Tuesday, August 16, 2011

Against Dietary Dogmatism

by Chris Masterjohn

According to the Online Etymology Dictionary, the word dogma comes from the Greek dogmatos, literally meaning "that which one thinks is true."  This dictionary further states that it derives from dokein, meaning "to seem good" or "to think," a root which also gave rise to the English word decent.

Basil the Great, a fourth-century bishop of Caesarea (modern-day Turkey) who is widely venerated as a saint by liturgical Christians and who some historians controversially credit with inventing the hospital, wrote a treatise toward the end of that century entitled On the Holy Spirit.  Therein, he defined dogma as that which is "observed in silence," and stated that the Church had such dogmas because the early fathers had "learned their lesson well" that "reverence for the mysteries is best encouraged by silence."  He contrasted this word with kerygma, which he defined as those things that are "proclaimed to the world."  

Nevertheless, Wikipedia, that veritable fountain of etymological wisdom, tells us that a dogma is "the established belief or doctrine held by a religion, or by extension by some other group or organization. It is authoritative and not to be disputed, doubted, or diverged from, by the practitioners or believers."  The article notes further that "the term 'dogmatic' can be used disparagingly to refer to any belief that is held stubbornly, including political and scientific beliefs."

I would like to state at the outset that I have no problem with people who ponder the hidden mysteries of their diet by observing them in silence.

Likewise, I think it is fine to think about diet, or for dietary things to seem good.  What really becomes a problem, however, is when one adopts the rigidity, inflexibility, and stubbornness that characterizes the modern concept of dogmatism.  

Three Types of Dietary Dogmatism

When Hans Keer of Cut the Carb said "goodbye" to low-carb, Dr. Richard Feinman left him a great piece of advice in the comments:
You did what low-carb people have been recommending. Find out what works.
Nevertheless, not everyone takes this approach.  For every vegetarian who starts eating meat, there are at least three others who have a list of things the first person did wrong that stopped the diet from working the way it was supposed to.  For every high-carber who cuts the carbs and subsequently finds their health down in the dumps, there are plenty of successful low-carbers ready to harangue them about how they didn't wait long enough to get fat-adapted.  For everyone who stops drinking milk, there is a line of raw milk drinkers behind them waiting to point out why their milk wasn't raw enough, wasn't grass-fed enough, or wasn't fermented long enough.

Humans are creatures of bias, and we can all be tempted to take this approach.  We've probably all done something like this before at one point or another in our lives if we feel strongly about the importance of diet in health.  This is something I believe we should try to resist.  If we don't, we fall into the same category as the people who insist that the reason attempts to institute prescriptive forms of Marxism have invariably failed is because these forms of Marxism have never been instituted "correctly."  We become so wedded to an idea that we either ignore the contrary evidence, or take the even easier approach and never bother to look for it.

I think there are three basic types of negative dietary dogmatism:
  • Subscribing to a dietary theory based on insufficient evidence, without realizing that in fact virtually all dietary theories have insufficient evidence to be maintained inflexibly.
  • Generalizing from our own experience to that of everyone else, or vice versa, not realizing that there is enormous variation in individual responses to diet.
  • Generalizing from our own transient experience to our own selves with a sense of permanence, not realizing that our dietary needs may change over time.
All of these pathological modes of thought can be cured with a little humility.  If we just attempt to do a little more listening than talking, a little more reading than writing, and a little more learning than teaching, we will do a great service to ourselves and to the thousands of people out there looking for help.
 
Subscribing to a Dietary Theory Based on Insufficient Evidence 

Mat Lalonde gave a great presentation at AHS about the impropriety of jumping to conclusions about diet based on evolutionary or ancestral principles without thoroughly investigating them with science:


"An Organic Chemist's Perspective on Paleo" by Mathieu Lalonde, PhD from Ancestry on Vimeo.

Dr. Lalonde argued that observations of ancestral health can only be used to generate hypotheses, not to confirm them.  I essentially agree, although as I pointed out in my AHS reflections, I think we also need to use ancestral health observations as a fall-back framework for interpreting how we should act in the face of scientific uncertainty.

But if we use these observations as a framework for interpreting uncertainty, just how dogmatically can we use them?  Just how certain can we be about the way we use them?

As the atheist philosopher Sam Harris once said, "as advocates of reason, we know that mystery is going to be with us for quite some time.  In fact there are good reasons to believe that mystery may be ineradicable from our circumstance."

This will always be as true of the field of human health as it is of any other field.  In all likelihood, most of what is true in the universe is either unknowable, untestable, or both; most of what is knowable and testable is likely untested; and most of what is tested retains either some controversy about the basic facts or at least some uncertainty in its application to life outside the laboratory.  I don't mean to diminish or ignore the many remarkable accomplishments of modern science — we can see them all around us — but we will never have justification for being know-it-alls.

We can try eating like an Inuit or like a Kitavan, but if our aim isn't to do what Dr. Feinman says and "find out what works," we may find ourselves in trouble.

Generalizing to Everyone Else Ignoring Variation

People exhibit remarkable variability in their response to diet, or at least in how they report these responses.  

Take Katelyn Giovino.  She posts a lot on my Facebook page about her positive experiences with zero-carb dieting, and more recently with very low-carb dieting, and judging by her pictures it seems to be going well for her.  Or consider a 39-year-old man named Erik who wrote to me the following:
I enjoy reading your in-depth articles on nutrition. I have been on a very low carb diet (20 Grams or less) since 2008 and I have never felt better.
I also hear from a lot of people who have problems with low-carb diets.  Consider this woman's experience:
I too have tried many diets to find perfect health and an anxiety-free
life. I have been following a paleo type diet for two weeks and my anxiety
has gone through the roof...very low carbs. Today I finally broke down and
had some soaked oatmeal with almond milk and butter. How long did it take
you to feel better? I am so tired I can barely walk let alone work out,
which I live to do. Any insight would be helpful.
Or consider this woman's experience:
I wonder why I am overweight with the way that I eat.  I try to maintain a diet of less than 80 grams of carbs each day, and even followed a SPC diet for 3 months and lost no weight.  If I go below 80 grams a day with carbs, I begin to shake...so much so that I can barely turn the pages of a book.  My blood sugar levels are running in the low 90s fasting, with an HbA1C of 5.9.  Years ago, I followed a fairly low fat diet with higher carbs and lost 18 pounds, yet my reasoning tells me this can't be healthy!  I had a lot more acid reflux on that diet as compared to very little on a lower carb diet.  . . . Years ago I went on the Schwarzbein diet of 60 grams of carbs a day.  I gained weight and was shaking all the time! How is this possible on such a low level of carbs?  I do not crave carbohydrates.  I don't crave bread or candy or rice, yet I can't seem to go so low in carbs without terrible side effects:  shaking, despondent sinking feeling, unable to move or exercise at levels very low - 20 to 40 grams or so.  What is wrong with me? I hope you can lay this mystery to rest!  Thank you so much.
If we see other people thrive on low-carb we might ask "what's wrong with me?"  Or if we thrive on a particular diet and see someone else who doesn't, we might ask "what's wrong with you?"  We should instead be asking what's wrong with the diet, or what's wrong with the diet's interaction with the particular person.

Some people just need someone they respect to validate their concerns and make them feel like it's ok to trust their own bodies and learn from their own experience.

A False Sense of Permanence

In the third type of dietary dogmatism, when we have a success, we may feel that we've found all the answers for at least ourselves, but this may be a false sense of security.  

I have found that over the years since I've retreated from vegetarianism, I have increased my ability to eat a more plant-based diet for periods of time.  I also find that if I eat a diet very low in muscle meats and rich in organ meats for a few months, I can go two months on a practically vegan diet, with maybe some oysters and clams here and there, and feel terrific.  How we feel right now is not just influenced by what we ate today, but how we ate the last week, three months ago, six months ago, three years ago, and so on.  As a result, what was true of my ability to eat one type of diet for a period of time six years ago is not true of my ability to eat the same type of diet for a period of time today.

Likewise, what is optimal for us might change over time.  We might spend a period of time correcting past deficiencies and imbalances, but perhaps a time will come when we are replete and it is time to tweak our diet again.

Finally, we may have found only part of the answer. If we lost 100 pounds with one diet, but we have 100 pounds more to lose that just won't come off, we're not done searching.  If we improved our anxiety but now our hair is falling out, we're not done searching.  A time may come when we choose to re-evaluate our past successes and consider whether the paradigm we used to interpret them should be modified.  Our success may have been real, but our interpretation of it may not have been.

Thus, even our own success can trap us into harmful dogmatism if we don't keep an open mind.
 
The Chinese philosopher Lao-Tzu taught that the weakest thing in heaven and earth conquers the strongest.  Substances that are inflexible break apart much more easily than those that bend.  If we learn to bend a little, we will find ourselves winning our battles much more often.  Lao-Tzu was a smart guy.

(See also my conversation with Anonymous). 

Read more about the author, Chris Masterjohn, PhD, here.

102 comments:

  1. "If we don't, we fall into the same category as the people who insist that the reason Marxism has failed wherever it has been erected is because it has never been tried the way Marx intended."

    Very true.

    Also true of market fundamentalists who argue that any real world examples of market failure are not in fact market failures because holy economic principles as prescribed by Friedman, von Mises, Hayek, etc. have never been faithfully followed.

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  2. Science has gravity which eventually leads us to foundational reasoning but the path to this reason is tough to walk.........problem is she has no direction for those who follow her.

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  3. P.S. In Chinese medicine, it is recognized that there is no ideal diet for everyone and not even an ideal for one person that doesn't change over time. They recognize that factors such as constitution (genetics), geography, season, life circumstances and current health status will all influence dietary needs.

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  4. Chris, I love this post. All too often at my seminars people want a one-size-fits-all answer to how to reach their goals. I think sometimes I sound undereducated when I continue to tell them that IT DEPENDS. It sounds like a cop-out, but in reality, it's the honest truth. I can give them ideas about what has worked for either myself, or others from whom I've heard testimonials, other clients, etc., but at the end of the day, each person is SO unique that there is never one diet that will be the perfect answer. I've also talked a lot about making sure that someone checks in with themselves when their diet stops working for them, as you mentioned, because people think that what works today might work forever. They even go so far as to forget that maybe they used to be very active and ate one way, and now are less active and the diet no longer works and they can't figure out why...

    Every variable in a person's life can impact how their diet works for or against them, and changing our diet may need to happen nearly against one's better judgement because of the dogma they've assigned to that one way of living.

    Interestingly enough, our friend Katelyn you mentioned in the post was a very serious zero-carb eater until quite some time after following me and becoming encouraged to add fresh herbs and raw sauerkraut to her diet. So now she eats a VLC diet. She stepped up and challenged her own dogma EVEN while feeling great, with a hunch that maybe she could still feel great or even better. Kudos to her for that- for stepping outside of her comfortable box and seeing what else might work for her.

    In a similar light, I had my own N=1 with a ketogenic diet last fall/winter which worked very well for me when I had a bit more bodyfat hanging around. I have decided to try this approach again, now, but am well aware that it MAY NOT work the same way it did before. It's not the only variable that's changed in my life, so I know that I may not get the same results I did previously, but I think the experiment is worthwhile.

    Cheers.
    Diane :)
    http://www.balancedbites.com
    ps- I had an awesome offal-filled dinner with your lady tonight! You're a lucky man!

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  5. Sorry for asking this straight but I am curious, did you direct this article as a subtle comment upon the recent 400+ mega-debate on Stephan's blog? I had similar thoughts but my take is that the problem lies more in the fact that they (both sides) may be taking themselves too seriously (and developed too many followers) rather than their dogmatism per se. Now that the deletions started, the situation reminds me a little bit of McDougall's vegan forum 8-:)

    Regards,
    Stan

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  6. The paucity of evidence some people (including myself once) believe things on is astonishing. It's a very complex science, not a believer-whatever-you-feel-like ideology. Good stuff.

    When you mentioned how people will instantly have many explanations for why a diet didn't work for someone, do you think that can also extend towards "diet studies"? Like where they take a few different types of diets and see how they fare in a clinical setting. Do these sorts of studies have any value at all in your view?

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  7. Great Chris. Time to proofread the post I started to put up a few days ago but backed out on. Same theme, but I pulled back because I'd used a few guru's names. People think I'm obnoxious already, I'd hate to upset even more ;)

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  8. @Grok,

    I actually had some names in mind as I was reading, but Chris is way to gracious to do anything like that, assuming he had any names in his head while writing (and no @Stan I seriously doubt Stephan G. is being subtly hinted at in this article). :P

    @Chris,

    So right about the variability of our dietary needs over time. This past spring while in a monastery in upstate New York was the first time I was able to do a low-fat vegan diet for a long period of time.

    I had the occasional piece of fish the very few times the calendar called for it. I couldn't eat the shellfish (which was regularly on the menu) cuz I'm allergic to all but raw oysters, and my coconut milk from Wilderness Family Naturals didn't arrive until well into the fast. But I did just fine.

    @Chris K and Balanced Bites,

    My clients always ask me upfront, "what kind of diet are you going to put me on?" and they are always puzzled and surprised when I say, "it depends." :-)

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  9. Awesome post Chris, hopefully it will help many people that are struggling with whatever diet they are doing but are sticking with it due to a need "to be adapted" or "detox" etc...

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  10. "I have no problem with people who ponder the hidden mysteries of their diet by observing them in silence."

    Well, that's what we all do everyday in the bathroom anyway.

    Seriously, though, I was struck by this statement:

    “…what was true of my ability to eat one type of diet for a period of time six years ago is not true of my ability to eat the same type of diet for a period of time today.”

    This sounds like Don Matesz in a nutshell. Macrobiotic -> Paleo -> back to a plant-based diet. Also my own experience. I went macrobiotic in 1970, felt great for the first 6 months, then it was all downhill from there. Increasing listlessness, and my mother pointing out my cracked lips and pale complexion. Slowly but steadily the diet slipped away. I must have run out of rump fat!

    Matesz in the intensity of his conviction seems to be able to push a diet to the limit, where it breaks down. I can never get to that point.

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  11. Calling someone "dogmatic" is nothing more than a thinly veiled personal attack insinuating that your opponents do not have a rational, science-based argument. Is that really the level you want to put this debate on? If you care so much about science, how about providing some scientific references that backs up those random quotes about low carb diets causing anxiety, shaking, etc.?

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  12. I tend to agree with the entire content of your post but then I can't stop the typical caveats of n=1 experimentation coming to mind.

    I can see how feeling good in the short-term might not always be a reliable indicator of being in a path towards long-term health (as in given that I feel great eating fruit all day, I can therefore thrive in the long-term under a vegan diet)

    The phenotypical and genotypical variations inherent to our species must, in many cases, have some effect on our anatomy and physiology so I completely agree on tailoring our diet to one's individual needs in order to thrive. I, however, think that the composition range within which we can tailor our diets need not be huge. Our anatomy and physiology do not seem *that* different across the gene pool anyway...

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  13. Finally -- a grownup! :-)

    The score-settling and camp-following is boring, unhelpful and soooo 7th grade homeroom.

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  14. I hope posts like these keep appearing. There's a lot of false dichotomies being created and it is easy to get carried away. Being carried away is ok as long as we find our way back. A post like this helps us do that.

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  15. Amen Chris. I could only think of this word while reading the article. thanks.

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  16. Great post, Chris! Diane is right that I now do not consider myself "zero carb." I have long been uncomfortable with how the term has come to me a complete and frightful avoidance of all carbs, and its association with the "muscle meat only" crowd. I proudly eat lots of organ meats, and recently, added lots of spices and raw sauerkraut, seeing how healthy these foods are and on Diane's recommendation. I now average 10-25 grams of carbs a day.

    I am highly active with my heavy weight training and often wonder, reading paleo blogs and forums, whether I am doing something "wrong" by staying VLC while I am active, and have never been overweight. I am not metabolically damaged. The fact that Kurt Harris states that VLC is healthy, but adding starch for active and non metabolically deranged individuals might be MORE optimal, has me thinking deeply.

    Dogmatism is definitely something that afflicted me quite severely when I first went zero carb over 2 years ago. I am embarrassed to be one of those people who was afraid of eating eggs for the carb count, and believed the lies about the Inuit not eating any organ meats. I am grateful I escaped that trap and embraced eating a nutrient dense, nearly carnivorous diet.

    I continue to follow the works of bloggers I respect and keep an open mind. Among those I trust are you, Kurt Harris and Stephan Guyenet, MUCH more so than Taubes, if one is to know my view. I often find myself defending safe starches on Facebook forums now, which confounds many knowing that I choose to eat VLC.

    Time shall tell if I stick to this way of eating--which "feels" right to me, or if I add safe starches (I have no desire for a wide variety, and will avoid any fruits and nuts.) My purpose in adding starches would just be for recovery purposes and to keep out of constant ketosis. I value having a simple, nutrient dense diet that works for my body and health goals over having a large variety of foods and recipes, though I know that interests many others. Give me raw grassfed ground beef, pastured butter and eggs, some delicious beef heart or pork tongue, add spices and sauerkraut, and I am never bored!

    Keep up the great work. Needs do change over time, and the reminder of this can only do me a world of good!

    Your fan,
    Katelyn

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  17. Hi Chris -

    This post comes as a surprise - I'm not really sure what the point of it is actually.

    Lao Tsu was a smart fellow though insightful might be a better description. He also said:

    "To know that you do not know is the best. To pretend to know when you do not know is a disease."

    But sometimes we DO know. And when we do know something, it is important not to ignore it.

    FE: We do know that the go-to diet for a diabetic is low carb. We do know that all humans require a certain amounts of fat and protein and given an adequate amount of each we do know that there is no need for dietary carbohydrate.

    We also know that if you do not take in adequate protein on a daily basis, the required amino acids will be gleaned from your own tissues. This is not good. I'd say it's bad.

    We also know that people odd creatures and lie through their teeth about what they eat and the diet approaches they have "faithfully" tried and stuck to for months.

    IOW, you absolutely cannot go by what people say. You have to go by the data.

    I've had clients tell me they feel like crap on a low carb diet. I ask them what they are eating and it sounds like a fantastic low carb diet to me. Like the woman who got the shakes, they do not stick to it faithfully and/or long enough.

    FE: I asked a client after a session one morning if she was sticking to her LCD 100% and she answered "Yes 100%." She left and went to get breakfast at the corner diner. My next client late cancelled. I went to the diner for a coffee and BAM! There she was sitting and eating a waffle with toast!

    People do this ALL the time.

    I like your work Chris - many people do as you know. This blog post seems to me at least to be a way of riding the fence to stick with a few smart folks out there who are deriding Taubes, Eades, etc. and falling prey, once again, to the calories in/calories out nonsense.

    Stephan Guyenet and his food reward theory is a good example. He's a sharp, smart fellow. But who cares WHY one eats more? Once you do, WHAT you eat matters. His theory (well it's not just his) is just a fancy-schmantsy way of saying calories in, calories out rules the day and that, as you know, is nonsense.

    Sometimes we do know and we shouldn't be afraid to say so.

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  18. Posted this in another thread, in response to one of Chris's earlier post...

    "The requirement for saturated and monounsaturated fats is quite high, but they can be fulfilled by carbohydrate or protein. The requirement for carbohydrate is quite high, but it can be fulfilled by protein. It would, on the whole, be much easier to run a physiological deficiency of glucose by eating a high-fat, low-protein, low-carbohydrate diet than it would be to run a physiological deficiency of fat by eating a low-fat diet. None of that makes it a good idea to eat a low-fat diet or low-carbohydrate diet." CM

    My response...

    "Assuming, as Chris says, carbs or protein come in sufficient quantities, low-fat, as long as EFAs are supplied in ample quantities(which is only needed at 4% of total calories, so easily achievable, even on low-fat), theoretically speaking, shouldn't pose any problem...

    For low-carb, as was also noted, assuming protein is high enough, production of carbs should prove to be sufficient.

    Semantics mostly, I know, but this idea of "no essential carbs" and therefore carbs not being necessary just rubs me the wrong way... They may not be "essential" as in "your body can't produce them", as is the case for EFAs, but they are still essential for basic physiological/metabolic function and, arguably even moreso than EFAs, since the body will go to great lengths to ensure adequate supplies...

    However, to Katelyn (and other healthy/knowledgeable VLCs' credit), it seems worthwhile to note that to create this "carb deficiency" on very low carbs, one would have to severely limit BOTH carbs AND proteins, which is very unlikely, unless following a long-term ketotic diet for therapeutic purposes and/or undergoing high-volume/high-intensity activity on a regular basis.

    To run a deficiency of fat on very low fat, as noted, you would need to limit BOTH fats AND carbs (and possibly protein).

    Interesting to note how, in both cases, carbs CAN be the "make or break" factor...

    All very complex. All very interrelated. And, if anything, to simplify and satisfy our human urge to compartmentalize everything, evidence that it is quite possible to not only survive, but thrive on a wide array of macronutrient ratios..."

    And, it bears adding also that, assuming ample carb consumption, protein requirements are actually quite low (probably around 10% of total calories, or 75 to 120g per day, depending on lean mass).

    Fred, here again, is doing a disservice to everyone by clinging on to the low-carb approach as applied to specific subsets of the population (namely diabetics, in this case), and creating dogma out of it... In other words, exactly what Chris as been referring to, and guilty in some combination of all 3 dogmas he presented (clinging on to one's theory in spite of contradictory evidence, clinging on to one's theory in spite of many unknowns, and clinging on to one's theory as applied to specific subsets of the population, and assuming this same approach is valid for all)...

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  19. @ Katelyn

    Dogmatism is definitely something that afflicted me quite severely when I first went zero carb over 2 years ago. I am embarrassed to be one of those people who was afraid of eating eggs for the carb count, and believed the lies about the Inuit not eating any organ meats.

    I never could figure out the "muscle meat" only claim among the Inuit (by the "zero carb" crowd) when the very passages often quoted belied such a claim just a few short sentences before and/or after. I pointed that out to Danny Roddy on his website a long time ago and would like to think I played a small part in helping him get away from that untenable stance.

    Not only that but the Inuit's carb intake clocks in at well over 100 grams a day, and they did eat plant food on a regular basis. Truth is it may have been even higher or at least differently sourced at various times during the year (see Plants That We Eat: Nauriat Niginaqtaut - From the traditional wisdom of the Inupiat Elders of Northwest Alaska) since the author of the paper below is dependent on Cordain who IMO is unreliable when it comes to estimating the carbohydrate contents of primitive diets.

    American Journal of Clinical Nutrition: Hunter-gatherer diets—a different perspective

    So I'm not sure we have any true examples of VLC, thus it is truly an N=1 approach that seems to be working well for you.

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  20. Nice comment. :-)

    which is only needed at 4% of total calories, so easily achievable, even on low-fat

    I would like to note that the EFA's aren't even needed at that percentage for a healthy adult.

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  21. Eric wrote "this idea of "no essential carbs" and therefore carbs not being necessary just rubs me the wrong way... They may not be "essential" as in "your body can't produce them", as is the case for EFAs, but they are still essential for basic physiological/metabolic function and, arguably even moreso than EFAs, since the body will go to great lengths to ensure adequate supplies..."

    I agree completely. Just because one can survive without carbs doesn't mean one can thrive without them. I personally would like to do more than just survive.

    My experience with ZC was that I lost a bunch of weight but eventually felt terrible, with no energy and feeling cold all of the time. That wasn't thriving.

    I know that the dogmatic ZCers accused me of "failing the diet" but I think the diet failed me. It finally occurred to me that, just maybe, living on a diet that mimics starvation wasn't the best idea. Adding in safe starches and fruit made a huge difference in my energy level and body temperature.

    However, it is clear that some people do thrive on ZC. I have a theory that I can't back up that people that do well on ZC are very efficient at gluconeogenesis, so easily keep their glycogen levels up. Those of us that aren't as efficient (or don't eat enough protein) have constantly depleted glycogen which appears to cause the body to downregulate the thyroid.

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  22. Agreed Michael :) Should have actually specified "a maximum of 4%", so it's not even necessarily the goal to achieve that level...

    I forgot to add also to the list of dogmatism Fred is guilty of:

    Clinging on to one's theory on the basis that everyone that fails on a said diet is "cheating"... Not saying some aren't, maybe even many, but to assume that they all are and that it's the person, and not the diet, that is at fault?!?!?!? What's that called again :)

    Fred, have you been watching too many House MD episodes?!?!?

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  23. I agree with my dear friends Michael and Eric. I was once the dogmatic voice that naively and stubbornly believed that EVERYONE was meant to do ZC in EVERY circumstance. I was so ill-informed. I love the way I am eating now and cannot believe that I once spouted that a muscle meat only diet of Wal-Mart meat is sufficient for a thriving human.

    --Katelyn

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  24. Just because you feel well doesn't necessarily mean your diet is serving you well. While on a hi carb diet staying away from sat fat i felt great until my doc did an NMR and showed i had a particle count of 1800, all small! A subsequent calcium score showed CAD. I guess that while i felt great, normal weight and Trgs of only 75 and HDL of 45 something was amiss. A switch to a lower carb diet led to a LDL particle count of 2200 of which 200 small. HDL up to 63 and trgs at 60. Still feel good as on hi carb diet. Something tells me that with all the particles my liver is creating that there is something functionally wrong with the LDL receptors and hence CAD. Thyroid normal,D3 about 50, fasting BG of 73 and A1C of 5.4.
    So, felt great on either diet,but underlying cardio health not so great. Yes a family history of heart disease and maybe a need for statins.
    Cannot always go by how you feel. That which you cannot see may be as or more important than what you can see

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  25. Thoughts of wisdom, maturity and moderation from Chris M and Chris K. Thank you!

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  26. I mentioned what Steve is referring to before...

    Here's where it all gets confusing, at least to me... According to many (most notably, KGH), going by "how we feel" might not always be the best way to go (think: a cigarette for a recent ex-smoker...).

    Knowing this, we are then faced with the problem of finding reliable tests for reliable health markers that will tell us something of value (according to many - I'm thinking again of KGH, but also Taubes and others, cholesterol levels would not qualify, and it remains to be seen what biomarkers, can indeed, be of value... Trigss, C-reactive protein, homocystein, etc. ?!?!).

    Then, there are those people who claim that even body composition or muscle mass is not a true/real/good indication of level of health or, at the very least, we can acknowledge that a healthy level of optimal body fat has not been established. (Think "washboard abs"/heroin-addict supermodel or ripped and massive bodybuilders vs a more healthy and normal body type... And, as Chris as made reference to this before, maybe body composition should, ideally, fluctuate with the seasons???) Basically, some claim you can be healthy without being ripped, while others believe that low body fat and health go hand in hand.

    Confused yet????

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  27. "Fred, here again, is doing a disservice to everyone by clinging on to the low-carb approach as applied to specific subsets of the population (namely diabetics, in this case), and creating dogma out of it..."

    Dogma? It is the go-to diet for diabetics. It's not dogma, it's the truth.

    "In other words, exactly what Chris as been referring to, and guilty in some combination of all 3 dogmas he presented (clinging on to one's theory in spite of contradictory evidence,"

    What contradictory evidence? I haven't seen any yet.

    "...clinging on to one's theory in spite of many unknowns,"

    It's a theory that has many biochemical truths to it and is a better hypothesis than anything else I've read.

    "...and clinging on to one's theory as applied to specific subsets of the population, and assuming this same approach is valid for all)..."

    As far as health is concerned, it is valid approach for all. But certainly not when it come to personal preference. Tell me, who would do better on a low protein, low fat, high sugar diet?

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  28. Also true of market fundamentalists who argue that any real world examples of market failure are not in fact market failures because holy economic principles as prescribed by Friedman, von Mises, Hayek, etc. have never been faithfully followed.

    This is wrong. With Marxism force was initiated against the citizens and economic liberty was violated. Full Laissez-faire has never been implemented so the system can never be said to have failed. What has failed, and is currently failing, are mixed economy welfare/regulatory states.

    The ultimate vindication of Laissez-faire will require its implementation. True. But there is such overwhelming historical and economic evidence of intervention failing literally every time that its been applied that Laissez-faire's legitimacy is a safe assumption.

    The above quoted statement is a popular statement by Leftists to defend their bankrupt advocacy of the mixed economy welfare state; ie "socialism but only we wont call it that".

    D. Bandler

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  29. Why does taking a stand on some topic is so frequently seen as being dogmatic? (negative atheism comes to mind) And why does the opposite many times seen as being open-minded?

    On could make an argument where a compulsive reluctance to take a stand about a topic (sometimes called accommodationism) could also be labeled as dogmatism.

    Sticking to moderation or a middle ground is not necessarily the best position to take (golden mean fallacy - http://goo.gl/P24Ev).

    Since we cannot even measure anything with 100% of certainty, we will never be able to have 100% certainty about anything. Does that mean that we should not take a stand about a subject when confronted with compelling evidence? Stands are not necessarily permanent, or at least should not be when confronted with contradictory evidence (a clear example of dogmatism).

    Compulsory accommodationism under the threat of being labeled dogmatic = middle ground fascism.

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  30. "Dogma? It is the go-to diet for diabetics. It's not dogma, it's the truth."

    Eeeeuh, OK, read that again... I specifically wrote that the fact that you want to apply this "truth" to everyone, not just diabetics, is what is dogmatic...

    "What contradictory evidence? I haven't seen any yet."

    Oh, you mean you don't WANT to see the evidence that one can be healthy and eating high carbs... I see, I see... That clears a few things up...

    "It's a theory that has many biochemical truths to it and is a better hypothesis than anything else I've read."

    Which doesn't necessarily imply that it's applicable to all and in all circumstances. Or that it's the only valid theory or approach to maintaining/improving health...

    "As far as health is concerned, it is valid approach for all. But certainly not when it come to personal preference. Tell me, who would do better on a low protein, low fat, high sugar diet?"

    If you had stopped at "As far as health is concerned, it is a valid approach", I would have agreed. It's just the "all" part, at the end of the sentence, that irks me... Oh, and who said anything about a low-protein, low-fat, high-SUGAR diet?!?!?!?!?

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  31. Fred,

    What you say about people lying is a great point. There are very few n=1 stories that I actually care about now. I see it with my own family and friends. Their "pretty healthy diets" consists of restaurant french fries, desserts, bagels, and cookies/snacks several days per week. But, because they eat salad sometimes and don't eat at Mcdonalds, they think they're great. I'm sick of all the arguments on blog comments consisting of everyone just telling his/her story. Stephan's comment section has been completely out of control lately.

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  32. Excellent thought-provoking post as usual, Chris. One question - you talk of not being dogmatic as far as diet is concerned which, it seems to this lay-person, often means how much or how little carbohydrate any one individual is choosing to eat or any one writer/expert/nutritionist is advocating we should eat.
    The comments show a variation in experience - some thrive on VLC others not (despite liking the primal idea I think I am in the 'not' category, I know those shakes) but the ONLY talk of carbohydrate is 'safe' carbs. I'm presuming these mean gluten-free, non-grains - i.e. starchy vegetables but, if I am right, I think you, Chris M, have written on the assumption that we are mostly all gluten intolerant and how this is not backed up by much evidence. So, if an individual has no problem with gluten (she - ok, me - assumes) why not a half slice of well-fermented sourdough with breakfast eggs? Or is the paleo/primal thing the ultimate dogma, whether you choose to eat high or low carb?

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  33. "Oh, you mean you don't WANT to see the evidence that one can be healthy and eating high carbs... I see, I see... That clears a few things up..."

    That is not "evidence." Sheesh Eric. I can show you a bunch of healthy smokers. At least, healthy now...

    "Which doesn't necessarily imply that it's applicable to all and in all circumstances. Or that it's the only valid theory or approach to maintaining/improving health..."

    Really? All humans have a normal circulating blood glucose level of about a teaspoon or two. That is what our body considers normal and non-toxic. How can more be better? You explain this to me why doncha.

    "Oh, and who said anything about a low-protein, low-fat, high-SUGAR diet?!?!?!?!?"

    This is what Masterjohn is implying. Find what works for you as if some people might find that a high sugar diet is best for them. No they won't.

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  34. Responses to Sam, Chris, and Diane

    Hi Sam, I agree it would be quite dogmatic to hold that any market failures exist because laissez faire does not exist, but I don't think that means one cannot make a legitimate argument that specific interventions caused specific failures. For example, one could use the Austrian theory of the business cycle to predict a bust after a period of monetary inflation, and, if the facts are consistent, argue that the monetary inflation caused economic malinvestment that had to be liquidated, without being dogmatic about it. One could also make, perhaps, reasonably non-dogmatic arguments that borrow from Marxian analysis. But I think one has to face the facts that there is something about instituting a dictatorship of the proletariat that inevitably produces figures like Stalin, Mao, and Castro. I think an analogous point you could make about markets would be the Chomskian criticism that if there ever were a free one, it would exist for about three minutes before the business class subverted it.

    Chris, preach it!

    Thanks for making that point about Chinese medicine. While I'm on the subject of throwing Church Fathers, atheists, and Chinese philosophers together, I will reciprocate that favor by providing the following quote from Saint John Cassian: "[The Holy Fathers] have not given us only a single rule for fasting or a single standard and measure for eating, because not everyone has the same strength; age, illness, or delicacy of the body create differences. . . . They found that the eating of greens or pulse did not agree with everyone, and that not everyone could live on dry bread. . . . Food is to be taken in so far as it supports our life, but not to the the extent of enslaving us to the impulses of desire. To eat moderately and reasonably is to keep the body in health, not to deprive it of holiness." As for atheists, it appears Sam Harris has promoted Gary Taubes's article on sugar: http://twitter.com/#!/rangarajum/status/103106560250753024

    Diane, great points. Thank you for your story! And I'm glad you enjoyed Takashi with Melissa. I hear absence of men brought the bill down a little bit :)

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  35. Eric said: "Which doesn't necessarily imply that it's applicable to all and in all circumstances. Or that it's the only valid theory or approach to maintaining/improving health..."

    Fred said “Really? All humans have a normal circulating blood glucose level of about a teaspoon or two. That is what our body considers normal and non-toxic. How can more be better? You explain this to me why doncha.”

    Inane pseudoscience is one of the Dogmatist’s best friends…

    M.

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  36. Fred, I see you're up to your same old, easily refutable tricks :)

    "I can show you a bunch of healthy smokers. At least, healthy now..."

    Right, because cigarette smoking and carbs (something the human body needs and actually PRODUCES) are one and the same!?!?! Sheeesh right back at you :)

    "All humans have a normal circulating blood glucose level of about a teaspoon or two. That is what our body considers normal and non-toxic. How can more be better?"

    More isn't better, and the healthy body is more than capable of maintaining that delicate balance, even in cases of higher carb consumption. You are again confusing carb ingestion with circulating carbs and metabolically-deranged individuals with perfectly healthy individuals.

    "This is what Masterjohn is implying."

    Hmmm... Funny since I didn't see it that way at all.

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  37. Responses to Stan, Stabby, Grok, Michael, rosenfeltc, and Garymar,

    Hi Stan, I don't mind those types of questions. :) No, I didn't write this in response to what's going on at Stephan's blog, except in the sense that that particular debate spilled over on to the comments of my AHS post and the conversation with "Anonymous" that I link to at the end of this post did play a role in my decision to write it yesterday. I'd actually been thinking of writing something like this for a while, though, because I see many people get stuck in ruts where they thing they've found some success so they stop exploring further even though they are far from having resolved their health problems, and it causes a lot of pain.

    Hi Stabby, I think those studies have value, but as with anything else one has to realize their limitations. They are often short term, rarely if ever take into account individual variation, generally can't take into account a person's history, at best are able to show one diet is better than another within a certain setting but not that it is optimal, and are generally biased by the investigators' hypotheses and paradigms. For example they may look at the effect of the diet on cholesterol levels, or BMI, but the diet may affect 1000 other things, 100 of which weren't measured but could have been, and 900 of which no one thought of. So you have to realize you are slowly chipping away the vast layers of ignorance that hold in their depths a very elusive but nevertheless very real truth.

    Hi Grok, Thanks. I'd say your comment here is rather un-obnoxious. :)

    Hi Michael, Great points, thanks for commenting and sharing your experience.

    Hi Rosenfeltc, Thank you so much, I'm glad you enjoyed it and I hope as you suggest that others find it helpful.

    Garymar, LOL! I was wondering if anyone would comment on that sentence as it was rather ripe for being interpreted in some amusing way. What you say about Matesz makes a lot of sense.

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  38. Responses to Dave, VidaPaleo, Anonymous, Pal, and Anand

    Hi Dave, I did not call anyone dogmatic or attack anyone personally. Surely, if I did so, I must have personally attacked myself since I stated that "we've" probably all done this at one time or another, and the word "we" clearly includes "me." I didn't realize that I had any "opponents." I don't think I need a scientific reference to show that someone got anxiety when they ate low-carb and had it improve upon eating oatmeal. That doesn't make any sense, unless they'd gotten someone to publish their story as a case report in the literature, which wouldn't have any effect one way or another for our ability to draw inferences from it. I also never made the claim that "low-carb causes anxiety." I made the claim that different people vary in their responses to diet, and illustrated this by contrasting two people who had great success with low-carb with two other people who had failures with low-carb.

    In order to address this with hard science, you'd have to enlist people to undergo several bouts of low-carb and high-carb dieting in a randomized order so that you could assess the variation within trials of a single diet in a single person and compare it to the variation between trials in a single person, and identify whether the difference between diets differs between people -- this is rarely if ever done in the scientific literature, so you can hardly expect me to cite it. However, the idea of variation is supported by variation in genes related to metabolism and is consistent with the massive amount of conflict anecdotal data.

    VidaPaleo, I agree with you. As Aravind alluded to in the comments of my AHS post, we discussed n=1 self-experimentation and I do not agree with that terminology. But there are caveats to every methodology. A randomized, controlled trial is also limited by its duration. The obvious reductio ad absurdum for this limitation is fasting -- short term fasting may improve health but long-term fasting reliably produces death. I agree that there is some limit to variation, and I imagine on most things we have distributions that look something like a bell curve. The problem is if we say variation is "large" or "small" we have nothing to calibrate that without actual quantifications. I imagine you'd agree.

    Anonymous, Yeah but grown-up is the new 'in.' Childishness is so yesterday.

    Pal, good points. I like coming home. :)

    Anand, thank you for your appreciation. You're welcome.

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  39. Hey Chris

    FREAKING AWESOME POST. What I was most impressed with by AHS was that many of the attendees and speakers are NOT dogmatic (exception of a few, Gary Taubes,etc!).

    I tried low carb as well and both my wife and I struggled in a number of areas. Then we read Perfect Health Diet and shifted our carbs to 20%-30% of our diet and all the issues we had disappeared.

    Everyone's body is different. Each person has to tweak and find what works for them.

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  40. Responses to Katelyn and Fred

    Katelyn, Good to hear from you. Thank you for sharing your story. I will edit my post to say very low-carb. I'm glad your diet is supporting your health so well, and glad you have the humility and open-mindedness to see your journey as a continuous one.

    Hi Fred, The point of this post is to highlight some of the paradigms that people get some people stuck in a rut, so that they can have the freedom to find a way out of the rut if that becomes relevant to them. I would say Lao-Tzu was wise, though I like insightful. I said "smart guy" as a casual colloquialism. Lao-Tzu probably would have found friends in Socrates, who said "All I know is that I know nothing," and Saint Paul who said "Any man who thinks he knows something does not yet know as he ought." I think these were hyperbole and the quote from Lao-Tzu is the most practical. I agree that we should not be afraid of admitting what we do know, but we should acknowledge the limitations of that knowledge.

    We do not know what the optimal macronutrient ratios are. We have good data on this, but it has limitations. For example, there is substantial scientific disagreement about how to quantify protein requirements. Nitrogen balance studies are the most quantitative, but protein turnover declines on a low-protein diet, so it is easy to suggest that the ideal protein level could be higher than that needed to maintain nitrogen balance. Moreover, nitrogen balance is not a clinical endpoint. What is the effect of variation in protein intake on cancer, bone health, and other things we care about? There is data on these factors but it is sparse and we have a long way to go. We know that if you have enough protein you can live without dietary carbohydrate, but we have no data showing that going without carbohydrate is optimal for clinical parameters of health and disease.

    I agree that people lie, but I do not understand your distinction between what "people say" and "the data." People will lie to you about eating waffles or to me about eating oatmeal, but they will not lie on a food frequency questionairre or a 24-hour recall? They will not lie about whether they took the capsule with dinner as directed by the investigator of a clinical trial? People can lie in all of these situations. All of them constitute "data" of one sort or another.

    You know your clients much better than I do, but from the story you tell it doesn't seem obvious to me that the person had not been sticking to her diet. Perhaps she stuck to it for some time and felt it wasn't working so decided to eat a waffle and toast. Or, if she was lying, she may have been trying to save herself embarassment and/or conflict by not telling you she'd skimped on the plan you made for her. I don't have any clients, so I think people who email me out of the blue about their experience with a diet that I never recommended are less likely to be lying, but I agree it is possible.

    I'm not sure I understand your point about calories in/calories out. Stephan has never maintained anything remotely in favor of the idea that how much you eat matters but what you eat does not matter. His position is that energy intake and expenditure is largely regulated by the central nervous system and is offering a biochemical, neurological explanation for how this becomes dysregulated. I'm not trying to ride any fence. I'm trying to acknowledge the limitations of our ideas as well as their strengths. We should never be afraid of saying anything. But we should think carefully about what we say.

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  41. Responses to Eric, Michael, Frosty, Steve, Anonymous, Vida Paleo, john, Karen, and Sue

    Hi Eric, thank you for your comments. I think you corrected your statement below, but I don't think the EFA requirement is anywhere near 1% of calories in most cases, nevermind 4%.

    Hi Michael, great points. Just wait until I get to the food part of my Masai series! Anyone who does not begin with the realization that the Masai live not in a land simply of milk, but in a land of milk and honey, has not even begun to understand the central themes of Masai life. I number myself among those who understood the Masai very superficially until very recently.

    Frosty, thank you for sharing your experience. This is exactly the type of thing I am talking about -- people failing the diet. Do people exist for diets, or diets for people?

    Hi Steve, thank you for sharing your experience. I agree you cannot always go by how you feel, and didn't meant to suggest that you could or should. Thank you for making that important point.

    Anonymous, thank you, and you're welcome!

    Vida Paleo, I don't think taking a stance on something is dogmatic. I didn't say that, and didn't mean to suggest it. I said that "what really becomes a problem . . . is when one adopts the rigidity, inflexibility, and stubbornness that characterizes the modern concept of dogmatism." I think it is quite possible to take a stance that is not rigid, inflexible, and stubborn, and I agree that if one were to maintain a rigid, inflexible, and stubborn stance against taking stances, this would be dogmatic. I never stated that sticking to a middle ground is the best position. I agree that someone were to compel someone to accomodate a theory under the threat of labeling them dogmatic that this could be seen as some kind of 'middle ground fascism,' but I didn't threaten anyone so I'm not sure where that came from.

    john, Fred's point about lying is important, but people's stories are not irrelevant. Obviously calling a diet a "pretty healthy diet" when it is full of junk food is wrong.

    Karen, I meant this to apply to anything, I just used carbohydrate proportion as an illustrative example. I do eat some well-fermented sourdough.

    Sue, thanks!

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  42. Responses to Fred and Amit

    Fred, with all due respect, I appreciate the great work you do and your contributions here, but I have to disagree with this:

    "All humans have a normal circulating blood glucose level of about a teaspoon or two. That is what our body considers normal and non-toxic. How can more be better? You explain this to me why doncha."

    The amount of glucose circulating at any given moment is irrelevant, as it is in dynamic flux. If you want to set a maximum glucose tolerance in this manner, you should calculate the total turnover of glucose in all body compartments within a day.

    You also wrote this:

    "This is what Masterjohn is implying. Find what works for you as if some people might find that a high sugar diet is best for them. No they won't. "

    This is not what I was implying, but it is very easy to find people who report improvements after increasing natural sugars.

    Hi Amit, thanks, I'm glad you liked it! And thank you for sharing your story.

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  43. Nice post Chris and equally nice handling of the energy in the comments here.

    I hope there is an "N=1" post in the near future because I think the discussion we had with Stephan, Lindeberg, et al will be of great interest to many.

    Take care,
    Aravind

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  44. @Chris Re:middle ground fascism - the term wasn't aiming at anyone in particular, I used it to round-up the idea. Sorry if it came across differently.

    Setting fixed boundaries is always comforting, especially if they delimit a very narrow, easy range within which we can choose. Broad ones are more difficult to accept because they entail more uncertainty.

    Controversial posts like this one will surely attract commentators from both extremes:

    <[zero carb is bets for everyone], [n=1 with whatever I ate at the time that made me feel good because everyone is unique]>

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  45. Unfortunately from what it appears in the comments section, the people that "needed" to read this post the most are the ones that somehow felt personally attacked or the ones that are somehow trying to argue with Chris Masterjohn on something that makes no sense in arguing, I mean how can one argue with everybody should self experiment and find out what works best for them. Once again, this is very disappointing.

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  46. My old friend Rosenfeltc is correct.

    --Katelyn

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  47. Eric wrote ...

    Fred wrote: "Dogma? It is the go-to diet for diabetics. It's not dogma, it's the truth."

    ___________________________
    Hey Eric
    Did you ever read my comment on Fred Hahn @ Carbsanity? here 'tis

    FRED:
    Irony.
    Learn it.
    Know it.
    Live it.
    Don't trip over it accidentally.

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  48. Hi Chris:
    I listened to your talk at the Ancestral Symposium and found it to be fascinating. What is your position with regard to statin use for those who generate high LDL particle counts with family history and plaque? Seems that given it lowers particle count which means less of them around to degrade and oxidize it might be beneficial in this regard and its anti-inflammatory properties. What other ways to lower high particle counts of 2100, small 200 and provide protection against degradation/oxidation. Thanks

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  49. rosenfeltc,

    I think people just get annoyed with the answer "everyone's different," because it doesn't tell us much. If it is true (I mean I only know exactly what I do and eat), then we deduce that macros aren't the final stop, which is what most think. I'm so sick of all this stuff recently because the same arguments and stories just get repeated in the comments...We need to get back to topics besides bodyweight & macro ratios--I miss posts on choline, fructose, traditional cultures, etc. People freak out when bloggers they look up to don't all have the same feelings on everything.

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  50. @ Fred,

    When I was diagnosed with borderline diabetes (numbers all on the border is what I mean), I "went to" a low-carb diet for seven months. I'm sure it works for a lot of people. I read their posts. I've read Jenny Ruhl's book and corresponded with her off-line. She was the first person who told me that there are a few diabetics she's heard from whose glucose control deteriorates on a high-fat diet. My numbers improved on a lower-fat, higher-carb (soluble fiber-based) diet.

    Probably, Type II diabetes isn't one disorder but many. Your reaction to carbs vs. fat may have to do with what part of the system is malfunctioning. Unfortunately there may be more than one. Then you need to focus on which part is the worst off. In my case, I don't think it's the beta cells (yet?), but some other signal or transcription factor that's not what it should be.

    My unhelpful low-carb journey was my personal experience of dietary dogma. (I couldn't *believe* that mainstream medicine prescribed a high-fiber, "Mediterranean" diet! Which actually works better for me.) Not my first and probably not my last. It's good to remember, also, that one's dietary needs may change over time, as Chris points out.

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  51. Gotta love how the plugs for a free market economy keep turning up in these diet blogs. (Admitting that in this case the analogy in Chris's post invited them.) Also impressed with Chris Masterjohn's command of political economic theory as well as nutrition. And his sense of humor.

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  52. Thanks for the reply, Chris. I hoped you DID mean it to apply to anything and it's a timely post for me - I'll enjoy that sourdough! All the best, keep up the good work.

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  53. Interesting. The debate in the comments at Stephan was pretty constructive when I last checked in. Now, seeing the 400+ post count, I´m frankly a bit scared to look.

    As to dogmatism and debate, there are a number of rules that one can follow, that make it much easier to have a constructive discussion, and to avoid the tribalization of discourse:

    - No attacks on the persons of others. No invective.

    - Keep it factual and calm.

    - Try to be reasonably hard on yourself when it comes to leaving open the possibility that your argument is... gulp... wrong. (Keeping the discussion clean makes this much easier in itself). This makes it emotionally easier to actually change your mind, if new facts come to light.

    - Use sourcing to support specific arguments and facts, do not make broad appeals to authority.

    And so on. It´s a pretty high standard to live up to (especially the self-scepticism part), but it´s a pretty effective anti-dogmatism protocol if adhered to reasonably (80-20, as Sisson would say...).

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  54. "My unhelpful low-carb journey was my personal experience of dietary dogma. (I couldn't *believe* that mainstream medicine prescribed a high-fiber, "Mediterranean" diet! Which actually works better for me.) Not my first and probably not my last. It's good to remember, also, that one's dietary needs may change over time, as Chris points out."

    The "bundling" of different disorders under one label is probably one of the factors that makes high-quality health research so difficult to perform.

    Let´s say, for instance, that you have one group of dieters who are fat and insulin resistant (and hence respond very well to a lower-carbohydrate approach), and one group that is fat and insulin sensitive (who tend to get mediocre results from a low-carb intervention).

    If both of these groups are aggregated under the label "fat people", then the treatment of both groups will suffer in the end, as research will underpredict the utility of the intervention for one group, and overpredict for the other.

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  55. John,

    "I miss posts on choline, fructose, traditional cultures, etc." Amen brotha!

    JC

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  56. "Thanks for making that point about Chinese medicine. While I'm on the subject of throwing Church Fathers, atheists, and Chinese philosophers together, I will reciprocate that favor by providing the following quote from Saint John Cassian: "[The Holy Fathers] have not given us only a single rule for fasting or a single standard and measure for eating, because not everyone has the same strength; age, illness, or delicacy of the body create differences. . . . They found that the eating of greens or pulse did not agree with everyone, and that not everyone could live on dry bread. . . ."

    They also did not have the science we now do Chris. The fact that they gave anyone bread at all tells you all you need to know. Why did Jesus say "I am the bread of life." answer: 'Cuz he didn't know better that's why. If he knew what we know now he'd of said "I am the meat of life."

    Just because a person does not complain or show outward symptoms from the foods they eat does NOt mean they are ok eating them. Wheat is a perfect example. No one should eat wheat. No one.

    Is that a dogmatic thing to say? I think not. Is it dogmatic to say E=mc2 or F=ma?

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  57. Mackro -

    Agreed. Although my n=1 is diabetes - I'm not fat, but your comment is apt nonetheless.

    I also miss the posts about choline, fructose, and traditional cultures, although I'm getting a little trad-cult fatigue - seems you can find one to argue for or against nearly anything, or the same one to argue nearly opposite things (fish oil good/bad?: Inuits). Still, it makes for good reading and thinking

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  58. Chris - Thanks for your responses. Good points.

    It seems to me that one can't fluctuate between using N=1 stories as proof of something to look at the data. It's one or the other Chris.

    As for what I meant by "the data," I meant looking at things like CRP, HBA1c, tri's, HDL, LDL fractions, etc.

    On low carb diets, the vast majority of people see these numbers get better. As you said, even in non-ward trials, people do lie and cheat. So 'tis true that when you see just 85 out of 100 people in a study improve their inflammatory markers greatly on a VLCD, you know that either: A. 15 people were shoving snickers bars down their gullets at night or B. VLCD mess with some people adversely.

    But if the 15 weren't cheating, what then is the mechanism behind them not improving or getting worse?

    If we know the mechanisms as to why the majority got better, more then likely the diet did not mess with the 15, they messed with the diet.

    "...but we have no data showing that going without carbohydrate is optimal for clinical parameters of health and disease."

    Really? We know much from people's who eat/ate virtually no carbohydrate and who do not suffer from the ills we do. Is this not sufficient as data? Of course, we can speculate on anything.

    My take on Guyenet's work on food reward is that he is ultimately saying eating more causes fat gain. He has written that Taubes hypothesis is wrong but has yet to actually support his arguments completely. It is completely irrelevant why we eat more. There are scores of reasons why some people stuff their face with food. But once they do, why do some people get fat and others not. My food reward is animal matter - lobster, rib-eye, butter and bacon. I eat large amounts of these foods daily. I don't get fat. But when I was eating just as much food if not somewhat less, but mostly grains and sugars, I gained fat. N=1. True. But again, why we eat more is irrelevant to why we get fat. Who cares why?

    "The amount of glucose circulating at any given moment is irrelevant, as it is in dynamic flux. If you want to set a maximum glucose tolerance in this manner, you should calculate the total turnover of glucose in all body compartments within a day."

    This is beside the point Chris. I won't go into this here however but from my understanding of it how much carbohydrate you eat at a given time matters to how much circulating BG you experience and more than a teaspoon or two is bad news - highly inflammatory. It is not an appeal to authority to state that Drs. Eades, Su, etc. have written extensively on this.

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  59. Helen you said:

    "When I was diagnosed with borderline diabetes (numbers all on the border is what I mean), I "went to" a low-carb diet for seven months. I'm sure it works for a lot of people. I read their posts. I've read Jenny Ruhl's book and corresponded with her off-line. She was the first person who told me that there are a few diabetics she's heard from whose glucose control deteriorates on a high-fat diet. My numbers improved on a lower-fat, higher-carb (soluble fiber-based) diet."

    Could you tell me what you were eating before you went on a low carb diet and what you switched to when you went low carb?

    And what were your numbers before the diet and a few months into the LCD? Please be as honest as possible. Sorry to have to say that but in my experience it helps people to be more honest when asked to do so. I cannot tell you how many people add in little fibs (even people in my own darn family!).

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  60. Responses to Aravind, VidaPaleo, Steve, john, Helen, Karen, Marko, and Justin

    Aravind, I'm glad you liked the post. I actually have a draft of an "n=1" post that I started a few months ago and never finished, so I suppose I'll take your suggestion as a justification for finishing it. Thanks!

    VidaPaleo, Thank you for the clarification. I agree, then, that we have to be careful about suppressing other people's ideas under the threat of labeling them as "dogmatic" or as any other pejorative. "Unscientific" is another one people like to use to bully other people about their ideas. I agree that setting fixed boundaries is comforting -- I hope this doesn't come across as a boundary-bashing post. My point is simply to be flexible about one's willingness to alter the boundaries as needed.

    Steve, thanks I'm glad you enjoyed the AHS talk. I personally don't like statins too much, but I think there are cases such as familial hypercholesterolemia where they might be called for. That said, even in those cases I'd prefer to see people working with practitioners who can think and work outside-of-the-box and use better strategies. Still, I think in these cases the issue is serious and one has to work with a practitioner. I'll be writing more on managing FH in the future.

    john, I agree with you that "everyone's different" doesn't tell us much, but I see people trapped by the ideas I outlined all the time to their own detriment, so I thought it needed to be said. Clearly there are many people who will not find the post very eye-opening and not need it so much. But I just put up a new Masai post a few days ago! I promise you the diet posts in that series are coming soon. :)

    Helen, thank you for sharing your story, and for the mad props.

    Karen, you're welcome. Thank you, and enjoy your meal (sorry I used to wait tables. :) )

    Marko, good points, thank you.

    Justin, they're coming!

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  61. Fred,

    I think it is quite clear from context that I did not quote Cassian as a means of providing a proof for the concept of variation, just like I did not cite Harris's support for Taubes's article as a proof that Taubes is correct and just like Chris K. did not cite traditional Chinese medicine as a proof for the concept of variation. I would not say that e=mc^2 is "dogmatic," but I think Einstein put a lot more thought into developing that formula than was put into the theory that our carbohydrate requirement is equivalent to the amount of glucose circulating in plasma at any given moment. I think the main point here is to think things through carefully, recognize what we do and don't know, and act accordingly. We should be able to act decisively, but we should be able to do so without rigidity.

    I agree with you that "n=1 stories" are not "proof of something," but they are important data that need to be paid attention to, especially by someone treating or advising someone. They are a different type of data than you get from a clinical trial, and epidemiological data is another type -- they are all types of data and need to be handled accordingly.

    Who are the peoples who eat/ate "virtually no carbohydrate"? What do you make of healthy traditional cultures that ate mostly carbohydrate?

    Guyenet is following what everyone agrees on, that if your intake exceeds your expenditure you'll gain weight. Taubes agrees with this too. Both agree that as such, it does not explain anything important, such as why some people eat more or expend less energy. They disagree on the actual causes.

    I agree that if plasma glucose more than doubles it is bad news, but this happens in diabetics, not healthy people. But the vast majority of glucose fluxes through various types of storage, so to actually use the absolute amount of glucose in the blood at one moment as some type of yardstick for how much constitutes excess is profoundly illogical. But I agree that referencing other people's work is not an appeal to authority.

    Chris

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  62. @Fred - You've written "why we eat more is irrelevant to why we get fat. Who cares why?"

    I completely disagree. The question of "why" is the basis of scientific inquiry. I agree the lay person need not be bothered by the minutia, but researchers (like Stephan Guyenet) must care about why if we are interested in the pursuit of science.

    Related to this, I am not suggesting that the Food Reward theory is the be all/end all. I do think Stephan has done a good job of explaining it and backing it up. I personally find it compelling as a piece of the puzzle. It is A factor (not THE) and let's not get hung up on the word "dominant" please.

    Kind Regards,
    Aravind

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  63. Fred Hahn said:
    Please be as honest as possible.

    Fred, I bought (and liked) your Slow-Burn book and was a fan of yours for years, but I have gotten completely sick of you. You are a complete jerk in every comment thread I've ever seen you in.

    Please learn how to express yourself without insulting people.

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  64. Fred Hahn said:
    Please be as honest as possible.

    Fred, I bought (and liked) your Slow-Burn book and was a fan of yours for years, but I have gotten completely sick of you. You are a complete jerk in every comment thread I've ever seen you in.

    Please learn how to express yourself without insulting people.


    O, my god, are people thin-skinned these days.
    I haven't seen anything insulting in Fred's comments here (and elsewhere). He is assertive of his opinion, that's true, but a jerk, certainly not.

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  65. THANK YOU!!!!!

    I have been such a victim of not listening to what works for me due to carbaphobia in a Gary Taubes book or ketosis-phobia from PHD (i.e. carbs? no carbs? ahhhhhhh!). Regardless, you are so right - diet is such an individual thing - and it really just boils down to the" template" idea coined by Kresser - and allowing for INDIVIDUAL VARIATION within such template. Anyway, thank you. This totally made my day :)

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  66. Chris,

    I am impressed with your knowledge of economic theory! Your comment about Chomskian criticisms of markets is very astute. Your blog is always intellectually stimulating and rational. Daily Lipid and Hyperlipid are worth my time.

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  67. Chris, yes, Michael had also pointed this out! Thanks :)

    This has been a great thread. Great article, great response, great comments. I like, I like ;)

    Of course, me and Fred are bumping heads once again, but that's OK. We do see eye-to-eye as far as exercise is concerned. Can't say the same about nutrition but hey...

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  68. Hi Fred,

    I've posted this info on other blogs so many times (not that I expect you to be following random commenters' comments) that I feel a bit fatigued of the whole thing. If you have a blog where I could find you, I'll send you something in the next few days that tracks my experience, numbers included. I was obsessively tracking everything for many moons and I know I wrote of my travails in detail. :)

    Sorry I can't satisfy your curiosity right now. The most reassurance I can give you rigth now that I'm not fibbing is that I'm obsessive about my health and wouldn't be following a diet that gave me higher blood sugars than before. If my results change, I'll change my diet again, and consider medication, though with trepidation. (Metformin was useless and my fasting insulin/fasting glucose suggest I'm not insulin resistant. I believe a little dab would do me with injected insulin - I fear hypos.)

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  69. Ignore Fred. He's a prolific (and successful) troll.

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  70. Dogmatists are annoying, but they tend to stick to their diets, which are almost always a step in the right direction since they eat less factory food. So I'm in favor of being annoying, since it beats being sick.

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  71. Vindication! Thank you!

    My approach to a primal WOE has always been to find the foods that WORK for ME that SUPPORTS my lifestyle. Broad dietary concepts make excellent templates but customization/adaptation better suits the needs of the individual.

    To many "zealots" that POV is considered a cop-out as adherence seems to be more important than individual wellbeing.

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  72. Chris,

    ...did you just quote Sam Harris? :D Two of my favorite minds collide!


    Isn't it interesting how similar arguments/emotions/cognitive biases about religion and dietary approaches seem to be? I'd love to pop a bunch of us into fMRIs and see if the same portions lighting up re: 'diet' thoughts are the same ones that show activity re: 'faith' thoughts.

    Anyhow, thanks for this post. Will be spreading it around various dietary camps of folks I know; it's a healthy reminder. One of your best posts thus far. :)

    Onwards!

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  73. Responses to Chloe, Anonymous, Eric, Peter, George, and Satch

    Chloe, you're welcome. I'm glad it made your day. :)

    Anonymous, thanks! I'm far from an expert in economics but I suppose I know a little bit.

    Eric, glad you like. The progress of knowledge thrives on disagreement.

    Peter, I think perseverance is a positive trait responsible for people sticking to their diet. There might be some correlation between perseverance and dogmatism, but I think one can be perseverant without being dogmatic.

    George, you're welcome!

    Satch, yes indeed I did. I will forewarn you, I don't agree with Harris on quite a bit. In particular, I'm not an atheist -- but I think he's got a pretty brilliant mind and I have a lot of respect for him. I'm glad you liked the post and thanks for spreading it around. :)

    Chris

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  74. "@Fred - You've written "why we eat more is irrelevant to why we get fat. Who cares why?"
    I completely disagree. The question of "why" is the basis of scientific inquiry. I agree the lay person need not be bothered by the minutia, but researchers (like Stephan Guyenet) must care about why if we are interested in the pursuit of science. Related to this, I am not suggesting that the Food Reward theory is the be all/end all. I do think Stephan has done a good job of explaining it and backing it up. I personally find it compelling as a piece of the puzzle. It is A factor (not THE) and let's not get hung up on the word "dominant" please."

    Hi Aravind - What I meant was, why we eat more than we should is irrelevant to HOW the food gets stored as fat - or not. That is the main point - why do some people get fat/obese. The reasons why people eat more are important but no to why we get fat.

    EX: I have a restaurant. All of a sudden more people are coming to dine than ever. If I want to find out why more people are in my eatery, it does me no good if someone was to say because there are more people coming in than before. I know that already.

    It doesn't matter that there is more food going in the mouths of obese people (usually) than before. We know that. It's obvious they are eating more food.

    And if something switches off satiety, this too is an issue. The "comfort foods" do this. Fatty proteins don't.

    Chris you said:

    "Who are the peoples who eat/ate "virtually no carbohydrate"?"

    Say what?

    "What do you make of healthy traditional cultures that ate mostly carbohydrate?"

    What do I make of people who smoke and don't get lung cancer or people who jog for years and never get knee pain?

    And we both know that they kinds of carbs eaten matter - I never said they didn't. If you calculate the total carb intake of the Kitavans minus the fiber...if you factor in their activity...their fasting...their two meals a day...

    So sure, you can eat most of your cals as carbs but, you'll have to take measures - knowingly or unknowingly - to combat this intake. It's like the story of Keith Richards and all the drugs he took but was able to get away with it by getting frequent blood transfusions.

    "I agree that if plasma glucose more than doubles it is bad news, but this happens in diabetics, not healthy people."

    Healthy people can become diabetic. And I think we both know a reason how they can.

    "But the vast majority of glucose fluxes through various types of storage, so to actually use the absolute amount of glucose in the blood at one moment as some type of yardstick for how much constitutes excess is profoundly illogical."

    It seems to me that you're evading the larger picture of chronic excess. I know I can sit down and eat a bowl of grapes and survive. But that does not mean that it was a healthy thing to do.

    Like many people who eat too much sugar over time, the evils of such creep up slowly.

    Chris - Stephan does suggest that excess caloric intake is the reason why we have an obesity epidemic. At 10:15 into this video http://vimeo.com/27927729 he states such.

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  75. Chris -> "What do you make of healthy traditional cultures that ate mostly carbohydrate?"

    Fred -> “What do I make of people who smoke and don't get lung cancer or people who jog for years and never get knee pain?”

    If over half the world is fine on white rice and potatoes and “insulin spikes”, and THEN experience problems when adopting Western diet and lifestyle, would it not make sense that Western diet and lifestyle is the problem and that “insulin spikes” is not something new that the Western diet would have introduced?

    Would it not just be common sense to look at what is different about Western diet and lifestyle instead of trying to come up with a lot of elaborations as to why an entire class of macronutrients must be the central issue when the evidence overwhelmingly says it must be something else?

    It would seem that one would have come up a good theory why a billion white rice eaters don’t have problems with insulin induced fat deregulation until AFTER they adopt a Western diet and lifestyle before one wrote a book demonizing an entire class of macronutrient and blaming it as the one and only cause of the diseases of civilization. I believe one of Taubes’ belated answers was that they “really eat brown rice”.

    “Look at the smokers that don’t get lung cancer” seems somewhat lacking in a theory as well.

    There is no point in speaking in terms of “carbs” unless you already being dogmatic about “carbs”.

    On the other hand, there is pretty good reason to believe that smoking causes lung cancer…


    - M.

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  76. Anonymous wrote: If over half the world is fine on white rice and potatoes and “insulin spikes”, and THEN experience problems when adopting Western diet and lifestyle,...

    They don't experience insulin spikes! Only diabetics experience insulin spikes and glucose spikes eating starchy vegetables.

    Re: It would seem that one would have come up a good theory why a billion white rice eaters don’t have problems with insulin induced fat deregulation until AFTER they adopt a Western diet...

    They don't! - because boiled rice is only ~20% carbohydrates and it is not the main centerpiece of an Asian meal in Asia! What you see in the Western Chinese restaurants is a gross distortion forced by the "white" customers who like bulging-up on the white stuff. If an Asian switches over to SAD filled up with bread (70% carbs), baked pastry, pizza etc, they quickly end up consuming more carbohydrates then ever before. That is regardless of the percentage ratios although if they indeed add more fat on top of an excessive absolute intake of carbohydrates (which in my estimates is anything more than about 3g/kg body/day) - it will make it even worse, because of this.

    Taubes book was actually quite impartial about tracking various factors down. I have to give him this credit, he deserves it showing probably a lot more balance and objectivity than many of his vocal opponents which I have recently seen. (he may be wrong of course)

    Regarding SAD and diabetes.

    You first have to develop a permanent insulin resistance throughout your body tissues and organs (as in DM type II) or damage your pancreas as in DM type I in order not being able to tolerate the starchy vegetables.

    What I wrote above starchy vegetables and rice not being harmful in any way for healthy populations, may not necessarily apply to foodstuff delivering an extremely high glycemic load such as baked pastry, cakes, sweet beverages, bread and pure sugar. In such a case the un-naturally high intake of concentrated carbohydrates (especially if accompanied by a comparable proportion of fat) may be disrupting digestive processes and metabolism and thus harmful in many other ways (see my article link above).

    So, basically I agree that one can probably say: "it is not all about carbs!"

    At the same time I think it is very incorrect to claim that "it is not about carbs at all"

    Best Regards,
    Stan (Heretic)

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  77. Stan said: They don't experience insulin spikes! Only diabetics experience insulin spikes and glucose spikes eating starchy vegetables.

    Many low-carbers believe that “insulin spikes” cause diabetes. They believe “insulin spikes” cause obesity. They believe “insulin spikes” are the one and only cause of the diseases of civilization. Taubes said in one interview that cheese and nuts are fattening because of their carbs/insulinogenic properties. Low-carbers create diets to avoid “insulin spikes.”

    There is a lot mythology going on that doesn’t explain why a culture can eat white rice then suffer problems with Western diet and lifestyle.

    And Fred is here saying that there is nothing wrong with low-carb dogma because the low-carbers are right.

    Stan said: If an Asian switches over to SAD filled up with bread (70% carbs), baked pastry, pizza etc, they quickly end up consuming more carbohydrates then ever before

    They would quickly end up consuming more calories than before too. But “why” would they do this. Asians and Kitivans auto-regulate “calories in, calories out” before adopting Western diet and lifestyle. Taubes says it is not about the calories though - insulin causes abnormal fat accumulation, and then more calories are eaten to replace those being sequestered in fat. I don't think Taubes' insulin theory explains why all of a sudden they would eat more food.

    Stan said So, basically I agree that one can probably say: "it is not all about carbs!"

    At the same time I think it is very incorrect to claim that "it is not about carbs at all"


    Carbs in not a very precise term. Again, if you are looking at what is different about Western diet and lifestyle, it is not “carbs”. Things like glycemic load may or not be a factor, but framing the entire conversation in terms of “this macronutrient is good” and “that macronutrient is bad” does not make any sense.

    Eating too much is the central problem, but the key question is "why"?

    Taubes' argument on the other hand is that it has nothing to do with eating too much, that insulin causes abnormal fat storage.

    And people like Taubes (and Fred) still entrenched with “insulin spike” mythology still have to explain why the “insulin spikes” of white rice are less fattening than the “insulin spikes” of nuts and cheese.

    - M.

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  78. This comment has been removed by the author.

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  79. Fred,

    "Stephan does suggest that excess caloric intake is the reason why we have an obesity epidemic."

    I don't think I can explain it to you any more clearly than Chris already has, but I'll try.

    People get fat because they take in more energy than they burn. Just like people wither away if they take in less energy than they burn. That is just plain thermodynamics. There is no debate there. None.

    Our bodies can offset excess intake through thermogenesis, but if you overwhelm that capacity any excess calories have to be stored as fat - otherwise they'll sit in our blood and f#$k everything up.

    Nobody is arguing that. Taubes isn't arguing that. It's as clear as day.

    The fallacy was telling people they got fat because they didn't log on to Fitday every day of their lives to monitor their calorie intake. The fallacy was telling people they can achieve leanness by counting calories and semi-starving themselves without reaching a hypometabolic dead end.

    Stephan states in his presentation that increases in calorie intake caused obesity, but his question is WHY that happened. He understands better than most the regulatory mechanism in our body that is supposed to maintain our weight and he wants to know why it is malfunctioning.

    And interestingly enough, as he explains in his presentation, the bodies of obese people still remain weight stable and vigorously defend that weight - they are just at an unhealthy set-point.

    And his food reward hypothesis offers a much better explanation for why the obese would remain weight stable at an unhealthy size.

    As I understand it, this is how the 'carbohydrate hypothesis' goes:

    Carbs raise insulin, insulin increases appetite and suppresses fat-burning, and fat gets stored/trapped.

    Tell me, if that is the case, why do obese people eventually become weight stable?

    If they are weight stable that means calories in = calories out, and there's as much fat exiting fat tissue as entering. Once again simple thermodynamics.

    If your theory is right that shouldn't happen. According to you, the carbs will always spike insulin, and insulin will always suppress fat-burning and cause excess calorie intake.

    Think it through, I guess.

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  80. "If we don't, we fall into the same category as the people who insist that the reason Marxism has failed wherever it has been erected is because it has never been tried the way Marx intended."

    Well, Marxism-Leninism perhaps, or something of that sort. For Marx's Historical Materialism was a a false prediction rather than a suggested programme.

    It was something that was supposed "inevitably" to happen -- and of course in places where "Capitalism" was most advanced. In fact, not only has the theory no predictive value (which demonstrates that it is not in fact, despite Marx's claims, science) but the communist revolution happened in Russia, which was one of the less industrialised countries on the fringe of Europe.

    But then someone did once amusingly remark that Marx's writings were "a promise wrapped in a prediction", so perhaps this is a quibble.

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  81. Hey Stan and Fred, here is Taubes from a few weeks ago in an interview with Mercola blaming obesity on starchy vegetables:

    Taubes said: “He [NIH bioethicist Zeke Emmanuel] was telling me like how much this My Plate was going to be this great success. It was going fight back obesity because fruits and vegetables were half the plate and this was a big change.
    I feel like…how do I say it, but it’s still mostly carbohydrates and isn’t the potato a vegetable in America. And it is. It is a starchy vegetable. You could still end up with high glycemic index carbs as the bulk of your diet and you’re still going to make people fatter and not thinner.”

    If starchy vegetables in the US, then why not white rice in Asia...

    But there is no problem with low-carb dogma because the low-carbers are right...


    - M.

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  82. Responses to Fred.

    Hi Fred,

    I asked you which peoples ate "virtually no carbohydrate" because quite often the peoples used as examples in this context are not true examples of low-carbohydrate dieters (e.g. Masai) or their carbohydrate intake is at least controversial enough to question claims that they eat virtually none (e.g. Inuit).

    In any case, if we generally accept that some of these ate virtually no carbohydrate and didn't have the diseases of civilization, it seems to me that whatever inferences we draw from this evidence should be made similarly from peoples who eat mostly carbohydrate and have a similar absence of diesease risk.

    Here is how you had originally interpreted the use of such peoples as data, directly quoting from above:

    ================
    "...but we have no data showing that going without carbohydrate is optimal for clinical parameters of health and disease."

    Really? We know much from people's who eat/ate virtually no carbohydrate and who do not suffer from the ills we do. Is this not sufficient as data?
    ================

    It seems to me that you are thus interpreting two pieces of qualitatively equivalent evidence in diametrically opposed fashions according to hypothesis you favor. Thus, low-carb dieters with absent disease risk are "sufficient as data" in your words to conclude, in my words, that "going without carbohydrate is optimal for clinical parameters of health and disease." These people, then, are healthy precisely because they eat a diet low in carbohydrates. By contrast, the existence of peoples who eat a diet of mostly carbohydrate shows that people can be healthy *despite* their carbohydrate intake, because they have a sufficient number of protective factors mitigating the harm of carbohydrates.

    This leaves me with the impression that you do not consider either case to be evidence of anything at all. Neither piece of evidence impacts your theory in the slightest; instead, your theory is built on other evidence and you interpret these observations according to your theory. If they have no impact on your theory as evidence, I do not understand why you brought them up in the first place.

    [continued...]

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  83. [...continued]

    My objection to your use of a teaspoon of glucose present in the blood as evidence for any safe limit to carbohydrate consumption was not based on any theory of how people become diabetic, but simply based on the egregious fallacy of this argument. Based on my quick calculations, assuming a healthy man weighing 160 lbs has a plasma volume of 3.2 L, normal fasting glucose around 5 mmol/L would work out to just under 3 grams and thus just under 0.4 teaspoons. This might double to 0.8 teaspoons during an oral glucose tolerance test of 75 g glucose (as occurs in our laboratory experience here using healthy college-aged men). Thus, just under 10 teaspoons of glucose taken with water all at once will only wind up putting an additional 0.4 teaspoons of glucose into plasma the way you are calculating it. Clearly there is a major problem equating the total amount of glucose in plasma with the total amount of glucose in the diet.

    Of course the actual area under the curve over 3 hours indicates the flux of somewhat more glucose through the plasma than this, but that simply highlights the fact that we haven't even introduced a unit of time into your calculation yet. Should we consider one teaspoon of glucose present in the blood to be present each day? Each hour? Each minute? Each second? Each lifetime? Should we limit our glucose intake to a teaspoon per day? A teaspoon per hour? Per minute? Per second? Or should we try to eat one teaspoon in our entire lifetime?

    Right now I do not have the time to debate the carbohydrate hypothesis of the diseases of civilization in the comments on this post. I realize you are probably also very busy as well and don't want to bog you down either. You and others are perfectly welcome to use this post to debate this hypothesis, but I would prefer to stick to answer comments that are actually relevant to the post. I didn't mean to use the post to argue against the carbohydrate hypothesis of the diseases of civilization. I simply meant that each person varies somewhat from another, and that dietary needs change over time. Therefore, whether we are talking about carbohydrate or anything else, we should set boundaries for ourselves but be flexible enough to adjust them when we find they are not working.

    If you would like to present evidence against any of these conclusions, I'd be happy to discuss them further.

    Sincerely,
    Chris

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  84. Mike,

    Right and right.

    Not only that, but Marxism, as generally understood, is not the only concept of socialism that has ever been floated.

    Therefore, free market absolutists, Marxists, and other kinds of socialists are all correct. You can't argue that a system that has never truly existed has failed. Therefore, it surely would succeed. Right?

    And the analogy to the topic at hand might be that if a certain diet didn't work for you, you just didn't do it perfectly enough. Since no system or person is perfect, it's usually a fair enough accusation.

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  85. Mike and Helen,

    That's a good point and I suppose that sentence was written carelessly. I'm not sure this is the best way to render it, but I changed it to this:

    "If we don't, we fall into the same category as the people who insist that the reason attempts to institute prescriptive forms of Marxism have invariably failed is because it has never been instituted 'correctly.'"

    I could have used socialism and perhaps that would have been better, but that term seems to be radically misunderstood in common usage.

    I think, Helen, you are making a valid point, and perhaps you are actually trying to illustrate this with your comment, but clearly the fact that these are always "fair enough" accusations essentially precludes any type of falsification because no one can try every possible permutation of an approach within their lifetime. It makes sense to offer some legitimacy to the experiences people share when they try dietary approaches themselves, instead of haranguing them about the permutations they could have tried and didn't.

    Chris

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  86. Oops, I'll correct the grammar in that sentence!

    Chris

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  87. Yes, that was my point exactly. ;)

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  88. @Helen

    Therefore, free market absolutists, Marxists, and other kinds of socialists are all correct. You can't argue that a system that has never truly existed has failed.

    Not to sidetrack the discussion, but voluntary societies have existed throughout history quite successfully.

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  89. Hi Michael,

    I don't mind getting sidetracked. Which do you mean? I know there was a movement of utopian societies of various stripes in the U.S. in the 1800's, and there were anarchist communities around the time of the Spanish Revolution. It seems that on a small scale, many systems can work, but scaling them becomes problematic for a number of reasons.

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  90. @Fred,

    "Tell me, who would do better on a low protein, low fat, high sugar diet?"

    The Okinawans seem to do just fine on their low protein, low fat, high "sugar" diet. Find me an LC
    population that can match their health and longevity record.

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  91. http://www.corepsychblog.com/2007/08/celiac-notes-opiate-withdrawal-from-gluten-and-casein/

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  92. lots of theories (not hypotheses) later -- and many of us are still wondering *what should i eat?!* :-( i've found this week in the blogosphere extremely depressing. i'm too old to keep starting over.

    tess

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  93. @Anonymous,

    "i'm too old to keep starting over"

    First thing, ignore all studies. There`s a new one out every week it seems. Secondly, look at how the healthy, longest-lived populations live and eat. They don`t need any damn studies to tell them how to eat.

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  94. "How we feel right now is not just influenced by what we ate today, but how we ate the last week, three months ago, six months ago" - this is absolutely true! If fact, the real results from the diet may take years to come. From my experience, a diet becomes effective when it is treated not as a diet but as a normality.
    And also (like it or not, no offence), the effectiveness of diet and weight loss is a matter of will-power and self-control, and being really preoccupied with something but your diet. Carbs are the same addiction as smoking or drugs, people often shake because of lack of these not actually because they lack energy, but because it's withdrawal. I also had to go through this. Interesting, but I noticed - the active I am, the more I do sports the less I crave and shake and the better I feel. And I never crave after workouts of feel exhausted, even with little carbs. I think I had to owe this to positive metabolism changes.

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  95. This comment has been removed by the author.

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  96. Stan: "They don't! - because boiled rice is only ~20% carbohydrates and it is not the main centerpiece of an Asian meal in Asia! What you see in the Western Chinese restaurants is a gross distortion forced by the "white" customers who like bulging-up on the white stuff."

    Stan, these claims are as vague as they are false. EVEN Gary Taubes claimed in his book that normal Japanese people eat 50g of fat, 83g of protein, and 359g of carbs, average, and there's no rampant obesity among them. To say that boiled rice only has 20% carbs so they don't eat much is ridiculous. It's reminiscent of the argument that low-carb zealots trot out saying some culture does not really eat high-carb because of fiber. Get real. Show me the data!

    "If an Asian switches over to SAD filled up with bread (70% carbs), baked pastry, pizza etc, they quickly end up consuming more carbohydrates then ever before. That is regardless of the percentage ratios although if they indeed add more fat on top of an excessive absolute intake of carbohydrates (which in my estimates is anything more than about 3g/kg body/day) - it will make it even worse, because of this."

    Prove it. The articles you cite in popular media and the studies to back it up do not show that high-carb plus high-fat ALWAYS causes disease. I would bet you anything the studies used PUFA oils, hydrogenated oils, or highly processed/refined oils and carbohydrates, so what does that prove? Do you have data to show that UNREFINED WHOLE FOOD NATURAL FATS and CARBS do the SAME? I doubt it, but I will be waiting to see you respond. Most people eating packaged food, fast food, and junk food are inadvertently or knowingly eating processed oils, which are damaging even in small amounts.

    Fred: "This is what Masterjohn is implying. Find what works for you as if some people might find that a high sugar diet is best for them. No they won't."

    My health has improved eating a high-sugar diet. My blood pressure was normal and had IIRC fasting blood sugar of 90 and hba1c of 5.5 last time doctor evaluated. And I feel better than I did at the time, while eating abundant sugar from natural sources - like whole milk, fruits, 100% juices, unheated honey, unrefined Zulka cane sugar, etc. So try again, Fred. Don't let the facts get in your way, of course. Just make my facts fit your diabolical dietary dogma.

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  97. Here is some food for thought for Fred Hahn and Stan (Heretic). There is no consensus in the scientific literature that sugar is bad, esp unrefined sugar eaten with unrefined fat and unrefined protein in a natural diet. So, stop rePEATing the same tired studies of rats eating chow and give us some studies of people eating real food.

    http://raypeat.com/articles/articles/glycemia.shtml

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  98. A problem with the "low-carb" dogma is that it doesn't differentiate between high-protein and high-fat diets. High-fat, modest-protein, low-carb diets can work for many people. Conversely, a diet with the majority of calories from protein is a recipe for disaster, but that's what many people try because they're afraid of fat, but want to go "low-carb", and the only remaining option is to dramatically over-do protein, which makes them ill... Then they blame "low-carb"...

    Personally, I've done well on both high-fat/low-carb and high-carb/low-fat diets coupled with regular exercise. It's the "moderation" diets which work poorly for me and lead to weight gain...

    -steve

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  99. Sometimes it's not obvious whether a diet is right or not. One may not feel real differences from removing, say dairy, or even grains. Most people who feel good eating food most of us commenting here wouldn't touch really have no motivation to change their diet. For me, adding red meat and coconut oil - meaning more saturated fat, for one thing - did make a significant difference in my energy. So, I'm sticking with it. But in terms of further fine tuning, supplements, etc. - I don't know.

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