The quality and quantity of calories both count

Among others, Gary Taubes has famously argued that calories don’t count. Perhaps the more nuanced version is that the quality of calories, not the quantity, is what counts. Mr. Taubes and I have discussed this, and agreed to disagree. Leaving aside Newton and laws of thermodynamics, there is the Twinkie Diet on my side: evidence that weight can be lost when calories are restricted, no matter how truly dreadful the quality of those calories. To give Mr. Taubes his due, most people in the real world gain weight, not lose it, by eating Twinkies.

My view is that the quality and quantity of calories both count. The quality of calories is the quality of the fuel that runs our bodies — it counts for that reason. The quality of calories also influences the quantity. While it may be that “no one can eat just one” chip, everyone can eat just one apple. Quality and quantity interrelate.

Dr. Robert Lustig has argued that excess sugar, and specifically excess fructose, is the one thing most importantly wrong with the modern diet; he and I have also agreed to disagree. Dr. Lustig has invoked high-quality science to demonstrate how fructose can harm our livers by causing fat accumulation there, and thus damage our health, in virtually all the same ways as alcohol.

But a paper just published in the journal Applied Physiology, Nutrition, and Metabolism demonstrates that under real-world conditions, a preferential focus on fructose may be unjustified. The investigators found no increase in liver fat over 10 weeks with sugar-supplemented diets, and no differential effects based on the kind of sugar. On the other hand, the study was funded by the Corn Refiners Association, and was likely developed with this very outcome in mind.

But even if this study is suspect, there are other reasons to doubt that fructose is our one true cause for worry. A recent study shows an association between sugar-free soda intake and diabetes. This may be a direct effect of sugar substitutes, or more likely because people drinking intensely sweet sodas of any variety tend to consume a diet higher in sugar overall. But at a minimum, the association is a precautionary tale about benefits to be expected from replacing the sugar in soft drinks.

More importantly, if Dr. Lustig is right, the much-revered T. Colin Campbell, who has implicated animal protein in our health ills, must be wrong. Our trouble can’t be all about fruit sugar if it’s all about animal protein, and vice versa.

If Dr. Campbell is right, then not only Dr. Atkins and Dr. Agatston, but also Loren Cordain, a respected paleoanthropologist emphasizing the prominent place of meat in our native diets, have to be wrong. If Cordain and others are right, then not only Campbell, but Barnard and and Esselstyn and the other ardent proponents of veganism are wrong.

If the most ardent proponents of a vegan diet are right, the proponents of the Mediterranean diet must be wrong.

And on it goes. The Center for Science in the Public Interest warns that excess dietary sodium may kill as many as 150,000 of us each year. A sophisticated analysis, based on three distinct computer modeling approaches, just published in the journal Hypertension, indicates that meaningful reductions in average intake of dietary sodium in the U.S. could save between 280,000 and 500,000 lives over the next decade. This suggests that CSPI’s argument may be slightly exaggerated, but is directionally correct. But if sodium is a major source of harm, then arguments that our only worry is meat, or fructose, or eggs, or carbs, or aspartame are all wrong.

I think there is a better explanation for all of this, and it’s one we’ve heard before, courtesy of the poet John Godfrey Saxe. Saxe wrote the most famous version of the parable “The Blind Men and the Elephant,” in which each of six blind men seeking knowledge of the beast take hold of a different part, from tail to ear, and reach a distinct conclusion. Saxe wrote that “each was partly in the right, and all were in the wrong.”

All were in the wrong not about the part, but about the sum of the parts. And so, too, for diet and health. I believe all of my expert colleagues have something worthwhile to contribute to our understanding. Where they err, in my opinion, is thinking that any one part of this story is the whole story.

There is no question that dietary patterns at odds with the fundamentals of what we know about the basic care and feeding of Homo sapiens are a major cause of the most egregious injuries imposed on modern public health. There are many minor deficiencies and major excesses contributing to the adversities of our dietary intake.

But no one thing is wrong with the prevailing American diet, and no one-nutrient-at-a-time remedy will right it any more than a single part represents the whole elephant in the room. We need to see that elephant, and develop a better recipe.

David L. Katz is the founding director of Yale University’s Prevention Research Center

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  • http://www.facebook.com/people/Frank-Lehman/100002241640186 Frank Lehman

    Gary Taubes
    has written 2 books on this subject, “Why We Get Fat: And What to Do About
    It” (Dec 2011) and “Good
    Calories, Bad Calories: Fats, Carbs, and
    the Controversial Science of Diet and Health” (Sep 2008).

    I have read
    both of these books. I really wonder if
    Dr. Katz has read them.

    Katz indicates that he is in disagreement with
    Taubes because of “evidence that weight can be lost when calories
    are restricted, no matter how truly dreadful the quality of those calories.”
    But Taubes does not say that weight cannot be lost by restricting calories;
    what he does say is that that is not the easiest and best way to do it.

    Katz then goes on to
    cite conflicting studies/experts, one after another, some apparently “much
    revered,” as well as the real wackos at the Center for Science in the
    Public Interest, eventually concluding that “no one thing is wrong
    with the prevailing American diet, and no one-nutrient-at-a-time remedy will
    right it.”

    But Katz never gets
    back to the major point that Taubes makes: that our medical system as well as
    an entrenched government bureaucracy and weight loss industry, seem to be
    unwilling to do a serious, scientifically valid study of the issues regarding
    carb intake that have been seemingly well know for generations, but never
    scientifically tested.

    There are so many
    cases where the issues addressed by Taubes appear to be valid, so much
    anecdotal evidence in their favor, that it is long past time for us to do the
    research to either validate or invalidate them.

  • Suzi Q 38

    I can’t even eat anymore.
    Restrict fructose, sugars, salts, carbohydrates, and fats.

    What are left? Plants.
    Basically fresh vegetables and fruits no potatoes or rice.
    No oils, no nuts, candy pastries, cheeseburgers, burritos, tamales, Italian fattening foods, Chinese fried noodles fried rice, Japanese tempura, southern fried chicken, teriyaki steak, breads, avocados, mangos, processed foods, and junk foods..the list of forbidden foods keep growing.

    I also lay off of the wine and other alcoholic beverages.
    I walk for exercise, and sometimes use that easy going recumbent bike.

    Go vegetarian.

    I log my food when I have the time to “My Fitness Pal. com.”
    This device taught me about food and calories, and sodium, fats, carbs, and sugars. I know that a single piece of pizza not only has a lot of calories, but about 1,500 mg of salt.

    When I lost 30 pounds, though, my asthma went away.
    My blood pressure is now in control, my blood sugars are down, and my cholesterol is lower.

  • http://twitter.com/DrSherryPagoto Sherry Pagoto

    Great post and you are spot on. No coincidence that everyone trying to put forth one evil macronutrient/food substance is also trying to sell a book based on that premise. Classic cherry-picked science. The elephant analogy is perfect.

  • Julie Saeger Nierenberg

    Love the dialogue – well worth having. Look around at the people you see in North America (and in the mirror). A focus on better habits and choices is long overdue. Dietary and lifestyle success strategies are many and varied and maybe quite unusual (I have a ‘chocolate party’ almost every day), and the less contrived unnatural substances we eat and drink, the better our chances of letting our food be our medicine and our bodies our allies in health. Rather than focusing on definitive conclusions to this query, it may be wise to be with the questions that the discourse brings forward.

  • http://www.mightycasey.com/ MightyCasey

    If we’re all snowflakes, completely unique in our makeup, it makes sense that what works for one person might not work for another. However, the laws of thermodynamics are hard to break: energy taken in that isn’t expended will be stored.

    I think that the US population in particular, given our consumerist/quick-fix culture, falls prey much more to the fad diet than do the rest of the planet. Sadly, our biggest export, fast food, seems to be dragging the rest of the globe into GAS (Giant A** Syndrome), super-sizing everyone. Better to just pay attention: to what you’re eating, to what you’re doing (walking or sitting or standing, oh my), and to what kind of life you want to live.

  • Dorothygreen

    Seems to me if you read even more you will find some folks are close to making “sense” of human nutrient needs. The calorie is just a convenient way to estimate amounts of macronutrients. I think you and everyone who has not been brainwashed by the media that they are too stupid to understand what nutrients are and the word synergy – understand this.

    The few Drs you mentioned and the 100s of other in the business of writing books about food and diets you didn’t mentioned, all have a specific take, each have some valid points to make. It is these points I take into account and put the rest in the “TBD” file. And the more I read and put the valid pieces together, it becomes clearer what we need to eat for optimal health. Sure, we can deviate some without long term consequences. Take for example the “twinkies diet”, yes, he lost weight and improved his numbers (you do realize a protein shake and supplements went with this diet). But for how long and and what about the Triage Theory of Aging – robbing nutrients from the say, the pancreas to keep the heart,lungs and brain going? Or a slow destructive process of any one or several of the 50 or so unnatural ingredients in twinkies? What about Dr. David Kessler in his book “the end of overeating” with the research on addiction to sugar, fat and salt?. Perhaps the best model now is Dr. Terry Wahl since she actually reversed her progressive multiple sclerosis with diet – Paleo – yes, Atkins No – Plants – lots, fat – only natural. And of course out with the processed food, only pasture animal meats and wild fish. Dairy and wheat and other grains are gone as well, not because it is ‘fashionalble” but these two foods are notorious for causing allergic reactions of some sort or another – beyond lactose and gluten intolerance. But of course, 99% of physicians will tell their patients with MS, RA and other auto-immune diseases that diet has little or nothing to do with it.

    And, even more is coming down the pike. 2 day a week fasting is sounding like it might be a good thing. What piqued my interest was the neurogenesis that occurred in the mice models (granted we are not mice but we do share most of their genome) – read Michael Mosley, or watch his PBS show. And none of any of this means you shouldn’t eat your aunt’s Paella – sounds really great – but I guess it wouldn’t taste the same with brown rice, if one is a believer that all white carbs are bad.