The grisly plaster cast pictured above of the flayed corpse of a hanged murderer has quite a history.

On October 2, 1801, Mr James Legg shot one William Lambe to death in the latter’s bedroom.  Apparently the 73 year old Mr. Legg had been nursing a grudge against Lambe for some time.  As Mr. Lambe was awakening on the morning of Oct 2, Mr. Legg, gun in hand, confronted him, thrust a second pistol at him and challenged him to a duel to settle their differences.  Mr. Lambe tossed the proffered pistol out the door of his room whereupon Mr. Legg fired upon Mr. Lambe, killing him instantly.

Mr. Lambe’s wife witnessed the murder, but Mr. Legg admitted to it as well.  His trial took place on Oct 28, 1801.  He was sentenced to death, and his execution by hanging took place on Nov 2, a month to the day after the deed was done.  Justice was swift in those days.

So far, it’s just a run of the mill murder, but here’s where it gets interesting. During the time Mr. Legg was awaiting his trial and subsequent execution, three members of the Royal Academy of Arts – sculptor Thomas Banks and painters Benjamin West and Richard Cosway – had been debating the notion that artistic depictions of the crucifixion of Christ had been portrayed unrealistically.  They wondered what an anatomically correct crucifixion would really look like.

The three contacted a surgeon, Joseph Carpue, to help them with their anatomical inquiries.  At that time the only corpses legally available for dissection were those of convicted criminals who had been executed.  Carpue knew of the murder by Legg since both the perp and the victim were pensioners at Chelsea Hospital, where Carpue practiced.  Using his influence, Carpue was able to get possession of Legg’s corpse after his execution.

On the day of the execution, a small building was put up near the the site.  A cross was made and at the ready.  When the fresh corpse was cut from the gallows and transported to the waiting team, they stripped Legg, nailed him to the cross, and stood it up, allowing his still warm body to fall into the anatomically correct crucifixion position.

After the body had cooled and rigor mortis had set in, Banks, the sculptor, made a cast of the body.  Then the body was moved (maintaining its ‘correct’ position) to Carpue’s operating theatre where he proceeded to flay (remove the skin) from the corpse of the unfortunate Mr. Legg.  Banks made yet another cast, this one showing the position of the musculature in an anatomically correct crucifixion.  This is the cast pictured at the top of this post.

In an effort to keep this post in the realm of the nutritional, I might point out that Mr. Legg was definitely not obese.  He was probably pretty standard weight for his time.  He would have indeed stood out at Disneyland.

Now that you’ve had the history lesson, let me give you my request.  When MD and I opened our first little medical clinic years ago, a neurosurgeon friend of ours gave us a book on this gruesome episode.  It was a small book, well bound, and from a small press, the name of which I can’t remember.  We kept the book in the medical reference library in the clinic.  As the clinic grew, other doctors began working there with us. We finally grew out of our little clinic, and as I was packing the reference books to move, I realized that the book on the Legg affair had gone missing.

I’ve kept my ear to the ground since figuring that I would run across another copy I could pick up, but, as of yet, I haven’t.  I don’t remember the title of the book, nor do I remember the publisher.  But, I would love to have another copy.  So, if anyone happens to know the name of this book or even the publisher, drop me a note through the comments.  I would really appreciate it.

I happened to stumble across the photo of the cast of the flayed Mr. Legg while searching for something else this weekend.  I spent about three hours searching online, but alas had no luck finding the book. Nor any photos other than the one above. But I did find an account of Mr. Legg’s trial, such as it was, complete with verbatim testimony of various witnesses.

You can read it in its entirety here in the Proceedings of the Old Bailey.

I love the language they used two hundred years ago.  Here is an example.

The prosecuting attorney, a Mr. Fielding, begins his questioning of the victims wife:

You are the wife of the deceased; tell the story of the melancholy event that took place on the 2d of October?

Mrs. Lambe then gives her eyewitness version of the event:

I got up in the morning a little before seven; Mr. Legg was walking about the common room, swearing, and quite in an ill humour, I thought; I asked him what was the matter, when he began to swear the more, and said, I will turn you out of the room, if you speak another word; my husband was then in bed and asleep; I thought I heard him stirring, and opened the door to see; he had just got out of the bed, when the prisoner rushed past me, and put a pistol into his hand; he took it, turned it about, and looked at it, and said, what is this for; the room was dark, and then he threw it into the common room; my husband had just put on a little flannel waistcoat, and stood up against the door; the prisoner then, after my husband had thrown the pistol away, rushed up immediately, and fired at him, as he saw him through the glass door; when he had done so, he looked at me, and said, I have done it; I saw the blood coming out of his breast, and I cried out, murder; he fell directly; and expired; he endeavoured to call my name, but could not.

A bit later in her testimony, Mr. Fielding asks her if there was any ill-will between her husband and Mr. Legg.

She responds:

God knows what ill-will he had, but my husband had none towards him; I took him to be a very solid man, for he washed his own linen, cooked his own victuals, and took the sacrament regularly, so I thought he was a man rather better than what he has turned out.

Indeed!

So, if anyone has info on the book about this ‘melancholy event,’ please send it my way.  If I end up with the much-coveted book in my hand, I’ll see that whomever tips me off first gets a free, autographed copy of our new book when it comes out next month.  Thanks in advance.

Detail from Pieter Bruegel's The Triumph of Death

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

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

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

Opined Jennifer Levitz of the Wall Street Journal:

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

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

Tara Parker-Pope of the New York Times writes:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

As the great physicist Max Planck said

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

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

I think a nutritional renaissance is on the way.

I’ve just discovered that the soft-cover version of Good Calories, Bad Calories is out.  I guess it has been out for a few weeks, but I just discovered it was available.  If any of you have been waiting for the paperback before reading this terrific book, now is the time to get it.

Since GCBC came out a year or two ago, I’ve gotten countless comments asking me what Gary thinks about this topic or that one.  And I’ve gotten comments from folks asking me to ask Gary a question for them.  I was going to interview Gary and post his responses to my questions when it occurred to me that you all might like to ask questions of him directly without having them come through me.  I contacted Gary this weekend to see if he would be willing to answer specific questions from people on this blog.  He very generously agreed to do so.

Send your questions in via the comment section.  I ask on Gary’s behalf that you ask no personal medical questions, but questions about the science and the history of the science behind the way we eat today and the way we probably should be eating.  I promised Gary that he wouldn’t have to answer questions by the score, so we’ll see what comes in.  He and I will look at the questions and answer those that are a) the most common, b) those of the most general interest, and c) those that he feels are particularly important.

I know I don’t have to tell the readers of this blog not to be shy, but I will anyway.  Don’t be shy.  Get those questions in. If you’ve had a question that’s been gnawing at your brain, now’s the time to ask.

I’m heading off for a 9 hour drive to make it home in time to do my civic duty tomorrow, so I’ll be out of the loop for a while.  I can post comments through my Blackberry, however, so don’t hesitate to ask the question you would like to ask.

Note: I have closed the comments on this post.  Since Gary agreed to answer a number of questions, I think 101 is probably enough.  Thanks for all your interest and intelligent questions.

Ancel Keys, Ph.D.

Once again I’m putting up a post out of sequence. I just found this great video on the life of Ancel Keys that I wanted to make available to all readers of this blog.

Keys video high bandwidth download

Keys video low bandwidth download

The entire thing is pretty interesting, but the part about the starvation study that I posted on several months ago is really fascinating. As I pointed out in my post, the people on this long-term semi-starvation study were on a predominantly carbohydrate diet of almost 1600 kcal/day. This kind of diet is often recommended for weight loss and health by dietitians, nutritionists and even physicians. As this film demonstrates, it indeed works for weight loss.

In my post I discussed the depression, constant sleeping and loss of libido exhibited by the subjects in this study. Here are the words of Henry Scholberg, one such subject, as recorded on this film:

And what I wasn’t expecting was the effect it would have on the mind; the total feeling of, I guess, depression, the total occupation with the idea of food. Somebody would say, “food for thought,” an expression like that, and they mentioned the word “food,” you know what I mean? I remember eing a little bit critical of guys in the early part who would lick their plates. I thought that was really pretty crude, but by the time we were into about the second month of it, I was doing it myself. You just needed every single calorie you could get your hand on. Then the other thing that we weren’t expecting was how weak we became. I remember one time I was dating this girl and we were walking home from the movie, and I said to her, “You know, if we get attacked by a bunch of hoodlums, run like hell because I won’t be able to help you.” We lost our sex drive, and I told you I was dating this girl, and I never kissed her the whole time I was dating her. So sexually we were, you might say, dead.

Remember these words the next time someone tells you that you need to go on a calorically restricted diet to extend your life.  Would life really be worth living?

Among the many comments received on the Tim Ferriss post I did a few days ago were several questioning the psychological impact on people thinking they were going into a starvation study. As this film makes clear, these folks were glad to sign up because they believed they were helping the war effort. Their responses make it pretty obvious how they felt. I don’t believe they had a lot of negative psychology going in.

If you’re just interested in the part about the starvation study, go to about 8:22 in the film and finish at 14:39. I would watch the entire thing, though, because there are other insights into Keys’ psyche that I found intriguing.

For example, when he first presented his ideas on fat and cholesterol in the diet as causes of heart disease, he was publicly humiliated. Given his disposition, it is entirely in character for him to pursue the data showing himself to be correct and the rest of the scientific community wrong – even if it meant fudging the data, which he did his famous (infamous?) Seven Countries Study.

You can watch this short film below by Tom Naughton to see what I mean. In the above film about Keys it looks as though he selected seven countries based on a number of criteria, gathered the data, analyzed the data and found it to show a strong correlation between fat consumption and heart disease. The truth is that there were many more countries involved in the study than seven. Keys simply threw out the data on the countries that didn’t fit his preconceived notion. And everyone took it hook, line and sinker. Tom’s film shows this well.

There you have it. Two films on the long and productive lives of one of the main architects of the obesity epidemic. Enjoy.

In late November of this year Gary Taubes gave a number of talks to members of various departments at the University of California at Berkeley. One of these talks – The Quality of Calories: What Makes Us Fat and Why Nobody Seems to Care – was recorded and can be viewed by clicking here. You need Real Player to watch the video. If you don’t have it, simply Google real player or real player mac and you will find a free download of the program.

Gary’s talk expands on one of the theses in his book Good Calories, Bad Calories: the idea that obesity isn’t caused by gluttony and sloth, but by excess carbohydrate intake instead. If you haven’t read the book or if you have and you want the weight-loss section explained in greater depth, this video is for you. He’s a little more open than he was in the book about naming names and pointing the finger at people who for whatever reason can’t see the forest for the trees. The video is long – almost two hours – but well, well worth watching.

I’m going to be seeing Gary in about a week. We’ll have one of our many hour visits at a coffee house in downtown Manhattan. If anyone has a question for Gary, put in in a comment, and I’ll ask him as many as I can while I’m overdosing on caffeine.

So take a break from your Christmas shopping this weekend, kick back and watch this video. You’ll be glad you did.

Hat tip to blog reader Art D for giving me the heads up on this one.

John McCrae, M.D. (1872-1918)

On the 11th hour of the 11th day of the 11th month of 1918 WWI, The Great War, the war to end all wars, was formally ended with the German signing of the Armistice. We commemorate this day – formerly called Armistice Day – each November 11.

No one who wasn’t there or who isn’t a student of WWI can possible imagine the carnage, the vast populations of young English, German, French, Canadian, Australian and American males who perished in a conflict many feel was bungled by the generals on all sides. All who survived it couldn’t imagine there ever being another war like it. Little did they know.

After a horrific battle in the Ypres salient in the spring of 1915, a Canadian army physician named John McCrae buried one of his friends who had been blown to pieces by an artillery blast. The next day sitting on the back of an ambulance, watching a gentle breeze rustle the poppies that had sprung up in the battlefield, Dr. McCrae penned the poem below, which has become the most memorable poem from that brutal war.

Lt. Col. McRae was himself to die from pneumonia before the war’s end.

IN FLANDERS FIELDS

In Flanders fields the poppies blow
Between the crosses, row on row
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.

An annoying comment I hear all the time whenever I talk about how Ancel Keys set the country on the disastrous nutritional course it has been on for the last 40 years runs something like this: ‘I dunno. Key’s must have been doing something right because he lived to be 100.’

First, the fact that Key’s himself lived to be 100 doesn’t mean squat. Everyone has a relative somewhere that defied the odds. I would bet that just about anyone can name someone who smoked, drank and was obese who lived to a ripe old age. Winston Churchill, for one, comes to mind. Smoked, loved his booze, was obviously obese, and lived to be 90. It’s not the individuals that matter in terms of health and longevity, but populations as a whole. And since the US (and now the world, it seems) has been following the wisdom of Ancel Keys, look what has happened. Obesity and diabetes are at epidemic levels. So, while Ancel himself lived a long life, I’m not so sure a lot of his victims will.

But, since people obnoxiously continue to point out that Keys made it to triple digits by allegedly following his own recommendations, let’s look at another individual (which, again, mean nothing in scientific terms) for comparison’s sake.

A reader sent me the link to the following YouTube. It’s a few minutes long, but well worth watching. It shows diet and fitness expert Jack Lalanne having a heart to heart with viewers of his show back in the 1950s. Observe. And listen carefully to the diet he recommends. (And notice how far television production values have come in 50 years)

Now, let’s assume that Mr. LaLanne practices what he preaches. He is 93 years old now, going on 94. A photo of him taken this year is at the top of this post. Below are a couple more.

Below is a photo of Ancel Keys taken when he was 100 and was being honored by the Scripps Institute. I suppose he could have looked as good as Jack LaLanne seven years before this picture was taken, but somehow I kind of doubt it.

So, you be the judge. Who would you rather look like when you reach your golden years?

Remember these photos the next time you hear someone rabbit on about how Ancel Keys lived to be 100, therefore he must have been doing something right.

Finally the New York Times comes up with a halfway decent review of Gary Taubes’ book Good Calories, Bad Calories. In yesterday’s Science section John Tierney (obviously not a member of the Kolata/Brody/Burros coven) takes a serious look at Gary’s book and what it has to say about the mainstream medical/nutritional establishment’s recommendation to follow a low-fat diet.

Gary Taubes spends many pages in detailed analysis of how the mainstream went wrong in promulgating these incorrect recommendations for so many years despite the mountains of contradictory evidence. John Tierney brilliantly sums up the same situation in just a few paragraphs using a TV show most of us are familiar with as an example:

We like to think that people improve their judgment by putting their minds together, and sometimes they do. The studio audience at “Who Wants to Be a Millionaire” usually votes for the right answer. But suppose, instead of the audience members voting silently in unison, they voted out loud one after another. And suppose the first person gets it wrong.

If the second person isn’t sure of the answer, he’s liable to go along with the first person’s guess. By then, even if the third person suspects another answer is right, she’s more liable to go along just because she assumes the first two together know more than she does. Thus begins an “informational cascade” as one person after another assumes that the rest can’t all be wrong.

Because of this effect, groups are surprisingly prone to reach mistaken conclusions even when most of the people started out knowing better…

Cascades are especially common in medicine as doctors take their cues from others, leading them to overdiagnose some faddish ailments (called bandwagon diseases) and overprescribe certain treatments (like the tonsillectomies once popular for children). Unable to keep up with the volume of research, doctors look for guidance from an expert — or at least someone who sounds confident.

In the case of fatty foods, that confident voice belonged to Ancel Keys, a prominent diet researcher a half-century ago (the K-rations in World War II were said to be named after him). He became convinced in the 1950s that Americans were suffering from a new epidemic of heart disease because they were eating more fat than their ancestors.

As Taubes points out in his book Keys was strong of personality and didn’t shy away from vociferously attacking anyone with whom he disagreed. And he didn’t just point out in a civil way that he though opposing opinions were incorrect and give the reasons why, he attacked vituperatively in medical journals and in person during conferences. He was the Anthony Colpo of his day resorting to personal attacks and innuendo with the difference being that Keys was widely respected by the mainstream and was on the cover of Time magazine(see above); he was like E.F. Hutton: when he spoke people listened (by the millions) despite the fact that what he said was balderdash. Other academicians feared his wrath so they more or less published their findings but didn’t publicly promote them. As a consequence the cascade started with Keys and he made sure that it kept going until it took on a life of its own that still breathes today. If you don’t think so, take a look at some of the reviews of Good Calories, Bad Calories.

(To see an example of what a swine Keys could be, take a look at this exchange. In 1973 a well-respected scientist named Raymond Reiser wrote a paper questioning the idea that saturated fat might be the danger Keys thought it was. (click here for full text) Keys lost no time in responding, accusing Reiser of being a liar and distorting the facts. (click here for full text) Reiser responded (click here), but others got the message: don’t fool with Keys unless you want the same treatment. You can see the same kind of invective today on the part of anyone who questions the lipid hypothesis in the medical literature.)

Tierney has a follow up piece today in the online version of the Times that delves a little deeper into the phenomenon of informational cascades:

The belief that low-fat diets prolong your life is one example of a cascade. The crusade against global warming is another — which is not to say that global warming isn’t real. Cascades can be based on correct beliefs as well as mistaken ones. The point is that large groups of people can reach a “consensus” without most of them really understanding the issue: Once a critical mass of people starts a trend, the rest make the rational decision to go along because they figure the trend-setters can’t all be wrong. The danger is that you end up with the blind leading the blind…

He goes on to quote from a prominent researcher in the field as to why the group consensus over time doesn’t lead to a correct result. In short, it’s because the choice is posed in binary or yes/no form.

It all comes down to the fact that many choices are primarily binary. Endorsing a diet or not endorsing it. Buying a gizmo or not buying it. Going to the restaurant here or not. Running from the lion or not. Chasing the blond girl at the bar or not.

See, prior to our work, researchers thought that the following corrective force would be at work: If I see one agency adopt the 100% low-fat diet, and I think it is a bad idea, I should endorse it only halfway–say, I would suggest a 60% low-fat diet. The next person could figure out from my half-hearted adoption that I wasn’t so favorable, either. If he has negative private views, his choice would become even less favorable (say, 10% low-fat diet). Pretty rapidly, the truth will win out as more and more people act and their actions tell everyone how strongly they believe the diet. They communicate their private views through their action.

What cascades have done is to show that as long as the main choice is binary, this logic won’t hold. There is no strong corrective force any longer. I don’t really have the choice of going 50% low-fat diet. I have the choice of endorsing it or not endorsing it. No one cares about the details of how I am endorsing it. They can only easily observe whether I am for it or against it. If I follow, then those coming after me can no longer learn anything (easily at least) from what I have been choosing as my recommendation.

This analysis confirms one of the suspicions I’ve held for a long time, namely that the most vociferous popularizer of the low-carb diet – Robert Atkins – was its worst enemy in terms of its gaining wide acceptance. Atkins was so personally cantankerous and made such hubristic pronouncements that most mainstream researchers couldn’t stand him and couldn’t bring themselves to admit that he was right about what he said. As a consequence they thought in binary terms: either the low-carb diet is good or it’s bad. And since Atkins is its main proponent and we hate Atkins, it’s bad. Even low-carb proponents didn’t particularly like Dr. Atkins. As I mentioned in a previous post, John Yudkin, a low-carb proponent if there ever was one, said of the Atkins book that its

chief consequence [may have been] to antagonize the medical and nutritional establishment.

Had Dr. Atkins been charismatic, friendly, approachable, in full command of the medical literature, and had he not made the bizarre and hubristic comments about repealing the laws of thermodynamics, I think low-carb would probably be the diet of choice right now, recommended by mainstream nutritionists instead of being viewed as a fad diet that is dangerous. The obesity and diabetes epidemics might have been avoided. I’ve learned from many conversations with various scientists that they just can’t bring themselves to say publicly that Atkins was right because they loathed him so much.

Read these two pieces by John Tierney and you’ll see why people jumped on the low-fat bandwagon; read Good Calories, Bad Calories to see all the information they had to ignore to do so.

To end this post I want to relate an instance where I was almost publicly embarrassed by the cascade effect. In 1989 I was on my first book tour for my first book. It was early in the tour and I was in Minneapolis in the middle of January and going on my very first live TV show that had a studio audience. The book I was promoting told people how to concoct a protein shake and use it as part of a protein-sparing fast regimen. It’s hard to realize now with the plethora of tasty protein shake drinks available that in the late 1980s these products didn’t exist. I came up with a way to use powdered milk, some commercially available protein powders (there were a couple available, but they were used to add to a whole lot of carbs to make body building products – without the sweetening, they were undrinkable) and a few other ingredients to make a pretty good low-carb protein meal replacement. On this TV show I was to make up one of the drinks in front of the audience and have several people try it live.

Needless to say I was a little nervous. I liked the stuff, MD liked the stuff, all the people who loved me told me they liked the stuff, but here I was going to give it to total strangers on live TV and get their opinions. I was in a sweat.  I was in the Green Room feverishly making sure I had all the ingredients so that I could put it together without leaving something out. I wasn’t paying attention to the monitor showing what was going on on the show I was moments away from being on.

Unbeknownst to me there was a solar eclipse in process that the hosts of the show kept cutting to on an onstage monitor. As the eclipse progressed the monitor was showing the advancement of the moon across the sun. Of course the moon passing in front of the sun threw the moon’s shadow across the surface of the earth in places where the eclipse was visible.

The host had asked members of the audience what causes an eclipse. The first person asked responded that an eclipse was the shadow of the sun on the earth, which is, of course, idiocy because the sun is the source of light so it can’t be a shadow. As other people were asked the same question, they all fell into step and gave the same answer. This was the setup.

As my turn came and I (filled with angst about the protein shake I was going to make and unaware of the eclipse situation) walked out onto the set, the first thing I was asked after my introduction was something along the following lines:

Now we can get an answer to our question from a real scientist. Dr. Eades there is an eclipse going on right now and we’re all debating about what a solar eclipse really is. We all think it is the shadow of the sun moving across the moon, is that right?

I was caught totally off guard, and my first impulse was to agree with the consensus, but fortunately, I took a moment to think it through and said that No it was the shadow of the moon moving across the sun. But I realized after how easily I could have gone with the consensus. And if I had thought that going against the consensus would have branded me as a fraud and an idiot, I might have gone along. Or if there had been a Harvard astronomer on the set and the announcer had said Dr. Eades, Dr. X here from the Harvard astronomy department has just told us that the eclipse is caused by the shadow of the sun on the earth, what do you think? I may well have agreed. Cascades can be powerful persuaders.

Oh, and just in case you’re wondering, once we got into the diet part of my appearance it went great. All the people really liked the shake I made, or at least had the decency to say they did on live TV.

In the early part of the 20th century an entrepreneur name Charles A. Tyrrell developed and promoted an enema device called the J.B. L. Cascade (the J.B.L. stood for Joy, Beauty and Life). Mr. Tyrrell (later Dr. Tyrrell; he got a medical degree at age 57) found a ready market for his device – at that time a canvas-covered, rubberized-bag – because of the misbegotten doctrine of autointoxication that was prevalent during the latter part of the 19th and early part of the 20th centuries.

During those years many health practitioners believed that the contents of the colon were highly toxic and could seep through the wall of the colon and cause self-poisoning or autointoxication. It’s kind of easy to see how this notion would arise since the contents of the colon are malodorous and not particularly attractive. No one with a properly functioning brain would want his/her colon contents running wild throughout the body. And the idea that many reasonable people held at that time was that constipation or even mild constipation allowed the ‘putrifying’ feces within the colon (and even the contents of the small intestine) to make its way from the colon into the blood and thence throughout the body.

Highly regarded physicians of the time created medical sounding terms for the condition and the diseases that resulted. Enteroptosis and visceroptosis were the terms used to describe stasis (or ptosis) of the small or large bowel, i.e., constipation. Or at least their idea of constipation. The results of this stasis was the toxic colon contents escaping and the resultant autointoxication, symptoms of which included depression, neurasthenia, fatigue, sinusitis, coated tongue, lassitude, hysteria, anxiety and a host of other common ailments.

The cures for this made up disease ranged from the benign – wrapping the abdomen to increase pressure to enhance evacuation – to the dangerous – complex major surgical procedures to remove ‘kinks’ in the colon thus allowing freer flow of the colonic contents.

This entire idea of autointoxication was, of course, nonsense. And it was nonsense that hasn’t gone away. I still read in the alternative healthcare literature about people who have a multitude of symptoms that have defied diagnosis who end up in the hands of those performing colonic irrigations. The stories often include descriptions of agglomerated masses of old capsules and other medications that are washed out along with the feces during the procedure. And in these tales the patients often recall that they took those medications years before, which, of course, means that they had been there caught up somehow in the colon poisoning the patient. During my surgery days I was involved in a lot of colonic surgeries for cancers, gun shot wounds, stabbings, abscesses, etc. and all the colons I saw were pink and smooth. Just the law of averages would require that here and there I would have found one with a pocket of putrified masses of old pills or whatever, but I never did. Now in the days of routine colonoscopy it would seem that if these pockets existed they would be found and reported on often. But they never are.

In days of old, however, these ideas were prevalent, even in the minds of people who should have known better.

One of the most common treatments for visceroptosis and its resultant autoinoxication was the enema. And here enters our tale of the good Mr. then Dr. Tyrrell.

Charles A. Tyrrell was a Brit who came to the United States in 1880, and after six years in New York suffered an attack of ‘paralysis’ which resulted in his admission to Bellevue Hospital where his condition worsened. He was moved to St. Vinvent’s Hospital where he was, in his words, “given up for dead.” While ‘dying’ there he read a treatise by a Dr. Wilford Hall extolling the virtues of the enema for treating virtually anything that might ail one. Tyrrell apparently had the tube up his rear in a heartbeat and soon recovered his health.

A few years and many enemas later, Tyrrell founded Tyrrell’s Hygenic Institute, a company in New York that manufactured and sold emema products for home use. In 1894 he published a book titled The Royal Road to Health (click here for a full-text version) that excerpted Dr. Wilford Halls book and quoted heavily from a surgeon named Henry Turner, who claimed that after his examination of countless bowels he was of the opinion that all disease arose from constipation and decaying and putrid fecal matter.

Tyrrell’s J.B.L Cascade device held five quarts of water and differed from the standard enema bag in that the Cascade had its nozzle protruding from the center of the bag, which was designed to be sat upon using the body’s weight instead of gravity to propel the fluid into the colon. Below is a picture of a modern version that is still sold today. And below that is a picture of one in use in the event any readers have little imagination.

Tyrrell promoted his device tirelessly using ads in all kinds of publications and numerous customer testimonials. Here are a few that are typical.

Wrote Professor Arnoux

I bought one of your ‘Cascades against the advice from my physician. I am delighted with it.

Byron Cool said:

When our daughter was married, among the wedding presents, we included a J.B.L. Cascade outfit.

I would love to have seen the thank you note for that gift.

An Elizabeth Towne from Massechusetts wrote:

Why doesn’t everybody throw physic to the dogs and syringes to the junk man and use the ‘J.B.L. Cascade’?

And my favorite. A Mr. George Nutting writes

…a little over a year ago my house took fire in the middle of the night, and my wife, without as much as putting on her clothes, took the ‘Cascade’ under her arm the first thing, and started to leave the house without stopping to gather her clothes or valuables. I had the laugh on her later for it, but she said she valued the ‘Cascade’ more than anything else she had.

Through the years Tyrrell sold countless Cascades and became wealthy in the process. His relentlessly promoted ideas that constipation and autointoxication were the birth right of man and that a good enema (preferably with his contraption) could cure most anything were commonly held by many educated people until relatively recently. When I was a little kid staying with my grandparents and got sick or even acted like I might be sick, my grandmother hogged me down in a trice and filled me full of soapy water. And I always got well, or at least quit complaining.

Tyrrell’s immense success caught the eye of the medical authorities of the time, who, though still believers in autointoxication, felt that the enema wasn’t the proper treatment and verged on quackery. The American Medical Association (AMA) formed the Propaganda Department in 1906. (I guess at that time they called things what they really were. Alas the name was later changed to the Bureau of Investigation.) The Department took out after Dr. Tyrrell (he had received an M.D. from the Eclectic Institute in 1900) and wrote an article published in JAMA in 1912 that basically accused him of charlatanism and quackery. The AMA sent a copy to anyone who wrote asking about Tyrrell or his device.

The JAMA article was correct of course, but what I find interesting is that at the same time Tyrrell was making his outrageous claims as to the efficacy of his device and the enema in the treatment of autointoxication there were surgeons who were treating the same ‘disease’ with major surgery and no one at the AMA batted an eye.

One such surgeon, Willaim A. Lane, M.D., treated more than 1000 people by performing colectomies on them. A colectomy is the removal of the colon, major surgery indeed. Why didn’t the AMA bother with Dr. Lane? Because as reported in an article in the Journal of the History of Medicine he

was well-educated and conventionally trained, and he specialized in surgery. Like his orthodox colleagues, he was a part of a community that spoke the same clinical language, was familiar with a general pool of knowledge, subscribed to similar values, and strove for common goals. Lane’s versatility was such that he devised useful techniques for the treatment of fractures, harelip, and cleft palate, and infections of the mastoid.

Along with these accomplishments Lane believed that fecal retention caused disease. He felt that kinks in the large bowel, named Lane’s Links after him, caused the backup of bowel contents and the resultant autointoxication. He performed most of his 1000 colectomies on women because

he ascribed women’s perceived mental shortcomings and overall poor health not to the more popular nineteenth-century reproductive organs and gynecological etiologies, but to the causitive culprit of [intestinal] stasis.

So we have Lane and Tyrrell, both of whom profited from their treatment of a non-existant disease. One of whom (Tyrrell) promoted a fairly benign treatment, the other (Lane) who promoted a treatment attendant with much danger and many long-term consequences, yet the latter is embraced by the orthodox medical community while the former is scorned.

Things haven’t changed much today. I can think of two situations right now that are similar to the Tyrrell-Lane situation.

Unlike autointoxication, obesity is a real disease causing considerable morbidity and mortality. We have a perfectly good and benign way of treating it. It’s called the low-carbohydrate diet. And we have a way of treating it that is fraught with immediate peril and serious long-term consequences. That method is called gastric bypass surgery. Which one do you think the orthodox medical establishment believes in as the proper treatment for the morbidly obese and which one do you think is scorned as a fad?

One other is a treatment called insulin potentiation therapy (IPT) for cancer. Cancer cells by their makeup are glucose dependent. In other words, they need glucose to survive and grow, and they gobble it in huge amounts. Standard orthodox chemotherapy treats cancers by bombarding them with toxic drugs designed to kill the fast-growing malignant cells. Problem with this standard therapy is that these toxic drugs kill all of the fast growing cells, which include hair follicles and gastric mucosa to name just a couple. People who undergo chemotherapy lose their hair and are violently nauseated, not to mention seriously fatigued to the point of total debilitation. But that’s the price one pays to kill the cancer with orthodox chemotherapy.

Practitioners of IPT use the fact that cancer cells require large amounts of glucose against them. Physicians treat patients with cancers with IPT using the same chemotherapy drugs that orthodox practitioners use, but in much lower doses. Doses that are only 10-15 percent as much as the standard dose. These lower doses typically don’t cause the loss of hair, severe nausea and total exhaustion that the orthodox doses do. How do practitioners get away with these lower doses? By using insulin to reduce blood sugar and make the cancers more susceptible to the drugs. Here’s how it works.

Practitioners start IVs on their patients undergoing IPT and infuse the appropriate dose of insulin. They then administer the chemotherapeutic drugs when blood sugar levels are lowered enough to weaken the cancer. After a time the doctor infuses glucose bringing the blood sugar back to normal. During the time that the blood sugar is low and the cancer has no food to gobble, the effectiveness of the drugs is greatly enhanced allowing them to be used in much lower doses while achieving the same therapeutic effect. IPT doesn’t always work, but neither does orthodox chemotherapy.

But orthodox chemotherapy is regarded by most of the medical profession and certainly by the academicians as the only reputable way to go despite the huge morbidity it causes along with the lack of efficacy in many, many cases. These same people regard IPT despite it’s being grounded in science as pure quackery.

Besides these two there are many other examples out there showing us that the Tyrrel-Lane syndrome exists today. The take-home message is that just because the mainstream medical practitioners and the ivory tower folks are pushing something doesn’t mean that it’s the way to go. Many women who believed in orthodox medicine in the early 1900s and happened to live in the area where William Lane practiced ended up minus their colons.

I’ve read the book in manuscript form when it was 800 plus pages, again when it was cut down to 700 or so pages, and now I’m going through it again at its new, svelte 600 or so pages. It is a remarkable book, and one that, I believe, will initiate a sea change in the way everyone looks at nutrition. Unless I miss my guess, Taubes will be on every talk show known to man, and his book will be reviewed everywhere, and talked about by everyone. Just think of the satisfaction you will have (those of you who are long-term low-carbers) in just a couple of months when you can go around with big smiles on your faces telling everyone I told you so.

Here is a review from Pulitzer Prize winner Richard Rhodes that I cribbed from Amazon.com:

Gary Taubes’s Good Calories, Bad Calories is easily the most important book on diet and health to be published in the past one hundred years. It is clear, fast-paced and exciting to read, rigorous, authoritative, and a beacon of hope for all those who struggle with problems of weight regulation and general health–as who does not? If Taubes were a scientist rather than a gifted, resourceful science journalist, he would deserve and receive the Nobel Prize in Medicine.

I pretty much agree with Rhodes. The book is phenomenal. Gary has been working on it for as long as I’ve known him, and he has left no stone unturned in his quest for a complete understanding of how things have gone so wrong with the nutritional establishment. He has interviewed – and sometimes engaged in screaming matches with – all (and I mean all) of the living (and some who have recently died) ‘experts’ who have put their stamp on today’s nutritional paradigm. He has sought out the big names at the major institutions and the lesser lights laboring in obscurity, but who have made major contributions. He has read countless books and medical papers, and has crafted a highly readable, fully documented, authoritative history of diet and physiological primer of how and why the low-carb diet works.

I’m making copious notes as I read through this time and will post a more complete review when I’ve finished. The book starts by showing that by the late 1950s the medical establishment had pretty much concluded that following a low-carb diet was the most efficacious way for overweight people to lose excess fat and for normal weight people to stay thin. This idea came about as a consequence of a whole lot of clinical and laboratory research and wasn’t really in dispute. The first part of Taubes’ book tells how that (correct, as it turns out) conclusion came about and what has happened since to get us to the point where it is now academic heresy to recommend a low-carb diet.

Order your copy early through Amazon or your local book seller and prepare yourself for a great read. The book should hit the shelves in early to mid-September.