Here is the most talked about, tweeted and blogged moment of the Ancestral Health Symposium, captured on film. Two stars colliding.
Stephan Guyenet has just finished his talk on “food reward” being a major cause of obesity. Gary Taubes, the undisputed champion of the “carbs->insulin->fat” camp, steps up to the microphone for the start of Q&A…
[UPDATED WITH VIDEO]
Showdown
Taubes (usually my hero) makes the argument that Guyenet is ignoring populations that were poor, eating unrewarding food, and still got fat, thus “refuting” the reward theory. Guyenet disagrees and says that their food was not necessarily unrewarding.
Taubes says that in science it is always a good idea to consider all the facts, not just the ones that fit your theory. In fact, please do it before giving a talk on the subject. Then he walks away from the mike.
As the entire audience cringe from the awkwardness of the situation Guyenet answers, with superb coolness, “Thanks for the advice.”
Epilogue
From what I heard Taubes later apologized to Guyenet in person. Good choice, but I think Taubes would have gained a lot more by doing it in public during his speech. In fact he almost did it, but unfortunately ended up just mentioning that he had “insulted” Guyenet, without the magic “I’m sorry” words.
I heard quite a few influential people who were still upset about the incident much later. That is too bad.
On the positive side I think we can learn something important from this. Of course we should be respectful of our opponents. And if we are not, we can’t win.
PS
I have a few disagreements myself with the “reward” theory and consider myself much more in Taubes camp on the issue of obesity. I plan to make a post later on Guyenet’s talk.
I don’t give much for the almost bizarre idea of “bland liquid from a straw” being the ultimate weight loss diet. I don’t think that is necessary at all. In fact I seem to disagree with Stephan Guyenet more and more. But I still think he is a brilliant thinker, a good speaker and his blog is well worth reading.
Update
Actually the exchange may not have been quite as dramatic as the discussion afterward made it seem like. Now I have seen it again on video. Check it out yourself, the most interesting part starts at 3:26 and is pretty short:
Perhaps this is mostly a collision of cultures. The Q&A at these conferences is usually über-polite. So when someone is not polite it stands out.
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112 Comments
Re your PS, like you, I have some issues with his reward theory as well. One is that he is concerned with palatability specifically, and not potential reward complicators related to appetite dysregulation like dopamine.
The other is that while I suspect that eating a bland diet may be successful in terms of weight loss, I don't see it as being any more successful in terms of the real issue -- long term compliance -- than any other diet.
That said, my take on the "bland liquid from a straw" and yours is very different. I don't believe he is proposing this as an actual idea for weight loss. Rather, the implication is that very obese people who are advised to eat to satiety wind up eating a very small amount of calories when palatibility isn't a factor. Thus reducing palatability may be a useful strategy, the degree of which may vary among people. And even given that, his recommendation for those who require very limited palatibility is not bland liquid from a straw but rather a more limited menu.
Thanks! Wish I could have been there!
I think maybe here:
http://vimeo.com/ancestralhealthsymposium
No videos yet though.
I don't think a bland food diet is practical unless you're going to institutionalize obese people to the point where they develop anorexia, at which point they won't be tempted by more palatable foods in the outside world. But then you have to worry about starvation/lack of sufficient vitamin and mineral intake.
We've seriously undermined a (theoretically) pretty good system by creating hyper-palatable food that has virtually no nutritive value. Moving to a real foods diet helps to bring sanity and moderation back - both to our taste buds and our digestive system.
I think food reward will end up being an important piece in a larger, more complex understanding of obesity and diseases of civilization than that provided solely by LCHF.
I'm tired of it. I'm one of those fat people nobody believes who has to remember to eat because I get caught up and distracted by all sorts of interesting "ooh shiny" kinds of things, intellectually or otherwise, and forget to prepare meals. Once upon a time I still had high caloric intake because I was drinking soda. I gave that up. Now I find myself going too low on the calories and stalling. At other times I've lost weight eating up to 2900 calories a day, as tracked on a website. And I'm a low-carber. By definition, my food IS palatable. I get to eat all the good fatty bits.
Maybe Taubes is tired of hearing the "starve yourself you fatty" theories of weight loss. I know I sure am. I have loved Guyenet's blog for most of the time I've been reading it but this is really beyond the pale.
Also, as I've understood it, "rewarding food" does not equal "good tasting/palatable", it's more about how the food affects the brain's reward center. So it's more on a subconscious level.
http://www.youtube.com/watch?v=4hzoFgwFeMQ
After watching the video I can't help but think this has been blown way out of proportion.
The Oz thing was such a set up, anything that made Oz look bad would have been edited out anyway. It is the "Dr. Oz Show" after all.
Good on Gary for making the challenge. It was Ancel and his like who took us down the road of bad science (through fudged statistics).
Are you saying you support bad science and skewed data, because it's polite to agree?
I'd say hats off to Mr. Taubes for sticking up for science.
Obesity does not have only one origin. A theory has to fit all facts. Food Reward Theory is not a complete theory. It is just one part of the whole picture. Like Paul commented on PerfectHealthDiet, it can be caused by malnutrition, infections, and toxins.
The real problem with glucose -> insulin -> fat, is that glucose is only one nutrient. If it does not cause problems in many communities it cannot be the problem. On the other hand it has been seen quite conclusively that sugar, wheat flour, and refined oils, quite reliably cause obesity in almost all people. These are not causing obesity because of glucose, but because of fructose, gluten/gliadin/wga, and omega6.
Anyway hopefully we can see a refutation of Stephan's latest article here, where he destroys the glucose -> insulin -> fat hypothesis.
http://wholehealthsource.blogspot.com/2011/08/carbohydrate-hypothesis...
Anand - what does the 'it' refer to in the last line?
Nina
I'm afraid you misquoted Taubes and mischaracterized the audience reaction. Here is what you wrote: "Taubes says that in science it is always a good idea to consider all the facts, not just the ones that fit your theory. In fact, please do it before giving a talk on the subject. Then he walks away from the mike. As the entire audience cringe from the awkwardness of the situation Guyenet answers, with superb coolness, 'Thanks for the advice.' "
Now here is what Taubes actually said, verbatim from the video clip you posted: "I would just recommend in the future that you should pay attention to populations that might refute your hypothesis rather than just present populations that support it. That's always key in science".
That's quite different! There is no putdown about checking alternative hypotheses, as in "please do it before giving a talk on the subject". That's quite an unfair distortion. And on the tape, a single woman is heard to guffaw, not "the entire audience".
We should be careful not to fan the flames here. This was an honest disagreement and Taubes came across as civil, albeit challenging. That's the way science should be.
Once Taubes' presentation is available for viewing, you'll likely be able to see his comment about 'insulting' Stephan -- I believe he makes this when Richard Feinman comes up during Taubes' Q&A. And if Stephan is to be believed, Taubes apologized later that evening. So apparently even Taubes was aware that he overstepped.
The exchange was written down from memory and after reading about it on the web. You are right the last line was wrong, he instead said "That's always key in science". However, the way he said it couldn't help to be interpreted as very condescending, although it is possible it was not meant that way.
There may only have been a modest audible reaction from the audience but I know many people reacted very strongly, based on what they later said.
The thing is, what was said would have been pretty much OK if it was just a discussion one to one. In front of a mike, with hundreds of your closest peers in the audience, every hard word is magnified a thousandfold.
OK, I'll take your word for the audience reaction, since you were both there. I was only going by what the video revealed. I'm sure that Taubes could have phrased things more tactfully, as he appears to have recognized himself. Still, I don't see anything personal or vindictive in his comments, but more of ill considered choice of words to express a valid point about the need to avoid confirmation bias in selecting studies - something that others have accused Taubes of. Plus, this is an important argument, so perhaps a bit of passion comes in on both sides, which is a good thing, if kept within reasonable bounds.
All this aside, the more important question is: who is right about carbohydrates, insulin, food reward, and obesity. The full picture may be more complex than either of the simple hypotheses. But I must say that after reading Guyenet's posts about this, he failed to convince me, for many of the same reasons you highlighted in your recent post on how Guyenet missed the forest for the trees.
Todd
I'm not sure if even the Inuit's intake of carbs is that low. They do store foods gathered in the summer for the long winter ahead. So I think what you propose is a non-starter.
Yes, the inuit's intake is that low. At most, their protein was around 35-40%, and their fat was around 50-75%. It's fair to say that very often, their diet was 0-10% from carbohydrates. Their belief was even that a diet with a majority being meat was healthy, and made you stronger and kept you warmer, so they made sure that this was the case, on top of nature lending a hand. Also, there were tribes where the warriors/hunters ate only meat, because they believed that eating plants was for the weak who couldn't hunt. It was a point of pride.
The problem I posed with Stephan's response is that he's misunderstanding Taubes' theory. Its as if he had never read any of Taubes' work. Taubes did not say that carbohydrates will always cause obesity. What he said was that with obesity, you will always find carbohydrates. In Taubes' mentioning of the Pima, he states that it is most likely the sugar and white flour that civilization gave them that made them obese, even though they were eating other carbohydrates before. It's like Stephan is arguing with this fictional version of Taubes that's saying things that Taubes never said.
The Inuit couldn't be used as a test case these days. They (mostly) follow a bastardized version of their traditional diet. Too many modern foods have found their way into their diet.
Thiness is associated with a high carb diet in most civilizations (the West excluded) and in some cases these populations lead the world in longevity. The Okinawans are a prime example. Does Taubes address Asian populations at all? The only Asian population that I know of with obesity problems are East Indians. It would be interesting to see a study looking at the health statuses of meat eating Indians versus the Hindu vegetarian population.
I tend to believe that refined flour and sugar have a lot to do with obesity and the Pima example shows this association. The American Pimas are obese whereas the Mexican Pimas are not. It is my understanding that the latter still follow their traditional diet.
We're both arguing the same point here, so I'm glad we're on the same page. Yes, I believe Taubes calls it "the Japan Paradox" or something like that, and he addresses them the same way he addresses the Pima, that added sugar in the diet is what causes the insulin resistance. Since Asians still don't typically eat a lot of sugar (they do eat more of it than they used to), they have not seen an epidemic of obesity. Japan and China have, however, seen a 2-3x rise in diabetes in recent history.
Its not surprising that obesity and diabetes is on the rise in Asian countries. Its on the rise everywhere else due to globalization. We see many cultures eating foods today that were not part of their traditional diets. The young in Okinawa are getting fatter because of this and we see what happens when Asians (and others) move to the US and adopt the local diet and lifestyle.
Funderaren, do they? Can you quantify "so many pigs" for me? They eat fish and pork but it makes up a very small part of their diet. They also consume more soy (in the form of tofu) than any other Asian country. Studies done in Okinawa by various researchers i.e. Suzuki, Wilcox et al and the Blue Zone folks reveal their diet plus I've seen a dietary comparison of Okinawa versus Japan from 1949/50. The amount of animal foods consumed was astonishingly sparse.
http://healthcorrelator.blogspot.com/2010/01/okinawa-island-of-pork.html
Look at what the centenarians eat and that will give you a better account of their real diet. Remember what I said about globalization? There are fast food restaurants in Okinawa and China just as there are in the US. The forecast is for increased beef consumption in China due to an increase in disposable income. It will be interesting to see how their health status changes, for better or worse, over the next 20-30 years.
What do you think was the major cause to this diet in 1950??
I do think the most amercans have some knowledge of the major pacific battle of the Okinawa in 1946?
http://en.wikipedia.org/wiki/Battle_of_Okinawa
And a lot of veganbloggs extrapolite a lot of this food-record from the 50s.. whith a population in famine, and allmost every building demolisht.
But its quite easy to learn about the traditional diet, there is a lot writhen about traditional Okinwan diet and its development over the history, they dont eat japanese food they eat norden chinese food!
They seems to have eating a lot of sweetpotato piggs and a lot of seafod.. and there food says to be very greasy!
"The relationship between ‘pork and sweet potato’ occupies a special position in Okinawan food culture, favourable geographical conditions helping the combination to become by far the most important food items. It goes without saying that all the pig was eaten, including the fat, leaving nothing behind. This is very different compared to the Japanese mainland where a vegetarian diet for religious occasions is observed. In Okinawa, pork is even included in the dishes served at funerals"
http://apjcn.nhri.org.tw/server/APJCN/Volume10/vol10.2/Sho.pdf
And here some traditional longevetyd Okinawan food!
http://www.chicagookinawakenjinkai.com/Cooking%20Pages/Traditional_Re...
First of all, thanks for the link to the PDF. I found it very interesting.
I always knew the Okinawans (plus many other Asian cultures) consume pork. It appears to be the meat of choice amongst Asian cultures. The paper doesn't quantify how much they ate on a daily basis but that it was part of the diet and that it was commonly consumed during festivals. Again, there is nothing odd about this. Many other cultures eat foods during their festivals and special celebrations that are not normally consumed in great quantities throughout the year.
The paper talks about the large amount of seaweed and tofu as part of the regular diet as well as the highly revered sweet potato, accounting for up to 90% of their calories in some areas. I believe for Okinawa as a whole the percentage is probably closer to 70-75%. If you're doing the math you will quickly realize that the animal component to their diet is rather modest. So this paper doesn't really refute what I've said, in fact it supports it.
Another thing to note in the report is how they boil their pork. Boiled meat is lower in fat than meat cooked using other methods.
Its true, the Hindu vegetarians of India don't make good role models for the vegetarian cause.
If vegetarians and vegans want to point to a successful vegetarian community they should use the Loma Linda, California vegetarians as an example. Its a Blue Zone. The South Indian example does bear out Taubes' hypothesis to a certain degree but keep in mind that they use a lot of refined flour and sugar. Taubes said ALL carbohydrates are the same to our bodies, so that would include, according to Taubes, whole grains, potatoes, fruit, etc. I disagree with the hypothesis that carbs make us fat, period, case closed! Why? Because of all the non-western populations that keep to their traditional diet, which is high carb, high starch and remain slim and in good health. In this scenario high-carb is associated with leanness, not obesity.
The keywords here are "non-western" and "traditional diet" because non-western populations that don't stray from their traditional diet maintain slim physiques and don't suffer from the diseases of civilization. When they do stray from their diet and eat like westerners, their health status declines, they get fat, they become diabetic, etc., etc.
When they move to a western country their health generally declines. When they move back to their country of origin their health improves! Sadly, more and more western foods are finding their way into these cultures' diets and we all know how that will play out in the end. We see evidence of it right now!
For instance, I don't believe that it is good for you to eliminate ALL carbs. Vegetables provide much needed nutrients that your body needs, and yes, it is possible to get a lot of that thru pills..but again...getting it from a natural source is much better for you.
Also, hard to get fiber on a low-carb diet unless you are eating vegetables...again, unless you use a "supplement".
But it all comes down to the basic formula.
If you get rid of carbs, and only eat fat and protien (within limits on the protien), you WILL loose weight.
If you get rid of the fat and substitute carbs, you WILL gain weight.
Scientifically, blood sugar measurements don't lie. Understanding how insulin affects our bodies is key to understanding how our bodies process food.
And what do you say to the many populations of the world that eat low fat, high-carb diets and are slender and healthy?
Of course they don't eat much sugar. That's pretty much a given in a traditional diet, wouldn't you say? But they do load up on foods that Taubes claims makes us fat. Look at the Kitavans diet which is based on sweet potatoes and other tubers. Fruits, vegetables and fish make up the remainder of the diet. Their protein accounts for around 15% of their daily calories.
Its true that lean doesn't necessarily mean healthy. The groups I mention are healthy. The two I'm most familiar with are the Okinawans and the Kitavans. The Massai, often revered by the LC supporters, have low cholesterol despite the high amount of saturated fat in their diet. Are they healthy though? The Massai have short lifespans.
South Indians are lean? Once upon a time they might have been lean. Perhaps the poor that are undernourished are lean. Obesity is major problem. Indian food is not low fat, they love their sugar and the rice of choice is white basmati. Naan bread is made from white flour. They use lots of vegetable oil, ghee and thick yogurt-based sauces in their cuisine.
Perhaps you were talking about Sri Lankans?
The Massai, often revered by the LC supporters, have low cholesterol despite the high amount of saturated fat in their diet. Are they healthy though? The Massai have short lifespans.
I suggest you do some reading before making this false claim. The Masai suffer very high rates of child mortality. They also suffer for malaria and numerous infectious diseases. They don't die of western lifestyle diseases like CHD.
No one knows really how long the Kitivans live or what diseases they suffer. There are no birth or death records, no medical records and no post mortems.
The Lindeberg Kitiva studies are nothing more than questionnaires and very superficial medical examinations that are unlikely to detect many serious health problems.
My mother died a few hours after being examined by a very experienced doctor from an unusual heart condition. She would have been given a clean bill of health by the Kitiva study a few days before she died - healthy weight, no diabetes, low cholesterol, no ECG abnormalities etc.
The denial and rationalization going on here is amazing. I didn't realize the LC crowd was this religious. I generally expect that from vegans.
Kitavans are short? So what? So are Asians. So is my mother. Your point would be?
Kitavans don't have much muscle or have relatively high body fat levels? I've seen photos and video from Kitava. Your claim isn't supported by Lindeberg nor by the material I've seen. If they are carrying around any fat it sure is well disguised.
Fat Okinawans? I'm sure that may be a problem in modern Okinawa amongst the young who have adopted a more western diet but the elderly and the others who still follow the traditional diet are not fat. I'm sure Wilcox, Suzuki et al, would take issue with you here.
The keywords wrt your mother are "unusual+condition". The Kitavans were given a clean bill of health so you come up with a personal example in an attempt to discredit Lindeberg's work and suggest that Kitavans could all be walking time bombs due to some unusual undiagnosed condition? Aren't we grasping at straws here! I guess by your logic we can discredit any positive diagnosis made by a physician since the beginnings of medicine.
As far as the Massai are concerned, yes, I'll give you credit for the point you raised about their rates of childhood mortality and infectious diseases. However, before the LCers claim the Massai as poster boys for their high fat, low carb lifestyle remember that unless you are willing to walk 20km per day, you may not want to make the leap in faith that their high-fat diet is in any way pertinent to us. The Amish eat a meat and potatoes, high fat, high sugar diet but have a low obesity rate. Like the Massai, their activity level is very high. This only serves to prove that exercise can erase a multitude of sins.
From your comments it really makes me wonder what populations you hold in high regard in terms of health.
"Non-industrialised countries and affluence: Relationship with Type 2 diabetes" (http://bmb.oxfordjournals.org/content/60/1/33.full)
The introductory paragraphs from the study are quoted below:
"Standardised prevalence data for type 2 diabetes are available with a world-wide coverage probably unequalled for any other disease, allowing confident comparisons between people of similar ethnicity living in different settings, and giving a clear picture of secular trends in many populations over the last 20 years. The epidemiological story is remarkably consistent. An epidemic of diabetes is unfolding in countries undergoing rapid economic development and modernisation. Non-industrialised countries are exchanging their high morbidity from infectious disease for morbidity from 'diseases of affluence' including type 2 diabetes and cardiovascular disease.
The prevalence of type 2 diabetes is lowest among people who still have a 'traditional' or 'primitive' lifestyle as either hunter-gatherers or subsistence farmers. Examples are the Mapuche Indians in Chile, rural Bantu in Tanzania, and rural communities in the Pacific islands and South Asia1–4. Even in these populations, it cannot be described as a 'rare' disease, affecting 1–3% of people aged 30–64 years. The prevalence is higher in people who have moved away from the traditional way of life, either to live in towns and cities or through migration to another country. This has been described in all major ethnic groups (Fig. 1). Among South Asians, it is less than 5% in rural South India, around 12% in urban South India, and 15–20% in migrants to Mauritius, Fiji, Singapore, Tanzania, The Netherlands and the UK1,,5–12. Among Chinese, it ranges from less than 3% in rural China to 15–20% in urban Taiwan and Mauritius, and among people of African origin, from less than 3% in Cameroon, to around 10% among people of West African descent living in Jamaica, and 15% in Jamaicans living in the UK."
So this study certainly confirms that a switch to a Western diet and lifestyle does produce a significant increase in the rate of type 2 Diabetes. BUT, adherence to a more traditional or primitive diet doesn't really provide immunity to Type 2 Diabetes, as per this particular sentence, which I will repeat for emphasis:
"Even in these populations, it cannot be described as a 'rare' disease, affecting 1–3% of people aged 30–64 years. "
That does cast a somewhat different light on the subject: this study suggests that a high carbohydrate diet is a problem for some fraction of the population even when eating primitive foods, and following a traditional lifestyle. From this starting point, it is not particularly difficult to believe that increased use of unnaturally processed foods, and more sedentary lifestyles simply increase the fraction of the population that has metabolic issues with a high carbohydrate diet.
I read the study. Nothing particularly shocking here. We have known for some time what happens when populations stray from their traditional diets whether from urbanization, migration, etc.
"That does cast a somewhat different light on the subject: this study suggests that a high carbohydrate diet is a problem for some fraction of the population even when eating primitive foods, and following a traditional lifestyle."
No Craig. The study suggested nothing of the kind. How did you come up with this interpretation? I found only two references to carbohydrates in the full text of the study:
1. "On the other hand, prospective studies looking for dietary determinants of diabetes (so far confined to industrialised countries) have failed to show a clear link between carbohydrate or fat intakes and incidence"
Notice that it says "failed to show a clear link" between carb intake and incidence of type 2 diabetes.
2. "Dietary advice included detailed recommendations about intakes of carbohydrate, fat, protein, vegetables and alcohol and achieving a target body mass index."
This text was found under the section "Prevention of Type 2 Diabetes. Notice, there was no recommendation in this study as to what these macronutrient percentages should be for the prevention of type 2 diabetes.
So 1-3% of a high-risk age group (30-64) within a population exhibits problems with a traditional diet, meaning the remaining 97-99% have no problem at all with it. Is anything 100% protective when diet and environment are concerned? Hardly a reason for concern and certainly not a reason for not adopting a natural whole foods diet even if it is high carbohydrate.
The takeaway message from this study is that the adoption of a diet high in calories and low in nutrients (aka: a junk food diet) increases the risk of type 2 diabetes and that adherence to a traditional, whole foods diet is highly protective.