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There are several layers to this and, frankly, there are some things we can’t fully explain – I’ll always acknowledge this.
Take a look again at the figure below, which shows you how many calories folks are consuming on each diet and, more importantly, where those calories come from. You’ll note that people on these diets, including the strictest low-fat high-carb diets, significantly reduce their total amount of carbohydrates (therefore reducing the amount of insulin they secrete). The reason, I believe, most of these diets have some efficacy – at least in the short-term – is that they all reduce sugar and highly refined carbohydrate intake, either explicitly or implicitly. Someone made a great point in response to my post on why fruits and vegetables are not actually necessary for good health. I know a lot of people who eat this way and, I’ve got to say, these folks do not eat a lot of sugar or a lot of highly refined carbohydrates. While I do plan to write an entire post on this topic of what one can and cannot conclude from an experiment, I do want to at least make the point here: The biggest single problem with nutrition “science” is that cause and effect are rarely linked correctly.
I am, to be clear, not implying this is the case for this trial, but I want you to understand why it’s important to read papers fully. This trial, The Lifestyle Heart Trial, prospectively randomized a group of not-so-healthy patients into two treatment groups: the control group and the experimental group (or what we’d call the “treatment” or “intervention” group).
First off, and perhaps most importantly from the standpoint of drawing conclusions, compliance was reported to be excellent and the differences between the groups were statistically significant on every metric, except total average caloric intake. Take a moment to look over the rest of the table (or just skip reading it since I’m going to keep talking about it anyway). Though not shown in this table, the experimental group also reported less chest pain severity (though chest pain frequency and duration were not statistically different).
Let’s take a leap of faith and hypothesize that the dietary intervention (rather than, say, the social support) had the greatest impact on the measured parameters in the subjects.  It’s certainly the most likely factor in my mind.  But what, exactly, can I conclude? People don’t like to be hungry, and if they are reducing their caloric intake by reducing fat intake, they seldom find themselves satiated. Semi-starvation reduces basal metabolic rate, so your body actually adjusts to the “new” norm and slows down its rate of mobilizing internal fat stores.
I argue that reduction of fat intake has nothing to do with it and that the reduction of total calories has a transient effect. It’s *really* tough to study this stuff properly, especially compared to studying things blood pressure lowering pills, which are complex in their own right, but MUCH easier to control in a study. A nutrition department of a university accepts funds from a company that makes confectionery.
Do you think the Academy’s supporters want to hear that if you eliminate their products you will no longer need to rely on the products provided by the biggest supporters of the Diabetic Association? Pretty much solely because of their report, Suzuki was forced to eventually withdraw the Samurai from production in the US although they later won the lawsuit that was filed as a result of the forged report by showing videos from the actual testing of the car conducted by CR. Ironically, the fact that CR had to admit it was faked somehow wasn’t plastered all over their magazines and the front pages of a bunch of newspapers.
At that point, everything they publish became suspect and may as well line a birdcage somewhere.
Peter, I have a coworker who has recently lost 80lbs over the course of a year on weight watchers.
Looking forward to your next post, and of course people's comments for the current one! I will discuss all of this in great detail, hopefully in the coming month, when I do a post on PUFA (polyunsaturated fatty acids). Anyway, it’s nice to discover someone who takes the Taubes viewpoint on things, and also takes the time to actually post online about it with some frequency, so thanks! Oh absolutely, I was mostly referring to the fact that most of the excess carbs we eat are converted to palmitic acid, which is a SFA. There was an (1) average protein, low fat group (65% CHO), (2) High protein, low fat group , (3) Average protein, high fat, and (4) high protein, high fat (35% CHO). Also known as the Primal diet, Caveman diet, Stone Age diet, or Hunter-gatherer diet, the Paleo diet includes fresh vegetables & roots, tart fruits, nuts, wild fish, free-range poultry, grass-fed meats, olive and coconut oils. Recently, the Paleo diet has surged in popularity, perhaps as a reaction to refined food and the modern diseases that go along with it. Fruits – especially tart fruits, such as lemons, limes, grapefruit, tart apples and berries. Paleo foods contain no refined or processed ingredients, no gluten, grains, dairy, or sugars.  It excludes agricultural ingredients and any foods that did not exist during Paleolithic times. Processed and refined foods, such as: Alcoholic beverages, Soft drinks, Artificial sweeteners, Potato chips, Bread, etc.
The Paleo Diet is highly beneficial as it eliminates many of the common allergens and problem foods in our diet. Fermented Mango Carrot RelishThis refreshing relish adds zingy flavor and vibrant color to any meal.
5-Minute Sprouted Buddha BowlBreakfast, lunch or dinner, this is a great way to use leftovers. Moderation is one thing that you should be looking for when you are considering which healthy eating plans are the best. If you have been considering various plans, then you have probably seen those that make claims that can tip you off to why they may not be so good. But real healthy eating plans let you eat just about anything you want, but only in moderation. Thanks very much, Bob, both for the kind comments and for sharing the other data with folks. That said, many of the successes (at least weight-wise, though hopefully by now you realize there is much more to health than just body composition) of popular diets can be explained by a few simple observations.


You can argue that those who are overweight probably consume an even greater amount of carbohydrates. Even the Ornish diet, which is the most restrictive diet with respect to fat and most liberal with respect to carbohydrates, still reduces carbohydrate intake by about 40% from what people were likely eating pre-diet.
No one on the Ornish Diet or Jenny Craig Diet is eating candy bars and potato chips, at least not if they are adhering to it. The point was, essentially, that telling people to eat 5-6 servings per day of fruits and vegetables can hopefully drive a beneficial substitution effect.
I have no intention of engaging in a battle with proponents of plant-based eating or no-saturated-fat diets. Stated another way, it’s one thing to observe an outcome, but it’s quite another to conclude the actual cause of that outcome. In other words, for every intended difference between the groups a difference existed, except that on average they ate the same number of calories (though obviously from very different sources), which was not intended to be different as both groups were permitted to eat ad libitum – meaning as much as they wanted. Ornish’s study?  I think the reduction in sugar and simple carbohydrates played the largest single role in the improvements experienced by the experimental group, but I can’t prove it from this study any more than one can prove a low-fat vegetarian diet is the “best” diet.  We can only conclude that it’s better than eating Twinkies and potato chips which, admittedly, is a good thing to know. And, the majority of the benefit folks receive comes from the reduction of sugars and highly refined carbohydrates.
Case in point…they recently reported that olive oil is not good for you because it does not contain omega 6.
3, has a good point about some plans (including WW) having the advantage of group support, which I think is a very major confounder.
It is wonderful to watch these people glow once they have found some sort of solution to their weight problem.
One of my favorite things to say to people who are scared of saturated fat is that even on an entirely plant based diet, (ala Ornish Diet), if they are restricting their caloric intake, their bodies will be running on the saturated (animal) fat that they have stored on themselves. For example the degree of unsaturated fatty acids in our membrane bilayer probably plays a role in our insulin sensitivity, just as one example. It excludes all processed and refined foods, sugars, sweet fruits, grains, beans, GMO foods, seed oils, and dairy products.  The modern Paleo diet is part of a whole food lifestyle with exercise, and it has many interpretations. We can look for inspiration to our ancestors, who were were physically strong, fit, and active. Loren Cordain, one of the world’s leading experts on the Paleolithic diet, and author of the best-selling book The Paleo Diet: Lose Weight and Get Healthy by Eating the Food You Were Designed to Eat. Basically Paleo foods contain 100% whole ingredients that you could find in the wild before the time of agriculture or domesticated animals.  Paleo foods are as close to their original state as possible. When we remove refined and inflammatory foods from our diet, we reduce the risk of chronic diseases such as diabetes, arthritis, obesity, heart disease, and cancer. These bite-size Paleo cookies are absolutely irresistible, with chocolate chips, spices, and a hint of orange zest.
It takes 5 minutes to prepare and 1-2 weeks to ferment, so that every bite feeds your healthy micro-biome. Thanks for figuring out how to make your own low carb coconut butter, thanks for figuring out that it’s possible to make great desserts with carb-free sweeteners and thanks for designing and enjoying so many desserts for us. To put it another way, if the plan has extreme restrictions or makes wild claims, then the chances are good that it’s unhealthy.
A common example is a diet that says you can eat as much of one food as you want, but then severely limits how much you can eat of other foods.
A diet that tells you that you can eat all of the fat you like is just as bad as any diet that tells you to eat as much sugar as you want. What happens is that a person may try a reasonable diet, but then they find they crave certain foods. In other words, they make allowances for the occasional treat, but they offset it in some way; they balance it out. But for the purpose of simplicity, let’s assume even the folks who go on these diets are consuming the national average of approximately 450 grams of carbohydrate per day (in compliance with governmental recommendations, as a percent of overall intake). If you tell someone who eats Twinkies, potato chips, and candy bars all day to eat more fruit (and they do), you’ve almost guaranteed an improvement in their health if they eat bananas and apples instead of the aforementioned junk food.
I’m reasonably confident that the proponents of these diets are good people who really want to help others and have nothing but the best intentions. Ornish was the principle investigator on a trial published in the journal The Lancet in 1990. In other words, there were not enough subjects in the study to determine a difference in these “hard” outcomes, so we can’t make a conclusion about such events, only the changes in “soft” outcomes.
Good science, bad interpretationGravity and insulin: the dynamic duoIf low carb eating is so effective, why are people still overweight? His clinical interests are nutrition, lipidology, endocrinology, and a few other cool things.
Eg, the criticism of the Ornish Lifestyle Heart Trial is excellent (and I LOVED the kitten-stroking quip), and really could and should have stood alone. After short diologue with her on the particulars of her daily intake I quickly realized her consumption of carbohydrate was significantly reduced and eliminated almost all fructose. They had to walk many miles to gather food, migrate to distant areas, and outrun wild animals. Cordain studied human diets during the Paleolithic period spanning 2.5 million years, gleaning evidence from microscopic scratches and wear patterns on teeth.
Most people on the Paleo Diet report that they lose weight and experience higher energy levels.
An additional 100,000 are diagnosed with Parkinson’s disease each year, with countless cases unreported.
Carrot, mango, and ginger combine well with many dishes, like Paleo Meatloaf and Paleo Chicken Parmesan!


The best diets will focus on moderation in the types of food you eat, as well as the portions it recommends.
Yes, you may be able to lose weight on a low-carb diet, but it could have negative impact on your health if all you’re eating is meat and eggs. Popularity, of course, was determined by a number of factors, including compliance with current government recommendations (sorry Atkins), number of people who have tried the diet, and reported success on the diets. That doesn’t mean bananas and apples are “good for you” – it just means they are less “bad for you.” Here’s the kicker, though. But that doesn’t mean we can or should overlook the errors being made in drawing their conclusions. I’m not discounting soft outcomes, only pointing out the distinction for folks not familiar with them.
They never factor in that the chicken was breaded or that when someone ate steak or fish they had a large amount of bread of potatoes along with it. Just two hundred years ago, Lewis and Clark crossed the Pacific Northwest wilderness on foot with a company of soldiers, walking as far as 50 to 75 miles per day. Cordain researched the evolution of human diet and the links between modern diets and disease. They let you eat all the protein and fat that you want, but try to get you to cut out as many carbohydrates as you can. Second, the idea of eating all the bacon (for example) you want sounds very appealing at first, but the craving for carbohydrates is more than most people can handle, and they end up binging on carbs…and weighing more than when they started. There’s nothing wrong with that, but then you start wishing you could eat a big, juicy cheeseburger and go off the diet. We’re led to believe that the reason such folks get leaner and more healthy is because they are eating more fruits or more vegetables or more grains or more [fill-in-the-blank], rather than because they eliminated the most egregious offenders from their diet. Ornish personally, and I can only assume that he is a profoundly caring physician who has dedicated his life to helping people live better lives. But as always, I STRONGLY encourage folks with access (or folks who are willing to purchase it) to read the paper in its entirety. Cordain, our ancestors were omnivores, eating a hunt-and-gather diet of fresh wild fruits, vegetables, and animals, depending upon the climate in which they lived. For people who don’t want to read the study completely, or who may not have much experience reading clinical papers, I want to devote some time to digging into this paper. The end conclusion is the whole thing must be bad and therefore needs to be reduced or outright expunged from the diet.
I recall hearing Gary talking about his discussion with a participant from the Biggest loser on Larry King and the rapant weight gain after the show. The major difference between their diet and our modern diet is the development of agriculture about ten thousand years ago, which brought us grains and legumes (beans). Neuropathy is a disease that affects an estimated 20 million Americans, and 60% of diabetics suffer from it. It’s hard to tell if this change was statistically significant by inspection, so you glance at the p-value which tells you it was not.
That is one big difference I’ve noticed between studies cited by writers who want to condemn the entire diet consumed by Americans vs those who look at it with a more in depth eye and realize that certain components are the problem not the whole diet across the board. More recent changes to grain cultivation and processing methods came around 120 years ago with the advent of refined flour. Both Parkinson’s and Neuropathy are neuro-degenerative diseases involving the brain and peripheral nervous system. Again, they are too restrictive for certain foods, and that’s your clue that they may not be good for you. You start off doing great, but even though you can eat your burgers, the new diet doesn’t let you eat pasta.
Why did the people in the China Study who ate more plants do better than those who ate more animals (assuming they did)?
Well, for starters, reading abstracts, hearing CNN headlines, or reading about studies in the NY Times doesn’t actually give you enough information to really understand if the results are applicable to you. In the last sixty years, industrial farming techniques, pesticides, preservatives, chemicals, and longer shelf lives have brought major changes to our tables. So, you go off this diet and look for one that lets you eat pasta…and you keep repeating this cycle over and over again. Parenthetically, if you actually want the answer to this question, beyond my peripheral address, below, please read Denise Minger’s categorically brilliant analysis of the study. Beyond this reason, and let me be uncharacteristically blunt, just because a study is published in a medical journal it does not imply that is worth the paper it is printed on. The Paleo Diet attempts to return to the fresh living foods that humans were genetically designed to eat.
Steve Rosenberg, once told me that a great number of published studies are never again cited (I forget the exact number, but it was staggering, over 50%). Translation: whatever they published was of such little value that no one ever made reference to it again.
The thing is, it is possible to eliminate wheat and still eat way too many carbs (can we say ice cream?). I’m now happily in ketosis, and the best part is, I know the WHY of weight loss now, how totally liberating and hope giving.



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