Gary Taubes — "Why We Get Fat"

[Applause] thank you now that you're done exercising I've been asked to tell you that we're going to feed you four or five times today um I actually switched my talk so I'm going to apologize for this I didn't realize what I was invited that this session was conference focusing on obesity and since my other talk the case again sugar doubles up with a lot of what Rob Lustig just said is also some conflict and how we look at the world but Dom I figured this might be a more appropriate talk so I hope you'll bear with me okay it's also more thought-provoking because I can't help but try to be provocative um so again I'm not a physician I'm not a dietitian I'm not a nutritionist I don't have an MD or PhD I was trained as a law business on a physics major who then went into journalism became an investigative science reporter and I wrote my first two books on Sciences on physicists who discovered non existent elementary particles who screwed up in the course of that I was among other things lied to repeatedly by a Nobel laureate whose work I was chronicling and I developed a healthy skepticism for virtually everything I was also taught by some of the best experimental scientists in the world and they convinced me that then science so we often use science as an adjective things are scientific and that's a good thing as our non-scientific into bad thing but it turns out that there are good Sciences and bad science it's just like there are good doctors and bad doctors and good plumbers and bad plumbers and so a certain amount of further what you're seeing is reliable and as a journalist I'm again probably more skeptical than most um one of the ways I approach my work once I got into public health is to try and figure out why we believe something so there are certain truisms in the world of medicine in public health and in med school you'll be taught that 50 percent of what's in the textbooks are wrong we just don't know what 50 percent so the way I dressed my controversies that I covered first in a series of the expose investigative report for the journal Science is to go back in history and figure out the time at which a field a controversial subject was most controversial and at that point you could see the best evidence being presented by both sides and then you go back in history from then and by the time I got on the subject of obesity nutrition the Internet had come along which was remarkable experimented remarkable tool to allow a person like myself for the first time in history to in effect go back and find every primary source on the relevant field going back to the 19th century so I don't want started doing this research google books didn't make this you couldn't just download the sources on this research was based on this lecture based on five years of research and which among other things I employed students in five different cities his only jobs were to go to on the the local med school libraries I tend the lists of 50 references or entire books that I needed copied and they would copy them and ship back so in the course of five years I was able to do more research on this subject than any human being alive and I could say that pretty confidently and I was the only journalist to ever just simply ask this question in the midst of an obesity and diabetes epidemic the likes of which the world has never seen why have we so completely failed as societies to solve those epidemics we've made zero progress and in a circumstance like that like if this was HIV and HIV rates had continued to increase you know year the year to year since nineteen eighty four eighty five when the HIV virus was identified and if aids mortality and continue to increase despite the creation of drugs based on our understanding of the HIV virus we would be wondering what it is about the etiology of this disease that we don't understand and we would be calling our public health authorities to the mat asking why they haven't solved this problem you know from bola was everywhere today instead of having been that epidemic having been successfully contained we would wonder what it is we don't understand about the disease and we would be calling our public health authorities asking there would be you wouldn't be able to cross the street without passing teams of researchers and whites who's trying to figure out what they miss about their understanding of the cause of obesity or of the AIDS or lung cancer or any epidemic that continued to increase in there with obesity and diabetes we just consider it sort of business as usual we assume that we understand the cause of these diseases but we don't question it we don't think maybe we missed something so ineffective the journalist I was again and I could say this confidently the only journalists who ever approach this from the perspective of maybe the scientists got it wrong think we don't understand these diseases and I'm going to give you a hint when Rob Lustig said he would hunt you down if you talk about counting calories which I know they don't do in Canada the Rob can relax today the job is done okay so why we get fat that's the talk that was the episode um context obviously and again I apologize these are us centric slides because 99% of my talks are in the US and I never thought before I came here to turn them at the Canadians life epidemic we have an obesity epidemic you guys know this it's clear we have a diabetes epidemic that goes with it on the diabetes numbers are even more dramatic in my book the case against sugar what I'm basically arguing is that sugar is the cause of the diabetes epidemic okay so when Rob said that sugar consumption can explain 29% of diabetes I argue that sugar consumption can explain probably about 95% of diabetes okay that books for sale here it's worth reading that's not what this talk is about in the US if you go back to 1960 diabetes prevalence has increased 700 percent that's a national disaster and that's what I mean how can you have a slide like this and say we understand what causes this disease okay obviously with obesity comes a whole cluster of chronic diseases it increases the risk of the fatter you get it greater your risk of stroke heart disease gallbladder disease type 2 diabetes which is an effective disease of insulin resistant hypertension neural degeneration which includes Alzheimer's fatty liver disease osteoarthritis cancer the conventional wisdom do we have a laser printer but a laser pointer to any chance the conventional wisdom is that whatever that that as you get fat or there's something about the condition of being fat or maybe the the inflammatory molecules released that increase the risk of other diseases and the alternative causality would be to say that whatever makes you fat is the same thing that causes these diseases just some more simplistic causality and we'll get to that in a second but what it means is all of this talk is called why we get fat it could be called why we get sick because I'm positing that whatever it is things whatever it is that that that causes obesity also causes these metabolic diseases both directly and through obesity so here's the conventional wisdom you could used to be you could rather you could probably still find a line like this uneffective Li every on how public health website the world the reason I'm copy adding that now is because the Centers for Disease Control in the u.s. recently stopped including this line which I considered somewhat of a victory so the fundamental cause of obesity and overweight is an energy imbalance between calories consumed in calories expended so by that thinking obesity is what's called an energy balance disorder that's the technical terminology sub calorie then are greater than calories out and that's why we get fat and short form as we Aubry biblical terms for this would be gluttony and sloth and you know I wish that wasn't so resonates but basically we're still working on a biblical theory of the disease um okay so one of the things I want to do in science the key thing you want to do in science is you want to explain what you observe okay either in nature the laboratory and of the creation of the universe I'm one way the other we observe things and we want to explain them what we're observing now is the obesity epidemic so we want to take this overeating hypothesis this energy balance hypothesis and explain the obesity epidemic and the way we do it is we say that increasing prosperity makes people you know gives a greater access to energy dense food another definition is a toxic obesogenic environment by the way increased prosperity one of that your Dean's who introduced this remember said obesity is a problem both in the richest societies and poorer societies so right there you would start questioning whether or not prosperity has anything to do with it but this idea of a toxic obesogenic environment then we have to define obesogenic environment this how kelly brownell who's now Dean of the Stanford School of Public Policy at Duke did it a few years ago we should cheeseburgers and french fries driving windows and supersize and soft drinks and candy potato chips and cheese curls once unusual they're much our backgrounds trees grass and clouds few children walk or bike to school there's little phys-ed everything conspires to keep our children inside certainly my kids succumb to all of that stuff so basically there's all these factors that drive up consumption and drive down expenditure and you end up with a hypothesis that looks like this so too much food too little physical activity leads to overeating energy and greater than energy out and the result is obesity in the obesity epidemic that's the gist of the conventional thinking and by the way I'm talking fast because I have a lot of ground to cover so I'm both trying to sell you something which is why I'm talking fast but I'm doing it for a reason okay how many of you generally believe that this is true okay no you don't count calories but you generally believe that this hypothesis is true that the reason people get fatter is they take in more calories than they expend for all this okay so fewer like 10% I could have given my sugar talk um it's a hypothesis okay like anything it could be absolutely fundamentally true but the way I approach is eventually I didn't even approach it like this I stumbled on the fact that this is a hypothesis clearly it is might be a true one and you can ask a question with any hypothesis is a true okay and the funny thing is it has a history it's not passed down on tablets you know like the ten commandments to heaven history and when you go back in the literature dates back actually the early 20th century and a German diabetes specialist named Karl von Jordan and then it was promoted by Louis Newberg an American physiologist and researcher at the University of Michigan and it's based on the laws of thermodynamics clearly um it comes out of the 1880s after physiologist demonstrated that the laws of thermodynamics hold true for humans as well as inanimate objects and then in 1890s he's two American scientists showed the thermodynamics holds true for humans it pioneered the science of calorimetry and the energy going into people could be measured for the first time ever and they started doing it and we started focusing on you know calorimetry is is a word that's obviously based on the same route as calorie so we started focusing on this energy idea and in the 1901 Norden of our 1903 1907 declared that caloric imbalance was the cause of obesity the way he pudding said the ingestion of a quantity of food greater than that required by the body leads to an accumulation of fat and to obesity if you keep it up okay then Louis Newberg took it over in the 1920's 1930's and became an effective leading authority of deleting the most influential authority in the US on obesity and Newburg had one revelation that really drove his work and it was based on the work of a German researcher named Hilda Brooke who will come back to him but the revelation was that all obese persons are life in one fundamental respect they literally overeat okay that's true and therefore if obesity if all obese people are oh breathe and obesity is caused by what Luber called either perverted appetite even too much or lessened outflow of energy insufficient expenditure so you have this balance between calories and in calories out and it looks like this so the focus of attention is a full body more energy comes in less energy goes out the body increases in mass you get fat okay the problem with this so which is how much you reading how much you exercise you basically determine their behaviors okay so the question was always why don't know these people compensate by eating less or exercising more you can do that you can decrease your intake and increase your expenditure now under conscience control a new bargain I included his photo I couldn't resist okay I I don't believe somebody who looks like this can understand human obesity and I'll give you a metaphor I have male friends who are obstetricians and have delivered thousands of children babies and I don't believe they can understand childbirth as well as one woman who's given birth okay until you've actually understood what it means to get fatter day in and day out regardless of how much you eat and exercise you don't know what it is you're trying to explain okay remember science is about observing and explaining if you're observing your own struggles with weight you're trying to explain something different than if you're observing other people's okay because if you're observing other people you could say they suffer from various human weaknesses such as overindulgence and ignorance and you think you've solved the problem so what you've done is you take a physiological defect in the body and you've turned it into a mental character issue ignorant self-indulgence gluttony and sloth okay and then you could say simple things we can look for counter examples that's what you do in science when you have a hypothesis the first thing you do is are there any obvious examples of populations or people circumstances can we create an experiment something to refute our hypothesis black swuan and as it turns out in the literature I'm the only person to accumulate these studies and I hate to keep repeating that but I have to justify why a journalist is talking to you about this you can go back in the data and find populations that had very high levels of obesity okay a lot of them were native Aboriginal populations and that had none of these toxic obesogenic characteristics that Kelly Brownell describes they were incredibly poor population the 1928 to this was immediately after a government study in 1927 of the conditions on the Native American reservations in the u.s. in which they said they were unimaginably poor and yet 40 percent of the women and 25% of the children were distinctly fat on this population and this is a coexistence of obesity and malnutrition the same population on that today is referred to as a double or dual burden of obesity and malnutrition and then the question becomes and you can go down in all these populations where you see in 1961 63 and Trinidad there was a health crisis in Trinidad the US government sent a team of nutritionists down to check it out and they come back and they report that a third of the women over 25 or obese and that obesity is a potentially serious medical problem this is 1961 on and yet the next year they sent it an MIT nutritionist went down to quantify the diet being consumed and reported that these people weren't even getting as much food as the FAO was suggesting was necessary for a healthy diet banned to pensioners in South Africa 1964 this is the poorest of addition franchise black population in South Africa in the midst of the apartheid era and the mean weight of women over 60 is 165 pounds and 30% are seriously overweight how did they get there if what they have to do is eat too much so the shorter is short coming to the energy balance hypothesis they're easy to find if you go looking for so for starters are feeding too much causes you to gain weight you should be able to eat less and lose the way okay today your weed reports about what happens when the biggest losers try to lose 400 pounds and how that affects their metabolism but they weren't always 400 pounds overweight at one point they're only 10 pounds overweight or 20 pounds overweight er for the rest of us that we recognize our belts too tight we're 5 pounds overweight why can we stop them why can we eat less and reverse it then before any metabolic problems have come in and yet when you do these assessments of calorie restricted diets you find that they just don't work that was first pointed out in a clinical report in the late 1950s but it was clear to anyone who studied obesity till the book who I mentioned through the German pediatrician came over in the u.s. in 1933 as many German Jews did and she was walking around the streets in New York in 1934 stunned by how fat the kids were in New York City tonight just fat but roly-poly fat kids in 1934 and the very single worst year of the depression and so she started the first obesity clinic at Columbia in the pediatric obesity clinic in the world at Columbia University in 1957 she wrote this very thoughtful book the importance of overweight and she talked about why eating less doesn't work and she said this more than any other illness the physician is called upon only to do a special trick to make the patient do something stop eating after it's already been proved that to not do it every obese person those are supposed to eat last having a doctor in a white coat tell you or a dietitian tell you doesn't change their inherent knowledge if there's still obese means that eating less failed the other problem is exercising more doesn't work okay and this has been documented in clinical trial after clinical trial and I could show you the meta analyses I find this statement more compelling okay in 2007 the American Heart Association the American College of Sports Medicine wrote joint physical activity guidelines and these are people who think we should all be physically active as do i and i think we should all do what you guys just did okay and you'd expect them to spin the data to make that point as strongly as they can but instead this what they say it's reasonable to assume that persons with relatively high daily energy expenditures would be less likely to gain weight over time compared with those with low energy expenditures the equivalent of saying it's reasonable assuming that I have a couch potato and I become a marathon runner I'm less likely to gain weight over time than if I remain a couch potato and they say so far data to support this hypothesis are not particularly compelling this hypothesis is 100 to 150 years old so the point is it doesn't mean it's not true might be maybe we never did the studies right we didn't do enough exercise or enough you know who knows but the point is if after onion 50 years the best you could tell you about a hypothesis data support are not particularly compelling to put a good chance the hypothesis is wrong so now let me give you a different way to think about this i'm imagine well you guys being fed five times today did you know that imagine and the invitation to come here not only you're being fed you're being fed by some of the best chefs young Chefs in toronto okay so imagine in the tension that you were told you're going to be fed four to five times today and it's going to be enormous amounts of food the likes of which you've never seen course after course after course of a veritable feast bring your appetite come hungry what would you do to make sure that you got you're hungry you would work out okay there used to be a concept called building up an appetite remember that that's what you did when you worked out what else might you do eat laughs the day before or that morning you might also say geez George Brown University is only seven miles from where I live I think a walk because I'm going to build up an appetite the two things that any normal human being would do to assure that they get hungry eat less and exercise more the two things we tell obese people to do to lose weight there's something wrong with that right there that that begins to tell you we may have a failed paradigm on our hands okay here's another problem energy imbalance okay we're all about calorie balance the CDC tells us in the u.s. at Weight Management it's all about balance balancing the number of calories you consume but the number of calories your body uses and burns off how many you when you go to the gym or do the little exercise you just did think about how many calories you're burning like if you get on one of those machines you look at the calories thank you um okay so what does this mean that's the question I'm going to show you what it means I'm going to use an analysis that was done in 1937 that I first saw by Eugene Dubois who is a leading expert metabolism in the United States pre-world War two and he did this calculation for the very same reason I'm doing it okay to discuss the concept this concept okay so a typical adult food intake in the u.s. around 2700 calories a day that's average men and women okay that's about million calories a year it's about ten million calories in a decade it's about ten tons of food over the course of a decade now we want to answer question how carefully do we have to balance calories into calories out so we don't gain any more than two pounds of fat a year we gained two pounds of fat a year that's 20 pounds in a decade okay that's 40 pounds between your 20s and your forties you'll go from being lean in your 20s of obese in your 40s unless you cannot do so what does that take you got to balance calories into calories out there 21 calories a day let me rephrase it this way if you store 21 calories a day in your fat tissue that you do not burn you will gain two pounds a year here's the calculation it's probably eighth-grade math I actually think my sixth grader he should be able to do it but I can't swear like that's why even I'm getting a tutoring the some 20 calories a day times 365 days a year times 10 years divided by 3500 calories per pound of fat was the reasonable estimate of 21 pounds in a decade okay it is 0.8 percent accuracy not that it matters I'm a big guy let's say I ate 3,000 calories a day okay and I'm going to say that comes in 20 calories a day is a bite of food so that's 150 chews of bite swallows of food you know blood fluids and and foods if I burn off or excrete a hundred and forty-nine of them and 150 it ends up in my fat tissue I am destined to become obese okay that's then you're telling me how do you avoid that hundred and fiftieth getting there if that's all it takes okay this is what Dubois said about this he worked out this calculation and he said considering this there is no stranger phenomenon than the maintenance of a constant body weight under marked variation in bodily activity and food consumption how do we do it I mean maybe you can do it you can argue that we do it because we look in the mirror we see we're getting fatter so we understood so we basically or our pants start getting tight so we oscillate between weight stability weight maintenance and you know gaining and losing but remember even though these people are in weight maintenance they are balancing their calories into their calories out they're not gaining weight they might be 50 or 100 pounds overweight they're not continuing to gain two pounds at some point you reach weight maintenance how do you do it if your requires and effect perfect energy balance it's a crazy concept how did we ever get here okay so now I'm going to show you some photos of naked human beings for which I apologize these photos come from pre-world War two textbooks okay pre-world War two something I didn't realize prior to my research the best medical science in the world was done in Germany in Austria and the lingua franca of medical science was German if you wanted to be a serious researcher you had to read German and ideally you spoke German as well so you could go to Germany or Austria you could intern or study with these hair professor doctor types would basically pioneered every field of medicine that was relevant to obesity so nutrition metabolism genetics product of these endocrinology they all grew up and matured in Germany and Austria these were the best scientists in the world okay just as they weren't physics if I asked you to name five famous physicists from the 20th century they would trying to be people like Einstein inch open our and Heisenberg and plunk all gern all Eastern Europeans basically that's where science was honed to a fine edge so and they were interested in obesity clearly and they thought well what's interesting if you look at obesity just BMI and you say somebody's obese if they have a BMI over 30 you don't really know much about it you have no no idea they could be muscular they could be lean they could be fat here they could be fat here you don't know when they got fat you don't know where they got fat so they were interested in all those questions because they were interested in observing things about obesity so they can understand how to explain what they were observing a viable hypothesis so the first thing they said is look look at genetics we know that obesity is a huge genetic component in part because the identical twins they'll just have the same faces they have the same bodies so here's a lean pair of identical twins and an obese pair of identical twins and the lean pair their fat distribution is virtually identical they apparently also practice perfect energy balance and the obese pair well they're a the fat accumulation is also identical so what controls that maybe they took in more calories and they expanded surely they did to accumulate that excess fat but why is their body fat go to the same places what do the calories have to do with that how does the hypothesis of obesity and energy balance disorder explain that in any way how does studying how much they even exercise explain that in any way what am I doing wrong one too many controls you can ask the same question with animal husbandry okay you can use this is another example so on the left is a lean breed of cattle the Jersey cow it's a dairy cow you could see the swollen udder in the photo on the right is a meat count an Aberdeen Angus and you can see it's a big fat bulky stocky animal and it's got a lot of fatty accumulation in the meat and you just ask this question we know it's genetic there's are different breeds right what controls why this animal stocking this animals lean that how much they exercise that the genes determinate that maybe the Jersey likes to go for jogs when it gets dark at night the Aberdeen Angus does it and watches TV the Jersey take smaller bites or chews more mindfully let's think of a different thing I mean this producing milk is very expensive okay then the energy expense if it takes an extraordinary amount of energy to do that so maybe the genes that determine this maybe this animal has been bred such that the energy that comes in gets directed to the honor to produce milk and they you don't want it accumulating here is protein and fat because all you want out of this animals milk where's this one you do want it accumulating so maybe these genes are genes that determine how we partition fuels how we use the fuels we take in so it's not about how much we take in or expend it's how we use it what Rob said earlier times that you are and what you eat you are what your body does with what you eat so maybe in this animal the body takes the galleries and turns it into milk and there aren't enough how we reason about that it's not trying to accumulate when fattened code maybe this animal is trying something different so we can look at sexual variations men accumulate fat above the waist this is a apple-shaped obesity women accumulate galleries below fat below the waist this man doubled his risk of heart disease by getting fatter above the waist this woman did not what are the calories have to do with it what does this energy balance idea tell us about I want a hypothesis of obesity that could tell us why the fat went here on him and there on her okay I mean that would be a nice thing to explain there are other there localized fat distribution skatopia and in African tribes women okay this woman will accumulate that fat regardless of how much she to exercise I would like to hypothesis it tells me why because it's not just obesity I want a hypothesis of adiposity why where when puberty the question of when okay so boys and girls enter puberty with roughly the same amount of body fat as they go through puberty they both did bigger and heavier so they both exist accumulate body mass they're clearly taking in more calories and they're expending what's interesting is the boys lose fat and gain muscle and the girls gain fat making that in very specific places girls get fatter in puberty always get more muscular in puberty what does the caloric intake and expenditure have to do with that fact if I ask you to explain why that girl got fatter and why she got fatter in very specific places that perhaps may have been carefully crafted by evolution to drive the boys crazy what are the calories have to do with it there's a guy energy balance hypothesis give us any answered that question clearly it's dominated by hormones I got taller because they were secreting growth hormone stimulating info like growth factor the boys blonde fan gain must home because of the action of testosterone primarily and that's why they become unreasonable and insane and the growth ain't fad gained in a very specific places because of the way that cells in those places respond to the female sex hormones how much they exercise irrelevant fact I'll probably do this even to the point of starvation you can inhibit it with starvation but that's not all you can say okay so why do we believe this answer is physics I told you it two laws of thermodynamics this is considered you know the god this is God's rule to you know people who study obesity the first law of thermodynamics it's the only one that's easy to understand which is a blessing because the other two are difficult um don't be is the energy stored in a system and they're basically just a law of energy conservation so you've heard this as energy can neither be created or destroyed it can only change form so out of this we get this very simplistic idea that's a Delta II the amount of energy in a system is equal to G and the energy in the system minus the energy that goes out of the system and we in a health and obesity we say Delta G is fat mass a change in fat mass is equal to the energy consumed minus the energy expended which may or may not be true but this is certainly true it's God okay it's like saying that a room gets more crowded because more people enters and leave okay it's just it's you know you make more money you get richer when you make more money than you spend okay that's what that rule says the problem is there's no arrow of causality here and we turn this into an arrow of causality so we say if you know if somebody eats more and they don't exercise more than delta e goes up there for causality eating too much causes obesity and some of the exercises less and does it rain in their appetite therefore delta e goes up so we add a causality that doesn't exist and we end up with this idea that changes in intake and expenditure cause changes in fatness to narrows this is how is all my year put in 1954 said obesity too many people believe is explained by overeating actually it should be recognized if it's simply restating the problem in a different way and reaffirming somewhat unnecessarily one's faith in the first law of thermodynamics to explain obesity by overeating is illuminating a statement as an explanation of alcoholism by chronic over drinking I can imagine if I was giving a lecture today on wealth accumulation and you said dairy you know why do people get how do I get rich and I said how did Bill Gates get rich and I say well we took in more money than he spent have I told you anything meaningful I mean Warren Buffett took in more money than he spent also and he got rich an entirely different way and I taken more money than i spended I'm not rich what if I was giving a lecture on climate change another vitally important subject and you said very wise amis fear heating up and I said because it's taking in more energy than it expands I mean clearly it is and yet that's not an explanation that's a statement of a fact if it's taking more energy than it explains its got to be heating up and vice versa okay this idea that taking in more calories than you expend is because of obesity is nonsensical it wolfgang pauli a famous theoretical physicist also from Eastern Europe would have said it's not even wrong that's how bad it is and this is the fundamental fact of our nutrition science ok all of nutrition science is based on this simple fact that makes no sense whatsoever another pali ism was to call something spherically senseless it was makes no sense no matter what direction you look at it we need an explanation if somebody is getting fatter they're taking in more calories than they expend that's what that was the Newberg's revelation they literally overeat they are literally taking in more calories than they expend but that tells you nothing about why they're getting fatter tells nothing about when into getting fatter where they're getting fatter why they're taking in more calories than they expend which what we want enough the fact that they're taking more calories than they expend is just another way of saying they're getting fat unless they're growing which case are still taking more calories but that's not overeating or getting more muscular in which case or take so you can see the problem so there is an alternative hypothesis this cou had history okay in this alternative hypothesis it starts with a first principle okay I know about first principles cuz Hannibal Lecter told Clarice and silent for the Rams that Margy so I really thought you should begin with first principles I couldn't actually find it Marcus Aurelius so I quote Hannibal Lecter obesity is sort of excess fat accumulation okay if you see somebody in their obese that's the UM know again which they either exercise you shouldn't even care how much they your exercise I'll track you down me and raw both obesity is the sort of excess fat accumulation described it what you see no assumptions okay and if it's a disorder of excess fat accumulation it's not necessarily energy balance or overeating or sedentary behavior those are all assumptions but if you start with that single sentence you ask the question what regulates fat accumulation I mean if your doctor you should thank you I wonder what regulates fat accumulation by this hypothesis over eating an activity or compensatory effects are not causes and we don't get back to the ovary we overeat because our fat tissue is accumulating excess fat and I'll explain both of these so we switch the direction of causality by then I mean the first law of thermodynamics says that change an intake and expenditure will change body mass fat mass the causality goes this way and in our alternative hypothesis it says the bondage of mass storing the human body is very well regulated just like everything else is like your blood pressure or in your you know heart rate and you have to dis regulate this to get fatter and if you dis regulate it you will get changes in intake and expenditure because you have to the laws of thermodynamics tell us at stroke so here's an analogy and a thought experiment that I'm going to give you just to think about so this fellow right here in the photo karl-anthony towns at the time as a senior at the University of Kentucky was predicted to be the first number one draft in the end of the NBA Draft this year he was drafted by the Minnesota Timberwolves he's now a young superstar there's an article about him in the New York Times that described the growth spurt he went to when he went to high school so they just never seemed to be enough food to safety a town this growing body after school he would eat a footlong sub before his mother's home cook dinners even after having a happy lunch of homemade chicken rice and vegetables and his favorite snacks where nola bars and bunch of crunch I'm gonna go broke my kids do it okay in technical term for this is hyper fascia okay this kid had an enormous appetite now what's interesting is karl-anthony grew to be 7 feet tall 250 pounds he was going through a growth spurt so his BMI was never 25 he never got even really too overweight so we want to understand his growth spurt and his hyper Faiza but we know is all that hunger came because he was growing right we have praises for that my teenage kid ate me out of house at home or they load it light around the house saw that growth causes changes in appetite okay so karl-anthony towns was growing when he was in high school we ate all the time I created in the thought experiment I gave Carl Anthony a fraternal twin brother Anthony Carl within quite rows hi Anthony Carl was 6 feet 250 okay so he was a foot shorter but the same way which means he was in exactly the same amount of positive energy balance as his brother Carl Anthony but with and so he probably ate the same kind of food he was probably just as hungry in high school but yeah with Carl Anthony we switch Anthony Carl we switched the causation so here we assume that he got fat because he either ate too much or exercised too little so here's Anthony Carl growth causes change in intake and expenditure Carl Anthony changes it intake and expenditure caused growth there's absolutely no reason to do that and I challenge I've given plenty of talks in medical schools have challenged physicians to find any other example in nature or in the medical textbooks where growth actually is caused by changes in intake and expenditure rather than vice-versa or to that effect any other condition in their medical textbooks where they would defer to physics for the solution rather than medicine okay so here's the alternative hypothesis it had a history of the German Austrian hypothesis pre-world War two that primary proponents were Gustav von Bergman it was a leading authority in clinical medicine in Germany prior to World War two today v one of the most respected Awards of the German society of internal medicine is the Gustav von Bergman metal and then Julius Bauer who was a pioneer in the field of endocrinology and chronic disease at the University of Vienna in Austria one of the great universities in the world prior to World War two here's how Bauer described this theory so he used the term lipophilic which meant a love of fact the ideas that some tissue is lipophilic and other tissue is and some tissue wants to accumulate fat and other tissue doesn't or we don't accumulate fat on our foreheads to the back of our hand but we do accumulate fat elsewhere and we all know where those places are and they're different on everyone we is that like a malignant tumor like the fetus uterus of the breast of a pregnant woman the abnormal lipophilic tissue tissue that wants to accumulate fat seizes on foodstuffs even in the case of undernutrition so even if somebody's trying to eat less or a population is malnourished and lacks food you could still have its fat tissue trying to seize on foodstuffs just like a good tumor would and maintains that stock may increase it in depending the requirements of the organism a sort of Anarchy exists the adipose tissue lives for itself does not fit into precisely regulated management of the whole organism a lipoma tough subject may die of starvation and still were pain the poem at dis meaning you can take a fat person and starve them to death before you will turn them into a lean person just like you could take a basset hound and start with the death before you'll turn into a greyhound Eric Graf who wrote the seminal textbook metabolic disease in their treatment this was a German textbook in the early 1930s Eugen du Bois asked Graf to write an English version because we had nothing like that in the back waters of North America Graf was a Branagh famous clinic at wurtzburg he described this hypothesis as a condition of abnormally facilitated fat production impeded fat destruction a sort of little collateral mitosis Universalis in the sense that the little filly and certain tissue tissues is primary the sparing in the energy expenditure is secondary it presupposes over nutrition if somebody's body is regulated to store calories as fat they will by definition take in more calories and they expand because their body is getting bigger the question is how they'll do it it's a good working hypothesis Russell Wilder was the leading authority on diabetes and obesity at Mayo Clinic pre-world war ii during World War two he went to become the first director of the food nutrition board in Washington he said the effect after meals were throwing from the circulation even a little more fat than usual might well count both for delayed sense of satiety for the frequently abnormal taste for carbohydrate encountered and obese persons a slight tendency in this direction would have a profound effect in the hope of course fine remember 20 calories are dead all you have to do is have a dysregulation that stores 20 calories a day and you end up with obesity this hypothesis deserves attentive consideration Walter said you Veroni was Hungarian endocrinologist who came to the u.s. in the 1920s wrote the first monograph on obesity and leanness in the US and 1940 said this theory was strongly supporting the theory which is now more or less fully accepted chiefly in Germany by a number of leading investigators and then it vanishes okay the war comes it's a German Austrian hypothesis the lingua franca of Medicine is German pre-world War two post-world War two we have a society of young doctors and nutritionists and others who have very good reasons to not like the Germans and Austrians and don't want read the German and Austrian literature this hypothesis literally vanishes you can see it happen in the literature so Bauer a German Austrian Jew fled to the US in 1938 and in 1941 he wrote an article on obesity and the annals of internal medicine in which he basically ridiculed Newberg's hypothesis using a lot of the thinking I did today for how nonsensical this energy conception was and explained why obesity had to be a hormonal regulatory disorder and his paper was published 10 was cited 10 times by 1941 and then never again until my books came out 40 years later 60 years later Newberg Louis Newberg in 1943 wrote a response to Bower that ridiculed Bowers hypothesis and Newburg theory became the basis for all thinking that follow ok you are literally watching a paradigm dying and it's dying in the midst of World War 2 in part because it's a German Austrian hypothesis the interesting thing is if you look at animal models of obesity there dozens and dozens and dozens virtually all of them support the new burke hide the bauer hypothesis oh john my year was a leading nutritionist in the US by the 1960s when he's in the nineteen fifty be studied it'll be strain of mice and he said these mice will make fat out of their food under the most unlikely circumstances even when half starved this is true of all these obesity models you can have starved these animals and they will die with their fat tissue mostly intact ok they don't get fat because they eat too much they get fat and stay fat if they eat at all eating too much has nothing to do with it so if obesity is a sort of excess fat accumulation a hormonal regulatory disorder the question is what regulates that accumulation that's what we should have been asking for the past 70 years ok unfortunately we couldn't figure it out until the 1960s we didn't have the technology available the Germans and Austrians didn't have the technology available to understand the hormonal regulation of fat tissue because we could measure hormones in the bloodstream until 1960 with the discovery by Rosalyn Yalow and Solomon version that later one yellow the Nobel Prize and was um discussed by the Nobel Committee and basically revolutionising the whole science of endocrinology so yeah it's a simple question okay what we want to know is why fat cells get fat okay and so here's a diagram of a fat cell with a cell membrane and you could ants here's where the laws of thermodynamics come if more energy goes into the fat cell then comes out the fat cells clearly getting fatter so the question is what regulates it the conventional wisdom is somehow too much energy floats around out here and it kind of floats around through here and it kinda ends up in here and that's why you get fat but in the 1960s this was all worked out very carefully and what we know is that fatty acids come to the bloodstream it's triglycerides in lipoproteins like LDL cholesterol the same you know LDL we worry about perhaps incorrectly in heart disease on their enzymes on the cell membrane lipoprotein lipase --is that reach into these l DS lipoproteins break down the triglycerides into fatty acids which is absolutely carefully the fatty acid it's smaller than the triglyceride so the fatty acid can actually pass through the membrane of the cell get into the fat the fat cell itself and then in the fat cell it's called its terrified glycerol molecule is attached to the fatty acid and you end up with the triglyceride and we store fat as triglycerides because triglycerides are bigger and they can't get out of the fat cell and if you want to get the fat out if you want to use it you have to break the triglyceride down into the component fatty acid and glycerol and we have these other enzymes called hormone sensitive lipase is primarily that do that job so all of this was worked out in the 1960s so in effect anything that works to get fatty acids into the fat cell and ass terrifying this triglycerides works to make the fat cell fatter and so you fatter and anything that works to break down the triglycerides into fatty acids then get them out so they can be used for fuel out here works to make you thinner okay it's pretty much that simple and again it wasn't work down to the 1960s but by the 1960s Newberg thinking it so infected the field honorable B city resources being done by mostly by psychiatrists and psychologists who are trying to alter the behavior of the fat person and the chronologiste didn't do this work so you didn't care so what happened is you had this disassociation of science where the textbooks would explain why a fat cell gets fat but it wouldn't be relevant to why a human gets fat no I'll show you that a second - so by 1965 yellow and Burson with their very first papers with the radium in OSA studied what was going on with fat cells and they had established that the hormone insulin is a principal regulator of fat metabolism and here's a graph a diagram from a 2010 textbook by the leading authority on fatty acid metabolism in the world keyframe and it shows fat storage and fat mobilization what regulates it it's insulin insulin insulin insulin insulin and then other hormones a little bit here's the same thing if you want to suppress the mobilization of fat from fat tissues if you think of obesity is a fat trapping disorder such as getting more in it's getting less out again at insulin insulin insulin and as Alan bersin said release of fatty acids requires only the negative stimulus events and deficiency from a biological perspective instead of a physics perspective if you want to get fat out of a fat cell you've got a lowering okay and then the question is how do you do that and if you want to get fat stuck in a fat tell you elevated when it happens and among other disorders is type 2 diabetes so insulin is a fat storage and mobilization it's just an illustration in the 2001 textbook on this a woman who had type 1 diabetes and she's diagnosed at 17 over the next 50 years she gave 49 years she gave herself her insulin shots in the same two spots in her thighs and she ends up with these huge fat deposits and this photo was used to illustrate a box on insulin and fat storage because the overall action of insulin on the fat cell is to stimulate fat storage and inhibit mobilization the argument is we've been doing to ourselves that this woman did to her thighs for the last 50 so here are the key points of fat cell regulation when insulin is secreted a chronically elevated fat accumulates in the fat tissue that's textbook science it's an endocrinology textbooks and biochemistry textbooks when insulin levels drop that escapes from the fat tissues that Depot shrink and that's textbook science also and we secrete insulin primarily in respond to the carbohydrate content of our diet okay so that's all textbook science and you end up with this George Cahill was one of the leading authorities used at Harvard in the 60s he edited a textbook on this science in 1965 and as he put it to me said carbohydrate it's driving insulin is driving fat so this is textbook science if you take out these three words is driving insulin you have the logical equivalent carbohydrate is driving fat but now you have classically named the Atkins diet now a calorie is no longer a calorie now there's something unique about carbohydrates at dry fat accumulation textbook science textbook science textbook science textbook science remove these three words and you're exactly that's why I didn't even use the word carbohydrate until now because when I talk to medical schools the doctors are with me and with me and they're thinking how thoughtful I am and thought-provoking and I get to that sentence they're like oh my god it's jack and diet he snuck up on me he's a cat how did you get there Jesus it's not acceptable okay so here's the textbooks I say this Lenin Jers principle of biochemistry it's the leading the most authoritative biochemistry textbook we used in US med schools you look up a dipper sign the the the the index you get one makes fat cells fat high blood glucose which you get from eating carb rich meals or being type two diabetic elicits to release of insulin which speeds the uptake of glucose by tissues favors of storage of fuels as glycogen that's a storage form of carbohydrates and triglycerol while inhibiting fatty acid mobilization adipose tissue what makes fat people found they eat too much these are two different paradigms they're two entirely different paradigms and yet this one is so overwhelmingly believed and so powerful and seems so obvious that people never ask themselves wait a minute this is a different idea entirely okay den dem dis pointing this out this is an article from science magazine 2011 on human fatty liver diseases so this is a patent scientist a liver cell when you ask the question why do her parasites get bad you see carbohydrate intake increases glucose and insulin which activate transcription factors in fluent in hibbott lipolysis in adipose tissue by suppressing so we care when we talk about liver cells but we talk about fat cells we're into the gluttony and sloth idea because that paradigm is too powerful so here's the alternative hypothesis like any growth defect any growth defect obesity is a hormonal regulatory disorder like type 2 diabetes it's fundamentally the sort of insulin signaling type 2 diabetes and obesity are so closely associated that you know people call them diabesity and we don't care we know that a lot of things are going on in diabetes it's a very complex disorder we're willing to discuss it as an insulin signaling problem maybe oh diabesity is too and it's triggered by the carb content diet now not all carbs we don't have to get scared here um bread sorry away from these are high glycemic index highly processed carbohydrates um they elevate glucose very spontaneously when Katyn began at University of Toronto phrase hihglight high GI you know the fact that these will simulate insulin secretion and at the base of the food guide pyramid we told people to eat them 6 to 11 times a day so just a reason why there's an obesity epidemic and then sweets sugar um by the mechanisms that Rob talked about earlier these are actually two different mechanisms for the most part by which these work although related and green vegetables very low digestible card content fruit unless fruit o philic and Rob is but we're not talking about that we're talking about bees and sweets is the cause of obesity so here's the alternative hypothesis we're fine grain starches and sugars dysregulated so in signaling the result is excess fat accumulation obesity in the obesity epidemic and the fact also than diabetes and all the diseases that associate with it um implications the answer question how you get thin by the conventional wisdom you eat less and exercise more how do you get thin decrease excess adiposity but if you pay attention to the biology and the endocrinology you remove the fattening carbohydrates and you lower insulin and then just some hiss more history it turns out that from basically 1820 to nineteen mid-1960s carbohydrates were considered uniquely fattening okay from the practice of medicine written and i farinaceous is starchy and vegetable foods are fattening saccharine matters sugar especially british journal nutrition 1963 this is an article co-authored by one of the two leading dietitians in the UK first sentence every woman knows that carbohydrates are fattening this a piece of common knowledge which few nutritionists would dispute and then we decide that dietary fat causes practicing it and we put the country on a low-fat diet if you're going to take away the fat you replace it with carbohydrates and hence the 6 to 11 servings of high GI carbs in the food guide pyramid okay so you take a food that was unique considered uniquely Fanning and then up until the 1960s and you turn into a heart-healthy diet and if you go back and you look through the literature which I did you could find diets for obesity published by medical schools in the late 1940s early 1950s I found four of them from pretty good medical schools Cornell Medical School Harvard Medical School Stanford Medical School and Russian Chicago they were all identical to Raymond Greene's diet for obesity in the practice of endocrinology Raymond Greene was a brother of Graham Greene he was the leading endocrinologist in the UK this was the diet foods to be avoid bread everything they were shower cereals potatoes all white food vegetables foods containing sugar all sweets you can eat as much as you like the following foods meat fish birds all green vegetables eggs cheese fruit except tanana's with the exception of some of the fruits this is the Atkins diet published by four major medical schools in the United States and the leading endocrinology textbook in the UK and what each has you seen only percentages I don't say you need seventeen percent of your food from this and twelve percent from this and wood blah blah blah the ideas these are fattening don't eat them you avoid these are not fattening so you could eat as much as you like and they didn't realize this because yellow and Bernstein hadn't come along yet they didn't realise why those might be fattening and why those might not be fattening but once the 1960s came along the prime suspect would be these are family because they stimulate insulin secretion a lot of it they keep insulin elevated and so your body storing fat res and oxidizing these are not fattening let's get that okay I'm probably waiting weigh on way too long so yes I did okay I'm just going to say well at once came along Atkins came along published the best-selling book in history outsold the Bible for a few years his low-carb diet - the American Heart Association decided they had to put a stop because they were legitimately afraid that a high-fat diet so you get rid of the carbs you replace it with fat saturated fat you eat all those animal products it's the double cheeseburger and bacon it's Rob's 1400 calorie a day of that burger from Arby's burger without the bun gotta kill you they were worried they were worried I talked to these people they were legitimately worried so they write a critique of Atkins died and they say fat is mobilized but insulin secretion diminishes and yet low-carb diets which were to diminish insulin our bizarre concepts of nutrition that should not be promoted that was the end result they wanted to get rid of back and they threw out both the baby which was at bath water which was Atkins and the baby which was the science of endocrinology by the end of the 1970s and I documented this in my first book you can actually see this happen in the conferences the regulation of fatty acid metabolism the human body was rendered irrelevant to a disorder of excess fatty acid accumulation in order that we could not eat fatty foods because they were afraid and because a lot of thin people who ran the field thought that people got fat because they were gluttons and sloths um thank you very much I may have taken up time for questions about a man [Music]

Channel: The Centre for Hospitality and Culinary Arts at George Brown College

Views: 66,615

Rating: 4.7097793 out of 5

Keywords: gbcans, nutrition, ambition-nutrition, gbc, Centre for Hospitality and Culinary Arts at George Brown College, chca, health, wellness, healthy eating, healthy food, diet, healthy diet, ambition nutrition, ans, gary taubes, science, research

Id: u3fk0ZjkTf4

Length: 61min 24sec (3684 seconds)

Published: Mon Sep 11 2017