Functional Health Services for Your Well Being

GARY TAUBES WRITES A SMALLER BOOK

By Alex Boersma

For the better part of 2008, I carried around what would become to me the slowest yet most important read of a lifetime.  From the outside, Gary Taubes’ groundbreaking “Good Calories Bad Calories”  did not appear particularly intimidating.  Sure it was almost 500 pages long.  Sure it was written in the finest print legible to the human eye.  Sure it had about 50 pages of references…also in that barely legible fine print.  But it was just another book about health and nutrition.  I already knew a lot about health and nutrition!  Didn’t I?

As it turns out, there was so much controversial research exposed in this book that, between checking references and trying to figure out how all this new information would fit into my own theoretical paradigms, I was only able to read about 3 pages per day.  My 8 year old boy, who’s reading skills at the time were less than exemplary, was managing to read entire books in the time it took me to read a dozen pages.  In his new book, Taubes admits that “the book (GCBC) demands that the reader devote considerable time and attention to following the evidence and the arguments”  Understatement of the year?

When I was finally able to retire my dog-eared copy, I had only one regret.  I could not fathom how ever to recommend this bible of nutritional irreverence to anybody who didn’t have both a sound understanding of basic nutritional science and a pathological interest in the nitty gritty details. 

Apparently I wasn’t the only one.

 

This book is only 225 pages long.

And you don’t need a magnifying glass to read the print!

 The new book, “Why We Get Fat…And What To Do About It”  is by no means as comprehensive as GCBC.  Gone are the scintillating historical conspiracies illustrating the rocky scientific foundations upon which our misinformed nutritional consciousness has been formulated.  Gone are the detailed trails of evidence refuting much of what we believe to be true about health and nutrition.   Gone are the withering critiques of the individuals and institutions responsible for leading us down this garden path of deception.

This book is just the facts: Why we get fat and what to do about it…according to Gary Taubes!

Funny thing is, I guess the first book (GCBC) was really about why we get fat as well.  There was just so much other good stuff in it that I never realized what the point really was.  I thought of it more as a library of knowledge than a diet book.

Why We Get Fat is most definitely a diet book.  In it, Taubes hammers his message home repeatedly.  According to him, we get fat because we eat too many carbohydrates.  Period.  End of story.  What does he recommend we do about it?  Stop eating so much carbohydrate, of course.  In fact, stop eating practically any carbohydrate, as far as he is concerned.

I must admit that when I first read WWGF, I was excited.  Here was finally a book which clearly described the role of insulin as the hormone most responsible for making people fat.  Here, without much fanfare, was a book which outlined the profound and simple relationship between dietary carbohydrates, insulin and adiposity.  This was what I had been telling people for years, and finally it was officially out in print.

On my second pass through WWGF, though, I began to have some misgivings.  I began to realize that Taubes pushes the “insulin makes you fat” theory a little farther than what the science supports.  I also began to realize that Taubes has fallen prey to the use of questionable logic.  As anybody who studies nutritional science will know, it is much easier to use research in deconstructing conventional theories than it is in reconstructing your own.  Good Calories Bad Calories is Taubes at his journalistic best;  using his intellect and tenacity to deconstruct most of what we think we know about nutrition and disease.  In Why We Get Fat, Taubes’ arguments are less formidable; straw man arguments abound and evidence has clearly been cherry picked.

Still, there is plenty to like about this book.

What I like the most is the clarity with which Taubes outlines the specific relationships between carbohydrate consumption, insulin dysregulation and the accumulation/preservation of body fat.  Here’s a quick overview of how it all works:

  • Part I (outside the fat cell)
  • Fat in the blood comes from 2 sources.
    • Fat we consume in our diet.
    • Fat our liver makes out of glucose which comes from carbohydrates in our diet.
  • The fat molecules in our blood (triglycerides) are too big to get into our cells.
  • An enzyme called lipoprotein lipase (LPL), which is attached to the membranes of cells, is responsible for turning the large fat molecules. (triglycerides) into small fat molecules (fatty acids) which can then enter the cells.
  • Insulin makes LPL more active in fat cells, especially abdominal fat cells.  Insulin also makes LPL less active in muscle cells.
  • Therefore, in the presence of insulin, fat will preferentially be stored in fat cells and not in muscle cells where it could be used to fuel activity.

 

  • Part II (inside the fat cell)
  • Inside the fat cell, the small fatty acids are re-assembled into the larger, less mobile fat molecules called triglycerides
  • In order for the large triglycerides to get out of the fat cells (make the fat cell skinnier) they must, once again, be broken down into smaller fatty acids.
  • An enzyme inside the fat cell, hormone sensitive lipase (HSL) is responsible for turning the large fat molecules inside the fat cell into smaller fatty acid molecules which are then capable of moving out of the fat cell.
  • Insulin makes HSL less active in fat cells, effectively trapping fat inside the fat cells.
  • Therefore, in the presence of insulin, fat will preferentially be kept in storage and not used for energy.

Taubes sums it all up like this:

anything that works to promote the flow of fatty acids into your fat cells, where they can be bundled together into triglycerides, works to store fat…anything that works to break down those triglycerides into their component fatty acids so the fatty acids can escape from the fat cells works to make you leaner.”

  • A Few More Things About Insulin
  • Insulin is also responsible for the direct transportation of blood sugar into fat cells where it is broken down and partially turned to more fat.
  • Insulin helps to grow new fat cells so that you have more room to store more fat
  • Even the smallest increase in insulin above baseline will turn you into a fat storing, glucose burning machine.

What are the implications of all this?

The most important thing to learn from this, and I give Taubes credit for pounding this message home repeatedly, is that weight regulation depends on insulin regulation.  If we maintain above-normal insulin levels for the bulk of a 16 hour day, our metabolism will have only a very small window of opportunity to balance fat storage with fat usage.  If we become insulin resistant, the window begins to close.  If we become diabetic, we might as well brick the window in. 

Unfortunately, becoming insulin resistant in North America is practically synonymous with ageing.  Almost 27% of Americans over 65 are already diabetic and it is likely that another 50% of the remainder are insulin resistant.  It is impossible to know just how many people have become insulin resistant because regular blood tests cannot detect it.  One quick way to check your own insulin sensitivity is to look at your waist line.  If you have begun storing fat just above your hip bones and around your belly button, it may be worth asking your doctor for some more sensitive blood sugar tests such as a fasting plasma glucose test or an HbA1c test.

Back to the book!

Regulating insulin and preventing insulin resistance, then, are the necessary requirements for weight loss.  Taubes argues that these requirements are effectively controlled by manipulating a few key factors:

  • Limiting carbohydrate consumption…the less carbohydrate you consume, the less insulin you will secrete, the less likely you will be to become resistant to insulin and the less time you will spend in fat storage mode.
  • Lowering glycemic load…the lower your glycemic load, the lower your insulin will spike, the less likely you will be to become insulin resistant.  It should be noted that lowering your glycemic load probably doesn’t help you get out of fat storage mode…it may actually make things worse by lengthening the amount of time your blood carries above-normal insulin levels.  (It is also worth mentioning that the best way of lowering your glycemic load is simply not eating carbohydrates!)
  •  Severely restricting fructose consumption…Taubes points out that fructose consumption is probably the single biggest cause of insulin resistance and plausibly the main culprit behind the obesity epidemic.  Sugar(50% fructose), high fructose corn syrup (55% fructose), concentrated fruit juices(about 50%  of calories from fructose) and even fruits themselves (also about 50% of calories from fructose) are all collaborators in destroying our livers, overloading our fat cells and impairing our insulin sensitivity.

According to Taubes, depending on the severity of any individual’s metabolic dysfunction, the manipulation of these three factors is the sole requirement for successful and sustainable weight loss.  A 60 year old obese diabetic, for example, will probably require a more aggressive stance than a 30 year old who is just starting to put on some weight around the abdomen.  The former will most likely only lose weight on a strict ketogenic diet, with nothing but low glycemic vegetables to supplement her proteins and her fats.  The latter, on the other hand, may simply have to cut out pop and sweets and voila…no more muffin top!

Here’s where I start to have some problems with Taubes

Throughout the book, Taubes minimizes the effectiveness of caloric restriction and exercise in the achievement of weight loss.  Quite rightly, he chastises other researchers for believing that weight regulation is a simple function of the first law of thermodynamics.  This is the idea that “calories in equals calories out” and that weight gain is simply a matter of too many calories in and not enough calories out.  Taubes points out, again quite rightly, that the  “eat less, exercise more” mantra has not served people well.  Studies have shown repeatedly that, in the long term, people who diet and exercise to lose weight end up heavier than when they started.  This is Taubes at his doomiest and gloomiest!

Fair enough.  But here’s the thing.  Most diet and exercise studies control variables poorly.  Food frequency questionnaires are notoriously unreliable, so we never get to know what the subjects really eat.  Compliance is  generally poor, especially in the latter portions of these studies.  Exercise programs are usually not well thought out or well supervised.  The studies that do control variables tightly are limited in size and always confounded by the kinds of people they can recruit.

Taubes claims that compliance is weak because insulin- not lack of will power – forces people to eat more and/or be less active than the researchers want them to be.  In doing so, he ignores the addictive properties of many types of carbohydrates, particularly sugar and grains.  He ignores the impact of psychological issues and eating disorders.  And he ignores the fact that despite the general failure of most diet and exercise regimes, many people do, in fact, sustain weight loss on all kinds diets, many of which are not low carb.

The people I know who have lost significant weight have worked hard at it.  They have exercised wisely.  They have increased their activity levels.  They have de-stressed their lives.  They have re-prioritized themselves.  They have improved both the quality and the quantity of their diet.  In doing so, they have necessarily decreased the quantity of carbs consumed while simultaneously improving their quality.  This happens automatically when you eat less junk food.  But to say that  improved insulin sensitivity has made their journey into better health either simple or easy would be an insult to their fortitude.

Is insulin regulation an important and perhaps even an essential piece of the weight loss puzzle?  I agree with Taubes that it is.  Can weight loss be achieved without restricting calories or exercising?  Possibly.  Will insulin control make it easier to achieve?  Probably.  Will calorie restriction and exercise improve the chance of success.  Of course they will.

The truth is, most North Americans are fat because they eat too much of the wrong kinds of foods, because they lead stressful lives, and because they sit on their butts too much.  If we wish to lose weight and improve our health, it is imperative that we take responsibility for ourselves.  In WWGF, Taubes provides us with vital information which can make our battle against obesity less frustrating.   Unfortunately, he also implies that insulin management makes caloric restriction and exercise superfluous.  I believe that this implication does a considerable disservice to anyone who is struggling with weight loss.  If we are, indeed, to take responsibility for our own health, we should know that:

  • Yes, weight loss is difficult and often frustrating
  • Yes, weight loss requires major alterations in diet and lifestyle
  • Yes, insulin management will dramatically improve our chance of success
  • No, managing insulin will not negate the need for major alterations in diet and lifestyle

 

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