Gary Taubes on history, politics and flaws of contemporary nutrition science. Interview (part 1).

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We are happy to present part 1 of our interview with Gary Taubes, an American award-winning journalist and bestselling science writer, the author of Nobel Dreams (1987), Bad Science: The Short Life and Weird Times of Cold Fusion (1993), Good Calories, Bad Calories (2007) and Why We Get Fat (2011).

Taubes studied applied physics at Harvard and aerospace engineering at Stanford (MS, 1978). In 1981 he received his Master’s degree in Journalism from Columbia University and one year later joined Discover magazine as a staff reporter. Since then he has written numerous articles for Discover, Science, New York Times, Atlantic Monthly and other magazines. Taubes has won the Science in Society Award of the National Association of Science Writers three times and was awarded the MIT Knight Science Journalism Fellowship for 1996-97.  For more information on Gary Taubes visit his website.

While his original focus was on physics, Taubes’ interests have more recently turned to medicine and nutrition. All his books deal with scientific controversies and bad science. His latest research questions much of the 40-year-old low-fat nutritional advice, which, he argues, is both wrong and unsupported by good science.

In this part Gary talks, among other things, about the history, politics and fundamental flaws of modern nutritional science and explains why the concept of how to do science right in medicine and public health never crossed the Atlantic after WWII.

Here is the interview:

You started your career as a journalist and a science writer focusing mainly on scientific controversies in the field of physics. What prompted you to shift towards nutrition and public health issues?

At some point I became obsessed with the question of how hard it is to do science right, and how easy it is to get the wrong answer doing research. My approach was based on the first book I wrote, which detailed the misadventures of a group of physicists at CERN discovering non-existing elementary particles. Later I dealt with this scientific fiasco from the late 1980s called cold fusion. After the cold fusion episode, some of my friends in the physics community suggested to me that, if I was interested in bad science – something they called ‘pathological science’, which is the science of things that aren’t – I should look into public health.

At the time they were talking in particular about this idea that electromagnetic fields from power lines can cause cancer, which was based on observational epidemiology. And I noticed that everything I had learned about what you had to do to get science right, namely the rigorous attention to detail, to negative results and to well controlled experiments, was considered irrelevant in the field of observational epidemiology. So I wrote about the electromagnetic fields controversy, which by the way has never gone away and is still with us today in the form of the ‘cell-phone – brain-cancer’ controversy. I was fascinated by how observational epidemiology works, so I wrote a piece for the “Science” on that topic back in the early 1990s . Since observational epidemiology is the bedrock research tool of modern public health issues in nutrition, it was just a matter of time before I started writing about nutrition and the fruits of this particular pathological science.

In your book Good Calories Bad Calories you demonstrated that by the early 1940s, thanks to research done mostly by German and Austrian scientists, it was a fairly accepted view within the European research community that obesity was a metabolic problem caused by biological factors (hormones, enzymes etc.) rather than the disorder of energy balance as it is presented today. Why was this theory and all the related research dropped and forgotten after the war ended?

One of those fascinating realizations in doing the research was the effect that WWII had on medical research in general. Prior to the war all the best medical research in the world, all the meaningful medical research was basically being done in Europe.

An interesting aside is that when I was writing about the high energy physics and living at CERN outside of Geneva, the physicists had a line that the best thing that had ever happened to American science was Hitler because he drove all these brilliant European researchers to the US. And we embraced them, as we had a Cold War to fight, we had atom and hydrogen bombs to construct, and rockets to build. So by the mid to late 20th century all the leading figures in physics in the United States tended to be either these European émigrés or their students.

However, in medicine and public health we had no desire to embrace these people. A lot of the young physicians and researchers had fought in the war and they didn’t see any need to embrace those Austrian and German scientists. They didn’t see any reason to read the German-language literature, even though most of the significant science had been published in these journals. So this anti-German sentiment in medicine and public health, which was understandable, carried over after the war. One result was that the whole concept of how to do science, which had been pioneered by the Europeans, was effectively lost in medicine and public health fields. It didn’t cross the Atlantic after the war as it did in physics.

The other side of this is that with the refusal to pay attention to the German language literature and so the pre-War research on obesity researchers also ignored the European idea that obesity is a hormonal, metabolic, enzymatic disorder. That was left behind as well. And a lot of these researchers in America – lean, young doctors and nutritionists – had the same preconception that everyone else did that obese people were gluttons and they were  slothful and therefore it’s their behavior that caused the disease, not the disease that caused their behavior.

What was the most important factor driving the paradigm shift from the notion – commonly held by the medical community up to the1960s – that carbohydrates (especially refined ones) are fattening and their excessive intake may cause a number of health issues, including heart disease, to the belief that dietary saturated fats are the major cause of obesity and other chronic illnesses, most significantly CVD? Was the transition between late 1960s and early 1980s fuelled predominantly by scientific findings, or maybe other factors, circumstances, actors played a leading role in this process?

In the 1950s a nutritionist named Ancel Keys got this idea that heart disease was caused by the elevated serum cholesterol levels, and that you elevate cholesterol levels by eating dietary fat. Keys was a very powerful personality, a guy who, having once believed he was right, was capable of believing that anyone who disagreed with him was wrong and/or an idiot.

When Keys started promoting his idea, the American Heart Association (AHA) and the cardiology community in the U.S. initially refused to buy into it, arguing that the evidence simply wasn’t compelling. But Keys and his colleague, Jeremiah Stamler, prompted the AHA to get behind it. They did it by creating an ad hoc AHA committee – even though Keys was a nutritionist, not a cardiologist – and then having this committee, on which Keys and Stamler were members, produce a four-page report saying that there was enough evidence for Keys’ theory to act upon it and they urged Americans to start eating a low-fat diet. This idea then began to spread through the press and through medical journals, even though it couldn’t actually be confirmed in experiments. People started talking about Key’s theory and believing it, and Keys himself was so convinced it was true. As a result the conventional wisdom started to shift despite the lack of meaningful scientific evidence.

Once the AHA got behind it, the idea began to spread through all levels of society largely through the medical journals and the press. The journals perceived the AHA as an honest broker of ideas, which it was, but the AHA people were not scientists, they were heart doctors, they didn’t know how to do science. And the journalists covering health beat, I might add, were not the sharpest minds in journalism either.

Those days, however, we still had this counter-hypothesis – the so called conventional wisdom, popular among doctors and the public at that time – that carbohydrates are fattening. So if carbohydrates are fattening, and obese people tend to have higher rates of heart disease, then you have a serious problem: On the one hand, you’re saying that heart disease is caused by dietary fat, thus the way to prevent heart disease is to eat less fat and replace it with carbohydrate-rich foods. On the other hand, you have this 150-year-old idea that carbohydrates themselves make people fat, with the implication that you should eat fewer carbohydrates and more fat. And then this is compounded by the fact that obesity is a risk factor for heart disease, so they can’t both be true but whatever makes us fat, should be a cause of heart disease. These two paradigms directly competed with each other. And since nobody in the United States other than diet doctors and maybe a handful of researchers were pushing the ‘carbohydrates-are-fattening paradigm’, it was relatively easy to write it off as quackery, which is what happened.

The key point is that if dietary fat really does cause heart disease, then the dietary means of preventing heart disease almost has to be a low-fat, high-carb diet. What’s more, this diet must also be the answer to obesity, too, since obesity and heart disease are so intimately related. And so this is the logic that shaped the nutritional advice we’ve been living with for the past thirty to fifty years.

In Good Calories Bad Calories you observed that the European medical community was more reluctant to embrace Ancel Keys’ diet-heart hypothesis than their American counterparts. What was the main reason for this greater skepticism of European researchers about the theory linking dietary fat to obesity and heart disease?

I think in part the European researchers were simply better scientists. They had a culture of science that continued deeper into the 20th century. This tradition of science never really existed in the US and then pretty much vanished with WWII and the retirement of American nutrition and medical scientists who might have trained in Europe with Germans and Austrians prior to the war. That was one of the problems. The other issue was that there was this counter-hypothesis that had been promoted by British researchers, most notably by Peter Cleave and John Yudkin, who thought that refined carbohydrate and/or sugar is the problem, when it comes to heart disease, diabetes and obesity. And the Europeans were more tempted to pay attention to these British researchers than the Americans were. The Atlantic definitely represented a major obstacle to ideas.

European researchers ultimately jumped on the low-fat bandwagon and dismissed the views of John Yudkin, whose carbohydrate hypothesis could not be reconciled with the growing tendency to demonize dietary fats. What was the role of American political and research centers in advancing the fat-cholesterol hypothesis in Europe? How significant was the fact that the USA emerged as the political, economic and ideological superpower in the wake of WWII?

Indeed the USA did emerge as a political, economic and ideological superpower in the wake of WWII and this was also true in the field of medicine and public health research. Americans were doing research while Europe was rebuilding and the National Institutes of Health (NIH) in the U.S. became probably the leading source of research funds worldwide. Prior to the War, researchers who wanted to do serious science had to at least understand German so they could read the German language journals. After the world English became the lingua franca of science and all serious researchers took to reading the English language journals. Now it was the “New England Journal of Medicine” (NEJM), the “Journal of the American Medical Association” (JAMA), and to a lesser extent the “British Medical Journal” and the “Lancet”, that became the major purveyors of ideas, while the entire German medical literature, as far as I know, just dropped away to being trivial in its importance.

For instance, in the 1970s the researchers in Germany were still studying carbohydrate-restricted diets and they repeatedly demonstrated that these diets were far better than calorie-restricted ones. These German researchers told me that they simply dropped their research in the late 1980s because Dean Ornish, an American diet doctor, published studies in JAMA showing the supposed benefits of very low-fat diets. These Germans decided that the Americans must have been right all along and that they were wrong, just because this was what JAMA published.

As late as the early 1970s an unsettled debate continued between the supporters of the diet-heart hypothesis and the advocates of carbohydrate hypothesis, both paradigms functioning on more or less equal terms. Ultimately the former triumphed, all debate, at least in the mainstream, was suppressed, and the opponents of the new orthodox wisdom of obesity and chronic disease were effectively ridiculed in the public eye as “quacks”. Would such an unprecedented outcome ever be possible without the US government giving its political, financial and institutional support to the concepts of Ancel Keys and his supporters?

No, I don’t think this would ever be possible without the government’s involvement. A few factors were at work here. One is that the medical and public health researchers and nutritionists didn’t really have any conception of what science is and how to do it right. So when they started testing hypotheses in huge experimental trials beginning in the early 1970s, in two trials in particular – the Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT) and the Multiple Risk Factor Intervention Trial (MRFIT) – they were only testing one theory instead of trying to test multiple hypotheses. They invested approximately 265 million dollars in those two huge studies, an enormous sum of money at the time, and they had two possible answers: either their hypotheses were wrong, and then the Congress, which provided the funding, would see it as a waste of money, or their hypotheses were right and this would be the victory for everyone.

When the studies came out suggesting that the hypotheses were indeed wrong, the motivation to spin the data and interpret it as a victory anyway was so powerful that this is what they did.

Another factor was that the journalists got behind it. The reporters writing about health were not the most scientifically-attuned journalists in the country and they endorsed the low-fat doctrine very early. They would spin their articles, particularly in the New York Times, and the Congressmen, who read the Times (or, more importantly, the young men and women working on their staff) would believe what they were reading and they would try and force the issue. In 1977 a Senate subcommittee headed by George McGovern decided to settle the debate on what a healthy diet was in favor of the low-fat doctrine. Basically, it was a series of politicians, journalists, and then health organizations, one after another, climbing onto this anti-fat bandwagon until there was no going back.

Throughout your book Good Calories, Bad Calories you never refer to nutrition researchers advocating the fat-cholesterol hypothesis as “scientists”. Why? To what extent is the low-fat paradigm based on “bad science”?

 My book makes the argument that the prevailing paradigm is entirely based on bad science, on cherry-picking data, on failure to understand that experiments trump observations. I believe that the whole culture and philosophy of science, the concept of what it means to do science never crossed the Atlantic or survived in the field of nutrition, medicine and public health after the Second World War. These people really don’t care and we’re still fighting this struggle to have proper research done. I am trying to get some studies funded now that would be pure science and would speak directly to the question of what causes obesity. Is it really the idea of positive energy balance, or is it the nutrient content of the diet affecting hormonal and metabolic regulation of fat tissue?

The argument that I am making in my books is that the entire modern research community – at least in nutrition and public health — has never been trained to think scientifically. They have never embraced the idea that in order to make progress you have to rigorously control the variables in the experiment. If possible, you have to be able to change only one variable in order to discover what’s the cause and what’s the effect. This is stuff that is taught in America to high school students, when they’re 13-14 years old. And yet, the nutrition research community still doesn’t do this. They don’t base their recommendation on well controlled experiments, in which you actually know that if you change variable A, you can demonstrate an effect on variable B, and if you change variable C, then you get effect D instead. These types of experiments hardly apply to nutrition science today.

What do you think are the most fundamental flaws of contemporary nutrition science?

I don’t think there is such a thing as contemporary nutrition science. In my view, there is a lot of nutrition research simply aimed at confirming preconceived opinions. In fact, if you came up with an experimental design for a piece of nutrition research, and you went to the NIH and proposed it for funding, and the experiment was to rigorously test something we believe we know (eg. the effect of dietary fat on heart disease or the impact of energy balance on weight regulation), I would bet you the NIH wouldn’t even fund it. They tend not to believe that any benefits could accrue from testing such a well established belief.

Your research has exposed numerous dietary myths that are promoted to general public as scientific facts. What principles or concepts propagated by modern nutrition science do you find the most ridiculous in the light of available scientific evidence?

I would start with this idea that the amount of the fat we carry is merely determined by the difference between the calories we consume and the calories we expend. Another example is the concept that the laws of thermodynamics have anything meaningful to say about why we get fat.

I recently received a letter from a young PhD biochemist castigating me for writing quackery about thermodynamics. And what I want to say to him (and I did, in my response) is that if we we’re discussing any other disorder or phenomena of growth – for instance people who do not secrete enough growth hormone or have a defect in a growth hormone receptors, so they grow to be 4-4.5 feet tall; or people who suffer from gigantism secreting too much growth hormone, so they grow to be 8 feet tall; or if we’re discussing the growth of a tumor or a cyst; or even the disorder of excessive water retention in people – would you ever think that the laws of thermodynamics have anything to do with those problems? What do the laws of thermodynamics have to do with tumor growth? What do they have to do with the growth of a baby in a womb?

In all those cases people or objects are getting heavier, they’re getting more massive, but we’re not applying thermodynamics to explain these phenomena. It’s only in discussing obesity that we believe that laws of physics are relevant or explanatory to why some parts of somebody’s body get bigger. If you think about it, it’s inane, but it’s become almost universally accepted now.

In your research you have studied an enormous body of scientific literature on obesity, old and new. Since late 1970s it has become conventional wisdom among the obesity researchers that people get fat, because they consume more calories than they expend, thus creating a positive energy balance driving the weight gain. In other words, obese people are fat because they eat too much and exercise too little. This view, as you have mentioned, is said to stem from the first law of thermodynamics, which, as researchers stress, is inviolable. What are some of the fundamental flaws of this paradigm?

What the laws of thermodynamics tell us is that if something gets more massive, it’s got to take in more energy than it expends. But there’s no causality there, no causal information in that law. All it tells us is that when something is growing bigger, in this case heavier, it simply has to take in more energy than it expends, because energy cannot be created out of the thin air, and it cannot disappear into thin air. That’s why we call the first law of thermodynamics the law of energy conservation. Energy is neither created nor destroyed. So if we’re getting fatter (and heavier), we have to take in more energy than we expend, and if we’re getting leaner (and lighter) we have to do the opposite. That’s a given. That’s how the universe works. But it tells you nothing about why someone gets fatter; it says nothing about why we take in more calories than we expend.

The laws of thermodynamics are always true, they’re true for humans, they’re true for Martians, but that’s not the issue. The issue is that they simply don’t tell us anything about why a system gets more or less massive. They only say that if A happens, then B has happen. But if somebody is getting fatter, we want to know – why. We already know that they have to be taking in more calories than they expend, and now we need to find out why this is happening.

The analogy I use in my book Why We Get Fat is a restaurant. Say we want to know why a particular restaurant is crowded. When we want to know why someone is fat, we want to know why there is so much energy in their fat tissue. When we want to know why our restaurant is crowded, we want to know why it’s full of energy in the form of people.

Let’s say you and I are walking down the streets of New York and we see a crowded restaurant next to an empty one, and you ask me why is that restaurant crowded, and I respond – “it is crowded because it took in more people than it let out.” This is logically equivalent to saying that someone is fat because they took in more energy than they expended. You would still say to me: “well, of course it let in more people than it let out, but why? Why is it crowded?” Then I could flip the logic and say: “Look, if it takes in more people than it lets out, if more people go in than leave, it has to become crowded, right?” This is equivalent to saying that if more energy goes into your body, into you fat tissue, than leaves, it has to get fatter. But I still haven’t told you anything meaningful. The law of thermodynamics provides no meaningful information about the causes of obesity. It simply tells us how the universe works. It tells us nothing about why someone gets fat or lean.

(…)

End of Part 1. Read part 2

Interview by Mateusz Rolik and Tomasz Gabiś

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Z wykształcenia jestem anglistą (Uniwersytet Wrocławski), ukończyłem też stosunki międzynarodowe Unii Europejskiej (Loughborough University). W latach 2002-2003 byłem stypendystą w ramach programu Josepha Conrada (Chevening programme) ufundowanego przez brytyjskie Ministerstwo Spraw Zagranicznych. Interesuję się sprawami międzynarodowymi, historią, gospodarką oraz szeroko pojętą polityką nauki. Ciekawi mnie też geneza i historia obowiązujących paradygmatów medycznych oraz mechanizmy, dzięki którym dominują. Czytam, piszę i tłumaczę teksty na te temat. Mieszkam i działam we Wrocławiu.

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