(Part one of my review of Why We Get Fat and What to Do About It by Gary Taubes is here)
This is what I want out of my culinary lifestyle:
Above all other concerns, it has to keep me physically healthy, so I can feel good, stay active, get my stuff done, and maintain my weight. This is the natural purpose of food, so I have no problem putting it above every other desire in importance. But as long as I can get this, I have other desires:
- I want to enjoy a variety of tasty, real, unprocessed food.
- I don't want to feel dependent on eating large quantities of food; I want to eat lightly.
- I would like to have at least a little bit of foods that make me happy even if they are biochemically not so good for me.
- I don't want my family to consume a whole lot of meat.
- I want to be a gracious dinner guest, accepting some (if not all) of what's offered me. I don't want to require special treatment.
- I'd like to save money and preparation time.
- I want to be able to eat a meal in any restaurant whatsoever without resenting the choices.
- I want to obsess less about my diet.
These are not universal values. Some of you might pipe up: "Well, I'd like to grow as much of my own food as I can." Or: "I don't want to eat any meat at all." Or: "You'd like to save money in an abstract sense, but me, I have a food ceiling of $80/week." Or: "I love to try new restaurants and want to do it as often as possible." Or: "I have to have chocolate every day."
If you peruse the list of culinary desires, including the first one, you should notice one thing: I cannot satisfy all of them. The more I emphasize one desire, the more I must compromise with another. For example, the more I diversify the foods I eat, the more money I probably spend. The less processed food I buy, the more time I spend preparing food. The more-freely I eat in restaurants and the more I accept what the hostess offers me, the less control I have over things like sustainability and healthfulness.
Another thing you should notice is that some of these desires require effort. It feels good to eat food, and eating lightly requires that I stop before I might like to. It's easy to plan dinner around plenty of meat, and so using less requires me to work harder. It feels good to eat a large piece of cake; it's harder to stop after just a small one.
So my desire of staying physically healthy, even though it has primacy, has to be satisfied in context. I must also strike a balance among a number of other values in tension with each other and sometimes even in tension with the primary goal. And I must do it in an environment where there are many temptations to act contrary to my desires.
A really comprehensive diet book can't tell you what your own values are, of course, but it will promote some of the author's values and show you the tensions that exist between those and other values you might have. A really comprehensive diet book will devote some attention to strategies for balancing contrary desires, i.e., for living your life within the constraints of the eating plan: a chapter of suggested restaurant orders, advice on living with diet-sabotaging relatives, a section of recipes. A really comprehensive diet book will also suggest strategies that keep the dieter motivated in the face of temptation, or ways to remove temptations from the environment.
Why We Get Fat and What to Do About It devotes little, if any, attention to context. This means it is not a comprehensive diet book. But what it does provide is a crucial piece of information: a detailed description of an evidence-based weight-loss menu, one that has the best-demonstrated track record of really helping people lose body fat in controlled clinical settings.
This information is undeniably useful. It is also real-life-context-free. Except for a couple of implications and hints strewn throughout the book, Taubes declines to provide any suggestions about how to integrate this information into your life. Clearly, he does not think it is his job.
And I agree; it is not. Taubes is a science journalist. He is not a diet guru. He is not a cognitive-behavioral therapist. He is not a chef. And more importantly, he is not you. His job, it seems, is to tell you what the evidence demonstrates. Your job is to figure out how you can incorporate it into your life and your own set of values.
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So what does the evidence demonstrate? Remember the quote from the last post:
The one thing we absolutely have to do if we want to get leaner--if we want to get fat out of our fat tissue and burn it--is to lower our insulin levels and to secrete less insulin to begin with.
According to Taubes, evidence suggests that the only way to do this is to reduce the consumption of -- you've heard this before -- breads, cereal grains, white root vegetables, "foods containing much sugar" including a few fruits, and sweets. This leaves quite a bit left that can be eaten freely and still promote weight loss in most people: animal flesh, green vegetables, eggs, cheese, and many other fruits. (A rephrasing of a set of successful clinical recommendations quoted on pages 155-156).
A key, oft-repeated point is that among obese individuals, sensitivity to the restricted foods varies a great deal.
The fewer carbohydrates we consume, the leaner we will be... [T]here's no one-size-fits-all prescription for the quantity of carbohydrates we can eat and still lose fat or remain lean. For some, staying lean or getting back to being lean might be a matter of merely avoiding sugars and eating the other carbohydrates in the diet, even the fattening ones, in moderation: pasta dinners once a week, say, instead of every other day. For others, moderation in carbohydrate consumption might not be sufficient, and far stricter adherence is necessary. And for some, weight will be lost only on a diet of virtually zero carbohydrates, and even this may not be sufficient to eliminate all our accumulated fat, or even most of it.
Whichever group you fall into, though, if you're not actively losing fat and want to be leaner still, the only viable option... is to eat still fewer carbohydrates, identify and avoid other foods that might stimulate significant insulin secretion..., and have more patience....The more obese the patients, and the longer they had been obese, the more likely they were to remain obese [over the duration of the studies]....
What we don't know is whether these individuals could have succeeded had they further restricted carbohydratees, or had they simply had more patience, and maybe both.
So some people take a long time to begin losing weight even on a drastically low-carb diet, but others succeed immediately with even a little bit of carb restriction.
This explains why some dieters, including me, lose weight on diets that aren't intentionally "low-carb." Taubes insists that whatever they set out to change, be it reduced fat or reduced calories or more exercise, their success is caused by an incidental reduction of carbs or of refined carbs. If you eat less butter, maybe you don't want quite as much bread. If you cut calories across the board, well, some of that was by cutting carbohydrates. If you took up exercising and lost weight that way, Taubes is betting you also aren't drinking as much beer and soda as you used to.
Successful diets aren't low-carb, but they are all (Taubes says) fewer-carb-grams-than-before, or at least better-quality-carb-than-before.
That's the information in the book. The evidence marshalled in the book is compelling. Now you have to ask yourself: How can I fit these recommendations into my life?
Undoubtedly you'll want to know: What kind of success can I expect if I only "sort-of" follow the recommendations, because of balancing them with other things I wish to get out of my way of eating? And Taubes doesn't tell you the answer to that either. You will just have to try it and see.
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All this being said, Taubes does point out that there is some variety in the application of the diets. Taubes organizes the successful clinical diets into three different approaches:
(1) "To establish an ideal amount of carbohydrates that you can and perhaps should eat -- say, ... three hundred calories' worth... This is intended to minimize any potential side effects.... also assumes that it's easier to eat some fattening carbohydrates than to eliminate them entirely." The example diet is one that allows "small amounts of sugar and an occasional dessert, some crumbs for breaded food, a little lactose (in milk), and small quantities of carbohydrate in vegetables and fruit."
(Note that you can still eat quite a lot of vegetables while receiving from them only "small quantities" of carbohydrate. Many of the diets do not restrict green vegetables much except as a last resort for extremely sensitive individuals.)
(2) "[A]im for minimal carbohydrates from the outset" and get used to the side effects.
Here Taubes is talking about the physiological side effects of carbohydrate withdrawal -- but I would add that such an approach also has whole-life side effects as you transition to a meat-based lifeform. Your experience as a restaurantgoer, dinner guest, and cook will be irrevocably changed, and you're going to have to deal with this.
(3) The Atkins compromise: begin by drastically reducing carbohydrate to near-nothing (including limiting green vegetables), and then when weight loss is established, gradually add carbohydrates back in until the individual daily limit is discovered.
There are advantages and disadvantages to all these approaches.
A couple of other possible approaches are implied by Taubes' evidence, but he does not include them in this list because they are not represented among the clinical diets he has surveyed.
(4) The low- or no-meat approach. I was really hoping that Taubes would address the sustainability issue, but (other than a brief comment that it is more sustainable to eat fat with your protein) it seems he has no evidence for a low- or no-meat diet that will reliably cure obesity. Still, he has something to say about what a vegan or vegetarian (and by extension, a flexitarian like myself) can do:
[I]f you eat mostly plants... you're getting the bulk of your calories from carbohydrates, by definition. This doesn't mean that you can't become lean or remain lean by giving up sugars, flour, and starchy vegetables, and living exclusively on leafy green vegetables, whole grains, and pulses (beans). But it is unlikely to work for many of us... If you try to eat fewer carbohydrates by eating smaller portions, you'll be hungry, with all the problems that entails.
So if you're a vegan or a vegetarian you can still benefit from an understanding... You can always improve the quality of the carbohydrates you eat, even if you don't reduce the total quantity. This change alone will assuredly improve your health, even if it's not sufficient to make you lean.
So you could classify the low- or no-meat approach as "worth trying, probably won't hurt, and might even help."
(5) The cut-the-worst-offenders-first approach. This is not, I repeat, represented among the clinical studies that Taubes references. However, what he writes implies that it might be a viable option. "Clearly, as [Michael] Pollan points out, humans can adapt to a wide range of non-Western diets, from those exclusively animal-based to those mostly, if not exclusively, vegetarian.... [W]hat is it that distinguishes Western diets...?" Japanese and sub-continent Indian populations remained healthy on diets that were rich in legumes and rice before they started adopting the Western diet, after all.
This, plus Taubes' evidence that some people lose weight with only moderate carbohydrate restriction, suggests to me that one way to cut carbs is to begin by eliminating the worst offenders, and if that isn't sufficient to induce weight loss after a while, or if a plateau is reached, to cut back some more. First to go might be soda and sweets, then processed food with sugar, then white flour or polished grains. Later the portions of even the whole grains might shrink, and those be served less often. Eventually the obese person might find it necessary to cut categories of food entirely out of his diet; but by systematic and slow improvement and experimentation, perhaps the dieter can acquire good habits along the way to a sustainable lifestyle that also promotes better blood chemistry and eventually fat loss.
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I will continue this book review in a third part, where I want to address why, unlike Taubes, I conclude that--even if fatness isn't caused by gluttony--gluttony still isn't off the hook.
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