More braying from Bray
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’.
(You can read Dr. Bray’s original critique of Good Calories, Bad Calories along with Gary’s response in my July 2008 post. The full-text of Dr. Bray’s letter of reply we’ll be discussing in today’s post can be found here. You should pull it down in pdf and print it so you can follow along.)
Right off the bat, in the very first line, Bray leads off with his first porkie.
In his nearly 5000-word response to my book review, Mr. Taubes has raised a number of issues.
Gary’s response was slightly under 2000 words. You might think this just simply a typo, and normally I would too, but the entire piece is filled with so many inaccuracies seemingly designed to denigrate Gary’s response that I don’t think so. Why even put the number of words? Why not simply say: In his response to my book review…? By quantifying the number of words the way he does, Bray casts a pejorative shadow on Gary’s response from the get go.
If you read Gary’s letter, you will see that he methodically refutes Dr. Bray’s criticisms of GCBC and identifies those issues in which he feels Bray misses the point. In his response, Bray says Gary’s critique of his (Bray’s) review of GCBC
opened the door for [him] to contrast [Taubes’] hypothesis for obesity with [his own].
It’s a kind of disingenuous way for Bray to get his own hypothesis of obesity into play in what amounts to a review of Gary’s book, but let’s take a look at what he has to say. First, he completely simplifies and basically mischaracterizes Gary’s hypothesis of obesity. Here is Gary’s hypothesis of obesity and his proposed treatment as interpreted by Dr. Bray:
As you can see, it appears pretty simplistic, which, I’m sure, was the intent. Not shown are all the feedback loops and intricacies Gary has described at length in GCBC .
In referring to this diagram, Dr. Bray admits that it is based on “two sentences from the letter,” which doesn’t seem like a lot out of a 5,000-word letter (or even the 2,000-word letter that it was). Then he goes on to use three sentences to establish the basis for the diagram. (See what Mary McCarthy meant about even ‘and’ and ‘the’?)
After giving short shrift to Gary’s hypothesis of obesity, Dr. Bray then goes on to lay out in great detail his own theory of obesity as represented by the Rube Goldbergesque diagram at the top of this post. Bray’s entire hypothesis, for which he recruits leptin, insulin, the brain, glucocorticoids, and God knows what else to help make his point, is based on a faulty premise. But it’s a faulty premise he has accepted uncritically.
His hypothetical model of obesity, he authoritatively states
starts with the First Law of Thermodynamics, which states that the change of energy in a closed system is the difference between the heat added to the system and the work done by the system.
Dr. Bray then restates this hypothesis (and the First Law) in the form of this equation:
Δ E = Heat (q) – Work (w)
Readers of this blog know this as the energy balance equation, which looks like this in its more familiar form:
Δ Weight (the Δ means change) = Energy in (food) – Energy out (exercise plus metabolism)
The fatal flaw in Dr. Bray’s hypothesis (which is a flaw we’ve discussed often in these pages) is that he doesn’t understand that the components on the right side of the equal sign are not independent variables. They are dependent variables. If one eats less, the rate of metabolism falls to compensate. If one exercises more, the appetite increases, and one eats more to compensate.
Were these components truly independent variables, life would be easier (but we may not have survived). According to Dr. Bray, Anthony Colpo, and countless others, however, these components are independent variables. Eat less, say they, and you’ll lose weight. Which is true, to a point. But once the energy-out component of the equation kicks in, weight loss stalls, even if you are eating less, a fact everyone who has ever dieted knows. Exercise more, they pontificate, and you’ll lose weight. Which, again, works (maybe) in the very short term. But once appetite kicks in, you unconsciously eat enough more to compensate for your increase in exercise, as anyone knows who has tried to lose weight by walking or other exercise alone without consciously restraining eating.
Now don’t get me wrong, it is possible to lose weight by decreasing food intake and increasing exercise. It worked well in the concentration camps in WWII and in Ancel Keys’ starvation studies in the 1940s. But in those cases, people were under lock and key. It doesn’t work for the long term for the majority of people unless they are coerced.
This fairly obvious observation that the energy in/energy out components are not independent variables seems to elude most (if not all) obesity researchers, including George Bray. These people persist on basing the foundation of any obesity treatment on the admonition to eat less and exercise more, which is a total folly. Yet Bray and his ilk continue to clothe this folly in the garments of academic respectability and work to pass it off as the latest fashion in scientific thinking.
Dr. Bray believes that the reason so many people are fat is twofold. First, he thinks humans have a ‘hedonic’ drive that inexorably pushes them to increase their food intake. And, second, he reckons that this ‘hedonic’ drive also overrides the “appropriate negative feedback signals to stop eating.” What stimulates this ‘hedonic’ drive? According to Dr. Bray
It is caused by the pleasurable effects of high-fat, high-sugar foods.
Well, at least he’s half right on that one. No one binges on pure fat. It’s impossible because of feedback inhibition to eat a lot of pure fat at a sitting. Try sometime to sit down and eat some butter all by itself. See how much you can choke down. I can guarantee you it won’t be much. Then add a little sugar to the mix and see what happens. Suddenly the butter is converted to frosting, and you can put away a lot of it. What’s the difference? It’s the sugar. Sugar – and carbohydrates in general – override the stop-eating center in the brain. That’s why all binge eaters binge on a combination of fat and carbohydrate. That’s also why you can go out to dinner, eat ‘til your stuffed, not be able to eat another bite of any kind of meat or other real food, yet perk up when the dessert tray comes around. As the old saying goes: there’s always room for dessert. Why? Because your brain knows the stop-eating center will be overridden by the sugar and carb in the dessert.
Dr. Bray would have been more accurate had he said that the stimulus for the ‘hedonic’ drive is carbohydrate.
But he doesn’t. He is trapped in the fat-is-bad paradigm.
In experimental animals, highly palatable food or a high-fat diet is one of the easiest ways to disturb this homeostatic system [as defined by Dr. Bray], and this may apply to human beings as well.
Dr. Bray seems to believe that we live in a toxic world in food terms. We are unable to help ourselves, and are therefore destined to be fat because of our ‘hedonic’ drive. We are helpless. There is no cure save eating less and exercising more, which even he more or less admits doesn’t work despite his entire model being based on the idea. As I have discussed in another post, Dr. Bray is a major proponent of drug therapy to treat obesity.
In a way, I agree with him about the idea that we live in a toxic world, one with all kinds of the wrong kinds of food available to tempt us 24/7. Problem is that Bray and his ilk are a major part of the reason we live in such a world. But that’s a topic I’ll leave for a future post.
Dr. Bray makes a bizarre case for why he thinks the majority of dietary studies show better results in those subjects following low-carb diets than in those consuming low-fat regimens. I’m going to use his own words, so you won’t think I’m making this up.
the principal studies that directly support this model [Taubes’ theory on low-carb dieting] included the word ‘Atkins’ in their clinical trial. When similar low-carbohydrate diets were tested without using this ‘name’, the low-carbohydrate diets had no more effect than those to which they were compared.
There you have it. All you have to do to make a diet work is include the name ‘Atkins’ in the title. I wish MD and I had known that when we wrote Protein Power.
What is truly ironic about this nonsense is that in this very same issue of Obesity Reviews containing Bray’s rebuttal is a long review article titled Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. This article takes an in depth look at studies comparing low-carb diets to low-fat diets. Here is the conclusion as written in the abstract:
There was a higher attrition rate in the low-fat compared with the low-carbohydrate groups suggesting a patient preference for a low-carbohydrate/high-protein approach as opposed to the Public Health preference of a low-fat/high-carbohydrate diet. Evidence from this systematic review demonstrates that low-carbohydrate/high-protein diets are more effective at 6 months and are as effective, if not more, as low-fat diets in reducing weight and cardiovascular disease risk up to 1 year.
Dr. Bray lists five other issues about Gary’s letter to which he wishes to respond, but before he gets to the list, he makes one last flippant point.
I thus conclude that if any diet ‘cured’ obesity as their proponents often claim, there would be no obesity and thus no need for the next diet. Yet the past 150 years, since the publication of Banting’s first popular diet, have seen a continuing stream of new diet books.
The reason, of course, is that we dieting fish all swim in waters that have been polluted by Bray and his brethren, more about which in a later post.
Now to the list.
1. Near the end of the letter, Mr Taubes suggests that my review of his book may be a ‘conflict of interest’. He says ‘I [Bray] may be defending what my scientific research has led me to believe’. If this is a conflict of interest, then all scientists have a conflict of interest.
This first short point of only three sentences tells you everything you need to know about Dr. Bray’s scientific credibility. I have no problem with the first sentence. The second sentence is purportedly a quote from Gary Taubes letter. It isn’t. It is a paraphrase…sort of, but put in quotation marks. This is a real no no. It was done so for a particularly egregious reason, which was for a set up for Bray’s final sentence. But that sentence even further diminishes his credibility. Scientists are supposed to constantly challenge their own hypotheses, not accept them as fact simply because they’ve spent their careers enraptured with them. All true scientists don’t have this conflict of interest.
2. The first paragraph of his letter dealt with lipoproteins that I said he had not covered. The issue was not the lipoproteins but their receptors, from which we have learned so much in the past 30 years.
This one is a real copout. In Bray’s original critique he wrote:
As I read through Good Calories, Bad Calories, I found a number of errors of omission or commission that are important when relating diet to heart disease. There is no mention in the Diet-Heart section of low-density lipoprotein-cholesterol (‘bad cholesterol’) or of high-density lipoprotein-cholesterol (‘good cholesterol’).
The issue may have been the receptors and not the lipoproteins, but as you can see from his direct quote above, that’s not how Bray characterized it. Gary set him straight with a list of about two dozen pages and groups of pages where LDL and HDL were mentioned, yet Bray weasels instead of admitting his mistake. When I read his first letter, it made me wonder if he had even read the book.
3. In his letter he mentions doubly labelled water only to conclude that we knew this already from the 19th and early 20th century and he did not need to discuss it in his book. I would submit that we did not know that people under-report their intake by as much as they do and that overweight people under-report more than normal-weight people do.
Okay. There’s a total non sequitur. What does the second sentence have to do with the first? Weird. Was Bray on dope when he wrote this?
4. Mr. Taubes say ‘the goal of science is to determine causality…’
(What Gary actually wrote was ‘The goal of science is to correctly determine causality,’ but who’s counting?)
Then Bray wades into this strange discourse about the theories of Karl Popper, whom he misnames as Hans Popper. (Does this guy ever bother to look anything up?)
This is significantly different from the views of Hans Popper, the philosopher of science, whose search is for ‘reality’ rather than ‘causality’. Popper says ‘there is a reality behind the world as it appears to us, possibly a many-layered reality, of which the appearances are the outermost layers. What the great scientist does is boldly to guess, daringly to conjecture, what these inner realities are like. Popper also espouses the concept of ‘falsification’, which is at the heart of rationalist thought. To quote him again –’a false theory may be as great an achievement as a true one. And many false theories have been more helpful in our search for truth than some less interesting theories which are still accepted’.
If you can make sense of this gibberish, you’re a better man than I am. All I know is that Bray misses Popper’s point about falsification in a major way. (We discussed Popper and his theory of falsification in an earlier post. And it ain’t anything like Bray makes it out to be. I seriously doubt he has even read Popper’s work.)
The last sentence of the above paragraph I find particularly interesting. Writes Bray, apropos of nothing really:
And many theories have been more helpful in our search for truth than some less interesting theories which are still accepted.
I don’t know about the search for truth, but I can tell you that the inability of Bray and the rest of the academic obesity ‘experts’ to shake loose from their own ‘less interesting theories’ have led us into the obesity epidemic we’re in the throes of now.
Dr. Bray’s fifth comment, which I’m not going to reproduce in full, is a world-class case of totally missing the point. After commending Gary for proposing an experiment to validate his hypothesis, he goes on to quote Gary’s rebuttal letter:
He says ‘the positive energy balance hypothesis of obesity asserts that the only way to lose excess fat is to eat less and/or exercise more – that without consciously inducing a negative energy balance we will not lose weight’. His hypothesis is ‘the carbohydrate/insulin hypothesis asserts that if we restrict carbohydrates in the diet/and or improve the quality of the carbohydrates consumed then insulin levels will be lowered, reducing the accumulation of fat in the fat tissue independent of the nutrition state of the subject’. I would take exception to his use of the word ‘consciously’ in his statement of the energy balance hypothesis. For example, the current level of oil prices may increase human energy expenditure through more walking as it decreases automobile use. This is not a ‘conscious’ choice in the sense used above but would have the same effect.
Say what?!?!?!
Let me get this straight. Dr. Bray thinks if we walk more because we decrease automobile use as a consequence of the high price of gasoline that we’ll lose weight because we are unconsciously exercising instead of volitionally exercising? As I say, he misses the point, which is that the two components on the right side of the energy balance equation are not independent variables, but are dependent variables. It doesn’t matter if one walks as a part of exercise or because one can’t afford the gas, the body compensates by increasing food intake.
Dr. Bray ends his response by resorting to the old conservation of energy principle, which all the eat-less, exercise-more folks hew to. They seem to believe that no one who advocates low-carb diets can understand the laws of thermodynamics when it is they themselves who don’t understand them as applied to diet. There is nothing inconsistent with Gary’s theories of the cause and treatment of fat accumulation and the laws of thermodynamics. It’s Bray and friends’ lack of understanding of these laws and/or their refusal to accept the dependent nature of the energy in/energy out components of the energy balance equation that are the heart of the problem.
This entire rebuttal of Dr. Bray’s reminds me of my own favorite lines from Good Calories, Bad Calories. They are my favorite because I’ve seen first hand what they describe.
The institutionalized vigilance, “this unending exchange of critical judgment,” is nowhere to be found in the study of nutrition, chronic disease, and obesity, and it hasn’t been for decades. For this reason, it is difficult to use the term “scientist” to describe those individuals who work in these disciplines, and, indeed, I have actively avoided doing so in this book. It’s simply debatable, at best, whether what these individuals have practiced for the past fifty years, and whether the culture they have created, as a result, can reasonably be described as science, as most working scientist or philosophers of science would typically characterize it. Individuals in these disciplines think of themselves as scientists; they use the terminology of science in their work, and they certainly borrow the authority of science to communicate their beliefs to the general public, but “the results of their enterprise,” as Thomas Kuhn, author of The Structure of Scientific Revolutions, might have put it, “do not add up to science as we know it.”
The result is an enormous enterprise dedicated in theory to determining the relationship between diet, obesity, and disease, while dedicated in practice to convincing everyone involved, and the lay public, most of all, that the answers are already known and always have been—an enterprise, in other words, that purports to be a science and yet functions like a religion.
Is it any wonder that Dr. Bray didn’t enjoy the book?
Re the lady who eats a diet of white rice and a little meat – I have no trouble believing, that she is pencil-thin. A: she may be one of those people who tolerate carbohydrates well, B: you can ALWAYS lose weight on what more or less constitutes a single-food-diet. The questions that remain are: will that make you healthy? (I’d love to see some bloodwork of the white-rice-and-meat-lady) and can you stick to it? I know I could not. I have no trouble sticking to a low-carb diet.
Designing an all-fat food that creates the same addictive behaviour as the soft drinks? The very idea…Fat is an essential nutrient (as opposed to sugar). Nature has made sure, that essential nutrients are not addictive.
That article by Dr. Stephen Phinney on ketogenic diets and physical performance that you linked to earlier was really fascinating because it had a lot of useful information on what should constitute an ideal ketogenic diet that would preserve physical performance, especially with its recommendation that protein intake be constrained to 15-25% of daily energy expenditure or 90 to 120 g/day and the rest of the calories made up by fat. Also very useful was the recommendation of daily intakes for sodium at 3–5 g/d and total potassium at 2–3 g/d in order to maintain circulatory reserve and effective nitrogen balance with functional tissue preservation. Thanks!
Just a quick note to tell you about this video:
Paleo in a Nutshell Part 1: Food
In five minutes it covers:
- Why grains/dairy are bad
- The usual counter arguments
- Why doctors don’t know
- Why scientists don’t tell us
- The pharmaceutical / agricultural lobbies
Hope you enjoy!
Great video! Thanks for sending. Hope it becomes viral.
Stacia,
Have you considered intermittant fasting?
If you are testing your insulin levels you will learn more about how it is affecting you. There are a number of variations of IF. I would say it can’t hurt to try them, find one you are comfortable with and see what happens.
I was not testing my insulin levels, nor, at the time my BG. But the results I had with Fast-5 are certainly indicative of improvement in insulin resistance.
I am assuming you are having no grains. But you might also try no dairy if you aren’t doing that .
HELLO DR. EADES, AND FRIENDS: Happy Easter Holidays !! And thanks for the other great article you had about about critical-thinking and independence of thought which is real liberty. And i think that, this is not only happening in USA alone, but in many other capitalist, neoliberal, oligarchical, corporate states such as Mexico, UK, Peru, India, Colombia, Israel, Germany, Canada, Italy, etc, etc. where the “right” arguments and truths are the truths of the bourgeoise-classes, which owns the corporate-mainstream media, the medical sector, the private sector which in turns controls the state. One only needs to read the book by David Korten “When Corporations rule the world”. And this is the core of corporate-fascism, corporate-power. It is when states don’t regulate and control corporations, but when corporations have grown to be so powerful that they control every thing, the states and even science. I think that another cause of why many americans who have indeed access to internet, knowledge, books, and easily available electricity all the time, satellite TV, computers, etc. but at the same time even with all the information and knowledge that US citizens could benefit from are so closed-minded, and so dumbed-down, it is because of the extreme pragmatism and egocentric-individualist, relativism, and perspectivism of this society. which means that their truth is their right truth even if it’s very wrong.
So it is real hard to get around people in this country, to teach, to spread truth, philosophy, knowledge an information to US citizens. Because like i said most US citizens think that their own ideas about how the world works, are right 100% (no questions asked, no bias no bull) even if those ideas are very wrong.
For example, it’s real hard to convice many people in this country, that both political-parties are evil and don’t benefit american citizens, and that a diet high in carbohydrates increases insulin-levels which leads to fat-storage and there is literally no way to lose weight with a diet high in carbohydrates, specially high in starchy-carbohydrates (and we all know that most american citizens eat a diet very HIGH in starchy-carbohydrates such as bread, rice, pasta, potatoes, cookies, etc.)
Thanx for your article again !!
And have a nice day
.
Wonder if you have seen this article by Donald Layman in Nutrition & Metabolism?:Dietary Guidelines should reflect new understandings about adult protein needs
http://www.nutritionandmetabolism.com/content/6/1/12
“The new research establishes health benefits and provides molecular evidence of numerous metabolic outcomes associated with protein intake or amino acid metabolism that are not reflected in the traditional measure of nitrogen balance. These outcomes include cell signaling via leucine [7,8], satiety [9,10], thermogenesis [11], and glycemic control [12,13]. The dietary protein necessary to optimize each of these metabolic outcomes is not reflected in measures of nitrogen balance and is not represented within the current concept of the minimum RDA.”
Found it via this blog post: http://lowcarb4u.blogspot.com/2009/04/its-whats-for-breakfast-lunch-and.html
I have seen the article. Thanks for posting it for others.
Yes!
And I might add, the anti-inflammatory, anticancer and hepatoprotective effects of glycine, which become prominent when glycine (or taurine) becomes 5% of total calory intake – possible on a low-carb, high protein diet (and possible at a lower protein level if gelatine is part of the protein intake). http://www.springerlink.com/content/p29rmr53y5x1dkhu/
Abstract
The mechanism of the immunosuppressive effects of glycine and its pathophysiological applications are discussed in this review. Glycine has been well characterized in spinal cord as an inhibitory neurotransmitter which activates a glycine-gated chloride channel (GlyR) expressed in postsynaptic membranes. Activation of the channel allows the influx of chloride, preventing depolarization of the plasma membrane and the potentiation of excitatory signals along the axon. Glycine has recently been shown to have similar inhibitory effects on several white blood cells, including hepatic and alveolar macrophages, neutrophils, and lymphocytes. Pharmacological analysis using a GlyR antagonist strychnine, chloride-free buffer, and radiolabeled chloride has provided convincing evidence to support the hypothesis that many white blood cells contain a glycine-gated chloride channel with properties similar to the spinal cord GlyR. Molecular analysis using reverse transcription-polymerase chain reaction and Western blotting has identified the mRNA and protein for the β subunit of the GlyR in total RNA and purified membrane protein from rat Kupffer cells. Dietary glycine is protective in rat models against endotoxemia, liver ischemia-reperfusion, and liver transplantation, most likely by inactivating the Kupffer cell via this newly identified glycine-gated chloride channel. Glycine also prevents the growth of B16 melanomas cell in vivo. Moreover, dietary glycine is protective in the kidney against cyclosporin A toxicity and ischemia-reperfusion injury. Glycine may be useful clinically for the treatment of sepsis, adult respiratory distress syndrome, arthritis, and other diseases with an inflammatory component.
Dr Eades,
I am a 6 months reader of your blog. I appreciate three features of your approach, viz:
1. Step 1 – Increased individual healthcare knowledge (achievement) – As a statistician by original training (many years ago!), I appreciate the rigour with which persons such as Taubes and yourself argue your case. I find myself arguing with some friends that there is a rational position on self-health care, which is evidence based, which supports the low carb end of the spectrum. However, I also see that some in your camp are as religious and irrational as those in the opposing camp(s).
2. Step 2 – Increased health IQ, or ability to make reasoned judgements – This is the process of making judgements regarding the weight of evidence about the causality of many modern diseases and the appropriate preventive or treatment regimes. Your discourses on how to weigh the strength of various studies, are a good tutorial on the process of thought in science. Consequently we might disagree sometimes!
3. Step 3 – Increased healthcare emotional intelligence – You have made some early attempts to assist your audience to put all of these judgements about the evidence within a broader framework as to how they might make decisions regarding their individual lifestyle, including “treatment” regimes.
Much of the debate is still (appropriately) on the first step. Nevertheless, for a revolution to take place the second and third points will probably need to be addressed. They certainly will if one wishes to follow in John Gants footsteps and focus on the individual!
It is in the context of thinking about the third issue that I stumbled across a recent radio show in Australia. On a government owned, Australian Broadcasting Commission (ABC), radio station there is a credible show called “The Health Report”, which tries to adopt an evidence based approach to reporting on health issues.
Recently the show interviewed Professor Victor Montori from the Mayo Clinic, regarding work he has been doing on developing processes for patients to become involved in patient health care decision-making. Whilst I can pick holes (see above Step1) in the causality and outcomes information he has presented to patients in proper double blind clinical trials, I was fascinated by the algorithms he is attempting to develop about patient choices in an evidence based medical delivery system.
Hear the show at: http://www.abc.net.au/rn/healthreport/stories/2009/2532951.htm .
I am not an expert on the issue of “patient healthcare choices systems”, but can see an analogy with other areas of consumer skilling. Increasingly, the emphasis in such systems, leveraging off increased levels of education, is upon inculcating in the consumer a generalised algorithm that is aimed at promoting rational thinking, given their individual situation, where this situation includes not only rational evaluation of disease diagnosis and treatment options, but also all sorts of variables such as budgets, convenience, assessment of side effects etc.
One can sense the possibilities if an evidence based choices system, aided by physicians, might be presented to patients during consutlations.
Will the low carb folks obtain their proper market share for such systems?
I hope so. My only problem with the evidence-based medicine that is worshiped so highly by so many is that often the evidence used to base medical decisions is flawed or meaningless. For instance, many hundreds of thousands of statin prescriptions are written using evidence-based medicine, when the evidence is a handful of observational studies that mean nothing. Yet those writing the prescriptions think they are adhering to the highest standards. It’s really pitiful.
Dr Eades,
Would you be able to comment on the article from Nutrition and Metabolism that MAC posted? In a comment in an older post, you mentioned that 60 grams/day of protein was the minimum for a woman. I’m 67, 5’2″ tall and weigh about 120 pounds, so I’ve been trying to maintain that level of protein intake/day. The article indicates that to prevent muscle loss, elderly people should eat 30 g/protein at a single meal at least twice a day. The problem for me would be that as a T2, 30 g at a sitting would probably raise my bg to an unacceptable level. However, if it would prevent sarcopenia and osteoporosis, I’d be willing to sacrifice my stellar A1C or look into metformin or insulin in order to be able to increase my protein intake.
Not asking for specific advice, here, just would like your take on whether 60 g of protein a day is sufficient to prevent muscle and bone density loss in the elderly.
Thanks.
Maggie
I would think it was a little low, especially for one on a low-carb diet. A lot of the dietary protein is used to make glucose if carb intake is low.
Interestingly, the Mayo “health choices” program to which I refer, whilst being conventional in it’s reporting of Statin benefits to patients, appears to:
1. Specifically note the variance of the benefits according to sex, age, other co-morbid conditions such as Type 2 diabetes etc.
2. Note the variance of side effects and lifestyle impacts for each of the the same groups of people.
The Mayo professor specifically notes that when patients are presented with such evidence tailored to their circumstances, via some form of simple “expert system”, patients appear to act rationally, viz:
1. Those in low risk groups avoid the therapy in droves, as the supposed benefit is very small compared with the cost, side effects and/or lifestyle inconvenience – that is they react rationally
2. Those in higher risk groups also in many cases avoid the therapy, as they do not see that their increased risk outweighs the disadvantages and they often seek alternative therapies such as lifestyle, diet and/or exercise changes – for many this may be rational
3. Those who undertake the therapy do so knowing that their probability of preventing disease is quite low, but still consciously decide to accept this plus the risks
4. More generally, the positive outcome is more targeted therapy, that avoids issues such as “Statins for all middle aged men”
All in all, I was quite impressed, even if the initial data input may not be as good as we would like. The key appears to be to tell the patient the truth (even if independent of the physician) about the statistical likelihood of a therapy either preventing or remedying a condition, plus side effects, for a specific target group. This allows them to weigh such a therapy up against all sorts of other factors.
JUST AS YOU THOUGHT IT WAS SAFE TO GO OUTSIDE…..
http://www.nytimes.com/2009/04/14/health/nutrition/14qna.html?partner=rss&emc=rss
just an awful article in Canada’s largest and most influential newspaper the Toronto Star about a large scale study proving “once and for all” that low fat so-called “mediterainian diet” is the best…
http://www.healthzone.ca/health/article/617976
i can already see the support this will garner. i just never understood where people got the idea that southern italians and greeks eat a “mediterainian diet” of whole grains, olive oil and wine… spend a short amount of time at an italian or greek bakery and youll see white bread with olive oil, stewed meats with pasta sauces and pastry treats for every special occassion.
youll also see the most obese of european immigrants around in southern italians. half my family is obese eating this so-called traditional southern italian diet. a quick look at northern greeks (macedonians) and northern italians shows the meat heavy diet results in slimmer people period. this is cultural ignorance at its best. i honestly cant believe enough north americans think southern italians and greeks sit around eating whole grains, olive oil and some feta as a meal and thats why they are healthy….. go to a southern italian wedding, stuff yourself on the carb rich diet, enjoy the view of the majority obese people there and wonder where in gods name did anyone come up with this mythic dietary notion.
As a Canadian I can attest that the Toronto Star is possibly the largest but hopefully not the most influential new source in the country! It’s a tabloid….
pardon me – news source…..
I can understand the resistance of guys like Bray as well as the mainstream to Taubes and the arena of low-carb dogma.
For one, it is overly simplistic. To say that carbs cause a release of insulin, and that insulin causes one to store fat and become resistant to insulin over time is completely wrong. Examples of people who eat massive quantities of carbohydrates without running into obesity, type II diabetes, and early death from related complications is endless. Look no further than Tabues’ beloved Saccarine Disease by T.L. Cleave for evidence of that, where Cleave noted a lack of obesity, type II diabetes, and health problems amongst rural Zulus eating a diet consisting of 90% of calories as carbohydrates.
Or Kitavans…
Or the Japanese…
For an even better example, go straight to Taubes’ reliance on the Pima Indians to prove the ‘carbs make you fat’ theory. Pima Indians living in Mexico off of traditional carbohydrate staples – corn and potatoes (high GI BTW), have no such health problems like their Northerly Pepsi-slugging American Pima brethren.
Clearly, the carbohydrate does not, in and of itself, cause obesity. If we found it to cause obesity in the United States for example, that still wouldn’t answer why carbohydrate-based diets around the world in Asia and in numerous primitive rural cultures don’t cause obesity there.
If a person is deemed “carbohydrate sensitive” or has a metabolic problem (insulin resistance) that is apparently exacerbated by carbohydrate ingestion, then avoiding them is certainly one route to take. However, that still doesn’t ‘cure’ the problem, it just avoids it, like someone with allergies wearing a gas mask for life, or someone with a broken leg lying in bed for the rest of their lives. I think there is a much greater goal that can be achieved in the world of health, and that is overcoming insulin resistance and carbohydrate intolerance – instead of avoidance. That would be healing. True healing, instead of admonishing oneself to poor health and carb abstinence forever and ever, amen.
Dr. Bray is at least acknowledging that carbohydrate consumption does not cause insulin resistance, but that there are other underlying conditions that cause it. Hypercortisolemia is certainly one of them, which also causes leptin resistance and many other health problems. A low metabolism is yet another.
All in all, both Taubes and Bray, even though both have made some key contributions, are blind. Carbohydrate consumption, meat consumption, fat/natural sugar consumption in combination, fat consumption – you name it – they all predate the obesity/hyperinsulinemia epidemic.
Uh, did you actually read the Cleave’s The Saccharine Disease? I have my copy in front of me, and I looked up every reference to the Zulu in the index. Nowhere does it say that the Zulu eat a diet that is 90 percent carbohydrate, unrefined or otherwise. Such a diet would be unsustainable. Even such anti-fat zealots as Ornish, McDougal and others don’t recommend a 90 percent carb diet.
Taubes’ book has a reference for virtually each and every statement he makes. I would love to see your references about the Pima Indians of Mexico consuming a ‘traditional’ diet high in corn and potatoes and suffering no obesity. I would take issue with you that the Japanese and/or the Kitavans consume diets composed of 90 percent carbohydrates as your comment implied. If you have published data on that, I would love to see it.
I would also be very much interested to see the published data showing that hypercortisolemia and/or a low metabolism cause insulin resistance as you averred.
Provide the papers, and I’ll put them up for all to see.
You’re overlooking the elephant in the room; the micronutrients and protein in the western high-carb diets are inadequate to build and supply the insulin receptors etc. to deal with the carbs.
A healthy traditional diet that is reasonably high in carbs from whole plants is unlikely to be vitamin and mineral deficient, and the person eating it also gets more sunlight exposure.
It is this “empty calory” nutritional paradigm that starts the insulin resistance problem. The low-carb diet is the best way out; just supplementing the micronutrients while still locked into the carb addiction is not as effective; you need to give insulin a rest as well.
Also, in a low carb diet, calories need to come from somewhere – and they come from amino acids and fats, nutrients which can actually help to rebuild or protect the body.
Where is the sugar that has the health profile of glycine or DHA?
I am still baffled at the “Asians are slim and eat a lot of carbohydrates” argument. They do?
I have no conclusive research to say they don’t but so far all my observations failed to show that they do.
Most of my East-asian friends cook regularly and they do NOT consume a lot of rice, it’s a side dish to accompany all the sauces, soups and meat/fish dishes they prepare.
This is the same story as Italians and pasta, Italians use pasta as a side dish and in small amounts. The french and their pastry, tiny portions after a meal.
I spent a week in Japan eating with locals and yes rice and noodles are on the menu but so are heavy sauces, fish and meat. And no, these are not fancy restaurants, these are fill to the brim with locals, 5€-a-meal places.
Thailand is the same story, it was 2 weeks of mostly meat and fish stews next to rice, the rice portion was small. And again this was local non-touristy restaurants and at the home of a Thai family.
I think what happens is when Asians go to the west, money is not exactly flowing, so they focus more on the cheaper part of the meal: rice and noodles.
You are SO right with that quote from Taubes book about the “nonscience” regarding
obesity etc etc. It encapsulates some 50 years of garbage passed off as medical research
by people with no understanding of scientific method.
“You can “prove” anything with statistics.” That was a comment from my father when I was about twelve. He then added “Just dont believe it.”
There are even US university departments that (jokingly?) suggest that they will “prove”
anything you want (if you have enough money).
p. 65
“In that table it was shown that although 90 per cent of the calorific intake in the rural Zulu is provided by carbohydrates (which are generally regarded as the fattening foods), as against only 81 per cent of the intake in the urban Zulu, the crucial point is that, in the case of the rural Zulu, of the 90 per cent figure 89 is derived from unrefined carbohydrates, whereas, in the case of the urban Zulu, of the 81 per cent figure 71 is derived from refined carbohydrates. An explanation, therefore, based on the argument advanced in this work, fits the facts as a glove to its hand.”
-Excerpt from…
Cleave, T.L. and G.D. Campbell. Diabetes, Coronary Thrombosis, and the Saccharine
Disease. John Wright & Sons LTD.: Bristol, UK, 1969.
This is in reference to lack of obesity amongst rural Zulu’s on a diet of 90% carbohydrates.
And “uh” yes, I’ve read all of Cleave’s work, who was a proponent of a diet high in natural, unrefined carbohydrates for the prevention of every known modern illness.
I’ve also read your book, and literally hundreds of others – enough to know that “protein’s power” is the remarkable ability to slow down the human metabolism when eaten in excess, making it easier to gain weight on smaller amounts of calories than a diet rich in fat.
This is why Atkins stated on page 313 of Dr. Atkins New Diet Revolution that his diet “tends to shut down the thyroid,” which is the exact pitfall of a low-carbohydrate diet that contains more than 20% of calories from protein – a common mistake in the fat-phobic world.
Why not eat in a manner that improves the metabolism instead of catering to its insufficiencies?
Ah, a different book than the one I have. Sorry. But, irrespective of whether it actually says what you claim or not, I don’t believe it. Had he written that 90 percent of the foods eaten by the Zulu were of plant origin, I could maybe buy it, but not the idea that 90 percent are carbohydrate. That’s not a sustainable diet.
If you think that protein slows down metabolism, I would suggest a serious reading of the medical literature, not a cherry picking of those few papers that confirm your bias.
You’ve read a hundred books, but you’ve obviously never eaten protein “to excess” if you believe it slows metabolism.
A little experience is worth a (misread) library in this case.
Look at the animals that eat the most protein (and fat) – they are the fast, lithe, muscular types, and they have the shortest digestive tracts.
I live in New Zealand, in large parts still an unspoiled aboriginal subtropical paradise. I have tried living off the land, eating only the foods available to a hunter-gatherer in this country, using all the available books on edible plants.
Carbohydrate deficiency is the first thing I noticed. There are few edible carbohydrate plants (so few that pre-european Maori spent hours preparing bracken roots, which have carcinogenic properties if not prepared properly, and still suffered liver cancer as a significant cause of death). If it were not for seafood and birds, one could perhaps have lived in this country, but no people would have flourished.
It did not surprise me that the Maori (who came to New Zealand from Polynesia some time during the past millenium) drove the Moa (a large flightless bird) to extinction, then resorted to cannibalism.
Maori today suffer from extremely high rates of diabetes and heart disease – and they are being told to eat less fat and more whole grains. This to a people who had never even seen a grain until 200 years ago, and who cannot possibly have adapted to gluten in that time.
There is a point, when you give this high-carb low-calory advice to native peoples with their own dietary histories, at which medical folly crosses the fine line between misadventure and genocide.
Dr. Eades
For the guy several comments above me:
I watch travel shows alot. Many Asian nations are featured. Asians eat a lot of organ meats, bugs, insects,(Thailnad) seafood like Octopus(China) etc. and fish in Japan. And in the case of Vietnam- snake ,snake, snake, snake and more snake- even the blood. There are a lot of American myths about the Asian diet that are made up by low fat advocates.
They definitely consume a lot of animal / and or insect based protein too, very similar to a true paleo diet- like what Bear Grylles or Les Stroud eat on their shows.
Atkins “tends to shut down the thyroid”
The recent high-fat diet trials had lowered T3 as one of the anti-inflammatory end-points. A 10% drop in T3 accompanied better lipids, C-reactive protein, etc. But isn’t more T3 good for you?
Perhaps when people over-eat carbs they need to make extra T3 to cope, and this can be bad for the thyroid; an anti-inflammatory diet has less need for thyroid stimulation (after all, heat is already being produced by futile cycles) and the thyroid can ease off a bit.
Atkin’s comment is consistent with the most recent research and another example of how he knew what he was talking about long before anyone else did.
[...] Obesity Reviews? It is the journal that published George Bray’s unfair and almost incomprehensible review of Gary Taubes’ book Good Calories, Bad Calories. Share This Post If You Enjoyed [...]
Hello all: I would like to know if american cheese is allowed in the low-carbohydrate keto diet. Because i am trying to do a high-fat, moderate in protein low carb diet and i do eat american, mozzarella, monterrey, or swiss cheese and most hard cheeses only have about 1 gram of carbohydrate or less than 1 gram of carbohydrate for every 100 calories. But i read in a forum that cheese has a chemical which blocks weight loss. So i would like to know if its ok to snack on cheese on low carb diets.
.
Low-carber,
IMO, American cheese is a modern “industrial” cheese food product, and not real cheese, no matter what the carb count. It’s highly processed and bears little resemblance to the great cheeses of the world.
[...] not the first time. It was only less than a month ago that Dr. Eades demonstrated convincingly that Dr. George Bray is a fucking liar; Bold Faced. I want to go over Dr. Bray’s response to Gary’s letter in some detail because it is emblematic [...]
People overeat because they feel HUNGRY all the time. Stop the hunger feeling = loose weight. The only time I have never felt hungry was right after getting a Hepatitis B vaccine. I assume that the circulating liver enzymes as a result of the vaccine was the cause. A few days later, the appetite returned. Is it possible to take a liver enzyme tablet to cut off the appetite?