
UCSF Endocrinologist debunks "Calories In / Calories Out" Model - ahoyhere
http://www.youtube.com/watch?v=WjxyjcvW7RE
======
jerf
I saw this literally after just finishing this video:
<http://video.google.com/videoplay?docid=4362041487661765149#> Gary Taubes
giving a presentation about his book Good Calories, Bad Calories.

If you've never seen someone actually make the case for this stuff, but only
let other people diss it for you, I encourage you in the strongest terms to
actually listen to the case directly and make up your own mind. These are not
the rantings of people who think fire can't weaken steel or that insist
immunizations cause autism; indeed, they make a very strong case that the
people who insist on the "calories in/calories out" model should be lumped
right in with those folks.

(Oh, guess I missed the party 18 days ago. Well, nobody linked that video that
I saw. If you are interested in Good Calories, Bad Calories, but don't want to
buy it, that video is a reasonable substitute for the scientific explanations
in the book, which is very similar to the linked video. You don't get the huge
sheaf of references in the back or the long exposition of history explaining
how we got where we are, but if you're interested in that after the video I'm
sure you can find the book.)

~~~
glymor
Here's a review of Taubes' book by George Bray:
[http://www.proteinpower.com/drmike/wp-
content/uploads/2008/0...](http://www.proteinpower.com/drmike/wp-
content/uploads/2008/07/bray-review-of-gcbc.pdf) in case you do want someone
dissing it for you.

Also I don't think we should "make up [our] own mind" the biology on this is
way beyond the layman. Hacker News has a pervasive conceit that somehow as
programmers we can see the obvious truth that people with decades of
experience are apparently (or deliberately) unable to. In fact it's the
reverse most subjects are substantially more complicated than they appear. You
can't encompass the biology of obesity in a pop-sci best seller.

~~~
gruseom
_Also I don't think we should "make up [our] own mind"_

Although it's true that don't-think-for-yourself-and-don't-question-authority
is standard practice, it's not often one hears someone explicitly argue in
favor of it.

I have three objections to what you're saying. The first is that it's
ahistorical. You don't have to look back very far to see the insanity that
human deference to experts can produce. ("Breast feeding is bad for babies",
anyone?) Scientific consensus isn't nearly as stable or as true as you're
implying; nor, for that matter, nearly as scientific. Which brings me to my
second objection: it doesn't consider the economic and political interests
that drive these things. There is a great deal of money being made from people
being fat and sick. This has a huge influence on the research and regulatory
systems surrounding this stuff. It follows that naive trust of consensus
recommendations is foolish. Finally, everyone does make up their own mind
whether they intend to or not. It's like Sartre said: not to choose is to
choose not to choose. Everyone has a pool of their own judgment to allocate;
if you like to invest yours completely in the expert consensus _du jour_ ,
that's your perogative. I like to diversify mine, including putting a little
into my "own mind", thanks. As far as I'm concerned, any discourse that
penalizes people for asking simple questions is not to be trusted.

------
jackfoxy
Particularly noteworthy was the excerpt of how the government propagandized
reduced fat and increased carb consumption starting in 1982, and the resulting
behavior changes in the general population tracks so well with weight gain.

And yet some people still believe that a handful of Congressional staff
lawyers and lobbyists (that's who really write the legislation) should be
trusted to engineer the entire health care industry.

~~~
antipaganda
Works okay in other countries. And I know it's not because, say, Australian
government folks are just less corrupt than American govt folks.

------
charliepark
Here it is, all in one long (90 minute) video:
<http://www.youtube.com/watch?v=dBnniua6-oM>

------
chipsy
Reposted: <http://news.ycombinator.com/item?id=1006980>

But it's such a huge PSA I'm upvoting anyway.

------
viggity
I've struggled with weight my entire life. After trying every diet and
exercise plan under the sun, just to watch the pounds come rolling back. At
the end of November I said enough was enough and had bariatric surgery (an
adjustable gastric band, or lap band to be more specific).

While it has only been 8 weeks, I'm already deeming it an overwhelming
success. I can't tell you the feeling of utter relief when I feel completely
satisfied after eating a single cup of food (8oz). It is almost euphoric.
Living in my body before the op was almost like living in a prison, I was
shackled to my ravenous hunger. It didn't matter how much I ate, I was never
satisfied. I still have 80% more of my target weight loss to go, but I'm 100%
confident I can make it there with this tool.

If you've struggled for a long time and feel hopeless, please at least take a
look into bariatric surgery. Don't feel hopeless. Don't blame yourself, morbid
obesity is not something that 98% of people can handle on their own, there are
factors that are simply out of your control.

If you have _any_ questions that you'd like to ask to a fellow hacker, please
don't hesitate to contact me. I know what you're going through and would be
more than happy to talk to you.

v o n a t n i t r i q d o t c o m

~~~
neilk
downvoted for signature

~~~
viggity
It isn't a signature. I put my email address on there so that if someone has a
question about bariatric surgery, they could contact me. If HN had a way of
private messaging people, I wouldn't have done it.

~~~
gojomo
You can put contact info in the 'about' section of your user page.

------
apinstein
The title is horrible. This should be called "How a diet rich in fructose
makes us fat, poisons us slowly, and wastes billions of dollars on health care
for self-inflicted chronic diseases, and what you can do about it _NOW_.

Here's a brief summary of the salient points:

1) Consumption of fructose, sucrose (which is a glucose-fructose
disaccharide), or alcohol (ethanol is metabolized by the same pathway as
fructose) should be extremely limited. That includes HFCS and most fruit
juices.

Why? Because the way your body metabolizes fructose, eating a lot of it
results in insulin resistance (type II diabetes), hypertension (high blood
pressure), high triglycerides, high LDL cholesterol (the bad kind), and weight
gain due to inability to self-regulate hunger. The combination of these
effects is known as Metabolic Syndrome.

There are _two_ notable exception to this fructose prohibition: 1) it's ok to
eat as long as it's in _fruit_ because there's not much of it and it comes
with lots of fiber, which makes it even more OK, and 2) if you're in the
middle of (or have just completed) some seriously epic exercise and your are
glycogen-depleted, fructose actually helps you restore glycogen much faster
than regular carbs. See: Gatorade.

2) Do eat "food" as Michael Pollan would say. The closer to it coming out of
the ground, the better. Google "paleolithic diet".

3) His research shows that you can begin reversing Type-2 Diabetes in a short
number of weeks by eating an appropriate diet.

4) His research shows that the #1 factor causing most diets to fail is
cheating on fructose consumption (even worse than cheating on exercise!).

4) Exercise is good for you, but _not_ primarily due to calorie burning. It
barely burns any calories relative to food intake. It's good for you because
it reduces stress and helps your body maintain a "fast metabolism" on an
ongoing basis.

5) Fructose is a major part of our food supply due to politics. It will take a
while before the corruption that propagates the problem is broker. Thus, don't
trust the government on this one.

The full video is an amazing presentation by a talented presenter. It is worth
watching the full thing _especially_ if you struggle with obesity or don't
understand how the body metabolizes food.

The lecture is by a MD and/or PHD talking to a bunch of MDs and PHDs, so it's
pretty high level. He covers a lot of biochemistry, but in a way that is
pretty accessible.

<http://www.youtube.com/watch?v=dBnniua6-oM>

------
gort
After watching this all, I think the take-home-message was that, for fairly
complex biochemical reasons, fructose (which is also a component of sucrose)
is a particularly bad sugar. For one thing, it doesn't cause satiety very
well, and for another, it does some damage directly which glucose, nature's
preferred sugar, does not.

~~~
ahoyhere
My real takeaway was this:

Everybody always treats science as if it's a sure thing. But you can have
every statement you make be true, and still be wrong overall, because you
missed something important.

Like the 7 Countries study, where the author didn't regress with fat-vs-sugar.
Everything he said was true, but he was wrong in the end.

(Oh, yeah, and fructose is awful and mass food producers are poisoning us. But
I knew that already.

Many restaurants, not just fast food restaurants, even put high-fructose corn
syrup in meat.)

------
gojomo
While making his case against fructose, Lustig makes a few offhand positive
comments about glucose -- but it's not clear if he'd actually recommend
ingesting it from nearly-pure sources, or using it as a sweetener instead of
sucrose/HFCS. (Others with similar dietary recommendations often view pure
glucose as bad as any other sugar.)

Sweettarts, Pixie Stix, Lik-m-Aid, and a few other brightly-colored super-
sweet candies are almost entirely d-glucose, aka dextrose -- often with no
other sugars listed as ingredients. I wonder if according to the Lustig
analysis, these are relatively OK, or still have other problems (like
triggering rollercoaster blood glucose/insulin levels) and so should be
avoided.

~~~
gruseom
I have been wondering the same thing since watching the video a week ago.
Specifically, would it be good to use corn syrup (the old-fashioned glucose
kind, not HFCS) as a replacement for fructose/sucrose?

------
teach
I mentioned this video to my wife, who is a registered dietitian and a PhD in
nutrition science (the RD / PhD combo is relatively rare). She said, "Yeah,
I'm uncomfortable just saying 'calories in / calories out' because human
metabolism is just way more complicated than that."

She's interested in watching the whole video herself; I'll post her thoughts
if she does.

------
dejb
I'd prefer a written overview of the ideas rather than sitting through an hour
lecture. The first ten minutes really didn't offer a lot of detail.

~~~
charliepark
First, until there are comprehensive notes, it's worth watching the video. It
really is excellent.

That being said, here are the notes I've taken so far. I started these back in
December, but didn't have time to finish the video. If anyone wants to
continue where I left off, please feel free to.

16:30 - Introducing HFCS.

17:20 -Why use fructose? It’s sweeter. (Also, cheaper.) Should be able to use
less. But drink manufacturers use it more. (Shows chart with different types
of sugars and their positions on a sweetness index.)

18:20 - Chemical composition of fructose versus glucose versus sucrose.
Fructose and glucose are not the same. Fructose and sucrose are exactly the
same from a body processing perspective. Both dangerous.

21:50 - Slide: Secular trend in fructose consumption: Natural - 15g / day WWII
- ~20g / day 1977 - ~37g / day 1994 - ~55g / day Current adolescents - ~73g /
day It’s not that we’re eating more (although we are). It’s that we’re eating
more sugar.

23:30 - How did this happen? Why did this happen? The politics perspective:
three political winds that swirled at the same time, creating the perfect
storm. 1. In 1972, Nixon makes food prices a “non-issue.” 2. 1966, HFCS
invented, introduced to the US in 1975. This makes sugar CHEAP. “High fructose
corn syrup isn’t evil because it’s metabolically evil, but because it’s
economically evil. Because it’s so cheap, it’s found its way into everything.”
3. In the late 70s, the USDA, the AMA, and the AHA all call for the reduction
of fat in diets. Why? To stop heart disease. Did it work? No. So why’d they
tell us to stop eating fat? In the 1970s we discovered LDL. In the mid-1970s,
we learned that dietary fat raises LDL. In the late 1970s, we learned that
high LDL correlates to cardiovascular disease. So, the conclusion was that if
A leads to B, and B leads to C, then A leads to C. But the premise is
incorrect. Why? It suggests that it’s transitive. That isn’t the case.

John Yudkin - Pure, White, and Deadly.

Keys - performed multivariate regression analysis (running data to filter out
what really caused what) on cardiovascular disease. Showed calories from fat
correlated highly with cardiovascular disease. But he didn’t run a complete
regression analysis. He showed that sugar comes along with the fat, and that
if you hold saturated fat constant but increase sugar, it doesn’t show
results. But he didn’t go the other way, holding sugar constant and showing
that fat still has an effect. (around 35:00) So his results aren’t actually
reliable, but we’ve been basing 30 years of nutrition education and policy on
this incomplete study.

36:30 - Two types of LDL. Large/buoyant, and ...

~~~
blahedo
_"In the mid-1970s, we learned that dietary fat raises LDL. In the late 1970s,
we learned that high LDL correlates to cardiovascular disease. So, the
conclusion was that if A leads to B, and B leads to C, then A leads to C. But
the premise is incorrect. Why? It suggests that it’s transitive. That isn’t
the case."_

Specifically, there's no problem with transitivity, but (just based off you've
written) a correlation/causation problem: A leads to B but B _correlates with_
C. A conclusion that A leads to C would therefore be invalid. (Not sure if
this is an error in the summary or the video, and in any case it doesn't
undermine the larger point; I'm just being pedantic. :)

~~~
jerf
Actually, in the video he points out the following is invalid:

    
    
        1. A -> B
        2. B -> C
        3. A -> C
        4. ~A -> ~C
    

Step 3 is valid (skipping over the correlation issue); the problem is actually
step 4. ~C -> ~A is valid, but ~A -> ~C is a fallacy. The correlation issue
doesn't come up, possibly because it isn't even necessary; this logic fallacy
dominates it.

I used standard Aristotelian logic notation here; it really ought to be fuzzy
logic, but step 4 isn't valid there either, so it would just muck things up,
and I don't know the numbers for the fuzzy logic anyhow. Doesn't matter.

~~~
ced
You should use probabilities, actually. And while step 4 is not a logical
consequence, it may have substantial probability, per Bayes' theorem:

    
    
      P(C | A) = P(A | C) * P(C) / P(A)

------
jackchristopher
To steal a line, dietary science is younger than it looks. Don't be surprised
if decade spanning long held beliefs start collapsing.

Another good video. Stanford nutritionist and self-described vegetarian admits
benefits of low carb diets: <http://www.youtube.com/watch?v=eREuZEdMAVo>

------
keefe
I think this is a bit of a misleading title. At one point in grad school, I
had broke 225 @ 6'3 with little muscle mass and I've changed that to 188 with
much more muscle mass. My understanding is that fat is used for storing food
energy and that each pound of fat stores ~3500 calories. So, something like
dFat/dt = (f(calories in) - caloriesBurned())/3500 = amount of fat gained for
some period of time. f might include something about the structure of the
calories coming in, but it makes sense and my experience supports it.

~~~
natrius
I'm guessing you didn't watch the video. Sure, the lower your net caloric
intake, the less weight you will gain. However, the types of food you eat have
different effects on how much you want to eat. Therefore, if you eat different
foods, you'll be more likely to lose weight.

~~~
keefe
It's a bit long, I read one of the supposedly accurate summaries... I'm OK
with that idea, my main comment was on the title - doesn't exactly debunk the
model, just some supplement regarding a "fullness factor" nothing new there
imho.

~~~
natrius
Ah. Agreed.

~~~
keefe
plus I always WANT to eat. NOM NOM NOM NOM

------
hedgehog
A paper he wrote covering the same material:

[http://www.nature.com/nrendo/journal/v2/n8/full/ncpendmet022...](http://www.nature.com/nrendo/journal/v2/n8/full/ncpendmet0220.html)

------
carbocation
To be credible, you should not try to dispute the simple truth that derives
from conservation of mass and conservation of energy. Cal in = cal out;
however, I do agree that our bodies are wired in such a way that particular
substances trigger 'calories in' without a concomitant immediate increase in
'calories out', thus leading to increased weight and a new homeostatic
baseline. This is not merely a pedantic point: it is the difference between
making a credible statement about human nutrition and looking like someone who
rejects chemistry.

~~~
pohl
It's worth noting again that this should reflect on the credibility of the
submitter who chose the headline, not on the original presentation - which
makes a different point entirely.

~~~
carbocation
Yes, I do not have a problem with the content of the video at all. In med
school, we are already being taught the evils of fructose, so this well-done
presentation is actually in line with what we are taught now.

------
nickyp
It might be just me, but watching this felt like watching 'The Inconvenient
Truth of the food industry'.

So all we need now is a meeting of the leaders of the world in Copenhagen to
ignore this huge problem with the processed food everybody buys and consumes
for at least another 20 years. (potential problem, if you're not convinced
something is wrong with the massive amounts of sugar in our processed food)

------
pingswept
Summary at 6:30 of section 9 of 9:
<http://www.youtube.com/watch?v=_tyaRnfGRV0>

The guy seems pretty sensible in his explanations earlier in the video series,
but his style is inflammatory. If he left out the bitterness toward the
industry players that he's arguing with, he'd be more convincing.

~~~
neilk
He thinks he's uncovered a major medical emergency that affects maybe a third
of American citizens, to the profit of giant corporations, with government
agencies in collusion. I would doubt him more if (given his claims) he didn't
feel strongly about it.

~~~
pingswept
If he's right, it does seem to be a major medical emergency, and so forth, as
you describe. But it's not a sudden catastrophe, like an earthquake. He's
surely held these same beliefs for at least a few months, right?

Maybe I should be more specific. Calling sugar a poison is a good example. It
may be true, in a sense, but it's definitely not true in the conventional
usage. For example, if you call Poison Control and say you have eaten some
sugar, they would not help you. That's what I'd call inflammatory.

On the other hand, maybe it's just me. It's possible that I find dispassionate
argument more convincing than most people.

------
yaroslavvb
Slides from related presentation of his

[http://www.niehs.nih.gov/news/events/pastmtg/2007/cehr/docs/...](http://www.niehs.nih.gov/news/events/pastmtg/2007/cehr/docs/metabolicsyndromelustig.pdf)

------
steveplace
Anecdotes are great, and they're fun to read. Just keep a slight lean towards
actual data, please.

------
skmurphy
video also here <http://www.ucsd.tv/search-details.aspx?showID=16717>

------
thras
You will lose weight on calorie restriction as long as you go low enough.
Though I've been fat my entire life, after college, I was 150 pounds
overweight. I lost the extra weight by eating 900 calories a day for a year
and a half or so.

At my normal healthy weight, I was starving. And weak as a kitten. I took up
running, and stopped watching my diet. I literally could not keep up the
willpower necessary to continue a 3000 calorie diet, even though 900 had been
doable for so long. Despite running for an hour a day, I immediately started
gaining 10-15 pounds a month.

So I was convinced that it was all about calories. I was fat because I ate too
much. Why my body was so hellbent on eating 4000-5000 calories a day, I didn't
know. I seemed to have a lot more willpower than anyone else I knew. It was
sort of confusing. Then about a year ago, I read Taubes' book.

What if the human body is actually sort of complicated? What if hormonal
regulation controls fat? What if the "trash bin" theory of body fat is
actually a humongous oversimplification or just wrong? What if, after getting
to a "healthy" weight by starving fat, muscle, and vital tissue, I wasn't
healthy at all? What if it had also made me malnourished (hence the amazing
hunger at my "healthy" weight)?

Anyway, I cut the carbohydrates out of my diet last December. I made zero
effort at calorie restriction. In fact, I ate _a lot_. I made very little
effort to exercise more. After a year of this, I'm almost 100 pounds under my
max weight. I recently started running again, for fun, not weight loss, and am
up to 2-3 miles a day.

And I am stronger than I've ever been in my life. Eating steak every day is
probably more expensive than building the same muscle mass with steroids, but
I'm pretty happy. I wasn't expecting it. It's good being a carnivore.

~~~
FreeRadical
Just out of interest, have you had any tiredness from cutting carbs from your
diet? Many people on who restrict carbs, such as on the Atkins diet,
experience this from what I've read.

~~~
thras
No tiredness for me. There's the "induction flu" that people on Atkins get,
and I felt that for the first few weeks. Apparently it's caused by sodium
depletion (carbohydrates cause you to retain a lot of water/salt). Drinking
non-sodium-reduced beef broth every day for that month will cure you. Wish I
had known. I just toughed it out.

As far as my energy levels nowadays...pretty much boundless. I'm ravenously
hungry when I don't eat. But I'm told that's how it's supposed to work. When I
was fat, I was hungry around the clock, even after eating.

~~~
gojomo
Can you recommend any sources for more details about this 'beef broth' fix for
induction discomfort? (Would other sodium replenishment options be just as
good?)

------
yes_its_giles
seriously, what's with you guys? I lost 75 pounds in 6 months. I couldn't have
made my blog post about that more Hacker News bait than it already was. I know
a lot of you saw it. and still the ratio of people talking about it to people
doing it is like 10,000 to 1. and you'd still rather debate some tangentially
relevant research.

google "Dr Joel Fuhrman." I lost 100 points of cholesterol in three months. 75
pounds in six months. all you do is you eat vegetables. there's a little more
to it, but not much. it's easy. the guy has reams of case studies and science
backing him up. my 100-point cholestrol dip barely even blipped on his radar
personally - didn't even raise his eyebrows - because he sees it all the time,
but just for comparison, my dad and my uncle both got 100-point drops in their
cholesterol too, over the course of _ten years_ , and their cardiologists were
happy, because normal nutrition is so bad that ten years is an acceptable time
frame for that. so: ten years' progress in two months' time.

seriously, this is a solved problem. this is like, "let's figure out how to
get a computer into every home and office in America." they're already there!
why are you trying to answer a solved problem?

you could spend your whole life debunking invalid theories, or you could just
find the theory that works and run with it. which sounds like a more effective
use of time?

~~~
pohl
I think it's pretty clear from your rant that you did not watch the
presentation. The submitter did a great disservice to the speaker by framing
this presentation as a debunking of the calories in/out model, because that is
not, at all, the central point of this lecture.

(I have watched it through twice now, and it is a phenomenal presentation; I
recommend it highly.)

In no way does the speaker attempt to turn thermodynamics on its head. Rather,
he suggests that the storage of fat be perceived as the primary driver, and
caloric intake & expenditure taking a back seat. He re-frames it this way
because the real central thesis is about how fructose is a driver of obesity,
which in turn leads to increased consumption.

The caloric in/out slide only serves as motivation for why we should be wary
of the fact that fructose is a chronic toxin (in particular, the effects
thereof), and how HFCS is an economic evil as much as a metabolic one.

It's ok to rail against the headline, though. The submitter took too much out
of one slide, in my opinion.

------
dnsworks
Medical reporting is by far the worst type of reporting in the modern media.
Anything health related that a journalist sensationalizes today will be
contracted by something they sensationalize two years later. 16 years of
agonizing about weight, and still I have no clue what might work and what
might not work.

------
hugh_
I don't have time to spend a lovely Saturday morning watching a 90-minute
video just to criticize it, but how can one "debunk" the calories-in calories-
out model? Surely this is just plain old thermodynamics?

~~~
pg
If you're that busy you should skip commenting too.

The answer is that humans are not simple furnaces; different foods are
metabolized in different ways, and affect appetite differently.

~~~
ellyagg
While that's true, the prime mover in weight gain is still calories. The type
of calories is a secondary effect.

Discussing diet is hard because everyone reasons from personal experience.
E.g., in my experience, almost all my fluid intake is Dr. Pepper and I consume
large quantities of the "worst" food, as a proportion of my diet, but I don't
eat that much and I work out, so I'm strong and fit with low cholesterol.

