#74 — What Should We Eat？
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Summary
Gary Taubes is the author of three fairly recent books on nutrition, Good Calories, Bad Calories and The Case Against Sugar. He s a former staff writer for Discover Magazine and a correspondent for the scientific journal Science. His writing has appeared in The New York Times Magazine, The Atlantic, Esquire, and has received many awards. He has become fairly controversial for the very strong position he has taken on diet and human health, and the degree to which he has criticized the field of nutrition science. But we had a very interesting conversation, and it s one that may actually influence how you eat and what you feed your kids. In this episode, I speak with Gary Taubes about his writing career thus far, and what s caused him to focus on nutrition to this degree. He also talks about the Cold Fusion scandal, and whether it was a conscious fraud, or just a mistake. And he explains why he thinks someone should be fired if they make up false data for a scientific experiment that s actually a fraud. The Making Sense Podcast is made possible entirely through the support of our subscribers. Please consider becoming a supporter of what we re doing here, by becoming a patron of the podcast. You re getting twice the value you re getting, not only in words, but in audio and pictures, and in real-world examples of what you can do to help make sense of the world we're living in the world. Thank you for listening. You're making sense, and you're helping us make sense, not just in words and in pictures and graphs, and we're making it, we're listening, we'll all have it, too much of it, and more of that, we can help us make it, it's more of it. Thank you, Sam Harris, you're listening to it, right here, right down here, you'll get it, so we're watching it, it's not better than that, right we'll hear it, they're not not, right it's gonna be it, real it's good, right, it'll really, we've got it, It's not Happier, right in it's Not That, Right It's That, Thank You, Thank It, That, It'll Say It, Right, That's It, We're Gotta Have It, It s That, We'll Say That, That It's Better, That So Much, That Will Happie It, And It's Not Like That, And That's Not Really That, They're Not Geeeeeeayeeeeeeeeedeedeedeeeeeedeeeigheee It's Gotta It, This Is It, She's Not Gotta That, Good, That?
Transcript
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Gary is the author of three fairly recent books on nutrition, Good Calories, Bad Calories,
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Why We Get Fat, and most recently, The Case Against Sugar.
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He's a former staff writer for Discover and a correspondent for the scientific journal Science.
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His writing has appeared in the New York Times Magazine, The Atlantic, Esquire.
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He's been included in numerous best-of anthologies, including the Best of American Science Writing,
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in 2010, received many awards, and has become fairly controversial for the very strong position
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he has taken on diet and human health, and the degree to which he has criticized the field
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He has the knocks and bruises to show for having courted such controversy.
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But we had a very interesting conversation, and it's one that may actually influence how
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So let's start with your background as a journalist.
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I think many people are familiar with you, but you have a long background as a science
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journalist, and you've now focused of late on the science and pseudoscience of nutrition.
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You wrote Good Calories, Bad Calories, which was a very large and very well footnoted book.
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And then you wrote Why We Get Fat, and now The Case Against Sugar.
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And all of these are honing in on the same thesis, essentially, and making it more accessible
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These books were born of at least one very controversial article that I think was in
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How have you approached your writing career thus far, and what's caused you to focus on
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When I started my journalism career, I started, as you mentioned, as a science writer.
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My background was in physics, so I was naturally going to focus on physics.
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And my first two books, my first book, I lived at CERN, the big physics lab outside Geneva,
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and was embedded with a research collaboration of physicists who, over the course of the 10
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months I was living with them, basically discovered non-existent elementary particles, and then realized
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And then by the time I left to write the book, were willing to publicly acknowledge that they
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And then this led me to a kind of obsession and fascination with this question of how to
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do science right, which is excruciatingly difficult, and how easy it is to get the wrong answer.
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So I did a series of investigations, both for Discover Magazine, and then my second book was
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on this scientific fiasco called fusion, which I always saw as a, I actually wrote it hoping
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it would be a case study that every young researcher would have to read before they engaged in a research
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career, because it was basically about how making an error of any magnitude could ruin your career
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Just remind me, what was the cold fusion scandal?
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Was it a conscious fraud on some level, or was it just a mistake?
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I concluded for the most part that it was just a mistake, but it was a mistake that the researchers
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involved at the University of Utah clearly made up data, which is technically misconduct, it's
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technically fraud, but the reason they made up the data is because their incorrect discovery was being
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stolen from them by a physicist down the road at Brigham Young University.
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It's, you know, it's funny, I still have, there's still an option out on my cold fusion book by a now
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very successful Hollywood director who sees it as a wonderful comedic story about science.
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But if you think you've discovered something and you have premature data and then somebody who
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should know is stealing it from you, then that's a, seems to be compelling evidence that it must be
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real, but now you don't have enough data to actually publish your own paper, so then what do you do?
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So technically it was fraud, but I, they were such idiots on some level that it's even hard
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to say whether they knew they were doing something wrong when they did that.
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Um, crazy story. Uh, so anyway, that led me, I had a lot of friends in the physics community after
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doing these two books, a lot of physicists who saw me as a kind of investigative journalist that
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they could point at a subject that they, that smelled suspicious to them and kind of pull the trigger
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and I would go investigate it. And so several of these physicists suggested in the early nineties
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that I get into looking at the science and public health because they thought it was terrible. And
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indeed it was everything I had learned from these brilliant experimental scientists in the eighties
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that was required, not everything, but most things that they considered required to do science,
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right. And minimize the possibility that you're fooling yourself was considered is considered
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kind of luxuries in the field of public health. It's just too hard to do it. It's too expensive
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to do it. Your systems, you know, human beings living in the real world are so messy.
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So rather than acknowledge that they can't establish reliable knowledge, what the community kind of did
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on mass, you know, unconscious decision to just lower the standards that they would use to establish
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causality, you know, to make statements about what is or is not a healthy diet, which is here I ended up
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focusing on. So by the late nineties, I was writing these investigations for science first on this issue
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of whether salt caused high blood pressure, which seems to be common knowledge and the basis of
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dietary advice since the 1980s. And you look at the evidence, it's just not there. Unless God told
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you personally that salt, I know as soon as I say that I'm stepping into dangerous ground here, but
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unless God tells you perfect personally that salt caused high blood pressure, you'd never conclude that
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from the evidence, from the randomized controlled trials. This is really just one of the great
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scandals of science at this point, that there's still so much confusion about what constitutes a
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healthy diet. I mean, so like, I just imagine if I went to see a cardiologist today and I told him that
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I eat, you know, every day for breakfast, a bowl of oatmeal and drank a glass of orange juice,
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say, some number of cardiologists, a significant percentage would say that's great.
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Some would probably say I'm living on the edge. And I think you would probably say I'm living on the
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edge. And conversely, if I said I ate a plate of eggs and bacon every morning, many cardiologists,
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certainly most would say that I'm attempting a slow suicide, whereas some would say that is optimal,
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right? So it's just like, how is it that we're in this situation? I mean, we're getting ready
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to colonize Mars. And we cannot agree about what would be healthy food to take for the trip. Just
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it's a crazy situation. Well, and it's worse than that, because this situation exists in the midst of
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an unprecedented epidemics of obesity and diabetes, right? So a third, over a third of the population
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is considered clinically obese. Two thirds is overweight, something like almost 10%, almost one in
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10% in Americans are diabetic, which is a disease that was vanishingly rare just, you know, 120 years
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ago. So you would think, right, that, and beset by these epidemics, there would be, like, we wouldn't
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be able to cross the street in our neighborhoods without tripping over some scientific committee
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trying to figure out what we did wrong, what we don't understand about the nature of a healthy diet.
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And instead, there's this sort of placid acceptance that, well, people just eat poorly and we tell them
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how to eat. And we, you know, we've been telling them how to eat for 50 years and nobody listens and
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everyone goes to McDonald's and Taco Bell. And that's the cause of the epidemic. And that's what
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makes us fat. And yeah, it's a crazy situation. I mean, I've been stuck in the middle of it because
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I am one of these people who think you'd be healthier if you ate the bacon and eggs.
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person who believes that bacon and butter are health foods. And at least if I'm killing myself,
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I'll die relatively happy. Knock on wood. Jesus, I'm talking to you. I evoke God and the fact that
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I'm superstitious in the first five minutes. That's all right. If you sneeze, I'll probably say,
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God bless you. It's deeply wired in the brain. Okay. The, um, uh, so yeah, it's, I've tried to
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document this. I just, um, my first book, good calories, bad calories. Once I, so the, the two
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investigations I did for science first on salt and blood pressure, and then on this belief that a low
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fat diet is a healthy diet. Those led me to that infamous New York times magazine cover story. What
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if it's all been a big fat lie. And by that point, I was pretty confident that the science of nutrition
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was, I mean, that it's, it's the, as you put it to pseudo science of nutrition, it's not a functioning
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science, uh, as the scientists that I knew would, would call it. And so, you know, I spent the next
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five years of my life investigating and trying to figure out what other mistakes had been made,
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where the mistakes might've been made, what you have to do to fix it. But then that puts me in
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the position of being a journalist saying all the authorities are wrong. And while the doctors,
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you could go to the different cardiologists, cardiologists in your neighborhood might disagree
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on what's a healthy diet, the nutrition community, the, the influential nutritionists
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for the most part, I'll agree. And it's reflected in the public health guidelines.
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Let's talk about your basic thesis here. So what is your criticism of the current state of
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conventional wisdom? And what do you actually think is the ground truth of what we now have good reason
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Okay. So there, there are three more or less fundamental pillars of all nutrition science,
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uh, regarding a healthy diet, regarding, you know, what we should eat in a day-to-day level to be
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healthy. So the most fundamental is this idea that we get fat because we eat too many calories.
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Um, the technical terminology for it, because people need a technical terminology when they have a
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particularly stupid idea is the energy balance hypothesis or theory of obesity. And you'll see
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articles. I just downloaded one today. That was a working group report from the international agency
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for research on cancer. And the idea is obesity is an energy balance disorder. You take in more
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calories and you expend, you get fatter. That's sort of the basis of everything because the nutrition
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community knows that once you get fatter, as you get more obese, you increase your risk of diabetes
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and heart disease and cancer and gout and all these other diseases. So if you want to prevent that from
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happening, if you want to minimize your risk, the first thing to do is you're supposed to balance your
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calories into your calories out. And it turns out when you look at the literature, you go back,
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that it's an idea that came out of nutrition science from the 1870s to the 1920s. So modern
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nutrition science actually dates to the late 1860s when German researchers created devices called
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calorimeters, room-sized devices that can measure the energy expenditure of humans or animal subjects
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living in these rooms. So you can measure the energy content of food by burning them and burning the
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food in what's called a bomb calorimeter. Now you can measure the energy expenditure of humans
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and dogs. And the researchers start doing this around the same time that other researchers are
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working out the laws of thermodynamics and concluding that the laws of thermodynamics hold
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for animate as well as inanimate objects. And by the early 1900s, you have a theory of obesity that
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it's caused by consuming more energy than you expend because that's all the research community could
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measure. So the idea is that the way foods influence our weight is through their caloric content only.
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And there's this idea that phrase you've heard, a calorie is a calorie is a calorie. Because a calorie
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of protein and a calorie of carbohydrates and a calorie of fat all brings the same amount of energy into your
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body. But the problem is that belief system is technology dependent. You know, if all you can measure is the
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energy content of food, then you come up with a hypothesis that the energy content of food determines
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your weight. Beginning around 1920, the science of endocrinology, hormones and hormone-related diseases begins
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to grow and mature. It's pioneered in Germany and Austria. And the Germans and Austrians come to this conclusion
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that clearly obesity has got to be a hormonal regulatory defect. You know, they look at like
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men and women fattened differently. Men fattened above the waist, women fattened below the waist.
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So sex hormones have to be involved, right? When boys and girls go through puberty, boys lose weight and
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lose fat and gain muscle. Girls gain fat and gain it in very specific places. You know, there's got to be
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hormonal control of fat accumulation. But the American scientists who began to dominate the field,
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first of all, they just didn't understand. They weren't scientists. They were doctors. They didn't
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understand endocrinology. They were wedded to this idea that fat people just eat too much. They saw a
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hormonal explanation for obesity as an excuse for fat people to remain sort of gluttons and sloths.
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And they talked about it. You can see it in the literature and articles in the Journal of the
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American Medical Association in 1925, when whoever wrote, I can guarantee whoever wrote that article
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didn't have a clue what endocrinology was, is arguing that obesity is in a hormonal disorder.
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And then again, the Germans and Austrians are arguing clearly it's got to be. Just that you cannot
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explain anything meaningful about obesity by this energy conception.
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Let me just ask a few questions here to kind of bound just how far-reaching your claims are here,
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because you're not disputing thermodynamics, I assume.
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Right. Or you would be far more famous than you are if you were disputing it credibly. So I imagine
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you would admit that on some level, you gain weight because of a surplus of calories. So for instance,
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if I were going to eat, you know, 15,000 extra calories a day, it wouldn't matter if those were
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extra carb, fat, or protein calories. If I was at that surplus day in, day out, I'm going to just
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Yeah. Although actually it might matter. You might. But again, it depends how you define excess.
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Let's use a metaphor, an analogy to help understand. Let's say instead of thinking in terms of
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excess weight, we're talking about excess money or wealth instead of obesity. Okay. So now clearly
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you can't get rich without making more money than you spend, right? But you would never say that you
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got rich because you made more money than you spent.
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There are certainly degrees of that disparity. And where you put the line is a judgment call,
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Where you put the causality. Because again, to get rich, you have to make more money than you spend.
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You know, there's conservation of money, just like unless you're a counterfeiter, just like there's
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conservation of energy. So to get fat, it means you're taking in more energy than you're expending.
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But you might get fat because, for instance, I can give you a drug that makes your fat tissue
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What you're saying clearly is that there's more to the story so that...
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I'm claiming that as soon as you went to causality, as soon as you say...
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And again, we'd never do it in any other field. Think about climate. Let's use climate change as
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an example. Clearly, if the atmosphere is heating up, it's taking in more energy than it expends,
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But the question is, why is it taking in more energy than it expends? One possibility is that
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the sun is heating up. So we're getting more energy from the atmosphere, but we're pretty
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confident that's not happening. Another possibility might be that we actually have a heat-trapping
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phenomenon going on in the atmosphere, in theory, which I believe, for the most part. And so the
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fact that the atmosphere is taking in more energy than it expends and it lets out is irrelevant.
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What we want to know is, why is energy being trapped in certain areas of the atmosphere? Why
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do certain frequencies of light get trapped and not others? Why do certain molecules
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trap heat in the atmosphere and not others? And what's the source of those molecules? You
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could think of it as a heat-trapping problem. And then you don't think about how much is going
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in or out. You don't care about that, even though clearly more is coming in. You could think
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if you're getting richer, your bank account is accumulating money.
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Yes. But if I suddenly, again, to take the wealth case, if I suddenly told you that I'm
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now going to spend 10 times more than I earn and I'm committed to doing that, you can predict
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that if I live long enough under this regime, I'm going to go broke. And so you're not disputing
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that basic picture. There's nothing magical here about the hormones. I think you're saying
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that the difference between our macronutrients and how they interact with the endocrine system
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brings many other variables into play, including things like a person's level of appetite, a
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person's level of involuntary energy expenditure. There are other things happening, right?
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Yeah. But you're still thinking in terms of the fat mass being fundamentally controlled by
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how much people eat and exercise by intake and expenditure. And what I'm saying, so think
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of, let's use children's growth as an example. Okay. Now we could starve a child, can't do
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this as an experiment and stunt its growth. Okay. Clearly happens in famines all the time,
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but we would never say that the child grows because he eats a lot of food. Having a lot of food
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available certainly allows growth to happen, but the growth is pretty much food independent
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or not protein independent. So different macronutrients have different effects.
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But if we were talking about growth, so again, we could look at the boys and girls going through
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puberty as an example. They're both getting bigger, right? They're both getting heavier. So we know
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they're taking in more calories than they expend because that's what the laws of thermodynamics tell us.
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But the boys lose fat and gain muscle and the girls gain fat. So now the fact that they're taking
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in more calories than they expend is irrelevant to understanding why the boys lost fat and gained
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muscle and why the girls gained fat and where the girls gained fat because it doesn't happen
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everywhere. Right. So there are other examples come to mind. So for instance, you wouldn't say
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of the growth of cancer tumors that that's best explained by a surplus of calories.
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Not just that there's more to the story, but if you think of, like you could think of cancer as a
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caloric energy balance problem because clearly the tumors are growing. And if you needed to push the
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analogy, and I've got slides to this effect that I use on talk, you can find examples of like benign
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tumorous masses that weigh 50 pounds, 100 pounds. And, you know, so still you wouldn't think of it as
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an energy balance disorder, despite the fact that whoever had that 50 pound or 100 pound benign mass
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had to take in enough energy to create the tumor. And if you thought about it as an energy balance
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disorder, you would not understand the etiology of that mass.
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Right. So what is the etiology in your view of the obesity epidemic?
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So what happens in the 60s, and remember this is only one of the fundamental pillars, so we still
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have two more to get to. Endocrinology begins to be understood in the 1920s on some profound level.
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Insulin is discovered, growth hormone is discovered, other hormones are discovered. It's a
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German-Austrian occupation. The German-Austrians are arguing that obesity is clearly a hormonal
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regulatory defect and that discussing it in terms of energy balance is meaningless because, again,
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it's like discussing the puberty issue, which was one of the examples they used in the literature.
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The war comes around, the German-Austrian school evaporates, and the lingua franca of medicine
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switches from German to English. And post-war, the science of obesity is, in effect, recreated by
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young nutritionists and doctors at the Harvard School of Public Health and elsewhere, have no
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clinical experience with obesity and just embrace this energy balance ideas. You know, clearly fat people
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just eat too much. You know, we know this because I know a fat person and he eats a lot. That's about the
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depth of the thinking. And by the 1960s, obesity is considered an eating disorder, and it's studied
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primarily by psychologists and psychiatrists. The 1960, a couple of researchers in New York create
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something called the radioimmunoassay that allows you to measure hormones in the bloodstream for the
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first time accurately. One of them later wins the Nobel Prize for the work. And the 1960s see an
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explosion in the field of endocrinology. And by 1965, it's clear that fat accumulation in fat cells
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is primarily regulated by the hormone insulin. And this is conventional wisdom. You could look at
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biochemistry books and endocrinology textbooks today, and they'll tell you the same thing.
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So remind people, just what is the role of insulin in regulating fat storage?
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So we think of insulin as the hormone that's defective in diabetes. In type 1 diabetes,
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which is the acute form that usually hits in childhood, your pancreas doesn't
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secrete enough insulin or doesn't secrete any. And in type 2 diabetes, which is the very common form,
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95% of all cases, it associates with excess weight and age. Patients actually begin as what it's called
00:25:13.160
insulin resistant. So their pancreas secretes insulin in response to their diet, and the insulin
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regulate controls their blood sugar, but it doesn't do a good job of it. So they have to secrete more
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insulin to keep their blood sugar control. And they have elevated levels of insulin in their blood
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throughout the day. So by 1965, it's clear that insulin not only tells your lean tissue,
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your muscle cells and your organs to take up glucose, carbohydrates that constitute your blood
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sugar to keep the blood sugar in control. They also tell your fat tissue to take up fat and hold on
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to fat. So by 1965, insulin is being described, including by the couple that created the radio
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immunoassay. And again, Rosalind Yalow, the physicist in the pair, later won the Nobel Prize. Her partner,
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Solomon Burson, passed away. Yalow and Burson are describing insulin as the most lipogenic hormone,
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meaning it forms fat, stimulates fat formation. And the more insulin, the more fat you're going to
00:26:20.980
accumulate. And the problem is, well, a few things happen. First of all, working physicians read the
00:26:33.020
medical literature, and they say to themselves, look, if insulin stimulates fat formation,
00:26:39.300
and we secrete insulin in response to the carbohydrate content of the diet, which we do,
00:26:44.420
what happens if you just don't eat carbohydrates? And in fact, they find out that you happen to
00:26:52.080
lose a lot of weight. And this is the basis, the genesis of the Atkins diet. Atkins was a
00:26:56.740
cardiologist in New York who read that literature and said, gee, it seems to me if I remove the carbs
00:27:02.000
and replace it with fat, so I eat a high fat diet, bacon, double cheeseburgers without the bun,
00:27:08.340
I should lose weight because I'm going to lower insulin. If I lower insulin, I'm going to mobilize
00:27:13.720
fat from my fat tissue. And they write these very best-selling diet books. And the medical community
00:27:19.460
responds, the cardiology community responds, they're beginning to believe the second pillar
00:27:25.380
of the nutritional wisdom, which is that dietary fat causes heart disease. If dietary fat causes heart
00:27:31.960
disease, Atkins is going to kill more people than Hitler did. That's an extreme example. But
00:27:37.820
so this scares them. So not only do they have to sort of beat down Atkins, which they do with a
00:27:46.580
kind of vicious critique in the American Heart Association, excuse me, I guess it was, I forget
00:27:53.900
which journal it was, JAMA or the American Heart Association Journal, but they say that these diets
00:28:00.260
are quack diets, they're fad diets, they will kill people.
00:28:04.920
Are we talking about the 90s now? When's this happening?
00:28:09.840
But Atkins became very prominent with his books much later than that, right?
00:28:14.400
No, no, 19. He started to become prominent in New York in the magazine world in the late 1960s,
00:28:22.420
early on, 1973 was when he published his book, which is right around the time that this
00:28:28.320
belief that dietary fat caused heart disease was gelling.
00:28:31.980
Well, that's interesting, because my awareness of Atkins came much later. It seemed like there
00:28:36.300
was a resurgence of interest in his diet some decades after that.
00:28:40.880
Yeah, my piece in 2002 in the New York Times magazine, which was a kind of seen as an apologia
00:28:47.400
for Atkins, because I basically said he might have gotten it right.
00:28:51.680
So that piece in the New York Times magazine kind of resurrected Atkins, or was he humming
00:28:59.320
He was still around. He was still publishing books. People were still buying the books.
00:29:05.800
But yeah, my piece more or less resurrected it and prompted Michael Pollan to then write
00:29:11.600
his books in response to the lunacy of anyone suggesting that all of America should be on
00:29:20.120
The, yeah, that was interesting. The original, the problem happened, though. The disconnect
00:29:25.740
between what the science, the evidence said, and the way the field embraced that evidence
00:29:35.400
Okay, so this is just to keep everyone clear here that you've told us about the first and
00:29:39.440
now second pillar. Remind us what they are, and let's get to the third pillar before I
00:29:44.360
Yeah, so the first pillar is this idea that obesity is an energy balance disorder, is a
00:29:48.500
cause by taking in more calories and expense, rather than being a hormonal regulatory disorder
00:29:54.660
where the, the dysregulation is caused by the, what foods you eat rather than how much you
00:30:01.820
eat. So basically I can feed you foods and the idea is they're easily digestible carbohydrates,
00:30:10.540
refined grains and sugars, and they will work to elevate your insulin levels by two different
00:30:16.420
mechanisms. And once your insulin levels are elevated, you will store fat. And if you're
00:30:23.220
losing calories into your fat cell, because now some of what you are, you're eating is
00:30:27.320
being trapped as fat rather than used for energy, that in turn will make you hungrier and you'll
00:30:31.800
eat more. You may even exercise less. But the primary effect of these foods is to make your
00:30:39.700
fat tissue expand and accumulate calories as fat. Some foods are literally fattening independent
00:30:49.340
of their caloric content. And other foods are literally not fattening independent of caloric
00:30:56.760
Okay. So that's your retort to the first pillar.
00:30:59.420
Yeah. And that's, and I can document, and I have documented again, where this hormonal regulatory
00:31:06.580
disorder hypothesis died literally 1941. And how the energy balance hypothesis is what the Europeans
00:31:16.740
called the energy conception took over in the U S and dominated the field. And then in the 1970s,
00:31:23.800
he's, you know, what's interesting about fields of science create paradigms and paradigms shift when
00:31:32.160
the fields are small and maybe a half dozen individuals can determine what's good science and
00:31:39.460
what's not sort of what has to be known, what's inconsistent, what experiments have to be done.
00:31:45.040
For instance, in the revolution in molecular biology, it happens in the 1950s. And it's,
00:31:51.380
you know, Francis Crick and James Watson and a half a dozen other people who made that revolution
00:31:57.720
happen. And if you remove Francis Crick, you get no understanding of DNA. Then the same thing,
00:32:04.880
theoretical physics, you could remove one, Julian Schwinger, and we don't have a standard model
00:32:11.820
as we have today. Um, in obesity, they had the same half dozen people. These guys just didn't know
00:32:18.160
how to do science. They just weren't very smart. It's like, just like if you have bad plumbers,
00:32:23.500
we have bad scientists out there. And these guys dominated the field in 1970s. And they didn't like
00:32:30.560
the idea that a low carbohydrate, high fat diet was a preventive way to prevent or treat obesity
00:32:38.300
because they thought high fat would cause heart disease. And they thought fat people get fat
00:32:42.880
because they eat too much. Right. So high fat causes heart disease is the second pillar.
00:32:47.780
Yeah, it's the second pillar. So what they did is they just removed, and again, you could see this in
00:32:53.460
the textbooks and the conference proceedings. They said, because we don't like the implications of the
00:32:59.600
endocrinology, we are going to decide that endocrinology has no influence on obesity. We're just
00:33:06.320
going to kind of remove it from the literature to the point that, you know, two months ago,
00:33:10.920
the New England Journal of Medicine publishes an article on the pathophysiology of obesity,
00:33:15.880
pathophysiology and mechanisms of obesity, which is a disorder of excess fat accumulation.
00:33:22.080
And there is zero discussion in the article of the hormones and enzymes that actually regulate fat
00:33:30.340
So I want to get to how you explain that, but just, I don't want to leave your,
00:33:34.040
the structure of your thesis hanging here. So what's the third pillar?
00:33:37.660
So the third pillar is this idea that we should all eat mostly plant diets. So the second is,
00:33:44.660
again, dietary fat causes heart disease, and then specifically saturated fat. And saturated fat
00:33:50.020
is associated with, you get the significant part of the saturated fat in our diet comes from animal
00:33:55.280
products. Therefore, animal products cause heart disease. And out of this, we get this idea that we
00:34:03.540
should all eat mostly plant diets at populations or individuals that eat mostly plants or all
00:34:09.960
plant-based diets are healthier than people aren't. And that in turn is based on this field of
00:34:19.100
The Mediterranean diet and all the rest. So what is, well, let's just take the second pillar for a
00:34:24.540
second. How do we know that saturated fat in the diet isn't a problem? Isn't a problem generally,
00:34:31.580
and in particular, isn't the primary source of cardiovascular disease?
00:34:38.580
Well, and on one level, you can't know it for sure. So we have to leave that possibility out.
00:34:44.260
Anyway, you can't, all we could say is, is it likely to be a cause of heart disease or not?
00:34:49.940
So, and here's where the epidemiology comes into this as well. Back in the 1960s,
00:34:57.300
researchers in the U.S. primarily were interested in why there's so, such high levels of heart disease
00:35:04.320
in the U.S. and certain European countries and not others. So what they basically did is said,
00:35:11.220
let's look at these populations and see what they eat. And what they found is that populations that had
00:35:18.880
high levels of heart disease ate a lot of saturated fat. There was a famous study called the
00:35:23.380
Seven Countries Study done by Ancel Keys at the University of Michigan. And so the populations
00:35:28.840
at eight high levels of saturated fat, like the U.S. and the U.K. had high levels of heart disease.
00:35:34.780
And populations at eight high levels of unsaturated fats did not. So Greece, hence the Mediterranean diet,
00:35:42.360
and their olive oil. And this is a kind of observational study that the question then becomes,
00:35:50.040
if you see that people in the U.S. eat a lot of saturated fat and have heart disease compared
00:35:54.940
to some other country, does that mean they have heart disease because they eat a lot of saturated
00:35:59.380
fat? So this is a question that, you know, can you, you've got an association between saturated
00:36:05.660
fat consumption and heart disease, but that association holds, logically, it holds no causal
00:36:11.340
information. My mother used to say, what does that have to do with the price of tea in China?
00:36:16.540
You know, which is sort of just because the price of tea in China is going up and heart disease is
00:36:22.140
going up. We don't think there's an association there. You know, we don't think it's causal. Why
00:36:26.760
would we think the saturated fat thing's causal? So the only way to know if the saturated fat
00:36:31.900
association is causal is to do randomized controlled trials, to basically intervene, change people's
00:36:39.660
diets, and see if you tell them to eat more saturated fat or less saturated fat, well, they have
00:36:46.220
more or less heart disease compared to whatever they replace that diet with. And as it turned
00:36:50.680
out, trial after trial tried to test the saturated fat hypothesis, and for the most part failed
00:36:59.780
Just in defense of epidemiology, you could also find a population that is eating just as much
00:37:05.980
saturated fat, or perhaps even more, but isn't eating, in this case, sugar, and see that
00:37:14.120
the correlation breaks down. Has that, in fact, been found as well?
00:37:18.580
Well, and again, that's the kind of issues you have with the level of science. Remember,
00:37:22.960
I was told to go into this field, public health, because my physicist friends thought the science
00:37:27.640
was terrible. So this famous seven countries study that began to really shift Americans towards
00:37:35.460
eating a Mediterranean diet, eating olive oil and polyunsaturated fats instead of saturated
00:37:40.800
fats, looked at seven countries around the world. So the U.S. and the U.K. and Greece and
00:37:46.360
Italy and, I don't know, a couple of Scandinavian countries and Japan. I may have gotten that
00:37:53.080
wrong, but that's the gist of it. You know, the interesting thing is there are two countries right
00:37:57.260
in the middle of Europe that eat very high saturated fat diets and have among the highest
00:38:01.720
lifespans in the world, France and Switzerland. So you could just ask the question, instead of
00:38:07.620
picking, for instance, Greece and Italy, had they picked France and Switzerland? So I lived
00:38:13.320
in Geneva for a year. The two national dishes are both cheese dishes, fondue or something horrible
00:38:20.020
called raclette that you got at every cocktail party you went to. Clearly, these people eat very,
00:38:25.940
very high saturated fat. So depending on what countries you pick, you can get very different
00:38:30.340
answers. As it turned out, Ancel Keys, the investigator, ran that study, didn't pick France and Switzerland.
00:38:36.020
He picked Greece and Italy. This is the problem with those kinds of observational studies. There's a
00:38:42.360
host of problems with those kinds of observational studies. I had another cover story in the New York
00:38:47.500
Times Magazine in 2007 making that point, where these studies are basically uninterpretable.
00:38:55.180
So what you get instead are researchers with preconceptions interpreting the answers to fit
00:39:01.580
their preconceptions. In those two cases, you've picked out societies where I wouldn't expect
00:39:08.000
the sugar consumption to be especially low, certainly not the refined carbohydrate consumption.
00:39:17.260
Aren't they just eating baguette and chocolate as rapaciously as any people who've ever been born?
00:39:22.760
Well, French sugar consumption is about a hundred years behind ours. So they were always notoriously...
00:39:33.680
Not notoriously, but the sugar consumption in France was always about the 30, 50% of what ours was.
00:39:42.500
Switzerland, I can't say, but I would assume it's the same or close.
00:39:47.300
In fact, the whole Mediterranean that people talk about, the French paradox is actually a
00:39:53.920
Mediterranean paradox where all these countries, Spain, Italy, Greece, all had relatively high fat
00:40:02.180
diets. Then as you get into France and Switzerland, you go further north, the fat becomes more saturated
00:40:08.380
and less olive oil based, but they all had relatively low heart disease rates. And when you actually dig into
00:40:14.380
this literature, and I was the first journalist to really do this, I remember speaking to one
00:40:21.140
British epidemiologist who had come originally from Australia, and he talked to me, he said,
00:40:25.240
Australia had this huge Greek population that emigrated after World War II when Greece was
00:40:31.060
decimated. So they moved to Australia. They live on lamb chops and fosters beer, and their heart disease
00:40:37.280
risk goes down. And so how do you explain that? And the question is, who knows? You've got to do
00:40:42.560
randomized control trials. You cannot establish causality. The only times you can establish causality
00:40:49.140
with epidemiology is when you have a phenomenon like cigarette smoking and lung cancer. So you have
00:40:57.460
exceedingly rare disease in non-smokers, and you could compare non-smokers to smokers, and you see
00:41:04.700
a 20-fold increased risk of lung cancer in smokers versus non-smokers. And then the reason we believe
00:41:12.460
it's causal is because you can't think of how to explain it. You can't think of an alternative
00:41:18.180
hypothesis. Not that the cigarette industry didn't try, but you can't think of a viable alternative
00:41:24.560
hypothesis other than cigarettes called lung cancer. And of course, it makes eminent sense that
00:41:29.460
clearly, if you're drawing smoke into your lungs, you could imagine that that would cause lung cancer.
00:41:34.880
So it makes biological sense. But these other effects that we've based public health policy on
00:41:41.940
are relatively tiny. They're not 20-fold increased risk. They're not three- or four-fold increased
00:41:48.720
risk. They tend to be 20% increased risk or 50% increased risk. And that simply, you can imagine all
00:41:59.140
too many things that could explain it. It seems to me you do make this argument,
00:42:05.400
at least in the background in your books, where you emphasize the correlation between the, I think,
00:42:12.920
what are called the diseases of Western civilization, you know, cardiovascular and peripheral vascular
00:42:18.720
and things like gout. And there's a long list of things that seem to come with when a traditional
00:42:25.460
culture suddenly gains access to, in your case, the smoking gun is refined carbohydrates and especially
00:42:33.840
sugar. So it seems that you are talking about changes in populations, where you show up among the
00:42:41.480
Inuit, you see that they're eating nothing but whale blubber, or a lot of whale blubber, and they have no access to
00:42:48.300
any refined carbohydrates. And they don't exhibit these pathologies until you start giving them bags
00:42:56.840
of Doritos and soda. And then they have all the pathologies that we notice in Western societies.
00:43:04.740
Isn't that part of your story that you're telling?
00:43:07.520
Absolutely. So you still, you know, science is about, funny, I was a science journalist for,
00:43:13.180
I don't know, 20 years before I got around to reading Claude Bernard's introduction to the
00:43:18.140
study of experimental medicine, which he wrote in 1865. And Bernard said, science is about explaining
00:43:26.000
what we observe. Ultimately, science is about explaining what we observe. And it's weird,
00:43:30.320
I had never thought about that. But that's, you've got observations, whether in the laboratory,
00:43:35.040
or in your particle accelerators, or in nature. And everything we're trying to do is explain what
00:43:42.540
the cause of those observations are. Is it some new fundamental particle? Is it, you know,
00:43:47.860
some carcinogen in the water supply? Is it, who knows? So the observation that
00:43:53.600
led to this dietary fat hypothesis is that we had a lot of heart disease in the US. And then the point,
00:44:02.380
what I learned doing my research, and what I sort of brought back from obscurity is that while US
00:44:07.360
research were focusing on that, there was a sort of school of British research, the British had an
00:44:12.680
advantage, they had missionary and colonial hospitals scattered all over the world. So research would
00:44:18.300
be trained in the UK or in Europe, and then they would go work in Botswana land, or some South Pacific
00:44:25.340
Island or Australia, treating Aborigines. And wherever they were, they would document, report this,
00:44:33.860
in effect, epidemic of obesity, diabetes, these Western diseases, hypertension, heart disease,
00:44:39.800
cancer, they would all increase in prevalence, and in some cases, explode in prevalence,
00:44:45.760
as these populations all around the world became Westernized. And then the question is,
00:44:51.660
what is it about the Western diet that leads to this explosion of diseases? And this is
00:44:57.380
conventional wisdom. And Michael Pollan, with him, I disagree on sort of two of the three of his,
00:45:03.680
you know, his mantra, eat food, mostly plants, not too much. Yeah, Michael basically builds his
00:45:11.800
argument from the same data, that same observation. And that's what you have, if you try to explain that,
00:45:18.200
then you're asking the question, what is it that Western diets bring to these populations?
00:45:23.520
So you agree with him that we should eat food, but you're not so sure about the plant part or the not
00:45:28.720
too much part? Yeah, the plants I'm not too sure about, and the not too much, I think, is meaningless.
00:45:34.720
It's based on the assumption that you get fat if you eat too much, but then you can't define what too
00:45:40.580
much is. Except just to go back to thermodynamics for a second, you would agree that whatever
00:45:46.440
macronutrient or food you thought was blameless, let's say, you know, a steak, if I eat 15,000 calories
00:45:56.060
of steak, as impossible as that may be in practice, I'm going to get fat unless I burn 15,001 calories.
00:46:04.380
Well, and so the question is, yeah, and again, we're going to get back, because this is the
00:46:08.380
area that's so fascinating. Let's look at it a different way. Just again, I'm saying you could eat,
00:46:14.400
which isn't going to be difficult. You could eat, say, 2,000 calories of steak a day,
00:46:18.900
plus 1,000 calories of green vegetables, so 3,000 calories.
00:46:24.020
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