Posted in Susan Fekety on March 22nd, 2009
Unless otherwise noted, © Copyright 2009 by Susan Fekety. All Rights Reserved.

This year, I gave myself permission to take off the entire two weeks of our family’s “interval ownership” on Captiva Island (I think this is jargon for “timeshare”) — and then prepared for the trip by shipping myself a box of books to read.

Fellow reading addicts, is this not almost pornographic? I went through all the book-heaps I’ve accumulated around the house and picked my favorites. (Got rid of a few, too, as in “if I haven’t read this yet I probably don’t really want to.”) Overall, it was a satisfying little adventure. And economical, compared to packing all those books in my luggage!

Right at the top of the list of books I was happier to ship than carry was “Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health” by Gary Taubes. It’s thick and heavy, even in paperback. Perhaps you read or heard of his 2002 article in the Sunday New York Times Magazine* called “What If It’s All Been a Big Fat Lie?”

This fellow caused quite a stir in the health-nutrition world (a gnashing of teeth in some circles, a nose in the air in others; he got a standing ovation in the Functional Medicine world) so I was really looking forward to a book’s worth of his work. (Plus I was a little nervous. This guy is smart! He has great credentials! What if I discover that I’m wrong about things? This is the unspoken deep-seated nightmare of many health care providers.) If you like reading about health and nutrition like I do (well, maybe not so much as to take it on vacation and read it on the beach) do put this book your list.

Several years ago Taubes got interested in the obesity epidemic, and started to interview experts and dig around in the research. As he describes it, the more he read the “science” supporting the dietary recommendations articulated by conventional-medical experts, the more he became convinced that the recommendation to “eat less fat and more carbohydrates” is based on years and years of faulty science.

OK – anyone can see that doing nutrition research on humans is really tricky, particularly over the long-hauls needed to identify behaviors that prevent diseases that take years to evolve. Still, there’s evidence that important data were overlooked or misinterpreted, studies were designed badly, or the wrong research questions were asked in the first place. (In a Frontline interview Taubes said, “These were some of the worst scientists I’d ever come across in my 20-odd year career of writing about controversial science.”) Wow.

That there is flimsy evidence underpinning a substantial element of Medical Knowledge should actually come to you as no surprise. Candid practitioners will tell you that they often willingly accept and base their actions on an assortment of “facts” they were taught early on, but — well, no, they don’t know the actual source of the information, nor do they have a publication on it in their files. Particularly if the “fact” in question is a pearl of wisdom imparted by a beloved mentor, or the chairman of your department; it is so difficult for us to let go of these beliefs, even in the face of mounting evidence that they may indeed be patently incorrect. But one does want to do good work, right?

So, in nutrition lately (well, for the past 50 years or so,) “everyone knows it’s true” that cardiovascular health and healthy body weight are promoted by consuming a low-fat high-carbohydrate calorie-restricted diet. That fat people are fat because they eat too much fat no matter how much you plead with them not to, plus they just lay on the sofa all day instead of going to the gym. That having high cholesterol comes from eating too much fat and will give you a heart attack. That if you can just lose weight you will be healthier and live longer. This is just for starters – there are many corollaries, equally misguided.

Seriously, the epidemiological and biochemical evidence (and the clinical experience of people working with people instead of lab animals) simply does not support these beliefs. Unbiased, genuinely curious consideration suggests that what we’re hearing really reflects the combined influences of political and financial stakeholders, largely from the food/agribusiness and pharmaceutical industries, on what gets studied and what gets published. This makes for a real mess in the produce aisle. (Well, actually, maybe it’s in with beer and chips.)

Although his critics (and some have been quite nasty!) say that Taubes recommends we all live on bacon cheeseburgers and pork chops, what he really says is this: the science behind low-fat dieting is pretty thin, and the science supporting the idea that excess carbohydrates and sugars set people up for diabetes, obesity, and cardiovascular disease is both plausible and currently understudied – so let’s study it. This is NOT be a radical message, folks (though it could be revolutionary.) I say, God bless him.

I see people all day long with this or that health issue, overweight, fatigue, hair falling out, hormones a jumble, who think they are eating well (and are working hard at it, most of them.) When we actually drill down and look, many are way short on protein and fat and vegetables, way heavy on carbohydrates and sugars. They hit the metabolic wall at midlife and it all begins to fall apart. (Gotta say, a Functional Medicine approach (like I use in the FirstLine Therapy? program) makes a HUGE difference for many of these people.)

As we talk and I suggest some changes, they give me that deer-in-the-headlights look. Some burst into tears. Those willing to make the leap of faith and give my suggestions a try are typically delighted at what happens next. The unwilling…well, frankly, I expect to see them back in a couple years, and then maybe we can talk.

Back in statistics class I learned about a thing called the “BOGSAT Method” for developing clinical practice guidelines. BOGSAT stands for a particular form of pseudo-science based on a “Bunch of Old Guys Sitting Around Talking.” Typified by Expert Consensus Statements** (as opposed to things like clinical trials and actual scientific research) BOGSAT methodology is especially prevalent in medical fields pertinent to lifestyle, nutrition, and public health. BOGSAT guidelines (“In MY/OUR opinion…..”) can keep us wedded to wrong information with hoops of steel. In the world of clinical prevention, I pray this all doesn’t get cast into concrete when we start in on health reform.

I am starting to think that the “eat less/eat less fat” admonitions are coming from people who just hate fat PEOPLE: who believe that those of us who struggle with weight are just lazy and lacking willpower. Indeed, there was an interesting study done at Yale a couple years ago about fat prejudice in medicine; they found that the clinicians with the nastiest shaming-blaming attitudes about people with weight problems were the ones who specialized in bariatric medicine. I mean, come on guys.

How long till we put low-fat high-carb eating over where it belongs, next to “the earth is flat and also the center of the universe”? I’m sure there are some people who are doing really well on low-fat, low calorie, high carb food styles – but a lot of the folks who land in my office are getting pretty sick eating that way. Still, I remain optimistic that eventually we’ll gird our loins for another paradigm – maybe with some candor, clarity, compassion – and real science — behind it.

* I have a friend who refers to this publication as the “New York Times Journal of Medicine.”

** Taubes points out that if there were truly a consensus, we would not be needing people to come up with a statement about it.