Addressing Andreas (and Taubes): On Relevancy, Reality, Inconvenient Facts, and Internetiquette

OK ... Just so you know, dear readers, I thought a bit on whether Andreas Eenfeldt's response to my post was worthy of responding to, and on the best way to do so.  To respond to comments on his blog or a separate post here.  As you can see, I chose the latter, largely because he has allowed his comments to devolve with various and several scurrilous accusations of stalking, questionings of my mental capacity and stability, etc.  To engage in this environment is not appealing to me, and shame on you Dr. Eenfeldt for publishing such disgusting commentary on your blog.

I'm hoping this will be the last post on this particular topic, but who knows ... It seems a blogger's work is never done trying to debunk LC mythology, and for now Andreas is the only (somewhat?) credible voice speaking up in Taubes' defense.

For those not following the chain of events thus far, a linked summary:  Gary Taubes lost his cool a bit at the AHS and walked off after attempting to school Stephan on the proper way to research one's hypothesis.  Stephan first clarified his responses to Gary's questioning, and later addressed the science behind why it was that no major endocrinology/metabolism researcher takes TWICHOO seriously.

I believe that last post has garnered well over 400 comments as of publishing this one, with surely more to come.  I summarized my thoughts on many of those comments HERE.   I left off with Andreas' assertion that we don't want to throw the baby out with the bathwater.  I thought it was important to address these specifically since he seems to be the only prominent LLVLC'er stepping up to the plate in defense of Gary Taubes.  This I did HERE. I was left with a few impressions from Andreas' comments on Stephan's blog:

1. Let bygones be bygones Stephan.  Play nice.
2. The TWICHOO is the only working hypothesis we have to explain the obesity epidemic so don't be too hasty to discard it when there's nothing better, and 
3. We have no idea what causes insulin resistance (thus MetS and T2 diabetes).

This particular statement left a bad taste in my mouth:

The failure of obesity and metabolism researchers during the last decades is of epic proportions. It makes the Hindenburg look like a success story. Please don't tell me we should care what they think.

I was reminded of this interview Andreas did with Gary sometime in 2010.  Around the 9:15 minute mark.

Taubes is asked about how well his message is being received since GCBC was published in 2007.  You get the feeling, at least I get it, that Taubes is frustrated that after all these years and lectures, that  he can't seem to get the researchers to listen to him.  It depends on the audience and how they are prepped.  He tells of getting the stamp of approval by a prominent person at Dartmouth so they took him seriously, and everybody but one guy loved him.  Then at USC when he was introduced as a journalist who wrote a big book ... not so much.   

I think Gary Taubes forgets sometimes that he is, ultimately, just a journalist and author with a physical science background.  He doesn't get the luxury of being considered a respected authority in the field -- that is earned through years and decades of doing actual high quality research.  Not skimming a bunch of articles and texts and conducting a few interviews while taking five years to compile the results.   I've always wondered why institutions of higher learning have him speak to medical school students, but such is the pop culturalization of science these days?   When we're talking relevancy, Andreas and others, we have to start with whether Gary Taubes' works themselves should be considered relevant.  Stated another way, the onus is on Taubes to demonstrate that what he has to say is even worth considering.  This seems to bother him, thus his condescending attitude to those who do not.  Being factually correct is a prerequisite for such consideration Mr. Taubes.  You fall down on that count.

So anyway, Gary goes on to lament that since he was the last lecture of the day at USC and his audience was not sufficiently "prepped" to take him seriously, he mostly wasn't.  As he tells it, about 45 minutes into the lecture the researchers flocked en masse for the door and the awaiting low fat cheese and cheap wine.  (I think he meant his description to mock the scientists for being drawn to tasteless hors devours and cheap wine, but I think it speaks more to the quality of his presentation that even cheap wine was better than sitting through it any longer.)  Ahh ... but the physicians who don't keep company with rodents all day long, they were more convinced and stuck around for more of the wisdom of Taubes.  You see, these doctors live in the real world unlike those scientists.  They actually deal with humans.

The responses to the Guyenet v. Taubes debate have been rife with personal experiences, and indeed real life clinical results are most certainly pertinent to the debate on how best to treat obesity.  If something works for me, that's great.  I may shout from the rooftops that you should try it too!  What is unconscionable, however, is spreading untruths as to why it did work -- especially in the name of science.  It is not acceptable to say:  well it works, who cares if we get it wrong about how.  Mark Sisson's "buy in" ends-justify-the-means strategy is not morally defensible.  Sorry.  Perpetuating untruths -- especially in the face of readily available facts to the contrary --  is not a defense (much like that old adage about ignorance of the law goes ...).

Now, while admittedly my post on Andreas' comments was redundant and overly long, I believe it was respectful and did not misrepresent Andreas' beliefs in any way.  I spelled his name correctly, I read his post in its entirety, and carefully, and I offered my position/response on a point-by-point basis to direct quotations.

I was rather struck by a few things in Andreas' response.  First, the title:  Diet Doctor: Rising star or fraud?.  Of course at the end, after what I thought were robo-generated links (my Related Posts are robo-generated based on labeling here), he snuck in a P.S. "Regarding the title of this post: I have not been called a fraud by CarbSane yet. But judging from earlier events that may just be a question of time."  We'll get to those "earlier events" in just a moment.


Andreas begins his post as follows:

I just got a long blog post devoted to me by the blogger CarbSanity. I suppose I should feel honored, especially since she calls me a “rising star” promoting low carb diets. Unfortunately her blog seems mostly concerned with proving that everything Taubes says is wrong. Thus, of course, I must be wrong.

I really wasn't going to make anything of this, but considering that (1) I updated the Google ID to reflect "Evelyn aka CarbSane" prior to my post, (2) I've only ever posted anywhere as CarbSane for well over a year now (I was just "Me" prior to that with a very short foray into one or two others before settling on CS), and (3) this blog is headed by a big banner with "My Carb Sane-Asylum", it seems rather deliberate or indicative of hurried negligence that Andreas should address me as CarbSanity.   That term appears nowhere except in the URL for the blog.  I don't think it reflects well on the Doc to be making such errors right from the get-go, and he hasn't bothered to correct the name either.

On to his "evidence" that my "blog seems mostly concerned with proving that everything Taubes says is wrong".  Rather than at least citing the number of posts bearing a Taubes fact check label, Doc posts a Google search on, get this, the keywords "carbsanity" and "Taubes".  Would anyone be surprised that none of the almost 400 posts here at this blog that do not mention Taubes (or relate enough to his theories to warrant using the "fact check" label) came up in such a search?  It almost sounds to me as if Andreas checked with his buds on how best to misrepresent my work so the fewest of his devout followers would take it seriously.  As of this post, there are over 530 posts on my blog.  Around 150 of them use a GT fact check label, but I'd venture to guess that most of those merely contain that because they discuss peer review scientific research that just so happens to debunk TWICHOO.  But let's look at what came up on that Google search when I checked his link yesterday.  Keep in mind Google searches are fluid so it might not be what you get today.  Screenshots are below as these things tend to change.

In any case roughly half of the hits were not even posts on this blog!  Real "scientific" assessment of the content here, eh?  I contend that had Jimmy and Gary actually read my blog back around a year ago, they would not have risked the plot they hatched to bring me down.  It has backfired so beautifully on them, and I couldn't be happier for that, but I digress ...  Bottom line, Eenfeldt grossly misrepresents the content of my blog to his readers knowing full well they'll eat up the red meat he just threw them.  It's a nice diversionary tactic to prevent those few of his readers with the slightest of open minds from scrutinizing his commentary.

OK ... and so he continues:

I found the arguments amusing.

Nice way of putting it to set that constructive tone we're to expect from venerable medical practitioners and such.

Inconvenient facts are by definition “irrelevant”. On the other hand, facts that support your position “falsifies” the alternative. Here are a few striking examples

And now, rather than quoting from my post directly, in the same manner he employed with Stephan before me, Andreas reduces the posts to what I'll call "Eenfeldt summary form".  In doing so, he is misleading his apparently less-than-curious audience who will not bother to read and consider what was actually written.

Irrelevant facts?

Here is a version of the “carbohydrate hypothesis of obesity” that I agree with:
Excessive amounts of carbohydrates (especially refined carbs / sugar) increases insulin and results in fat gain.

CarbSane does not agree. She apparently does not believe that the hormone insulin is an important factor in common obesity. Conveniently enough, these facts are judged irrelevant in her post:

• Giving insulin by injection leads to fat gain.

• Taking insulin away (type 1 diabetes, octreotide injection) leads to rapid fat loss. Probably it is also “irrelevant” that at least 14 studies of the highest quality have shown more weight loss with low carb diets, and that these diets lower the insulin levels.

• Obese people normally have very high insulin levels.

• Thin people normally have low insulin levels.

First, I think we get what the TWICHOO is that Andreas agrees with, and hmmm ... he suddenly got my moniker correct ;-)   My judgment of irrelevancy is not based on convenience, or the alleged inconvenience of facts.  Let's deal with the last two bullet-pointsnee first.  There is no doubt that basal insulin levels correlate with level of obesity.  I have presented evidence that points the direction of causality in the correlation between obesity and insulin to be opposite to that proposed in TWICHOO.  Does Andreas deal with those in his "rebuttal"?  No.   How about it Andreas.  What is your opinion of the work of Keith Frayn that I presented?    Are you interested in understanding what causes insulin resistance ... or at least the most up-to-date information we have?  Or rather, it appears you're more interested in perpetuating the notion that nobody has a gosh darned clue and Neels 1982 (pre-obesity epidemic, almost 3 decades old) hypothesis in GCBC is the best we've got.  I did not dismiss the correlation between obesity and hyperinsulinemia as irrelevant.  I did, however, point you in the direction of vast quantities of well designed peer review research on this topic. But who cares what they think, right?  Instead of Google searching silly keywords, why not use the labels or search features here, and read the many, many posts on insulin resistance.  Or might doing so bring some inconvenient-to-you facts to light?  

Let's move on to the relevancy of weight LOSS studies.  If a good scientist wants to demonstrate that A causes B, (s)he will design a controlled experiment where A is manipulated, controlling for as many potential confounders as possible, and measure B.  Studies where the carbohydrate content is increased -- a 1:1 swap with fat, controlling for calories -- and see if weight gain ensues.   Still, one could offer up some substantiation for TWICHOO with weight loss studies demonstrating that carbohydrate -- and thus insulin -- reduction irrespective of caloric intake produced weight loss.  Again, I have presented the inconvenient facts in this regard.  I think Shai is a very poor study to look at for any of this, but in as much as it is on Andreas' "List of 14", and it is part and parcel of Gary's latest schtick, it is important.  The inconvenient fact is that the group who restricted carbs least lost as much weight as that who restricted them most.  And the diabetics in that study had improved markers of insulin resistance to boot.  Inconvenient I'm sure.  Which is why when Dr. Eades regurgitated this spiel at AHS, he, too, left out one-third of the data.  

I still contend that weight loss studies are irrelevant to a hypothesis on the cause of weight gain.  But even giving them that, Andreas is the one who, like Taubes and countless others, is ignoring inconvenient facts.  Grey & Kipnis being a classic in this regard.  Properly controlled studies have repeatedly demonstrated that with calories held constant, macronutrient variations (even varying protein in some cases) do not result in weight gain or loss.

As to insulin therapy and diabetics, I did cover that in my post with a concise explanation.  And a question for Andreas ... ignored of course.  Here's what I said about that:

Carbs and proteins elicit a very complicated insulin release and other hormones.  Furthermore, when an obese person progresses through type 2 diabetes to the point of requiring insulin, why doesn't their weight plummet? 

Preferential fat deposition at injection sites where local insulin levels bear no resemblance to those produced physiologically is helpful in looking at insulin's action *out of context*, but it is irrelevant to TWICHOO.  That hypothesis claims that the postprandial insulin spike from a person's pancreas makes your fat cells accumulate fat.  Key word is accumulate.  So I ask again, why doesn't the fat of T2's who progress to insulin dependence  spontaneously deplete as their disease progresses?  Indeed one way we can look at this is that a prediabetic obese person should hasten their progression to beta-cell demise ... that would lead to effortless weight loss right?  *sigh*

The Doc moves on with "Flimsy Falsification":

Basically CarbSane’s “falsification” boils down to the fact that weight reduction instead results from a calorie deficit (stated in big green letters towards the bottom of her post). Well, duh, of course. That’s just stating the obvious, that the first law of thermodynamics exists.

It’s like saying that to get to the North Pole, you must move north. That is indeed true, but platitudes like that do not help anybody.

This is the sum total of my evidence that carbohydrate restriction and/or the resulting change in insulin levels (basal, postprandial or whatever) does not produce weight loss.  For that, you need a caloric deficit.  Manipulating insulin levels through diet has no ... repeat NO ... impact on fat mass unless and until whatever you are doing ALSO lowers intake.  Just a little inconvenient fact for Andreas and Co.

Lastly, Andreas' closing paragraph is entitled "The problem with reality".  As if I have one?  Here we are treated to the classic regurgitation of how CICO is not only obvious but meaningless.  And then the excuses:

It works fine in a lab, but in reality people can’t know how many calories they are eating. And they certainly do not know how many they are burning. And even if they could know these numbers, they may not like having to stay hungry indefinitely to artificially reduce calories in below calories out.

*cough* ... bullshit! ... *cough*

This is absurd at this point folks.  Of course there are differences in intake and expenditure, but even as loosely as I monitor such these days, I have an idea of the amounts I can eat to maintain my current weight with a given activity level.  This myth that folks must be indefinitely hungry on "normal" diets, but never experience any hunger pangs on LC is ridiculous.  And since Andreas does not look like the sort who has ever had a weight problem, he should defer to those who have.  Ask around of the low carbers who remain significantly overweight or obese despite heralding the magic of LC.  A common sentiment is how at least they are not hungry all the time.  Many ... some might even say most ... are also not lean.

The interesting thing when it comes to weight loss is not that a calorie deficit works. It’s how we can best accomplish this calorie deficit in the real world. Ideally with no unnecessary hunger involved. The best answer so far, demonstrated in quite a few studies: remove the sugar and the starchy foods.

Well, I'll be darned.  I agree!  This does not tell us anything about how we get fat.  Many have successfully created that deficit through exercise only, or eating a low calorie-density high fiber diet, etc.  Potato diet guy reported not being able to eat his daily potato allotment thus effortlessly implementing a greater than intended caloric deficit.

And, I'm afraid Andreas is hopelessly mired in this notion that obesity cannot be cured because folks can't lose weight.  Again, next time you're amongst the LLVLC gang, ask them how many times they have lost weight in the past.  In my interview with him, I stated that I didn't have problems losing weight in the past it was always keeping it off.  Andreas, Jimmy agreed!  Indeed in 1999 he lost 170 lbs in 9 months time on a low fat diet.  That one value meal at McD's (according to his own relating of the story) set off a monumental binge to put the weight on and then some in a matter of a few months had nothing to do with normal hunger, insulin, leptin, schmeptin, ...

Incidentally this also reduces the insulin levels. And whether this has an effect on the fat cells (à la Taubes), or by reducing leptin resistance (à la Lustig), or both, it seems to work pretty well for most people wanting to lose weight. Especially people with metabolic syndrome (obesity, diabetes, hypertension etc.). A condition that incidentally comes with abnormally high insulin levels to start with.

Of course, all this will be considered “irrelevant” by people who know that it just ain’t so.

So silly Andreas.  Let me get this straight.  Researchers who try to understand how and why things work are worthy of your contempt because they haven't delivered that magic pill to you.  You don't care what they think, rather prefer to ignore it, because you know what works.  In your world, who really cares why?  This is not science and it is in the name of science that Taubes proposes his TWICHOO.

Let's revisit that quotation from the beginning of this post:

The failure of obesity and metabolism researchers during the last decades is of epic proportions. It makes the Hindenburg look like a success story. Please don't tell me we should care what they think.

In other words, you don't care what "they" think.  But since Stephan is one of them.  So for all your buttery (grass fed of course) flourish, you don't care what *he* thinks.  What a pathetic defense of the flawed science of Gary Taubes.