In the last post I wrote that I would explain why George Bray and his brethren in the academic obesity research world are in great measure responsible for the toxic world they all blame for the obesity epidemic.  We live in a world, they say, filled with impossible to resist foods that throw us into hedonic overdrive.  As long as we live in such a world, there is no hope – other than drugs, of course – for the obesity epidemic to be reversed.  They may be correct.  But, as I said, they are in part responsible.  Let’s see why.

You can’t just go around gibbering as they do about a toxic environment without defining what it is that is toxic about it.  If pressed, these folks almost always default to the position that it is the elevated levels of fat in the diet that are toxic.  They will often say – as Bray did in his rebuttal to Taubes – that the ready availability of high-fat, high-sugar foods is what makes the environment toxic, but that is just a kind of code for high fat, which is what they really believe causes obesity.

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Dr. George Bray's model of obesity

In July 2008 I posted on Dr. George Bray’s critique of Gary Taubes’ book Good Calories, Bad Calories that appeared in Obesity Reviews.  Included in my post was a copy of Gary’s response.  Now Dr. Bray is back with a rebuttal to Gary’s response to his (Bray’s) original critique.  In conversation, Gary told me he has elected to drop the issue because the discussion is going nowhere.  Gary makes substantive points; Bray obfuscates the issues and will continue to do so.  I, however, am not going to drop the case.  Maybe I’ll have the last word here.

I want to go over Dr. Bray’s response to Gary’s letter in some detail because it is emblematic of all that is wrong with obesity research today and clearly demonstrates why we will never get anywhere until the people of Bray’s generation fade away. I don’t know that I’ve ever seen so many instances of one writer missing the point as often as Dr. Bray does in this short reply.  The entirety of his response is an example of either shoddy thinking or intellectual dishonesty.  Or maybe both. It brings to mind Mary McCarthy’s famous quote about Lillian Hellman: “Every word she writes is a lie, including ‘and’ and ‘the’.

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Almost ten years ago when we were in practice in Boulder, Colorado we started looking for a good weightloss supplement to help our patients on low-carb diets lose a little more quickly.  We evaluated a lot of supplements on the market that were supposedly weight loss accelerators – chromium, hydroxycitric acid (HCA), ephedra, phenylpropanolamine, pyruvate and a few others – with out a lot of success.  The ephedra and, to a lesser extent, phenylpropanolamine unquestionably helped people lose weight, but were fraught with side effects.  Pyruvate showed promise, but was pretty expensive.  Our partner found a couple of medical papers using a combination of supplements, some of which individually didn’t work all that well but in combination seemed to show promise.  We cobbled together from healthfood-store supplements a sort of beta-prototype of this combination and used it on a number of our willing patients.  The vast majority, all of whom were on low-carb diets, tolerated the supplement and felt it made them lose weight better.

Happy with these results MD, our partner and I decided to take the next step and get an actual product made.  We did, and let patients try it.  Again, the patients liked the supplement and though they lost weight better on it.  Although we, too, thought the patients did better, we couldn’t really say because we hadn’t compared the supplement with a placebo in a controlled fashion.  We decided to take that next step.

We contacted a clinical lab that does testing for a fee (a substantial fee, I might add) and talked to the director of the facility, who was pretty discouraging.  He told us that he would be happy to take our money and test our supplement, but that we shouldn’t get our hopes up.  He related that his company had tested scores of nutritional supplements and had never found one that really did much.  And that he figured ours wouldn’t do well against placebo either.

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I’ve been working on a nice post showing the difference between a diet using the glycemic index and a regular low-carb diet that should be up tomorrow.  I took a quick break to catch up on a bunch of NY Times and Wall Street Journals that have been lying around giving MD (neat freak that she is) fits.  In reading yesterday’s New York Times, I came upon the following:

How to Stay on the Diet Wagon

From a posting on Diner’s Journal in which Bob Harper, shown at right training a contestant on “The Biggest Loser,” answered readers’ questions:

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A couple of days ago I ran into an old friend of ours, whom I hadn’t seen in about a year. She is a highly successful, intelligent, middle-aged woman who, the last time I saw her, was at least 30 or so pounds overweight. She is now slim and trim. In fact, I almost didn’t recognize her.

I told her she looked fabulous and asked her what happened. I knew that she had been a perennial low-carber, but, like so many people, never really got into it seriously for any length of time. She knew how much better she felt when she stuck to her regimen, but a million things kept coming up – parties, weddings, business travel, etc. – preventing her from really taking her diet seriously. As she put it:

There was always a valid reason that I couldn’t really get going. I had a friend’s wedding coming up, and I knew I was going to eat and drink. So, I put off starting until after the wedding. Then it was a business trip, then it was something else. It seemed that there was always something lurking in the future that kept me from getting serious today.

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