A Better Recipe

By David L. Katz, MD, MPH, FACPM, FACP

Among others, Gary Taubes, the well-known science writer and health advocate, has famously argued that calories don’t count. Mr. Taubes and I have discussed this issue in the past and have agreed to disagree. Leaving aside Newton and the laws of thermodynamics, there is evidence that weight can be lost when calories are restricted, no matter how truly dreadful the quality of those calories may be (e.g. the Twinkie Diet. To give Mr. Taubes his dues, most people in the real world gain weight, not lose it, by eating Twinkies.

Not One but Many Solutions Are
Required to Stem the Obesity Crisis

My view is that the quality and quantity of calories both count. The quality of calories is the quality of the fuel that runs our bodies, and it counts for that reason. The quality of calories also influences the quantity. While it may be that “no one can eat just one chip,” everyone can eat just one apple. Quality and quantity interrelate.

Dr. Robert Lustig, a pediatric endocrinologist at the University of California, San Francisco (UCSF), has argued that excess sugar, and specifically excess fructose, is the one thing that is most importantly wrong with the modern diet. He and I have also agreed to disagree. Dr. Lustig has invoked high-quality science to demonstrate how fructose can harm our livers by causing fat accumulation there, and thus damage our health, in virtually all the same ways as alcohol.

However, a paper that was recently published in the journal Applied Physiology, Nutrition and Metabolism demonstrates that under real-world conditions a preferential focus on fructose may be unjustified. (The investigators found no increase in liver fat over 10 weeks with sugar-supplemented diets, and no differential effects based on the kind of sugar. On the other hand, the study was funded by the Corn Refiners Association, and was likely developed with this very outcome in mind.)

But even if this study is suspect, there are other reasons to doubt that fructose is our one true cause for worry. A recent study shows an association between sugar-free soda intake and diabetes. This may be a direct effect of sugar substitutes, or more likely because people who drink intensely sweet sodas of any variety tend to consume a diet higher in sugar overall. But at a minimum, the association is a precautionary tale about benefits to be expected from replacing the sugar in soft drinks.

More importantly, if Dr. Lustig is right, the much-revered T. Colin Campbell, a biochemist and former professor at Cornell University who has implicated animal protein in our health ills, must be wrong. Our trouble can’t be all about fruit sugar if it’s all about animal protein, and vice versa.

If Dr. Campbell is right, then not only are Dr. Robert C. Atkins, a cardiologist and author of the “Atkins Diet,” and Dr. Agatston, Dr. Arthur Agatston, also a cardiologist and author of the “South Beach Diet,” but also Dr. Loren Cordain, a respected paleoanthropologist who emphasizes the prominent place of meat in our native diets, have all to be wrong. If Cordain and others are right, then not only Campbell, but Dr. Neal Barnard, author of “Power Foods for the Brain,” and Dr. Caldwell Esselstyn, author of “Prevent and Reverse Heart Disease,” and other ardent proponents of veganism must be wrong. And if the most ardent proponents of a vegan diet are right, the proponents of the Mediterranean diet must be wrong. And so it goes on.

A sophisticated analysis, based on three distinct computer modeling approaches, published in the journal Hypertension indicates that meaningful reductions in average intake of dietary sodium in the U.S. could save between 280,000 and 500,000 lives over the next decade. But if sodium is a major source of harm, then arguments that our only worry is meat, or fructose, or eggs, or carbs, or aspartame are all wrong.

I think there is a better explanation for all of this, and it’s one we’ve heard before, courtesy of the poet, John Godfrey Saxe. Saxe wrote the most famous version of the parable, “The Blind Men and the Elephant,” in which each of six blind men seeking knowledge of the beast take hold of a different part of its body, from tail to ear – and reach a different conclusion. Saxe wrote that “each was partly in the right, and all were in the wrong.”

All were in the wrong, not about the part but about the sum of the parts. This applies for diet and health as well. There is no question that dietary patterns at odds with the fundamentals of what we know about the basic care and feeding of humans are a major cause for the most egregious injuries imposed on modern public health. There are many minor deficiencies and also major excesses contributing to the adversities of our dietary intake. But no one thing is wrong with the prevailing American diet, and no one remedy will right it any more than a single part represents the whole elephant in the room. We need to see that elephant, and develop a better recipe.

David L. Katz, MD, MPH, FACPM, FACP is the founding director of Yale University’s Prevention Research Center. He is a board certified specialist in both Internal Medicine and Preventive Medicine/Public Health. He is the director and founder of the Integrative Medicine Center at Griffin Hospital in Derby, CT. For more information visit http://www.davidkatzmd.com and http://www.turnthetidefoundation.org

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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