Book Review: Good Calories, Bad Calories

When I first planned to write this review, I have to admit I took it too lightly.  I thought that it would be a simple matter of "liked this; didn't like that" and that would be it.  As it turns out, there's a lot more to consider.

About the author: 

First, let's get to the elephant in the room: the author.  Gary Taubes is a controversial name in nutrition.  Some go so far as to say "utterly discredited".  But why?  There are all kinds of flat-out crazy assertions in diet and nutrition books out there and they don't carry the kind of stigma that Mr. Taubes does.  It would seem that he fell victim to his own enthusiasm (Gary, I can sympathize).

Set the way-back machine to July 2002 and Gary Taubes wrote an 8,000 word editorial titled "What if it was all a big fat lie?" in the New York Times.  Clever play on words, as his assertion was that long-demonized dietary fat may not be at the heart of the obesity epidemic or the threat to heart health that it was made out to be.  The problem is, he cited some experts he interviewed about his premise, but "curtailed" their quotes in a way that supported his theme, but not their actual feelings on the matter.  The result was a thorough blasting that eclipsed the substance of his argument.

This book, published in 2007, appears to be his way of redeeming himself from the aftermath of "... Big Fat Lie."  It is a tome, nearly 700 pages, loaded with research, citations, and footnotes.  It's probably the single most complete compilation of the story of how our thinking has evolved surrounding nutrition over the last 100+ years.  This alone makes the book, in my opinion, essential to anyone studying nutrition and weight loss.  Taubes actually published a "Reader's Digest Version" of this work, titled "Why we Get Fat".  The shorter read promotes the same thesis, but in a much more condensed format.

About the book:

Taubes is unabashed in promoting his theory (one which I generally share) that refined carbohydrates in excess are a significant factor in today's obesity epidemic and seemingly spiraling growth of Type II Diabetes.  By contrast, he asserts how dietary fat has been wrongly accused of being the culprit.  On that score, this is a mixed bag for the inquisitive reader.  It's great that you know exactly what Taubes' point of view is, but it is far from a balanced presentation of the merits of both arguments.

But that's not what makes this book interesting or unique.  Regardless of whether you agree with Taubes or not, this book is a must-read. Read it because it is, in fact, a three-way cautionary tale.  Through his tireless pursuit of historical data and anecdotes to make his case, you see clearly how confirmation bias, cults of personality, and even a little class warfare have shaped the message and, therefore the attitudes of pretty much the entire Western World.  Moreover, he shows clearly the risks involved when public policy makers dispense sweeping medical advice (something we have come to accept and expect, thanks to groups like the American Heart Association and others), that ought to be left to physicians and their individual patients.

Finally - Taubes clearly exposes the danger of taking studies and their findings at face value, particularly when you don't understand the mechanics and controls behind the study.  In many ways, these scientific studies have taken the place of our own observations of reality, much the same way over-relying on a GPS seems to rob people of their ability to navigate on their own.  Think of this: it's a statistical fact that obesity is on the rise.  It's generally accepted across the board that 80-95% of "diets" fail to produce any meaningful weight loss.  Yet we are still devoted to the same methods that have been failing for the last 30-40 years. Definition of insanity, anyone?

Taubes shows how, too often, researchers have relied on data of convenience, rather than those data points that are most meaningful, to support their pre-existing assertion.  This is, in part, because a truly meaningful nutrition / weight loss trial is virtually impossible unless you govern every single aspect of their behavior and measure it meticulously and with precision.  Any variation in intake or expenditure can cast the results in complete doubt.  It is also in part due to the duration required to really determine whether an approach "worked," "initially worked," "looked like it worked, but turned out later not to," or just plain "didn't work".  Trials like that take years.  And people tend to prefer not to have every single meal and activity governed for such a duration.  

And what is "worked?" exactly?  Most of the dietary trials were trying to assess whether manipulating a single variable, fat, for instance, would measurably improve a person's incidence of heart disease and, ultimately, death from it.  This sort of trial is the methodology employed by the field of epidemiology to prevent the spread of infectious disease.  The trials' ultimate finding is not about whether a treatment is 100% effective or 100% ineffective, but rather how many people need to be treated in order for one person to be positively affected.  Think: flu shots here.  We know it isn't going to work for everybody, and the majority aren't at risk to begin with, but the "relative harm" is considered negligible for the "relative benefit."  So - flu shots, issued as broadly as possible, are considered an effective epidemiological practice.  Since no one at the time was looking at Diabetes, but instead at heart disease, the "relative harm" of trading benign carbohydrates in favor of fat seemed like an altogether simple recommendation.

In these recommendations, obesity was always assumed to be the proximate cause of heart disease and not a related outcome from some other condition, so the results, time and again read: "X makes you fat, which makes you susceptible to heart disease."  And, by and large, it was also accepted that the proximate cause of obesity had to be gluttony.

It was a revelation to me, personally, to realize just how disconnected fields of expertise in health and nutrition have become.  Impacts to inter-related systems, upstream and down, are not necessarily considered if those systems reside outside the specialist's purview.  

About the premise:

As I said, Taubes' argument is that refined carbohydrates, consumed in excess, are both uniquely fattening and uniquely harmful to the human body.  He presents a series of arguments, both against the "fat hypothesis" and for the "carbohydrate hypothesis".  

The most compelling support for his position is, in fact, the oldest.  He spends a good amount of time walking us through how missionary doctors in very remote populations never had to deal with "western diseases" such as diabetes and cancer. How it was only after introducing highly refined carbohydrates into their newly-westernized diets (they had to be highly refined in order to survive the long transport), that these populations began to exhibit these conditions.  He provides numerous examples of this pattern across the world.  Since we, in the western world, only recall dealing with Diabetes and heart disease in terms of increasing or reducing their occurrence, we've never had the luxury of considering the posibility of their absence.  These missionary doctors had the unique opportunity to examine their own "patient zero" at the time the conditions manifested, to and directly observe the changes in environment and lifestyle that may have contributed to or caused them.

And here is where Taubes' assertions differ so drastically from the conventional wisdom of energy balance and the First Law of Thermodynamics.  Taubes treats obesity as an outcome to the metabolic damage caused by constantly elevated insulin levels.  He explains (often in terms you'll have to read through more than once) the biochemical processes from system to system, from intake to storage and consumption, and does something nobody else does: connect the dots.  The energy balance group doesn't have to connect anything, because at the end of the day, all they're looking for is a zero sum, and the rest is fat.  But hormone imbalances, the impact to the liver and pancreas, the mechanics of fat metabolism itself, are all laid bare in the pages of "Good Calories, Bad Calories".

Despite his passion for his position, Taubes does take care to repeatedly state that his evidence is equivocal.  That we still have to infer much of what leads him to the carbohydrate conclusion.  Again,  whether you agree with him or not, one has to admire his commitment: Taubes has long been an active practitioner of the Atkins Method, and he is currently partnered with Dr. Peter Attia, a ketogenic diet proponent and practitioner, in an organization called the Nutritional Science Initiative (NuSI.org).  NuSI is advocating for the best possible nutritional trials and studies to finally deliver some definitive answers to the full picture of human nutrition and how our eating affects the quality and longevity of our lives.

The Bottom Line:

Good Calories, Bad Calories is absolutely worth the read.  For me, it appeals as a student of public policy and history, as an analyst, and as someone who has sought to further my understanding of nutrition, health, and the function of the human body.  Whether your interest is in only one, two, or all of these areas, you will find it enlightening and engaging - if you start it off with an open, but skeptical, mind.  And, with it, you'll have a virtual catalog of studies, pro and con, to further your own understanding.