Taubes - Chapter 19 - Following Through

Taubes starts out

“This is not a diet book, because it’s not a diet we’re discussing.

Once you accept the fact that carbohydrates –not overeating
or a sedentary life – will make you fat,
then the idea of “going on a diet” to lose weight,..
no longer holds any real meaning.

Now the only subjects worth discussing are
how to best avoid the carbohydrates responsible
--the refined grains, the starches, and the sugars –
and what else we might do to maximize
the benefits to our health.”

He says that there have been many low-carbohydrate diet books
published, and that

“these books are worth reading for the guidance they offer.
But the diets themselves, no matter how they vary in the details
or the author’s understanding of the underlying science,
fundamentally work because they restrict fattening carbohydrates.”

Taubes tells us that he put a “pared-down” version of a
low-carbohydrate diet in the Appendix, and then provides
some details about that particular University hospital clinic
and the doctor in charge.
He says the guidelines in his Appendix are 

“more detailed but otherwise little different
from the guidance offered by hospitals to their
overweight and obese patients in the 1940s and 1950s:
Eat as much as you like of meat, fish, fowl, eggs, and leafy green vegetables.
Avoid starches, grains, and sugars, and anything made from them
(including bread, sweets, juices, sodas), and learn for yourself
whether and how much fruit and non-starchy vegetables
(such as peas, artichokes, and cucumbers) your body can tolerate.”

For those familiar with the concepts, and who don’t need details,
Taubes recommends that they use the simple diet from the
1951 endocrinology textbook that he provided in Chapter 16.

Taubes says that we can’t improve on the list of foods to eat,
foods to avoid, and foods to eat in moderation without guessing.
This is because there haven’t been any long-term clinical trials
that would tell us more about what makes up the healthiest variation
of a low-carbohydrate diet.
The extent of reliable knowledge so far is 

“that carbohydrate-restricted, eat-as-much-as-you-like diets work,
and that they have beneficial effects on Metabolic Syndrome,
and thus our risk of heart disease.”

Instead of clinical trials, all we have is the science itself,
and the clinical experience of doctors

“who have had enough faith in their own observations
and their understanding of the science
to wean their overweight, obese, and diabetic patients
off fattening carbohydrates, despite having to go
against established convention to do so.”

Next Taubes discusses the issue of whether
we should eat fattening carbohydrates in moderation,
or renounce them entirely.

Part I of Moderation or Renounce Them Entirely?  Taubes begins

“The fewer carbohydrates we consume, the leaner we will be.
This is clear.
But there’s no guarantee that the leanest we can be will ever be as
lean as we’d like. This is a reality to be faced.

There are genetic variations in fatness and leanness
that are independent of diet. Multiple hormones and enzymes
affect our fat accumulation, and insulin happens to be the one hormone
that we can consciously control through our dietary choices.

Minimizing the carbohydrates we consume
and eliminating the sugars will lower our insulin levels
as low as is safe, but it won’t necessarily undo the effects
of the other hormones…and it might not ultimately
reverse all the damage done by a lifetime of eating
carbohydrate- and sugar-rich foods.”

Taubes says there is no “one-size-fits-all prescription” for the amount
of carbohydrates we can eat to lose fat or stay thin.

“For some,…(it) might be a matter of merely avoiding
sugars and eating the other carbohydrates in the diet,
even the fattening ones, in moderation: pasta dinners once a week,
say, instead of every other day.

For others, moderation in carbohydrate consumption
might not be sufficient, and far stricter adherence is necessary.

And for some, weight will be lost only on a diet of virtually
zero carbohydrates, and even this may not be sufficient
to eliminate all our accumulated fat, or even most of it.”

He continues

“Whichever group you fall into, though, if you’re not actively
losing fat and yet want to be leaner still, the only viable option…
is to eat still fewer carbohydrates, indentify and avoid other foods
that might stimulate significant insulin secretion…
and have more patience.”

Taubes talks about the findings of doctors who have treated
patients with low-carbohydrate diets for a decade or longer
and published about their experiences.
Kemp (1956) and Lutz (1957) reported 

“that a small proportion of their obese patients failed to lose
any significant fat even though they faithfully avoided
fattening carbohydrates (or at least said they did).

Women failed more often than men, and older patients
more often than younger ones. The more obese the patients,
and the longer they had been obese, the more likely they were
to remain obese.

Lutz said this doesn’t mean “that the carbohydrates were not
responsible for the disorder (obesity) in the first place.
It is quite simply and sadly, that a point of no return has been reached.”

Taubes says we don’t know whether those people could have lost weight
if they had restricted carbohydrates more, or had more patience, or both.

“The conventional logic of diets is that people go on them
expecting relatively quick returns in weight loss.

…the dieters are not trying to reregulate their fat tissue;
they’re only reducing the calories they consume.”

expecting their fat cells to respond by giving up stored fat.
If they don’t see weight-loss in a month or so,
they decide that the diet has failed and go on to the next one,
or resign themselves to being fat.
He says

“But the fact is that we are trying to counteract
a regulatory disorder of fat metabolism,
one that may have been years or decades in the making.
Reversing the process might take more than a few months,
or even a few years as well.”

Taubes points out that usually one thinks of carbohydrate-restriction
as eating animals and animal products, and says this is because,
if you eat mostly plants, you’re getting most of your calories from carbohydrates.
He says 

“This doesn’t mean that you can’t become lean or remain lean
by giving up sugars, flour, and starchy vegetables,
and living exclusively on leafy green vegetables, whole grains,
and pulses (beans). But it is unlikely to work for many of us,
if not most.”

If you are eating mainly plants, the total amount of carbohydrates
you are consuming will still make the glycemic load of your diet high
which may be enough to keep or make you fat.
Eating fewer carbohydrates by taking smaller portions will keep you hungry.

Part II of Moderation or Renounce Them Entirely?
Taubes says that doctors who promote carbohydrate restriction
typically take one of three approaches to this way of eating.

One Option
is to establish an ideal amount of carbohydrates that you eat
each day. A set amount like 72 grams or 300 grams, or whatever.
This is to minimize side effects  while the body transitions from
burning primarily carbohydrates to burning fat.

“This approach also assumes that it’s easer to eat some fattening
carbohydrates than it is to eliminate them entirely.”

Taubes says 

“This may work for some of us,
but not for all.”

A Second Option
is to aim for minimal carbohydrates from the beginning,
and just deal with any side effects you might have
while your body adjusts to a nearly carbohydrate-free diet.

A Third Option

“is a compromise that was pioneered by Robert Atkins forty years ago.
It was based on …(the fact that)…you enter into a weight-loss diet
with the singular purpose of becoming as lean as you safely can be,
so your gustatory desires should be put on hold temporarily
until that goal is achieved.

…when the excess fat has been lost, you can decide if you feel the need
to incorporate back into your diet some of the foods you’ve been avoiding.“

Atkins called this

“an induction phase, which allows effectively no carbohydrates,
(fewer than twenty grams a day).”

which speeds up weight-loss and encourages people to stick with the diet.
After your body is burning fat stores and losing weight,
a small amount of carbohydrates can be added back into the diet.
But then, if you stop losing fat, it means your body can’t tolerate
those carbohydrates, and you can’t eat them.

The same approach is used once an ideal weight is reached.
Add back carbohydrates you miss and see how your body responds.
This lets you find out what your body can tolerate
and how much dietary fat you are willing to trade
for the carbohydrates you miss.

Taubes says

“this approach makes sense. But one other factor has to be taken
into account: allowing some carbohydrates into the diet
for some individuals may be like allowing ex-smokers a few cigarettes,
or reformed alcoholics the occasional drink.

Some may be able to deal with it;
some may find it is a slippery slope.
The occasional dessert on special occasions
may become a weekly luxury,
then biweekly, and finally nightly,

and suddenly you’ve decided that carbohydrate restriction
failed as a weight-loss regimen because you failed to stick with it
and regained the weight.”

A common argument is that all diets fail
because people just don’t stay on diets.
Taubes says there is a difference between
semi-starvation diets and carbohydrate restriction.

Semi-starvation diets will fail because:

1. Your body adjusts to the caloric deficit by expending less energy;
2. You get hungry and stay hungry,
3. You get depressed, irritated, and chronically tired
.......because of those first two.

However, Taubes continues, in carbohydrate restriction

“you don’t have to restrict consciously how much you eat;
indeed you shouldn’t try.
You can eat all you want of protein and fat,
so you don’t get hungry and you don’t expend less energy.
You might even expend more.

The biggest challenge is the craving for carbohydrates.
The hunger that accompanies our attempts to eat fewer
calories is an unavoidable physiological phenomenon;
the craving for carbohydrates is more like an addiction.

It is a consequence, at least in part, of insulin resistance
and the chronically elevated levels of insulin that go with it,
and thus caused by the carbohydrates in the first place.”

Taubes says that sugars are a special case, 
 as sugar appears to be addictive in the brain.

“Whether the addiction is in the brain or the body, or both,
the idea that sugar and other easily digestible carbohydrates
are addictive also implies that the addiction can be overcome
if you make the effort and have sufficient patience.
This is not the case with hunger itself.”

According to a 1975 study by Sidbury

“After a year to 18 months the craving for sweets is lost.”

Taubes cautions

“If you continue to eat some of the fattening carbohydrates
or allow yourself some sugar (or even, perhaps, artificial sweeteners),
though, you may always have the cravings.

You may always have…”intrusive thoughts of food”.
Anecdotal evidence suggests this is the case,
and that’s all we have to go on.”

Next, Taubes covers what it means to eat as much as we would like.
He says

“We’ve been told for so long, and believed for so long,
that a fundamental requirement for weight loss is that we eat
less than we’d like, and for weight maintenance that we eat
in moderation, that it’s natural to assume the same is true
when we restrict the carbohydrates we eat.

But protein and fat don’t make us fat
--only the carbohydrates do—
so there is no reason to curtail them in any way.”

People who restrict carbohydrates often eat LESS than they normally do.
This is because their fat cells are working properly, and their
appetite adjusts accordingly. Also their energy expenditure increases.

“By avoiding the fattening carbohydrates,
you remove the force that diverts calories into your fat cells.
Your body should then find its own balance
between energy consumed (appetite and hunger)
and energy expended (physical activity and metabolic rate).
This process could take time,
but it should happen without conscious thought.”

Taubes says that trying to rein in your appetite consciously,
could cause you to hold onto fat that you might otherwise burn,
and that conscious self-restraint might   prompt an urge to binge.
He states that the same argument applies to exercise. 

“There are very good reasons to be physically active,
but weight loss..does not appear to be one of them.
Exercise will make you hungry, and it’s likely to reduce
your energy expenditure during times when you’re not exercising.

The goal is to avoid both of those responses.
Trying to drive weight loss by increasing energy expenditure
may be not only futile, but also actively counterproductive.”

Taubes says the reason you are sedentary   when you are fat is

“because of the partitioning of fuel into your fat tissue
that you could be burning for energy…
You literally lack the energy to exercise, and so the impulse to do it.”

Taubes continues

“The goal is to remove the cause of your excess adiposity
--the fattening carbohydrates – and let your body find its own
natural equilibrium between energy expenditure and consumption.”

Should a carbohydrate restricted diet be high in fat, or high in protein?
Taubes states

“there’s no compelling reason to think that fat, or saturated fat,
is harmful, whereas there’s good reason to question the benefits
of diets that abnormally elevate the protein content.
The short-term symptoms of ..high-protein, low-fat, low-carbohydrate diets
…are weakness, nausea, and diarrhea. These symptoms will disappear
when the protein content is reduced to a more moderate 20% to 25%
of calories and fat content is increased to compensate.”

Whether or not a diet that has 25% protein is healthier than one with 35%
protein is an open question. Taubes says

“If you find yourself satisfied eating skinless chicken breasts,
lean cuts of meat and fish, and egg-white omelets, so be it.
But eating the fat of the meat as well as the lean, the yolk as well as the white,
foods cooked with butter and lard may be the better prescription
for sustainability, and it may be for health as well.”

Taubes ends the chapter by talking about Side Effects and Doctors.

“When you replace the carbohydrates you eat with fat,
you’re creating a radical shift in the fuel that your cells will burn for energy.
They go from running primarily on carbohydrates (glucose) to
running on fat –both your body fat and the fat in your diet.
This shift, though, can come with side effects.”

Side effects can include weakness, fatigue, nausea, dehydration,
diarrhea, constipation, hypotension. Authorities in the 1970s said
these potential side effects was why the diets couldn’t be used safely.
They confused 

“short-term effects of what can be thought of as carbohydrate withdrawal
with the long-term benefits of overcoming that withdrawal and living
a longer, leaner, and healthier life.”

Taubes continues

“Carbohydrate withdrawal is often interpreted as a ‘need for carbohydrate’
…It’s like telling smokers who are trying to quit that their withdrawal
symptoms are caused by a ‘need for cigarettes’ and then suggesting
they go back to smoking to solve the problem.”

Next Taubes goes into detail about the symptoms of side effects,
and what happens in the body that causes these symptoms.
He says drinking a couple of cups of chicken or beef broth daily
will help avoid electrolyte imbalances.
Taubes says it is important to have the guidance of a knowledgeable
doctor when deciding to avoid fattening carbohydrates, but that
unfortunately, they are hard to find.

“those doctors who do understand the reality of weight regulation
often hesitate to prescribe carbohydrate restriction to their patients
--even if this is how they maintain their own weight.”

This is because doctors who go against established medical convention
have a higher risk of being sued for malpractice. 
Taubes ends the book by saying that we need doctors, public health officials,
and obesity researchers to

“open their minds to these ideas, and more important,
to the hard science that has too often been ignored.”

Taubes wraps up this book
by stating his opinions and conclusions clearly.
He shares his own thoughts,
without trying to get me to purchase something else.
I really like this.

He provides direction for those who are looking for it,
by making a typical low-carb diet available,
and advises us that this is an individual matter,
and different diet variations work for different people.
For me, he puts Reality back into that modern cliché, “Lifestyle”. 
    I see the core of his advice as”:
“You have the body you have. Live with your condition.
If you choose to restrict fattening carbohydrates forever,
in the very individual way that you require,
your body will begin to regulate itself properly,
reach its potential for leanness, and maintain there.”
I am left with the option to choose whether or not to follow that advice.
 I have been involved with “semi-starvation” diets for my entire life,
and have been now been successful at doing this for a bit more
than six consecutive years. I am now a reduced obese person,
maintaining a normal size body.

However, I do experience the normal side-effects
of lengthy “semi-starvation”…
specifically, Hunger, Cravings, and Obsession with food.
None of the behavioral techniques or Habits I’ve learned
have been able to resolve that issue for me. 
  Probably because it is a physical problem, not a mental one.

I’ve come to accept this condition
and continue to learn how to live with it,
while remaining open to the possibility
that there might be a better option. 
  Perhaps this is it.

Despite Taubes’ intelligent and informed presentation,
and even though I now believe most of what he says,
I can not bring myself to believe that calories don’t matter.
However, I don’t have to believe every particle of Taubes’ conclusions
to bring myself to try out his advice.

In my current Experiment-of-One with low-carb eating
I am choosing to combine restricting carbs with restricting calories.
If I achieve success with this, I plan to experiment with increasing
my fat and protein while continuing to track my calories.
 If I achieve success with this, I plan to experiment with lessening
the level of my carb restriction.
Success at all these things would mean I’ve found a
workable long-term way-of-eating to maintain my normal size body.

My doubts about the sustainability of low-carb for me have not vanished, 
 but Taubes’ writings have extinguished any fears about low-carb,
and given me motivation to experiment with the concept.

Finally,
In preparing this Summary of Taubes book,
Why We Get Fat and What To Do About It
I did my best to do relate an overview of Taubes Concepts.

 But no summary or review can do justice to Taubes writings
or be a substitute for actually reading his book.
If you find these concepts interesting,
buy and read the book. It is Everywhere.
At bookstores, on Amazon..including Kindle.
on Google books…just everywhere.
The knowledge you will gain is worth far more
than the small amount you will pay for the privilege.

If, after reading this entire book, you have further questions
about the underlying history and research,
buy a copy of his previous book, Good Calories Bad Calories
and slough through that dense and highly annotated tome.
I’ve already done that about 5 times, 
 and there’s still more there for me to learn.