Good Calories, Bad Calories   by Gary Taubes

Prologue

"Banting" 

1863 wrote a pamphlet launching the 1st popular diet craze, based on his experience. 

Known as "bantingism" or Banting - to bant was to diet. 

The Lancet said the diet was old news - Banting said maybe, but it was still news to him and to others. 

"To attribute obesity to 'overeating' is as meaningful as to account for alcoholism by ascribing it to 'overdrinking'" suggested Harvard nutritionist Jean Mayer back in 1968. 

The carbohydrate had become heart-healthy diet food. Now it was the butter rather than the bread, the sour cream on the baked potato that put on pounds. This was one of the more remarkable conceptual shifts in the history of public health. As clinical investigators were demonstrating the singular ability of carbohydrate-restricted diets to generate significant weight loss without hunger, the mainstream medical establishment was insisting that the diets were dangerous fads - "bizarre concepts of nutrition and dieting that should not be promoted to the public as if they were established scientific principles." 

The reason for this book is straightforward: despite the depth and certainty of our faith that saturated fat is the nutritional bane of our lives and that obesity is caused by overeating and sedentary behavior, there has always been copious evidence to suggest that those assumptions are incorrect, and that evidence is continuing to mount. It is quite possible, despite all our faith to the contrary, that these concepts are such neat, plausible, and wrong solutions. Moreover, it's also quite possible that the low-fat, high-carbohydrate diets we've been told to eat for the past thirty years are not ony making us heavier but contributing to other chronic diseases as well. 

Consider, for instance, that most reliable evidence suggests that Americans have indeed made a conscious effort to eat less fat, and particularly less saturated fat, since the 1960s. According to the USDA, we have been eating less red meat, fewer eggs, and more poultry and fish; our average fat intake has dropped from 45 percent of total calories to less than 35 percent, and NIH surveys have documented a coincident fall in our cholesterol levels. Between 1976 and 1996, there was a 40-percent decline in hypertension in America, and a 28-percent decline in the number of individuals with chronically high cholesterol levels. But the evidence does not suggest that these decreases have improved our health. 

Heart-disease death rates have indeed dropped over those years. The risk of suffering a severe heart attack may have diminished as well. But there is little evidence that the incidence of heart disease has declined, as would be expected if eating less fat made a difference. It's been suggested that the death rates are declining largely because doctors and emergency medical service personnel are treating the disease more successfully. AHA statistics support this view: between 1979 and 2003, the number of inpatient medical procedures for heart disease increased 470 percent. In 2003 alone, more than a million Americans underwent cardiac catheterization, more than a quarter-million had coronary-artery bypass surgery. 

The percentage of Americans who smoke cigarettes has also dropped considerably over the years - from 33 percent of Americans over eighteen in 1979 to 25 percent fifteen years later. This should also have significantly reduced the incidence of heart disease. That it hasn't, strongly suggests we're doing something that counteracts the beneficial effect of giving up cigarettes. Indeed, if the last few decades were considered a test of the fat-cholesterol hypothesis of heart disease, the observation that the incidence of heart disease has not noticeably decreased could serve in any functioning scientific environment as compelling evidence that the hypothesis is wrong. 

Throughout the word, on the other hand, the incidence of obesity and diabetes is increasing at an alarming rate. Obesity levels in the USA remained relatively constant from the early 1960s through 1980, between 12 and 14 percent of the population; over the next twenty-five years, coincident with the official recommendations to eat less fat and so more carbohydrates, it surged to over 30 percent. By 2003, one in three Americans was considered clinically obese. Diabetes rates have increased apace. Both conditions are associated with an increased risk of heart disease, which could explain why the incidence of heart disease is not decreasing. It is also possible that obesity, diabetes, and heart disease all share a single, underlying cause. The surge in obesity and diabetes occurred as the population was being bombarded with the message that dietary fat is dangerous and that carbohydrates are good for the heart and for weight control. This suggests the possibility, however heretical, that this official embrace of carbohydrates might have had unintended consequences. 

Public health experts had assumed that if they advised all Americans to eat less fat, with its densely packed calories, weights would go down. What we see instead is actually weights have gone up, the portion sizes have gone up, the amount we eat has gone up... Foods lower in fat became higher in carbohydrates and people ate more. 

The result has been a polarization on the subject of nutrition. Most people still believe that saturated fat, if not any and all fat, is the primary dietary evil - that butter, fat, cheese, and eggs will clog our arteries and put on weight - and have reduced their intakes. Public-health experts and many in the media insist that the obesity epidemic means the population doesn't take their advice and continues to shun physical activity while eating fatty foods to excess. But a large number of people have turned to the message of Banting and one remarkably best-selling diet book after the other (list page xix). All advocate an alternative hypothesis: that carbohydrates are the problem, not fat, and if we eat less of them, we will weigh less and live longer. All have been summarily dismissed by the AHA, the AMA, and nutritional authorities as part of a misguided fad. 

BUT IS IT? If 150 years of anecdotal evidence and observation suggest that carbohydrates are uniquely fattening, it would be unjustifiable scientifically to reject that hypothesis without compelling evidence to the contrary. Such evidence does not exist. Taubes' purpose here is to examine the data that do exist and to demonstrate how we have reached the conclusions we have and whether or not they are justified. 

Diseases of Civilizaton

Prior to the official acceptance of the low-fat is good dogma, clinical investigators, predominantly British, had proposed another hypothesis for the cause of heart disease, diabetes, colorectal and breast cancer, tooth decay, and half-dozen or so other chornic diseases, including obesity. The hypothesis was based on decaes of eyewitness testimony from missionary and colonial physicians and two consistent observations: that these "diseases of civilization" were rare to nonexistent among isolated populations that lived traditional lifestyles and ate traditional diets, and that these diseases appeared in these populations only after they were exposed to Western foods - in particular, sugar, flour, white rice, and maybe beer. These are known technically as refined carbohydrates, which are those carbohydrate-containing foods - usually sugars and starches - that have been machine-processed to make them more easily digestible. 

In the early 1970s, refined carb theory went head to head with dietary fat hypothesis. They are mutually exclusive and not compatible. 

We have come to accept over the past few decades the hypotheses - and that is what they are - that dietary fat, calories, fiber, and physical activity are the critical variables in obesity and leanness in health in disease. But research over the years shows the singular effect of carbohydrates on blood sugar and insulin, and their effect on cells, arteries, tissues, and other hormones, that explain the original observations and support this alternative hypothesis of chronic disease. 

A relatively easy, reliable test for blood levels of cholesterol was available as early as 1934, and therefore it was easily fixated on the accumulation of cholesterol in the arteries as the cause of heart disease, despite considerable evidence to the contrary. By the time they developed reliable methods for measuring blood lipids, such as triglycerides, and measuring blood levels of insulin and a condition known as insulin resistance, a critical mass of clinicians, politicians, and health reporters had decided that dietary fat and high cholesterol levels were the cause of heart disease, and that low-fat high-carb diets were the solution. 

In science, researchers often evoke a drunk-in-the-streetlight metaphor to describe such situations: One night a man comes upon a drunk crawling on hands and knees on the pavement under a streetlight. When the man asks the drunk what he's doing, the drunk says that he's looking for his keys. "Is this where you lost them?" asks the man. "I don't know where I lost them," says the drunk, "but this is where the light is." For the past half-century, cholesterol was where the light was!!!!!!!!