A story to be told

Published 3.18.2016
Inspiration for these thoughts and presentations was (again) the comment section on this post at The Carb-Sane Asylum. I highly recommend reading through the comment thread on that post, at over 2000 comment, a great many interesting topics have been raised and discussed. I want to expand my comments made in that discussion here though, where I need not worry about length.

Hall v Taubes

I don't often discuss Gary Taubes or his organization Nutritional Science Initiative (NuSi), which he started with Peter Attia, MD, but I both listened to Taubes's presentation at Mark Hyman's Fat Summit and wrote up my notes and commentary about it. NuSi has bee covered extensively at the Carb-Sane Asylum, beginning with this post. Carbsane (I know that her actual name has been revealed, but she still blogs and tweets under the moniker Carbsane) has been skeptical about NuSi and Taubes's intentions from the first. NuSi is privately funded, and there does seem to be an agenda, but that isn't all that rare. People who give money usually have a goal in mind for that money to reach. However, NuSi was supposed to be different because it was supposed to be correcting all the horrible science done about nutrition. Recent events, however, have convinced me that Carbsane's skepticism was well founded.

NuSi was started by Gary Taubes, journalist, and Peter Attia, MD. They solicited proposals from the best names in nutrition, and then chose the projects they wanted to fund. One such project was to be led by Kevin Hall of the National Institute of Health (NIH). Kevin Hall's name has been mentioned here before because he, along with Carson Chow— and a host of other collaborators I'm sure, created the NIH's calorie calculator. The NIH calorie calculator is baed on the latest energy balance science and remains my favorite online calculator. The purpose of the NuSi funded Hall research was (in part) to determine once and for all whether the 'alternative' hypothesis Taubes pushes was valid.

However, in early September 2015, Kevin Hall's research group may have scooped his NuSi funded study results when this paper about an earlier NIH funded study was published. The NIH study is freely available because it was funded with tax payer dollars. There can be no doubt that this study was AIMED at Gary Taubes. Taubes is both mentioned and quoted in the introduction. This study was testing his 'alternative hypothesis.' AND. IT. FAILED.

The study created quite a reaction, both positive and negative. I collected links to some of them, and will list them below, though the list (extensive as it is) is in no way comprehensive.

• Here is Hall's guest post on Yoni Freedhoff's blog. Freedhoff seems to be a Taubesian, based on Twitter comments, and that will add to the reasons he irritates me. Here he is in 2013 slamming calorie counting, but also admitting that it works. Apparently, he doesn't really understand how the energy balance works. No wonder Hall's results "shocked" him.

  The diet changes resulted in an average ~800 Calorie reduction from baseline and the composition of the RC diet was 21% protein, 50% fat, and 29% carbohydrate with ~8% sugar. The RF diet had the same calories and was 21% protein, 8% fat, and 71% carbohydrate with ~35% sugar. According to the carbohydrate-insulin theory, the RF diet should not lead to body fat loss because insulin secretion won’t decrease since total carbohydrates, sugar, and protein were unchanged from baseline. According to Mr. Taubes, if insulin doesn’t decrease, then fat is effectively trapped in fat cells. In contrast, because the RC diet decreased total carbohydrates and sugars, insulin secretion should decrease thereby mobilizing fat from fat tissue and increasing net fat oxidation resulting in body fat loss.
  
  All but one of these predictions of Mr. Taubes’ version of the carbohydrate-insulin theory held true in our study. Unfortunately, a theory is disproven when any of its major predictions fail, and in this case the failure was a doozy! 

• Josh Sosland states it plainly in his title: Carb foes slammed in NIH research, and he notes that Hall calls out Gary Taubes and David Ludwig explicitly. (Ludiwig spoke on the same day of the Fat Summit as Taubes, and I commented on his presentation too at the link above.)
• Here is Dr. David Katz's take on the study. I remain conflicted about linking to Katz's writings, for the reasons I have stated previously.
• Kevin Hall's frequent research partner, Carson Chow, presents his take.
• Gary Taubes offered a very lame response, which Carbsane addressed here. Carson Chow also responded to Taubes's response:

  His first book on nutrition – Good Calories, Bad Calories, was about how the medical establishment and in particular nutritionists have provided wrong and potentially dangerous advice on diets for decades. He takes direct aim at Ancel Keys as one of the main culprits for pushing the reduction of dietary fat to prevent heart disease. The book is a great read and clearly demonstrates Taubes’s sharp mind and gifts as a story teller. In the course of researching the book, Taubes also discovered the biological mechanisms of insulin and this is what has mostly shaped his thinking about carbohydrates and obesity. He spells it out in more detail in his subsequent book – Why We Get Fat. I think that these two books are a perfect demonstration of why having a little knowledge and a high IQ can be a dangerous thing.

  Zing!
• Katz also addressed Taubes and his response:

  Inevitably, and regrettably, this has induced Mr. Taubes to defend his disproven assertion, taking advantage of the once rarefied real estate doled out somewhat indiscriminately these days by The New York Times. Taubes references the Hall study, but misrepresents it. Dr. Hall did not set out to establish a diet people could follow for a lifetime; he set out to challenge a very specific assertion propounded by Mr. Taubes himself. The study selectively shows that the assertion that weight loss is exclusively about carbohydrate and insulin is false.
  
  Taubes goes on to suggest that hunger is the neglected consideration in the world of weight control. He conveniently fails to mention the veritable mountains of scientific work devoted to that very topic. Michael Moss is not mentioned; Brian Wansink is not mentioned; David Jenkins is not mentioned; Barbara Rolls is not mentioned; and so on. Failure to consider hunger, and satiety, during a weight-loss attempt may be characteristic of the false hopes of dieters looking for a quick fix, and the slick hucksters who peddle the same – but pertains to no serious researcher I know. This is the classic "straw man" tactic, where the position being refuted isn't a position held by any reputable person in the first place. Satiety is a salient consideration in all work on weight loss worth a look in the first place.

• Examine.com discussed the study here.
• Here is The Atlantic's take, with a quote that explains why the low carb high fat (LCHF) crowd panicked over this study (and they did).

  “The great thing about this study is that it is strong science,” Susan Roberts, a professor of nutrition at Tufts University, told me in an email. “So much of what gets published in nutrition ... these days is weak stuff: non–compliant participants, poor methods, not enough subjects, self-reported data, etc.”

• Kevin Hall himself corrected the incorrect analysis in this assessment (see first comment).
• Insulin does not control weight loss. After that opening sentence, the author goes on to predict that the study results will hack off a lot of people AND will be very influential. I agree on both points. This is a VERY good take on it. Because he goes through exactly what Taubes' idiotic hypothesis was and how this slams it down. 

  During the low fat phase, participants had no change from baseline in the metabolism of any macronutrient: rate of fat oxidation, carb oxidation and protein oxidation did not significantly adapt to cutting 800 calories from fat. As a result, during the low fat weeks, the subjects lost very close to the theoretical maximum of 800 calories worth of fat per day (765 +/-37). 
  
  During the low carb phase, on the other hand, there were significant metabolic adaptations. Subjects were found to have ramped up fat oxidation by 403 cal/day and decreased carb oxidation by 520 grams per day. This would seem like validation of the low carb hypothesis, right? Everybody switched to "fat burning mode" when the carbs were cut. But the switch wasn't efficient. The slow down in carb burning overbalanced the increase in fat burning, such that overall rate of oxidation of nutrients was slower while on a low carb diet than baseline. They still lost weight, but not as much as theoretically possible from cutting 800 calories, because of the inefficiency.

  The author also spoke with Hall, which also sets him apart.

  I suggested to Dr. Hall that if we stop thinking like a low carb person and just start from scratch, it shouldn't seem weird that reducing fat caused a loss of fat from the body. It needs to make up the deficit. I suggested that the study results were unsurprising (don't say that to a researcher that just finished a study that took like three years. He didn't seem to mind, but still).
  
  He answered: "A surprising feature of the study was the lack of change in fat oxidation in the low fat group. If you reduce fat intake, but otherwise leave protein and carbohydrate unchanged, why does the body go on burning fat like it did before? Why didn't it switch to a higher mixture of oxidation of carbs or protein? Why would the body say, 'Ya know what, I'm going to go on burning my fat just the same, even though I've cut 800 calories from the diet and I'm eating 8% fat in the current diet?' I find that interesting."

• Lyle Macdonald weighed in, and pointed to the insanely low fat level of the diet (which was the case because they only changed one macronutrient) and that the reduced carb diet wasn't ketotic. These points soon became THE talking points for the LCHF blog-o-sphere— along with the criticism that the study was too short. The NuSi funded study was designed to answer all three of those critiques.
• Low carber knees jerked everywhere, pinning their hopes on the short duration which wouldn't allow enough time to become 'fat adapted.' However, this author says definitively these results can NOT simply be dismissed, and there IS NO conspiracy— I think he may be in research, which, if he is, is why his tone and language is more reasonable. He has standing in the LCHF world, Hall does not.
• Low carbers aren't happy, but they're having a hard time knocking down the design of this VERY well planned experiment. The target here was NOT all LC diets. It WAS Taubes' alternative hypothesis. Some of the responses are frankly, unhinged. They are truly worried.
• Some apparently have poor reading (and reasoning) skills.
• Some missed the point entirely.
• Others tried to emulate Taubes and move the goal posts, suddenly it wasn't about the action of insulin, it was about satiety.
• But others clearly read the paper and reacted more reasonably.
• There was even the occasional admission that Taubes was wrong.
• Lamest of all were those who somehow couldn't figure out how to read the study, which is easily accessed for free (plus the supplemental material) online. Just lame.
• Stephan Guyenet devoted two posts to the study. One to note that Taubes hypothesis was proved wrong (again), and a second to answer many of the LCHF critiques.

Needless to say, the reaction in the LCHF sphere was negative, but after a bit seemed to coalesce around the idea that the LCHF diet in the NIH study was now low carb enough, while the low fat was truly low fat (< 10% fat), plus it wasn't long enough to allow subjects to become 'fat adapted.' I will note that Hall disputes that last point, saying that the blood markers tracked showed that the subjects had adapted to the low carb diet, but LCHF defenders are not convinced.

NuSi to prove Nestle right

Hall's NuSi funded study is designed to eliminate those critiques. The study compared a very low carb diet to a low fat one and conducted for 8 weeks in a metabolic ward. Literally, it's designed to be the gold standard of nutrition trials. Such a study is hugely expensive, but it is done and all are awaiting the publishing of the results. The study is done, there should be years of papers generated from it— if they ever see the light of day. There is growing evidence that all is not well at NuSi.

Peter Attia wrote that he left NuSi at the end of 2015, with no reason for the departure is given. He is again practicing medicine, though only part time, and his new emphasis is longevity. In a recent interview with Chris Kresser, Attia mentioned that he was no longer with NuSi. He did not say why he left, but did seem to throw a bit of shade NuSi’s way, saying that he was done with nutrition 'religion'. The nutrition religion at NuSi is LCHF— it's what Taubes has staked his entire hypothesis on. So Attia is saying (without saying) that he's done with the LCHF dogma. Add to that his admission that he "leans into" his kids processed crap on occasion, and what you have is someone who has gone off the LCHF reservation in a big way. Whatever else Attia may be, he seems (to me) genuinely interested in how he can manipulate his body for maximum performance (and apparently now for longevity). If extreme LCHF is shown to be detrimental to that effort, then Attia would drop his support of it.

The Attia interview, taken together with Taubes statement during Hyman's Fat Summit about how the Hall study results were delayed because there were "issues,” makes me wonder if part of the reason Attia left NuSi is that Hall's study does not support Taubes hypothesis— and thus NuSi will never publish those results. In fact, it makes me wonder just how badly the results destroy his hypothesis.

I listened to what Taubes said about the NuSi funded Hall study a couple of time to be sure I transcribed it accurately, but did not record anything. This quote, “There are issues with the study, there are issues with the paper…” was made in the context of Taubes talking about NuSi's biases opposed to the biases of the researchers who agreed to take its money. Taubes is aware that these researchers do not accept his "alternate" hypothesis, but his expectation seems to be that despite that the results will force them to do so. This quote and the conversation around it suggest to me that the results do not, in any way, support his hypothesis. And that he does not want them to see the light of day.

Couple that with Attia leaving (abruptly and suddenly as no one seemed to know he'd gone until the change on the website was noticed) and his subsequent statement about nutrition "religion," and I think there's a story there to be told.

As to the title of this section, Marion Nestle has been carping about industry funded studies and how they are inherently biased for a while. NuSi isn't an industrial concern, it's an advocacy group. As Carbsane suspected from the beginning, there is ample reason to doubt the independence of any and all results that wind up being published. The difference between NuSi and most sponsored research is, the independent study and results have already been published. If NuSi's version varies significantly from those results, it will have to withstand great scrutiny.

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