What Taubes Has Proven and What Remains to be Studied

Thinking over the Taubes book, Good Calories, Bad Calories, I've been struck by two things: What he has proven and what it is that he didn't discuss that is just as important as what he did.

What Taubes Proved

1. Taubes proves beyond a shadow of a doubt that the quality of nutritional research published in mainstream journals over the last 50 years is abysmal

2. Taubes proves beyond a shadow of a doubt that the Cult of Personality allowed politically powerful experts to impose their theories on the health community even when the research did not support their theories.

3. Taubes proves that the belief that eating saturated fat causes heart disease has never been well supported by the data and that cutting back on eating fat and replacing fats with carbohydrates has never been shown to reduce the incidence of heart disease.

4. Taubes proves very solidly that the belief that a low fat/high carb diet prevents cancer has never been supported by any well-conducted research and that, in fact, it is possible that lowering cholesterol may promote rather than prevent some cancers.

5. Taubes proves that most of what "everyone knows" about the causes and treatment of obesity is urban legend and that the findings of the better obesity researchers have been ignored because they do not support the dream that self-control and exercise are all it takes to solve a serious weight problem. In this he pretty much agrees with Gina Kolata's conclusions in her review of obesity research, Rethinking Thin and with what is documented in the even better review of Obesity Research, Fat: Fighting the Obesity Epidemic, by Robert Pool.

The better research seems to show that losing weight once it has packed on is extremely difficult verging on impossible and that Taubes is very right that we need to understand what disorders the metabolic controls that prevent weight gain, because once they are shot, very little helps.

6. Taubes points to some good research suggesting that the huge increase in fructose intake from sugar (sucrose) and high fructose corn syrup may contribute to weight gain and heart disease. Unfortunately, there isn't enough rock solid research to conclude this categorically.

7. Taubes points to some good research suggesting that high triglycerides caused by eating too much fructose may disturb the systems used to regulate metabolism and lead to the accumulation of unnecessary fat.

8. Bottom line: There is a great deal we just don't know about the relationship of diet and health and the best way to deal with obesity. That is because so much of the research done over the past 50 years is of very bad quality, and that this research then gets recycled in "meta studies" that are treated as if they could somehow surmount the serious flaws in data in the studies used to create the meta studies.

Real Progress Could Come From Admitting How Much We Don't Know

Taubes anoints a low carb diet as the solution, but those of us who have been deeply involved with low carb diets for many years and who have gone past the religious conversion stage of low carb dieting know that low carb diets do not solve most people's weight problems and that there are significant problems that keep people from sticking to them long term.

To blame long term low carb dieters for their failure to stick to the diet, blaming either weakness of will or the very suspect concept of "carb addiction" is to fall prey to the same blindered "I know it's true so I'll ignore anything that suggests there are problems" attitude that let the failed low fat diet rule for so long, even though it rarely worked.

My own experience over almost a decade of involvement with the online diet and health community is that Low Carb advocates are just as religious about their beliefs as are the low fat people. They, too, ignore data that does not fit the conclusions they'd like to believe are true.

Low carb diet advocates get angry and abusive if real issues are raised, for example, the slowing of the metabolism on a on long term low carb diet. I've been shunned in more than one online community for raising this issue, and the related issue of possible thyroid problems which is the main problem that got me to stop my very low carb diet after sticking to it for 3 years the first time and 2 the second time.

My take on it for now is that Low carb dieting is more effective than low fat dieting for many people with blood sugar abnormalities, but it does NOT solve all their problems, and maintaining weight loss over time can become very tough as is the case on ANY diet.

Eliminating sugar, fructose, and corn syrup, did not solve my weight problems years ago though I did it for 3 years. It is not a magic bullet. In fact, if 75 years of diet research has done anything, it should have been to teach us there are no magic bullets.

What Was Left Out May Be As Important As What Was Put In Taubes' Book

Some issues that Taubes did NOT discuss that haven't been researched enough and probably won't be, which have a huge impact on health and obesity are these:

1. The impact of the skyrocketing use of plastics to wrap and contain food over the past 25 years on obesity. We know that phthylates seem to have a negative impact on health, but very little research has been done on this huge issue which is one of the biggest changes that has occurred during the period in which obesity rates have leapt.

2. The impact of various chemical additives used in packaged foods and fast foods on obesity, cardiac health and cancer. The list of preservatives and mysterious sounding additives like "dough conditioner", "texturized protein,", "hydrolyzed plant protein", as well as the many other chemicals used in prepared foods and restaurant foods is much longer than it was 50 years ago.

Few of us know much about these chemicals. Even worse, we do not know anything about the chemicals that don't appear on the label but may be in our food since so many food additives are imported from China where they are polluted both intentionally and accidentally, especially with the industrial chemicals and pesticides in Chinese water.

3. The impact of pesticide residues in our foods on our health and the mechanisms our body uses to maintain weight homeostasis. Our foods are full of pesticide residues and there is for all practical purposes NO EPA oversight in this area anymore.

4. The impact of industrial chemicals which are found in our air and water and get into our foods as they grow.

5. The impact of hormones and hormone mimics in water supplies which have become significant enough to cause sexual changes in some fish and amphibians exposed to them.

6. The impact of changes in the amount of exposure to radiation including X-ray and microwave radiation.

7. The impact of adding soy and soy byproducts to almost all prepared foods, even things like bread. The dangers of soy are well described in The Whole Soy Story by Kaayla T. Daniel. This book is as well researched as Taubes' book and it should be MUST reading for anyone who cares about food and health. Daniel shows the same pattern of fatally flawed research was used to turn an industrial byproduct into a supposed "health food" and documents a long list of serious health problems caused by soy in our food.

If obesity is caused by gluttony and sloth rather than poisoning from plastic soda bottles, soy in our foods, pesticide residues, and industrial chemicals people can feel safe.

But if obesity and metabolic diseases are increasing at a frightening rate because of the emergence in the mid 20th century of plastics, pesticides, and toxic clouds of industrial chemicals which saturate the air and soil, no one is safe--though industry is not going to want to pay the price for making the changes needed to end the "epidemic" and industry has so corrupted our politicians that you won't ever see this issue getting any press. Which is one reason why any theory that blames people who are experiencing metabolic failure on those people's moral failings is going to continue being attractive to the people running industry and government

Meanwhile, the mainstream response to Taubes' book seems to be mostly petty debates about his interpretation of this or that cited study rather than an acknowledgment that his main finding is very true: most of our nutritional and health research has been sloppy crap and WE DON'T KNOW SQUAT ABOUT THE STUFF THAT MATTERS.

Taubes Good Calories Bad Calories - A Lost Opportunity?

I recently got a copy of the new Gary Taubes book, Good Calories Bad Calories, which a lot of us have been waiting for with high hopes.

Alas, this was not the book I had hoped it would be. Taubes has done a heroic job of studying and analyzing the history of 75 years worth of dietary research. No one with a shred of intellect can read this book without coming away convinced that the Politics of Personality caused nutritional research to go where the data never led it and to spend 40 years wandering in that high carb/low fat desert.

But the Taubes book is 600 pages of some of the densest writing I've encountered in a long life of reading popular science. How dense? Well, I managed to sprain a finger reading it, that was how heavy it was. And the prose is just as dense as the paper. Long convoluted sentences that just don't come up for air, and explanations of technical issues so impenetrable that they left me scratching my head trying to figure out what the heck was he talking about.

And I'm someone who reads a lot of big fat information dense books. For example, I just this week read, and loved Vaccine: The Controversial Story of Medicine's Greatest Lifesaver by Arthur Allen which covered as much controversial medical research history as Taubes does and was a similar length.

But where I was reading the Allen book with the kind of excitement with which I read a good detective story, because Allen made his line of argument very clear no matter how much data he introduced, with the Taubes book every fifty pages or so I found myself taking deep gulping breaths and skimming despite myself because Taubes had just plain buried me under the weight of his data.

And if I had that reaction--a person who reads at least a dozen health and nutrition research reports every week and often more--I cannot imagine what Joe Public would make of this book. Indeed, as someone who led a long and happy career in nonfiction publishing I am bewildered as to who exactly it was written for. To me it seemed as if the target reader was envisioned to be someone who reads Science at the breakfast table and then digs into Nature on the train to work. If there are enough of those folks to make this book a success, I'm all for it.

But my impression just looking at the title, cover and packaging is that Good Calories Bad Calories is being marketed to the diet book buyer. Who is going to get about 25 pages into this book and then fall dead from exhaustion.

That is probably why it is looking like this book is only getting discussed online by the hard core diet wonks who already know what it is that Taubes is trying to document: that the mainstream dietary advice that blames saturated fat for heart disease and recommends a high carb/low fat diet as "healthy" was never based on good scientific research and that carbs in general and fructose in particular are probably what is causing the so called "obesity epidemic."

But if the only people reading the book are those who already know what it has to teach us, it's a failure. Which is tragic. Because its core message is VERY important. Fat has never been proven to do any of the things "everyone knows" it does and high carb/high sugar diets are just plain killing people.

If I had a buck for everyone who told me they are eating a low fat diet to lower their cholesterol and prevent heart disease I'd be rich. Ditto all the doctors convinced that saturated fat is what causes heart disease. Reading this book could cure that. But I can't see those people reading this book.

So I came away wishing that there was some way that Taubes could come up with "Taubes Lite"--a 250 page book that would extract the "pearls for practice" buried in his data and pitch that book to the person trying to figure out what a "healthy diet" might be. Something that would help people with diabetes understand why the ADA insistence that they should eat all the sugar they want is dangerous, and get the media to understand that obesity is not caused by overeating. It is caused by eating foods that short circuit the metabolic systems our body uses to keep our weight in homeostasis, foods high in carbs and fructose.

But it ain't going to happen with this book, and that's a damn shame.

More Bad Science: Cereal for Breakfast

Your friends in the grain business have been busy promoting the latest study that supposedly shows that eating "whole grain breakfast cereal" prevents heart failure.

Whole Grains Do a Heart Good

As reported in U.S. News and World Report: "Compared to those who ate no whole-grain cereal, men who consumed 2 to 6 servings per week saw their risk of heart failure fall by 21 percent, while those who ate 7 or more servings per week reaped a 29 percent reduction in risk, the researchers reported in the Oct. 22 issue of the Archives of Internal Medicine."

What's wrong with this study?

Well, for starters, we know nothing else about the weight, diets, ethnic heritage, and lifestyle of these people who ate whole grain cereal for breakfast, but it is very likely that they ate those breakfasts because they have been touted as "healthy" and that eating the cereal rather than causing the outcome was a marker for a lifestyle high in exercise, weight control, ethnic background, and other behaviors likely to impact health.

Using the same logic, you might be able to prove that people who owned a specific brand of running shoe had a lower "risk" of heart failure. Did owning the running shoe cause the health outcome? No. If you buy that running shoe and wear it while watching TV you won't improve your health.

The other big problem here, as usual is that you are comparing people eating one high carb breakfast with others eating an even higher carb breakfast. So yes, I'm willing to believe that eating granola for breakfast might be healthier than eating Sugar Frosted Flakes, but I'd really like to see what happens when you compare people eating the grain breakfasts with those eating NO carbs at breakfast.

Most importantly, the study did not separate out people with Diabetes from those with normal glucose tolerance. We know for a fact that anyone with Type 2 diabetes who eats a grain cereal for breakfast is likely to see their highest blood sugar of the day after breakfast, because of the natural increase in insulin resistance we all experience in the morning. And we also know that cumulative exposure to high blood sugar leads to bad health outcomes. In addition, people with diabetes are more likely to experience heart attacks--not being measured here--rather than heart failure, which usually develops in people who survive heart attacks.

This raises an important point: The condition being studied was "heart failure"--a condition in which people suffer weakened heart muscles--rather than heart attack, and that the measurement being used was "risk of" which is very different from "incidence of".

The Risk statistic is used to amplify very slight differences between the incidence of a condition in large groups of people, and is almost always used to make a very small effect look more significant. If you reduce the number of people in a group of 100,000 who get a heart attack from 10 to 8 you've made a huge difference in risk but a very small difference in incidence. But if you are trying to promote a drug or product, citing risk rather than incidence makes your product look like it makes a huge difference when it doesn't.

These studies seem to be more of the same kind of "let's prove what we believe to be true by ignoring rigorous analysis of the data" research that Gary Taubes highlights so brilliantly in his book, Good Calories, Bad Calories.

By the way, the nutritionists in the article recommend that you eat your high carb whole grain cereal with high carb low fat skim milk and fruit. More proof, if you needed it, that religious beliefs can not be challenged by logically supported argument. Sadly, no matter how densely documented the truth might be (and Taubes documents it to the point where it exhausts even ME, which makes me wonder exactly who his target reader must be!) the belief in the value of the high carb/low fat diet will not go away no matter how much more rigorous research shows it to be a flop.

Meanwhile, if you have diabetes and are tempted to breakfast on granola with skim milk and bananas, by all means do so. Just be sure to measure your blood sugar at 1 hour and 2 hours after eating. If you can get normal blood sugar values at those times (under 140 at 1 hour, under 120 at 2 at a bare minimum--under 100 at 2 hours is better) keep eating like that. If you can't, consider switching to a low carb breakfast of ground flax, protein powder pancakes, eggs, or meat.

Vitamin D lowers Insulin Resistance?

UPDATE

Research published after this blog post was written finds that supplementing with Vitamin D, even in intravenous megadoses does NOT improve blood sugar or insulin resistance in any significant way. You can find citations to that research HERE.

Vitamin D may have some positive effects on heath, and I continue to take it, but it will not reverse any already existing autoimmune condition nor is it a diabetes cure. In fact, my own blood sugar stopped responding to Vitamin D within a week after I wrote this blog post.


If you found this page searching for help with lowering blood sugars, please check out this page: How To Get Your Blood Sugar Under Control. I hear every week from people who have used this technique to lower their blood sugars dramatically.


===
Original Post

At my recent visit to the endocrinologist, the doctor suggested I add 1000 I.U. of Vitamin D to my daily regimen because of some recent data suggesting that it helps the body eliminate cells that have developed melanoma.

I followed her advice and started taking a pill every day around 10:30 when I take my metformin. A few days later I started to experience dramatic lows around 3 PM. Lows have rarely been a problem for me, as my body usually mounts an aggressive counterregulatory response at the first hint my blood sugar is dropping. All of a sudden I was seeing blood sugars in the 60s, and they were not resolving with the usual 2-4 grams of glucose. At one point as I battled a low I ended up eating 25 grams of Halloween candy and still only found myself in the 80s ninety minutes later.

It took me a few days to connect the lows with the addition of Vitamin D to my daily regimen. When I did, I started to read up on the relationship of Vitamin D to diabetes. It turns out that the relationship is a strong one, not only for people with Type 2,as a recent metastudy discovered--people with Type 2 appear to have low blood levels of Vitamin D and there is some suggestion that the combination of Vitamin D and Calcium may delay the diagnosis of Type 2, but also for people with Type 1. A Finnish study found that children who received Vitamin D supplementation appear to have a lower rate of Type 1 than those who did not.

There is also some data suggesting that Vitamin D may also be protective against Multiple Sclerosis, a disease that has long been known to be more prevalent in northern latitudes, as well as the data connecting it with cancer prevention.

The large dose of Vitamin D I am now taking appears to increase my sensitivity to insulin even though I am already insulin sensitive. It potentiates a dose as low as 1 unit of insulin, making it several times more powerful than usual. When I have skipped my insulin for a couple meals to see what the Vitamin D it might do when I don't use insulin (while eating very low carb meals) I did not experience the dramatic drop, but I did end up very slowly drifting down into the high 70s a few hours after dinner, rather than ending up in the 90s or low 100s as I would have expected to do.

I have read that it takes many months to completely restore Vitamin D levels to normal, so I'm going to keep supplementing and see what happens,though I'm thinking I might look for a lower dose pill and split the dose to see if I can avoid the dramatic drop all at once, as they are quite disturbing and leave me feeling jittery and off center for hours afterwards.

If you have had any interesting experiences with Vitamin D let me hear about them. I don't know if my sensitivity to Vitamin D is another of the things that grow out of my own, oddball form of Genetic diabetes or something that might be common among people with diabetes in general

An Idiot with a Computer Proves Right -- Exubera is GONE.

Scott's Web Log just published the news that in an amazing triumph of common sense over marketing dollars, Pfizer is pulling Exubera off the market.

When Exubera launched, I was quoted in Business Week (complete with horrible photo) as a "typical patient." I said I would not use Exubera because it had some serious problems.

The journalist did not go into what those problems were, though I had spelled them out in some detail, but the main one was that Exubera was a bolus (mealtime) insulin that was supposed to be dosed by the patient's body weight, not by the carbohydrate content of the meal.

That's just plain nuts.

I'm extremely insulin sensitive and dosing Exubera by my body weight would have been likely to send me to the hospital with a severe hypo, as it would have resulted in my taking a dose several times higher than what I actually use. In addition, Exubera was supplied in packs, but a one pack dose was not 1/2 of a 2 pack dose. Titrate that!

Investors did not respond well to my words in Business Week and in the comments section of the Business Week articles I was labeled "an idiot with a computer." I've taken pride in that ever since, and I'm thrilled that the judgment of this idiot with a computer has been vindicated by the medical community who refused to prescribe Exubera despite billions of dollars of money spent on marketing it.

Now if only my warnings on Januvia could get a bit of attention in the media . . . As proud as I am of calling Exubera correctly, this idiot with a computer really doesn't want to be proven right on Januvia by the discovery years from now that it caused hundreds or thousands of unnecessary patient deaths.

BTW, I owe Pfizer this much, that had it not been for the Exubera flap I wouldn't have started this blog. The journalist who interviewed me found me on the diabetes newsgroup, alt.support.diabetes, but described me in print as "a blogger." I figured if I was going to be called a blogger, I better blog, so I did, which has turned out to be a very good decision.

Two Million Human Guinea Pigs

Merck announced recently that patients have filled two million prescriptions for its new diabetes drug Januvia.

Wall Street Journal "Diabetes Drug Wins New Uses

It also announced that new and potentially worrisome side effects have turned up, all relating to the immune system, including rashes and swelling and one potentially fatal condition, Stevens-Johnson syndrome, where the skin literally peels off the body.

Januvia was approved after only 2 years of testing in only a few thousand patients. In addition, as I have pointed out in previous blog entries, the antiquated drug approval system does not require that drug companies look at potential problems caused by novel ways in which a drug functions.

So a drug, like Januvia, that turns off the part of the immune system now known to kill cells that have become cancerous before they become tumors, is NOT tested to see if those kinds of cancers are promoted by the drug. The required drug approval cancer tests only look to see if the drug itself causes cancer in cells in test tubes or in certain animal models which may not develop kinds of cancers humans do.

I cannot say it enough: Januvia changes the way the Immune System works in ways that are not understood by science. It does that by inhibiting the action of an important enzyme/protease, DPP-4, which is used through out the body and brain.

There is no question that Januvia does what Merck claims it does, which is suppress DPP-4, the enzyme responsible for destroying GLP-1, so that GLP-1 levels rise and, in people with living beta cells, stimulate the beta cell to secrete insulin.

But what is not known is what else happens when you suppress an enzyme used in the brain, used to kill rogue cancer cells, particularly melanoma and prostate cancer cells, and for a host of other functions.

Many of these effects may take more than the two years Merck tested Januvia to become evident in the group of patients taking the drug. Because drug companies have every incentive to avoid looking closely at the health of study participants five years after they participate in a drug trial, these long term effects may go unnoticed--or ascribed to chance or other causes, as happened with Avandia.

In addition, because the initial studies were small, severe and even fatal side effects like the promotion of melanoma, might not turn up in these very small study populations. A severe side effect that impacts .01% of a study population and takes 3 years to become evident will not show up on a 2 year study. But with two million people taking the drug, that may translate into 200 people who die needlessly.

A "rare" side effect that shows up in 5% of people taking the drug in 5 years could kill 100,000 people.

Do you really want to take this kind of risk for a small decrease in blood sugar that you could achieve just by cutting out some of the carbohydrates in your diet?

Some people may think I am an extremist, but it's worth noting that I posted on my Main Diabetes Site. about the rashes developing with Januvia almost six months ago. I was the first person to write online about the potential impact of DPP-4 inhibition on the promotion of melanoma.

And just last month, 6 months after I stopped taking Januvia I had another highly suspicious skin growth removed which my doctor told me was well on its way to turning cancerous. He found it unusual for such a growth to appear so suddenly (I get regular skin checks because I am a melanoma survivor.) I did too, which is why I rushed to the skin doctor when I noticed it. It started as a small zit during the period I was taking Januvia.

I only hope that Januvia did not promote the growth of rogue melanoma cells within my body during the three months I foolishly tried it, because if it did, I'll find out only when they are close to killing me. That is how melanoma works, and why you are crazy to be taking a drug, like Januvia, that impacts the system the body uses to kill cancerous melanocytes.

Fructose Raises A1c?

Jackie Patti posted an interesting comment to my earlier post about my disappointingly high A1c.

It seems that Gary Taubes' new book discusses this and reveals that fructose causes more glycosylation of proteins than does glucose. However, when we test our blood sugar we don't look for fructose, we only measure glucose, a different sugar.

Hence a diet that is high in fructose may raise A1c, and with it the risk of heart disease and other organ damage, in a person whose blood glucose is very well controlled.

Most people think of fructose as "fruit sugar" as it does occur naturally in fruits and in vegetables like tomatoes and squash which are technically fruit.

But this is only half the story. Sucrose, common table sugar, is 1/2 glucose 1/2 fructose. Honey, which is used in many health foods is higher in fructose than in glucose. And of course high fructose corn syrup is added to most packaged foods including ones you would not expect to have it, things like soup.

It is hard to find nutritional information that distinguishes between the different types of sugars found in other foods, but some helpful web sites list foods to be avoided by people who have a medical condition in which they are not able to metabolize fructose. These sites list wheat as being on the list of foods to avoid, though not rice.

Here's a web site that has the complete breakdown of sugars for many foods, where available. http://www.nutritiondata.com/

So heightened Fructose consumption may explain the rise in my A1c. I have been eating a lot of fresh farm-grown tomatoes and more chocolaty/sugary stuff than is probably good for me, thanks to the extremely good control I've gotten with my insulin. This new information suggests that my higher than desired A1c might be a result of tilting sugar intake too much towards fructose.

If that is the case, much of the problem has already been solved by the turning of the seasons. No more fresh farm stand corn or tomatoes. Back to glucose for treating lows. I'd been using some sinfully yummy hard candies, and that may also have been causing the rise.

I've got the Taubes book on order and can't wait to read the whole thing. Though once I have I probably wont' be able to ever again eat anything I feel like eating without dismay.