infection everywhere, often with fatal consequences.  His affliction was never far from his mind, which led to the tale that follows.

In those days Zovirax hadn’t been developed, so the only remedies for this loathsome disorder were OTC products that didn’t really work.  At that time the main OTC med was Stoxil, which my friend purchased by the car-load lot and coated himself (or at least his infected parts) with at the least sign of an outbreak.

One day he came down with some kind of upper respiratory infection and called me to get something for it.  He was prone to these infections, which responded well to minocycline, a tetracycline-derivative drug.  I called him in a course of the drug and forgot about it.

Unbeknownst to me, my friend was planning a day at the lake with his latest inamorata.   Complexion-wise, he was lily white and usually avoided the sun.  A day at the lake was not his typical recreation, so I can be excused from not telling him not to go out in the sun; it would have never occurred to me that he might do so. The sun can be a problem because tetracycline drugs have a propensity to give people who take them a photosensitivity reaction when they get too much exposure.  These photosensitivity reactions cause the skin to swell and become discolored and blistered.

My friend took his meds as prescribed, had a great day at the lake, came home with the girl and hit the sack.  After he had been asleep for a few hours, he woke up needing to relieve himself.  On his walk to the toilet, he passed the bathroom mirror and glanced at the mirror wherein he saw the Elephant Man staring back at him.  His face red, blistered and swollen, eyes just slits.  He had obviously had a bad photosensitivity reaction (obviously that is to those who knew about such things) after his day in the sun while on minocycline.  But he didn’t know this.  He flew into a blind panic because the first thing that sprang to his mind was that his herpes was swarming on him: that he had developed systemic herpes.  He immediately grabbed the Stoxil and practically bathed in it.  Then he put in an emergency call to his dermatologist, whom, I’m sure, found it strange since dermatologists rarely — if ever — get emergency calls.

When he told me about it later in the day, I burst out laughing and have laughed about it any time I thought of it up to this moment.  In fact, I’m having trouble typing these words because I’m still laughing so hard remembering.  Who says doctors are humorless?  My friend even laughed about it later, though admittedly not to the same degree I did.  What I found so funny was not his condition but the fact that he was so obsessed with his herpes that the first thought that jumped to his mind was that his disfigurement was his herpes going wild.  Maybe you just had to be there.

Don’t let my semi-off-topic detour make you forget about picking up a copy of Dr. Holick’s book.  Despite my few minor criticisms, it is an excellent book that provides a wealth of useful information.  Just the Q&A is worth the price of the book because in that section Dr. Holick answers all the questions anyone might think of about vitamin D, including the one I’ve been asked numerous times: If you shower after sunbathing, does it wash away the vitamin D.  The answer is No.  Then he explains why.

There is something for everyone in this book, from studies showing sun bathing works as well (if not better) than medications for lowering blood pressure to discussions of vitamin D and its effects on obesity and leptin secretion.  It doesn’t matter if you’re depressed, have multiple sclerosis, psoriasis, osteoporosis or even PMS, you can learn how vitamin D will help you out. Grab a copy and start reading.

Since the last time I posted (which, admittedly, was a while ago), I’ve flown about 8 billion miles, so I’ve had plenty of time to read while in the air.  Here is a list of the books  on my nightstand right now.

Pandora’s Seed: The Unforeseen Cost of Civilization by Spencer Wells.  I’m about a forth of the way through this book describing the problems we hunting/gathering humans have had in adapting to agriculture.  So far, so good.  A couple of medical missteps already, but nothing major.  But I haven’t gotten to the real meat of the part on disease, so I’ll reserve my judgment until then.

The Upside of Irrationality: The Unexpected Benefits of Defying Logic at Work and at Home by Dan Ariely.  This is the follow up book to Predictably Irrational, which I posted about earlier.  While the first book explained how predictably irrational we humans really are, this second one teaches us how to benefit from it.

Manthropology by Peter McAllister.  A fun book written by an Australian anthropologist discussing what wimps modern men (and women) are compared to their Paleo ancestors.  According to McAllister, today’s elite athletes would have trouble competing with our ancient predecessors in any events requiring speed or strength.  Unfortunately this book won’t be available in a US edition until Oct 2010.  If you want it before then, you can get it on Amazon, but you’ll have to pay through the nose for it like I did. I couldn’t resist the title.

The First Cut, Cut to the Quick, and The Deepest Cut all by Dianne Emley.  The careful reader can probably detect a theme in these books, which are are police procedural mystery novels set in Pasadena, CA.  The protagonist, Nan Vining, is a single mom and has recovered from a near death experience after having been stabbed in the throat while on duty.  These have been my escapist books over the past couple of weeks.  I’m running out of mysteries to read because it seems that I have read everything written by US and UK (and even Australian) authors.  Help!  Any and all suggestions will be appreciated.

36 Arguments for the Existence of God: A Work of Fiction by Rebecca Goldstein.  A literary novel if there ever were one.  Probably not everyone’s cup of tea, but I enjoyed it immensely.  It has so many moving parts that it’s hard to describe.  Read the Amazon review if you’re interested.

The Rational Optimist: How Prosperity Evolves by Matt Ridly .  I was curious to see how Matt Ridly, an excellent science writer, would approach a more soft science than usual.  His thesis is that collective human intelligence will save us from the fates all the Erhlich’s and Malthusians fear await us.

Decoding Reality: The Universe as Quantum Information by Vlatko Vedral. Another book that is no doubt not everyone’s cup of tea, but I’m a physics/quantum mechanics geek so I enjoy this kind of book.  It explores the idea that information is the basic element making up the universe.

Cro-Magnon: How the Ice Age Gave Birth to the First Modern Humans by Brian Fagan.  Dr. Fagan is an Emeritus Professor of Anthropology at the University of California, Santa Barbara and a fellow member of the Santa Barbara Yacht Club. This book, his latest, explores the time that Cro-Magnon man and Neanderthals co-existed in Europe and how the superior intellect of the former allowed them to survive the Ice Age.  Until I read this book, it hadn’t occurred to me that the Cro-Magnons, who were identical to us genetically, roamed Europe for about 30,000 years, a length of time vastly longer than all of recorded history.  And yet it seems we know less about them than we do most of the other primitive beings.

It’s time for the 2009 bestseller list.  These are books purchased last year through this website from readers either going through the Amazon portals on the page (more about which later) or clicking on Amazon links appearing in many of the posts when books are mentioned. As always, these are all the books purchased that are not books MD and I wrote or co-wrote.

The number one winner going away was Lierre Kieth’s brilliant The Vegetarian Myth.  If you haven’t read it, grab a copy ASAP.  For those of you who don’t know, Lierre was recently the victim of an assault at a San Francisco reading.  Masked thugs came out from behind the stage and smashed her in the head and face with pies laced with cayenne pepper.  After the assault took place, while Lierre was trying to get the burning pepper out of her eyes, the audience (of mainly vegetarians) cheered.  It was truly disgusting.  Richard Nikoley and Tom Naughton reported on the assault here and here.  Jimmy Moore has a  interview with Lierre about the attack here. Tom Naughton proposes a rationale for such behavior here.

It appears that militant vegans have secured  Lierre’s name and other versions of her name on Twitter and are mounting a vicious smear  campaign against her.  Purchase her book to fight back.  Success is her best revenge.

Here are the books in descending order.

#1 The Vegetarian Myth by Lierre Kieth.  My review here.

#2 Mistakes Were Made (But Not by Me) by Carol Tavris and Elliot Aronson.  My review here.

#3 Good Calories, Bad Calories by Gary Taubes.  My review here.

#4 Lucy: The Beginnings of Humankind by Donald Johanson. My review here.

#5 Control Theory by William Glasser My review here.

#6 The Brain Trust by Larry McCleary, M.D. My review here.

#7 500 Low-Carb Recipes: 500 Recipes from Snacks to Dessert, That the Whole Family Will Love by Dana Carpender

#8 Natural Hormone Balance for Women by Uzzi Reiss.  A mention here.

#9 How to Cook Everything by Mark Bittman.  MD’s review here along with her entire list of essential cookbooks.

#10 Crucial Conversations: Tools for Talking When Stakes are High by Kerry Patterson et al.  My review here.

#10 Primal Body-Primal Mind by Nora Gedgaudas

#10 The Great Cholesterol Con by Malcolm Kendrick.  My review here.

#10 The Happiness Hypothesis by Jonathan Haidt My review here.

The last four books on the list sold exactly the same number of copies, so they all tied for 10th on the list.  I listed them alphabetically.

Although not a book, sales of the DVD of Tom Naughton’s brilliant film Fat Head would have put it at #2 on the list.  If you haven’t seen this film, order it today.  Here’s my review.

I want to thank all of you who have ordered not just books but all kinds of things through this site.  And I want to encourage you to continue.  The small commission I make on each order helps underwrite the maintenance on this site, which is much higher than I would have thought it would be.  Plus, I’m still paying off the recent redesign.

For those of you who don’t know what I’m talking about, any time you order a book or a DVD or a CD or anything (groceries, supplements, tee-shirts, whatever) through Amazon.com, I get a small commission on your order.  But I get this only if you go through one of the Amazon portals on this blog or MD’s blog or anywhere on the website.  What is an Amazon portal?  If you click the picture of The Six-Week Cure for the Middle-Aged Middle at the upper right of this post, you will be taken to the Six-Week Cure page on Amazon.  If you’re looking for something else, just type it in the search window, click the ‘Go’ button to the right, and you will be taken to wherever you want to go, and anything you purchase once you get there will earn me a tiny commission.

This whine for help with Amazon is my own version of those awful PBS fundraising telethons.  The difference is that here it doesn’t cost you anything; you simply have to purchase whatever you were going to purchase through Amazon anyway by going through one of the portals on this blog.  And your free programming will continue.

As some of you may have noticed, I finally removed the tacky Google ads that were at the bottom of each post.  I didn’t even realize they were there until I was having lunch with Mark Sisson one day, and he asked me what my relationship with Atkins Nutritionals was.  I told him I had no relationship with them.  He told me he figured I did because a fairly prominent banner ad for Atkins Nutritionals appeared at the bottom of each of my posts.  I checked myself, and, sure enough, there were the ads.  I looked into it and found out that I was making about $45 per month for these ads (not all were Atkins, but most were) so I ditched them altogether.  Had I been making $1500 per month on these ads, I may have had second thoughts, but as it was, I had no problem giving them the ax.

So, at this point, no ads are cluttering the pages of my blog or MD’s blog.  Other, of course, than those for our own books, which are the previously mentioned Amazon portals.  Order early and order often.

A quick post just to let everyone know that I’m still among the living and that I haven’t given up posting for good.

MD and I have taken off a few days and are in Dallas with kids and grandkids celebrating Christmas.  It snowed like crazy all yesterday afternoon, and, according to the newspapers, Dallas has had its first white Christmas since 1926.  And we were here to witness it.  At left is a photo looking out the back door.  Granted, it’s not a New England eight inch snow or a Colorado two foot snow, but it’s a pretty substantial snow for Dallas.  Maybe it’s a harbinger of good things to come, although the last white Christmas preceded the year in which the Great Depression started.

I’ve been absent from posting because MD and I have been incredibly busy with Sous Vide Supreme stuff.  I just thought we were busy during the developmental stage.  The post-developmental era has consumed enormous amounts of our time.  Especially since our invention had such a nice write up in the New York Times a couple of weeks ago.  We’ve been inundated with requests for interviews from multiple media sources and for write ups for this and that.  And all that is not to mention a week’s worth of filming in Seattle.  We’re making a true infomercial on the Sous Vide Supreme with emphasis on the ‘info’ part.  So many people are unaware of what the sous vide process is, so we’re going to tell them.

We’ve teamed up with chef Richard Blais, whom many of you may know from Top Chef, Iron Chef America and other TV cooking shows.  He couldn’t be any nicer nor any easier to work with – a really great guy who can cook like you wouldn’t believe.  He will appear with MD on the infomercial that will start running early next year.  Below is a photo of the two of them camping it up on the set.

The infomercial filming went without a hitch, and the food that Richard Blais prepared in the SVS was incomparable.  On the eve of the filming my brother sent me a YouTube of an infomercial that had a few problems.  I forwarded it on to the rest of the team, and fortunately the Sous Vide Supreme functioned a little better than the popcorn popper in the video below.

Click here to view the embedded video.

We’ve also teamed up with the retailer Sur La Table.  They will be carrying the Sous Vide Supreme in their stores and in their catalog right after the start of the year.  MD and Richard will be doing demos in several of the stores, so if you want to see the SVS in the flesh, so to speak, head on over to a Sur La Table near you and take a look.

This entire sous vide experience has been different than anything we’ve ever done.  It’s really nice to see articles and reviews that are all positive instead of the hatchet jobs we’re used to getting while promoting low-carb.  No one accuses us of being purveyors of dangerous fad diets, of encouraging people to eat more artery-clogging saturated fat, of being doctors of death (which we’ve been called on live radio) or of simply trying to make a quick buck at the expense of the health of those gullible enough to follow our recommendations.  The new experience has been rewarding and a lot of fun but incredibly time consuming.  Thus my absence from my blogging duties.

But I’ve been absent in electrons only.  I’ve been flying all over the place carrying a satchel of scientific papers that I’ve been reviewing and preparing to blog about.  So I’m fully loaded with ammo and ready to write after I’ve taken a fews days of a breather.

I haven’t been totally offline, however.  I’ve been keeping up with the blogs I  read regularly and haven’t been able to resist commenting when something gets under my skin.

Food writer Michael Ruhlman did a great review of the Sous Vide Supreme, and in the comments section someone took me (and the SVS team) to task for profiteering.   As you might imagine, this kind of thing really gets my hackles up, especially since we are still way, way in the red on this project.  I kept myself in check (the good Mike won out as MD would say) and wrote a couple of mild  but informative comments.  You can read them here.

My friend Amy Alkon, the Advice Goddess, whose blog I read religiously, wrote a funny post on bacon featuring the kind of ill-disciplined child who gives the South a bad name.  Amy, who is an inveterate low-carber, wrote the post from the perspective of how much she likes bacon.  Of course some commenter couldn’t resist slamming low-carb diets in general and Gary Taubes in particular, so I couldn’t resist resorting to form (the bad Mike sort of won out on this one).  If you’re interested, you can read that exchange here (two comments). The guy turned out to be pretty nice and even sent me a friendly email via Amy.

Speaking of Gary Taubes… he tipped me off on an interesting paper on HDL that I’ll post on soon and I’ve uncovered a few others on the fallacy of the lipid hypothesis.  It looks like the mainstream is ratcheting up its jihad against low-carb again with a few spurious papers badly in need of a public dismantling.  I’ll soon be tanned, rested and ready to shred.  And to go after the statinators, the great medical menaces of our time.  Plus I’ll throw in a nice post on how long it might take the low-carb diet to become the diet recognized by all as the correct diet for most everyone.

Until then, I’m going to lay low and try to catch up on my non-scientific reading.  Speaking of which, I got a great book as a Christmas present from my grandkids today.  It is Fly by Wire: The Geese, the Glide, the Miracle on the Hudson and is about US Air Flight 5149 that went into the Hudson River last January.  Although the book extols the skill and courage of Capt Sullenberger and crew, its main emphasis is on the aircraft they flew: the Airbus 320.

Twenty five years before Flight 1549 took its plunge, a highly intelligent, charismatic French fighter pilot and test pilot named Bernard Ziegler talked the management at Airbus to let him design a plane that almost flew itself.  Ziegler recognized that pilots exhibited a bell-shaped curve in their level of skill and expertise and that some of the less skilled had ended up killing themselves along with all their passengers after getting into situations that more skilled pilots may have gotten out of safely.  He wanted to design a plane with layers of built-in redundancies that would allow all pilots, but especially those less skilled, to worry about the major goal of any pilot who is in trouble – getting safely on the ground – without  being distracted by all the little details of flying.  In other words – and in very simplistic words – if pilots could simply make the decision to land, the plane could almost fly itself.  When pilots get in tricky situations it is sometimes difficult to get out of them without stressing the plane to the point of structural damage.  As the pilots are trying to avoid disaster they have to worry not only about their main problem – a loss of power, say – but have to baby the plane to keep it from breaking up.  Ziegler fixed all that with the Airbus by designing it to perform maximally under control of multiple computers while the pilots tend to the main problem at hand.  Since the computers control these functions of the plane by electricity it’s called flying by the wire.

When Sully and crew brought the plane down safely in the Hudson, they were flying by wire.  And as the author William Langewiesche puts it

They had no choice.  Like it or not, Ziegler reached out across the years and cradled them all the way to the water. His assistance may have been unnecessary, given the special qualities of these particular two [the pilots of Flight 1549], but there is no question the practical effects were profound.  At the moment of the bird strike, when the engines lost thrust, a conventional airplane would have tried immediately to nose down.  It would have wanted to go into a sharp descent, and would have required whoever was flying to haul back on the controls with some strength and to retrim the airplane for a slower, more moderate glide, while disciplining the wings to stay level until the decision could be made to turn around.  None of this is inherently difficult, but it imposes insidious demands on the crew in an emergency, when they are already busy with more important concerns.  It is an accepted reality that the repetitive and menial jobs, associated with baseline control subtly impinge on a pilot’s capacities, and that during periods of truly high workloads, even simple thoughts are difficult to have.

Imagine trying to disarm a bomb while also having to deal with menial chores and talk on the phone at the same time.

This fascinating book doesn’t detract from the skill and heroism of the crew of Flight 1549, but explains in detail why they were able to make it look so easy.

I loved this book.  I opened it in the morning and had it finished before lunch (lunch was sous vide turkey, if you must know).  If you have any interest in aviation, Fly by Wire is a must read.  Despite the fact that the author dissects in detail a number of commercial aviation disasters in the recent past, the book actually makes one feel safer flying, especially in an Airbus 320.

This post is already longer than I had intended it to be, so I wish you all a Merry Christmas.  I’ll be back soon.

Merry Christmas from Dallas

I’ll leave you with a couple more photos.  Below on the left is my Southern grandson testing the snow barefooted.  On the right is MD slicing the sous vide turkey we had for lunch.

As anyone who regularly reads this blog can tell, I’ve been a bit hit and miss in posting lately.  The bride and I have been swamped with work on the Sous Vide Supreme project.  MD has been working with chefs to develop recipes along with creating a bunch herself; she has been editing a book on sous vide for the home cook written by yet another sous vide expert; she’s been posting on the Sous Vide Supreme blog (eggs the sous vide way); and, as you can see at the left, she’s been talking sous vide to anyone who will listen.  All this while she prepares for performing the Messiah in about two weeks.  I’ve been heavily involved in the business end of things, which is a never-ending task.  Plus, I’m the taster-in-chief.  Neither of us dreamed that this would turn into such a time-gobbling project after the development of the machine.  But it has.  It seems that we are spending twice as much time now working in some capacity on  Sous Vide Supreme than we ever did before – even when we were at our busiest.  I’m going to have to work harder on my time management if I expect to keep up with all the other projects – including this blog – that I have going.

Twitter

The sous vide time commitments have put a real hickey on my reading.  I’ve probably read less over the past four months than in any four month period of my life.  Instead of five or six books per week, I’m down to about two or three max.  I hate it.  I’m trying to keep up with my daily medical/scientific journal trawl, but that has even slacked off a bit.  When I do find something of interest, instead of blogging on it as I used to, I stick it up on my Twitter page.  I probably post 10-15 times per day on Twitter, so if you want to keep up on a moment-by-moment basis, follow me on Twitter.  If you have a problem thinking of yourself as a Twitter person, give it a try.  I dipped my toes in the Twitter waters with great hesitation, and now I love it.  I’ve found it extremely valuable because I find all kinds of new stuff daily.  You’ve got to be careful who you follow, however, or you can waste a ton of time.  If you get started, start following people who provide you with information you can use.  I avoid following people who do nothing but tell me what they ate for breakfast that day or what movie they’re going to see that night.  Sign up an give it a go. You don’t have to write anything (or tweet, as it’s called) if you don’t want to.  You can simply lurk and be the beneficiary of a ton of good info.   The Twitter people take you by the hand and get you squared away.  It takes all of about two minutes – if even that.  Literally.

Comments

I have fallen way, way behind on dealing with comments.  As I wrote a while back, I had to stop answering individual comments, and I’ve pretty much stuck to my guns on that.  Problem is, I had about three hundred comments stacked up before I started doing that.

When comments come in and I post them, they go up in by date.  So back when I was spending half my day dealing with them, I would often come across a comment that required some thought and a detailed answer.  If I didn’t have time to deal with it right then, I put it off until later.  Often when later came, I had 20 or 30 more that came in after the one requiring the time.  I didn’t want to answer those and put them up ahead of the one I hadn’t answered, so I simply didn’t deal with any of them.  Now I’ve got about 340 of them stacked up and it gives me heartburn whenever I even get on my blog administration screen.  The sad thing is that some of these comments go back months and months.

I’ve been wracking my brain trying to figure out what to do with them, and I’ve finally come to a decision.  I’m simply going to post them as they are.  I’m going to post about 30 of them per day until they’re all up.  Why not all at once?  Because I know many of you are set up to get comments emailed to you when I post them.  I don’t want to clot email accounts with 340 emailed comments all at once, especially since some of these comments are lengthy.  So, I dole them out over the next 10 days or so while keeping up with the new comments as they come in. I won’t start this process for a few days to get those of you who don’t want even 30 of them a day coming in to unsubscribe.

Since many of these hoarded comments contain very good questions, they are a trove of subjects for future blog posts.  As I post them, I’m going to reread them and clip those that would make for good posts into Evernote or my new favorite plaything DEVONthink that I’m just starting to feel my way along with. (See this great Steven Johnson (whom I follow on Twitter) article about the virtues of DEVONthink.)  After I’ve got these blogworthy comments in a format in which I can find them instantly, I’ll start working through them and posting.

Bloggers and the Federal Trade Commission (FTC)

I don’t know how closely blog readers attended to the recent announcement by the FTC that they were going to start riding herd on bloggers, but the bloggers went ballistic.

Among its other duties, the FTC patrols the universe of advertising in this country looking for anyone or any company engaging in, as they term it, deceptive practices.  In other words, the FTC is on the prowl seeking out advertisers who make false claims in order to stop them and punish them.  Which all sounds good in the abstract, but in reality is a whole other story.

As I pointed out in an earlier blog, it’s a valuable exercise to read Kevin Trudeau’s first book to see how the FTC operates.  The nutritional and health information he presents is total garbage, but his description of the practices of the FTC is right on the money. (I’ve got to admit that some of the nutritional and health information presented in Trudeau’s first book (the only one I’ve read) is accurate, but I write that off to the law of averages.  He presents so much information that odds are some of it just happens to be true.  So, if you read the book and come across something that is nutritionally accurate, don’t write me about it.  I know a few things are there, but not enough to justify reading the book other than the first part, which is an excellent treatise on the FTC.)

The FTC has the power to absolutely ruin anyone and/or any company it chooses to go after.  If you read the first part of Trudeau’s book, you’ll see how.

So, the FTC opined that they planned on monitoring bloggers to see if they disclosed the fact that they were paid to do reviews on products.  Apparently, many bloggers make money by doing paid reviews on products without disclosing such, and the FTC doesn’t like it.

I’ve never reviewed products for pay, but I have read enough about it to know how it works.  Companies provide bloggers products, then pay these bloggers for reviews of the products.  I guess the fact that bloggers are given the products and possibly paid for the reviews as well might induce them to write positive reviews of products that they thought sucked.  And I assume that’s what the FTC is concerned about.

The FTC’s actions certainly got the blogosphere in an uproar.  So much so, in fact, that the FTC started to crawdad, which I never thought would happen.  Just goes to show that if you turn the spotlight of public awareness on even the most aggressive and powerful of all government agencies, you can get results.

Not that I fear the FTC on this (at least not at this point), I’ll go ahead and disclose where I get dinero from this blog.  Virtually all of the money that comes to me through the blog comes from readers buying products through Amazon.com.  When they buy a book I recommend or go through one of the book thumbnails of Protein Power or the 6-Week Cure up at the top right or any of our other books I have up on the site, I get a little bit of lucre for it.  And I get a little more if they buy anything else after entering Amazon through one of the portals in this blog.  In a good month, it’s enough to cover my hosting and web guy expenses; in a bad month (as this one is turning out to be), it’s about enough to cover the hosting of the site and maybe an hour or so of the web guy time.

Google ads

I get a little income from Google ads, but I’m trying to get them off the site.  I’ve had several web guys working on the site over the years, and I guess code for these Google ads is stuck all over the place.  I get rid of them in once place, it seems they pop up somewhere else.  When I had Google ads everywhere, I made about $150 per month, which, in my opinion, isn’t enough to justify tacky-ing up the site with a zillion ads.  Plus, I don’t have time to go through and spend time trying to figure out which ads to block.  Many people, I’ve learned, don’t realize that these ads aren’t part of the site, and they wonder why, when I’ve just spent 2000 words bashing statins, an ad for a statin pops up.

A while back I was having lunch with Mark Sisson of Mark’s Daily Apple when he asked me what kind of a deal I had going with Atkins Nutritionals.  I told him I didn’t have any kind of deal going with them whatsoever.  I asked him why he asked.  He told me that he gets my blog posts by email, and that at the bottom of each one is a banner ad from Atkins.  I was embarrassed to say that I didn’t even know you could get the posts by email and that I didn’t have a clue why the Atkins ads were there.  I went home and pulled up the blog (I usually never look at the actual blog – only the admin page), and sure enough, there was a way I could get the posts by email.  I signed up to get my own posts, wrote one, and sure enough, here it came with an Atkins ad at the bottom of it.  I thought I had it all taken care of, but I just looked moments ago and there is still a banner ad at the bottom of the emailed post.  I’ve added it once more to the list of things to have my guy deal with when I get with him on Monday.

Book recommendation

While on the subject of Amazon.com, books and book recommendations, I might as well recommend one.
I finished a terrific book not long ago called A Colossal Failure of Common Sense: The Inside Story of the Collapse of Lehman Brothers. As the title implies, this is a treatise about the fall of the House of Lehman, one of the country’s oldest investment banks, and is written by one of the vice presidents who names names and points the finger.

Not only is this book chock full of great information about how Lehman Bros, Bear Stearns, Goldman Sachs and others operate, it is extremely well written.  The ‘author’ realized he didn’t have the skills to tell his own story in a readable manner, so he hired a writer.  But he didn’t just go out and hire one of the non-fiction write-for-hire folks that are swarming around out there, he hired Patrick Robinson, a best-selling thriller writer.  As a consequence, the book is absolutely gripping. Not only do you learn a ton about how the financial crisis developed, you learn it in a gripping, racing-through-the-pages fashion.  You’ve heard people say about certain books that they read like a novel.  Well, this one does.  I had real trouble putting it down.

After reading this book, you will know exactly why we’re in the boat we’re in now and will be stupified at the mismanagement at the top.  As I read through and learned about the perfidy of Moody’s, Standard & Poors, and the other financial rating outfits that gave the most worthless financial instruments triple A ratings, I was stunned that these companies hadn’t been prosecuted.  Without their complicity, the whole house of cards couldn’t have been erected because no one would have purchased the products.  I was interested to read in today’s Financial Times that at least  Ohio is going after them.  I suspect Ohio won’t be the last.  According to the author, these companies made billions while failing to do their due diligence before passing out AAA ratings like they were candy at Halloween.

Not long after I read the book, I came upon a piece by Calvin Trillin in the editorial section of the New York Times that summed up the situation nicely.  The problem was the enormity of the amounts of money waiting to be made drew smart people to Wall Street.  A funny but insightful short essay.

After you read the book and Trillin’s piece, take a look at this video I posted about a year ago.  It will make it all that much more funny.  And sad.

The 6-Week Cure blog

All I can say is that it’s about up.  And apologies for not having it up sooner.  I hope we’ll have it operational this week and populated with a few posts.

Another vegetarian myth

I wrote in a bookish post (or maybe in answer to a comment on a bookish post – I can’t remember) a while back that I had read most of the mystery novels out there and was looking for a new series to sink my teeth into.  Someone suggested the DI Charlie Priest mysteries by Stuart Pawson.  I got one and liked it, so I’ve been motoring through those as time allows.

The last one I read was Deadly Friends about a murdered doctor, a serial rapist and a host of other minor villains. At a point about midway through, DI Priest and one of his underlings are walking around scoping out a pharmacy prior to entering to get info about the dead doctor.  All these books – at least the four or five I’ve read so far – are written in the first person, so everything is from Priest’s perspective.  Here’s what he says:

We completed our circuit of the block.  Passing the back of the butcher’s I tried not to inhale and wished I had the willpower to go vegetarian.  Trouble is, I like my steaks.

AAARRRGGGHHHH!  Even in mystery novels I’m being reminded of how deep the vegetarian mantra has wormed its way into our collective brains.  How many times have we all heard variations on this theme?  One of the ideas the vegetarian movement has managed to get firmly implanted in the minds of many is that vegetarianism is a more healthful way to eat.  I’ve heard numerous people wistfully say they really would like to be able to follow a vegetarian diet because it’s so much more healthful, but they just like meat too much to do it.

The truth is, as we all know, that vegetarian diets are decidedly less healthful than diets containing animal protein. But the great unwashed masses don’t seem to have figured this out.

But I’ve got to hand it to the vegetarian brigade: they’ve managed to successfully propagandize most of the population.  And they’ve done so without any real science behind them.  The most they can point to is a sheaf of observational studies that don’t prove squat.

The low-carb/Paleo movement, on the other hand, is producing more data almost daily that a lower-carb, higher-fat, higher-protein diet is infinitely better for a majority of the population.  But, we don’t get the message out as well as the other side does, I suppose.  I went to a Borders Books the other day and found an entire collection of free booklets written for children telling of the horrors of factory farming and encouraging them to go vegetarian.

We are starting to make some inroads into this nonsense, however, with the help of some former vegetarians who have seen the error of their ways.  If you haven’t read Lierre Kieth’s book yet, add it to your Christmas list.

I’m girding my loins for all the hostile comments I’m sure to get from angry vegetarians.  These comments will be from vegans telling me how healthy they are and how many miles they can run and how they could kick my butt in any endeavor I might wish to engage them in.  And they’ll reference the idiotic China Study and a host of other meaningless observational junk.  But wait.  I don’t have to gird my loins.  I’m not dealing with these comments any more.  I’m just posting them as they come in.  Give it your best shot.

To see under what conditions our genome developed, read on.

The hunter-gatherer lifestyle

Just to wrap this long, meandering post up, I want to end with a link to a great article in the December 2009 National Geographic.  And to bring this post full circle, I’ve got to let you know that I found this article on Twitter.  I wouldn’t have discovered it otherwise. At least not as quickly as I did.

The long article is about the Hadza who follow a hunter-gatherer lifestyle in remote Tanzania.  The area the Hadza roam is being encroached upon by all kinds of agricultural and tourist businesses, and the author doubts these indigenous people can maintain their lifestyle for much longer.
The men hunt and the women gather.  The Hadza went on a nighttime baboon hunt and took the author along.  His account of the hunt makes for a riveting read.  Once killed, the Hadza haul the baboon back to what serves as a camp and prepare to serve it up.  I’ll leave you with the author’s description of the meal.

Ngaola skins the baboon and stakes out the pelt with sharpened twigs. The skin will be dry in a few days and will make a fine sleeping mat. A couple of men butcher the animal, and cuts of meat are distributed. Onwas, as camp elder, is handed the greatest delicacy: the head.

The Hadza cooking style is simple—the meat is placed directly on the fire. No grill, no pan. Hadza mealtime is not an occasion for politeness. Personal space is generally not recognized; no matter how packed it is around a fire, there’s always room for one more, even if you end up on someone’s lap. Once a cut of meat has finished cooking, anyone can grab a bite.

And I mean grab. When the meat is ready, knives are unsheathed and the frenzy begins. There is grasping and slicing and chewing and pulling. The idea is to tug at a hunk of meat with your teeth, then use your knife to slice away your share. Elbowing and shoving is standard behavior. Bones are smashed with rocks and the marrow sucked out. Grease is rubbed on the skin as a sort of moisturizer. No one speaks a word, but the smacking of lips and gnashing of teeth is almost comically loud.

I’m ravenous, so I dive into the scrum and snatch up some meat. Baboon steak, I have to say, isn’t terrible—a touch gamy, but it’s been a few days since I’ve eaten protein, and I can feel my body perking up with every bite. Pure fat, rather than meat, is what the Hadza crave, though most coveted are the baboon’s paw pads. I snag a bit of one and pop it in my mouth, but it’s like trying to swallow a pencil eraser. When I spit the gob of paw pad out, a young boy instantly picks it up and swallows it.

Onwas, with the baboon’s head, is comfortably above the fray. He sits cross-legged at his fire and eats the cheeks, the eyeballs, the neck meat, and the forehead skin, using the soles of his sandals as a cutting board. He gnaws the skull clean to the bone, then plunges it into the fire and calls me and the hunters over for a smoke.

The day after Labor Day (six days from today) our new book comes out, and our publisher finally gave us permission to excerpt it.  I’m going to post the entire introduction so you’ll know why we came to write this particular book.

The story you will read will be true and the names won’t be changed to protect the ‘innocent.’  Until the events transpired that you will soon be reading about, I was not especially a proponent of fast weight loss.  I mean a low-carb diet will make people lose weight quickly, but that’s not what I’m talking about.  I’m talking about the people who used to come into my office saying, “I’ve got my high school reunion in a month.  How much weight can I lose by then?’  I always considered these as fairly ludicrous requests because the requesters clearly weren’t concerned about health issues, but simply about how they would look in the short run, without an eye to maintaining their lifestyle.

As a consequence of dealing with so many of these patients, I really developed an aversion to the notion of quick weight loss to meet some sort of deadline where appearance counted.  But, as with so many things in life, it’s easy to pontificate until you find yourself in the same position as the people to whom you’re pontificating.

Go ahead and read this excerpt so you can see what I’m talking about, and we’ll pick up this conversation after.  This excerpt is from the manuscript version and not from the actual book so there may be slight differences, if you’re comparing the two.  I used the manuscript version because I could paste it in – had I used the actual book version I would have had to type it in.

Bob Hope famously quipped that middle age is when your age starts to show around your middle, and the audience always obliged him with a hearty laugh.  But for millions of adults the sad irony of the middle-aged middle is anything but funny.  Except for a select few metabolically-gifted individuals, crossing the threshold into middle age heralds the beginning of a battle of the bulge that seemingly never ends.  Granted some reach that threshold sooner than others; some acquiesce to the larger belt and the broader silhouette with some degree of aplomb, while others rail against time and fate. They take up and discard first one diet and exercise program and then the next in a frustrating quest to recapture the slender waist they can still recall, but no longer see in the mirror.

We’ve spent the majority of our medical careers helping people of every description with just this battle, combating overweight and weight-related health issues.  Although some were in their teens and twenties and some were in their seventies and eighties, the vast bulk of the many thousands of patients we guided to better health and lower weights were in middle age.  What we learned from these many years in the diet trenches is that middle-aged weight is stubborn; it’s different to deal with; it doesn’t respond readily to modest dietary changes or the incremental increases in exercise usually recommended by the purveyors of received medical and nutritional wisdom.  The factors driving middle-aged weight gain—which really does go straight to the middle—are like a perfect storm, metabolically speaking.  A confluence of changes in hormones, stress, lack of sleep, alcohol intake, medications, fat and cholesterol phobias, and a mountain of other nutritional misinformation combines to create a mid-life tsunami that seems to swamp the metabolism and fill every nook and cranny of the middle of the body with fat.

For more than twenty years we have researched this area of science, refining the tools to deal with it effectively, writing about it, lecturing on it, so you’d think that our expertise would make protect us from the tsunami, if it came our way.  But it didn’t.  Like everyone else, when the middle-age wave hit, we found ourselves floundering in the tide, paddling as fast as we could, and still not making much headway.  At least not until we dug back into the medical bag of tricks we had used with success in our middle-aged patients and applied them to ourselves.  Here’s how it all began.

Mike’s Story

Our wake up call came the morning we walked onto the set to film the pilot for our TV cooking show. Years before, I had gained a tremendous amount of weight while pursuing my career as a busy, practicing physician, then lost it on a diet I cobbled together from information I got rereading my old medical school texts and delving into the medical literature.  My weight loss did not go unnoticed by my patients, and soon many were clamoring for me to put them on the same diet I had developed for myself.  I did so with great success.  In short order my practice changed.  My wife, Mary Dan, left her busy family practice and joined me in what became a huge bariatric (the treatment of obesity) practice.  We refined the original diet and wrote about our methods in Protein Power, a book that sold nearly 4 million copies.  During the never-ending promotion of the book, we met a producer who proposed that we star in a TV cooking show designed around the precepts of our diet and a cookbook we had written.   We said “Let’s do it.”  He put the deal together and set the shooting schedule for the pilot.

We walked onto the set in sunny Southern California one morning filled with both enthusiasm and apprehension.   As we wandered through the semi-organized chaos that is a film studio, stepping over giant cables, ducking under the scaffolding for the overhead cameras, and dodging production assistants darting here and there, we began to wonder what we had gotten ourselves into.  The whirlwind of activity and the 30 or so people on the set were intimidating to say the least.  We had done countless live and taped television and radio interviews in the previous years, but never a project in which we were the sole actors on the stage, the ones who had to carry the entire show on our own shoulders.  A young man recognized us and directed us to the Green Room, telling us the director would be in to talk with us shortly.

The director, a total stickler for every aspect of the production, didn’t mince words when he joined us in the Green Room.  “We’re going to have to do something,” he said, “you guys are too fat to be starring in this kind of a cooking show.”

We were stunned.  I was a much lesser version of my former fat self and thought of myself as pretty slender.  Mary Dan had gained a little weight in the ten years since the publication of Protein Power, but certainly wouldn’t have been considered fat by anyone’s estimation.  People we met at lectures, book signings, and other appearances uniformly commented on how thin and healthy we looked and always added that we were good advertisements for our diet.

“Yeah, well, it doesn’t work that way on TV,” said the producer.  “If you’re the stars of a show on healthy eating, you’ve got to be thin.  Granted, you look better than the average Joes and Janes out there, but they don’t have their own health show.  TV is a youth-driven medium.  You’ve got to look young to make it on TV and young means thin, especially around the middle.  It’s like the golfer, Lee Trevino, says, the young guys are the ‘flat bellies.’  You’ve got to have a flat belly if you want to make it in this biz.  The camera is going to put 10 pounds on you and you’ve both got bellies starting out.  Imagine 10 pounds added to that.”

Bellies…?

“When you do lectures you’re dressed up, right?  You wear suits, don’t you?”

We nodded.

“At book signings you sit behind a desk, shake a few hands and sign books.  It doesn’t work that way on TV.  You’re going to be moving around, bending over, putting stuff in the oven; you’re going to be seen from all angles.  If we try to hide the fact that you’ve got a little extra weight around the middle, which will be hard since the camera will magnify it, the viewers will know.  Putting you in baggy sweaters or loose clothing will just make them think you’re fat and trying to disguise it, and the show will lose all credibility.”

In a flash, Mary Dan and I had both gone from being confident in our own 50-plus-year-old bodies to being aware of the small paunches that had suddenly seemed to materialize out of nowhere.  What before had seemed nothing more than a little tightening of the waistband now suddenly assumed Falstaffian proportions.

“What can we do?” we asked. “If we try to hide it, they’ll think were fat; if we don’t, they’ll know for sure.  It’s a Catch-22.  We can’t win.”

Our director said, “I haven’t worked in this biz for over 40 years and not learned a trick or two.  Here’s how we’re going to make this work.  Since you, Mary Dan, are going to be the main cook, we’ll keep you standing behind the counter.  You’re short enough that with the height of the counter and a little work with wardrobe we can keep you covered without appearing to do so.  Mike, we’ll have you do all the moving and bending, so you’re going to have to take the bullet.”

“Take the bullet?  What do you mean?”

He reached into his large canvas bag and pulled out what appeared to be a giant piece of black foam rubber.  “Before you go to wardrobe, let me help you put this on under your t-shirt.”The giant piece of foam rubber turned out to be a device called an abdominal censure; in other words, a giant girdle.

“I can’t wear that…” I said.

“Hey, don’t think you’re the Lone Ranger,” he replied, “why do you think I have this?  I didn’t buy it just for you.  A surprising number of the people you see on TV daily are wearing one of these.  Lift up your shirt.”

“Who?” I asked.

“I’m not going to tell anyone about you and I’m not going to tell you about anyone else.  Lift your shirt.”

I lifted my t-shirt; he wrapped the thing around my abdomen and put his knee in the middle of my back to cinch me in.  Feeling a little like the male equivalent of Scarlett O’Hara in the corset scene, I dropped my t-shirt down and looked in the mirror.  I had to admit, I looked better.

I wore the girdle and Mary Dan stayed behind the counter for the two days it took to film the pilot.  (Now we shoot two shows per day, but then we were raw beginners.)  Our show got picked up by PBS and we scheduled to start shooting about three months later.  Fortunately, the pilot was only shown to others in the industry, and now the show with me squeezed into neoprene and Mary Dan cloistered behind the counter has been relegated to the never-to-be-shown file.  What we took away from that day was the certainty that something had to be done and quickly…but what?

Not long after returning home from this experience we attended a large charity event at which we were seated at a table with several middle-aged women.  One was significantly overweight, but the others would be considered within or close to their normal weight range.  The discussion turned to weight loss.  The constant thread through the conversation was how much easier it was to lose weight overall, compared to the difficulty of losing it in the waist.  All the women bemoaned their stubborn middles.

Meanwhile, still stinging from our recent brush with abdominal truth, we had begun looking at the mid-sections of non-obese middle aged men and it quickly became clear that they all had paunches of various sizes.  It appeared that there were no (or damned few) middle-aged flat bellies out there of either gender.  Young people who were a little overweight didn’t seem to have protuberant guts; they carried their excess weight all over.  But in middle age, it went straight to the middle.  Even young people with guts don’t look the same as middle-aged people with big bellies; there is a difference, easily recognized.  We realized that our director had been right; it’s not just normal body weight, but a flat belly that is the real sign of youth, so we set out to get one, too. .  Drawing on two decades of experience in clinical practice, helping thousands of patients of all ages, we dusted off and examined every weight loss trick in our armamentarium. We did the same thing we had done years before when we did our research for Protein Power, combing the worldwide medical literature for insight and scientific substance, but instead of concentrating on weight-loss in general, we focused our search on abdominal weight loss, more specifically abdominal fat loss.  We discovered that, although spot reducing is impossible, the diameter of the mid-section can be reduced quickly with the right nutritional tools.  Fortunately, many of those tools dovetailed perfectly with those we’d used successfully over the years with patients in our clinical practice.  After a couple of weeks of intense effort, we put together a flat-belly program for ourselves that combined a reworking of our old Thin So Fast and Protein Power diets that we had used in many thousands of patients, a number of nutritional supplements we had learned about from our wide-ranging medical research in the intervening years, and a unique, but simple, abdominal exercise plan, based on the laws of physics.

We had exactly 6 weeks before our next shoot, so we launched into the program with full vigor, with the goals of avoiding the dreaded cinch and the safety of the counter.  The regimen vastly exceeded our expectations.  The greatest changes occurred in the first two weeks with smaller, but still significant, changes taking place over the course of the next 4.  We appeared for the shoot with flat bellies, much to the delight of our director.  and were able to move from refrigerator to sink to counter, showing full physique and with nary a trace of neoprene.   We no longer had to suck it in every time we changed positions for fear that the camera might catch our mid-sections at an unfavorable angle. The regimen had been a slam dunk.

It’s been a little over two years (and 26 episodes of our show) since we developed and took The 6-Week Cure ourselves, but our success has inspired countless readers, viewers, relatives, patients, friends, and friends of friends to want to know exactly how we did it.  This book provides those answers.  In it, you will discover not only what happens in middle age that drives fat into your middle body, but more importantly, what you can do, physically and nutritionally, to harness the metabolic forces at work and turn the tide.  With a little hard work over a very short stretch, you, too, can regain a more youthful silhouette. When you do, we’re sure you’ll agree with what we discovered: there’s nothing that restores youth like curing your middle-aged middle.

MD and I have been on a low-carb diet (sometimes stringently; sometimes not so stringently) for about the last 25 years, so some may take this story to be a repudiation of such diets, but it isn’t.  Our diet wasn’t really at fault; it was the inexorable creep of time that caused the problem.

As we age, things change.  What worked 25 years ago, doesn’t work exactly as well now.  Especially when we get a little sloppy with it.  One of the problems with carb restriction is that people who do it for a while, get good at it.  They become experts at both abiding by the carb restriction yet consuming a lot of calories and tending to overlook small carb indiscretions—a small piece of bread at dinner, just a bite or two of dessert, an extra glass or two of wine or beer—that they would have scrupulously avoided during the first heady days of low-carbing.  We were certainly experts on low-carb diets and we fell into those traps.   And time marched on making us even more susceptible to little indiscretions and to carb creep.

Now, we never came close to Orson Welles or Mamma Cass proportions – in fact most people would have described us a slim – but we had picked up little middle-aged middles.  So we set out to lose them.  Fast.  To do so, we relied upon our 25 years in clinical practice, pulling out every tool we had learned to help solve stubborn cases of middle- aged overweight.

As we describe in the book, the kind of fat people pack on around their middles in middle age is different than fat packed on earlier in life, which is both good news and bad.  Middle-aged fat is, by and large, visceral fat, the kind that accumulates within the abdominal wall and around the organs.  The bad news is that it is a dangerous kind of fat – the good news is that it’s relatively easy to lose.  Especially if you do it the right way.  Which is why you can make enormous strides in only six weeks even if you have a lot to lose.

Although it does contain plenty of information you’re not likely to have read before, this book isn’t intended as a giant treatise on everything known about health and weight loss.  It’s, quite simply, a primer on how to get rid of middle-aged abdominal fat fast and safely.  We solved our own problem.  I hope those of you who grab a copy and give it a try achieve the success that we did.  And I hope you give us your feedback so that we can improve future editions.