Good Calories, Bad Calories Part 48

93 Evans's first test diets "cal ed for no carbohydrate whatever" only later did he settle on twenty grams of carbohydrates to address nitrogen balance.

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*94"Wheat contains al of the essential amino acids," explained the Columbia University nutritional anthropologist Marvin Harris, "but to get enough of the ones that are in scarce supply a man weighing 176 pounds (80 kilos) would have to stuff himself with 3.3 pounds (1.5 kilos) of whole wheat bread a day.

To reach the same safe level of protein, he would need only .75 pounds (340 grams) of meat."

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*95 These included Graham Lusk and Eugene Du Bois from Cornel and the Russel Sage Inst.i.tute of Pathology; Russel Pearl and Wil iam McCal um from Johns Hopkins; the Harvard anthropologist Earnest Hooton; and Clark Wissler of the American Museum of Natural History.

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*96 There are only four experiments in the medical literature, not including Stefansson and Anderson's, in which the goal was to induce scurvy in human subjects-in one, four, twenty, and four subjects respectively. In each case, the goal was accomplished and the diets were carbohydrate-and/or sugar-rich.

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*97 According to Lewis Finn, then president of the Delaware Academy of Medicine, Gehrmann's department at DuPont was "one of the most outstanding industrial medical departments in the country."

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*98 One DuPont executive, discussed by Pennington in a later report, lost sixty-two pounds on the diet and kept it off for more than two years, while averaging thirty-three hundred calories of meat a day. If he ate any carbohydrates, "even an apple," Pennington wrote, his weight would climb upward.

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*99 These critiques were written by anonymous "competent authorities." In this case, the likely authority was Philip White, formerly at Harvard, now beginning his job as secretary of the AMA's Council on Foods and Nutrition and a columnist for JAMA. He would write a similar dismissal of high-fat, carbohydrate-restricted diets under his own name in 1962, and then edit another anonymous version in 1973.

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*100 Ohlson worried that "the large servings of meat" could get monotonous and that the diet did not meet the recommended daily al owances for essential vitamins recently introduced by the Food and Nutrition Board of the National Research Council. She therefore included in her diet more milk, cheese, and eggs than Pennington had recommended, and expanded the choice of fruits and vegetables.

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*101 Drug studies were encouraged by the relative ease of obtaining money and resources from the pharmaceutical industry, and the absence of funding for dietary treatments.

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102 In 1989, Wil iam Dietz, who now serves as director of the Division of Nutrition and Physical Activity at the Centers for Disease Control, reported that Bistrian and Blackburn's diet was "especial y successful" on obese patients with a genetic disorder cal ed Prader-Wil i syndrome, "whose characteristic ravenous appet.i.tes appeared to be suppressed."

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*103 When the authors included only randomized control trials in their calculations, they identified seven relevant studies of this severe carbohydrate restriction and seventy-five of higher-carbohydrate diets. The average weight loss was eight pounds for the carbohydrate-restricted diets and four for the higher-carbohydrate diets.

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*104 Indeed, the AMA's 1973 critique escaped the issue of hunger by including "anorexia" as one of the "untoward side effects" of the diet. Since anorexia, in this context, is the technical term for loss of appet.i.te, it seemed a peculiar criticism to make of a weight-loss diet.

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*105 The auxiliary "may" is critical here, because Yudkin based his conclusions on three-day dietary records, which are notoriously inaccurate. He then a.s.sumed that these three-day records could be extrapolated to the entire two weeks of the study, and from there to what would happen over months or years on the diet.

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*106 When Ted Van Ital ie, who worked with Jean Mayer in the 1950s, was asked why Mayer paid so little attention to the prewar German literature on obesity, he said, "Mayer hated the Germans. He shot a few of them in World War I ."

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*107 Brobeck paired each of a dozen lesioned rats with a healthy control rat and fed the lesioned rat precisely the same amount of food that the control rat had consumed on the previous day. "In three pairs of animals," Brobeck wrote, "the rat with lesions gained more rapidly than the control when they were fed the same amount of food." Thus overeating could not be the cause of the excessive fattening, because these rats weren't overeating.

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*108 In reference to the islets of Langerhans, the pancreatic cel s that secrete insulin.

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*109"Diet therapy and weight loss are extremely important in reversing this process," Rosenzweig added, "but the long-term results of these therapies have general y been disappointing, even in patients not receiving insulin."

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*110 In which the pancreas had been removed.

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*111 Schoenheimer and Rittenberg worked in Harold Urey's lab at Columbia. Urey had recently discovered deuterium and won the 1934 n.o.bel Prize in Chemistry for the discovery.

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112 Wertheimer began his career at the University of Hal e in Germany and was expel ed from his position in the same purge that sent Schoenheimer to New York. Wertheimer immigrated to Jerusalem, where in the 1940s he became head of pathophysiology and biochemistry at the Hebrew University.

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*113 ATP gives up a phosphate molecule, becoming adenosine diphosphate, or ADP, and releases energy in the process.

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*114 Synthesis of the enzymes required to convert carbohydrates into fat wil also increase and decrease in proportion to the carbohydrate content of the diet.

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*115 The VLDL particles we discussed when we talked about heart disease.

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116 The addition of a phosphate molecule to glycerol to make glycerol phosphate is said to "activate" the glycerol so that it can now be used in this process.

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*117 For this reason, vagotomy, as this surgical procedure is known, was later considered a potential treatment for obese humans with various syndromes of hypothalamic obesity.

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*118 Of Neel's two primary papers on thrifty genes, this is the one that is rarely read or referenced.

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*119 Brunzel and Bierman fed mildly diabetic patients a diet of 85 percent carbohydrates and no fat, and compared their glucose response with that of patients on a more typical American diet of 45 percent carbohydrates and 40 percent fat. Those on the carbohydrate-rich diet had a slightly lower blood-sugar response, and insulin secretion remained unchanged. Brunzel and Bierman interpreted this to mean that a carbohydrate-enriched diet "increase[s]

the sensitivity to insulin of tissue sites of insulin action."

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*120 This explains why preventing estrogen secretion in female rats-by removing the ovaries-wil make them obese, hungry, and sedentary, as we discussed in the previous chapter, whereas replacing the estrogen wil make them lean again.

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*121 He told me that I could confirm this observation by simply going to an airport and noticing, as he always did, that it was the overweight who took the escalators and the lean who walked up the stairs.

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*122 From 1990 to 1996, Keen was chairman of the British Diabetic a.s.sociation. He was also elected honorary president of the International Diabetes Federation in 1991, and was chairman of the WHO Expert Committee on Diabetes in 1980 and 1985.

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*123 Fat synthesis and acc.u.mulation.

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*124 The progressive addition of carbohydrates was similar to a common treatment of diabetics in the pre-insulin era: Diabetics would be fasted to lower their blood sugar to healthy levels; then protein and fat calories would be increased gradual y, until glucose appeared in their urine. That would be considered the critical calorie level, and the diabetics would never be al owed to eat any more than that.

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*125 Van Ital ie, Stunkard, Bray, Cahil , and Dwyer.

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*126 Van Ital ie attributed this ineffectiveness, as was common at the time, to the fact that "a varied diet reduced in energy content remains highly palatable" and so too tempting. "Even the Lord's Prayer does not cal for resisting temptation," he would say; "it asks that the supplicant be not led into temptation."

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127 This does not include several texts specifical y on the psychology and behavioral treatment of obesity.

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*128 According to Novin, when he wrote up his presentation for the conference proceedings Bray removed the last four pages, al of which were on the link between carbohydrates, insulin, hunger, and weight gain. "I couldn't believe he would make that kind of arbitrary decision," Novin said.

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*129 Indeed, Mayer would divide those who endorsed carbohydrate-restricted diets into those who were sincere and misguided, and those who were simply insincere.

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*130 It was not "even remotely true," Stare wrote, "that modern sugar consumption contributes to poor health."

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*131 In treating obese children, Sidbury noted, there is "concern that a low calorie diet wil be harmful to growth." On this low-carbohydrate diet, however, the children experienced "continued normal linear growth," even though it was also very low in calories.

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*132 Four glands that lie either behind or embedded in the thyroid gland.

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133 Adolph's studies were also noteworthy because, if humans are anything like rats, they contradict the popular notion that we gain weight by eating energy-dense foods or can lose weight and keep it off by decreasing the density of our diets-by eating soups, for instance, in which the calories are diluted by water, or fiber-rich greens and salads rather than calorie-dense meats-and so learning how to "feel ful on fewer calories," as the Penn State nutritionist Barbara Rol s has advocated.

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*134 Rats are nocturnal.

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*135 Because diabetologists and clinical investigators typical y measure insulin in humans or laboratory animals at longer intervals-say, thirty minutes or an hour or two after a meal-they pay little attention to the details of what's happening in between, which means missing this first great wave of insulin secretion.

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*136"Of or about the head," referring to the fact that these reflexes are not mediated by the peripheral organs themselves-just as the two waves of insulin secretion are an inherent property of the pancreatic cel s that secrete insulin-but are stimulated by nerve signals sent directly from the brain.

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*137 The USDA's standard nutrient database says eleven hundred calories. The Center for Science in the Public Interest puts the number at sixteen hundred.

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*138 After a year, subjects partic.i.p.ating in the lifestyle-modification trial had reduced their total food intake, on average, by 450 calories a day. They ate more fruits and vegetables (one to two servings more a day); they decreased their grain consumption by four servings a day and "sweets" by five. The calories from al carbohydrates increased, on average, by over 5 percent, but because of the decrease in total calories, the total amount of carbohydrates consumed decreased.