NuSI ... or Just Do It!

Imagine if you will, that a decade or more ago someone told you that if you really wanted to build your journalism career tearing down scientists, you needed to look at diet and nutrition research.  You picked up a copy of Atkins and lost a couple of pounds.  You began cultivating your schtick that simple obesity (the kind of the epidemic) was not about overeating or sedentary behavior, it was something else.  And you received three-quarters of a million dollars to research and write a book.  The book was a best seller and garnered you a cult following in certain circles and you were off to the races giving talks around the globe.  

There were doctors and others who bought into your hypothesis, spreading the word as fact and growing the movement.  But a following from one segment of the population remained elusive:  scientists.   Rather than address the reasons why (serious holes in your hypothesis), you double down and trash scientists more openly and frequently.  You also publish a second book with a dumbed down, even less scientific, hypothesis.  By all indications, this book falls far short of expectations ... and still the scientists are not coming around.  Worse still, many who had believed your hypothesis was plausible, at least worthy of investigation, were abandoning it.

Then a young used-to-be doctor who dropped out of the field after residency reads your book and hooks up with Volek & Phinney and you and declares war on insulin!  You get together and an idea is born.  Fund your own real science to show the world!  Your fears of ending up that old man muttering to yourself because nobody listened to you, perhaps playing the Fat Louisa card game some fan made for you, are abating.  

And then, it happens.  A major funding source materializes.  What to do, what to do.  Do you:

1.  Get right to work and fund a study to test your hypothesis ... because this is really important and a decade is already too long for failed conventional wisdom-based advice making people fatter and sicker.   Or ...

2.  Assemble boards of directors and advisors, talk up scientists, set up a website with nicely produced media, open offices, hire researchers and other support staff and announce the launch a grand initiative:  NuSI.  

Haven't we been hearing for long enough how bad the obesity research is?  About all of those poorly   designed studies, etc.etc.  Well, if you have the money, start out funding that one study and more shall follow.  I mean Gary Taubes is nothing if not certain and convinced what the results would be.  So why not cut to the chase ... Just Do It!!  Heck you can get scientists to do a lot of the work for you for free (grant proposals!), but there's not much work required to tweak existing study protocols to fix them.  I mean they've already done a "massive" review of the literature to tease out the problems with every existing study ... so just fix those problems!  

They might have to first go back and rescue the reputation of free living studies, because the sort of lengthier studies they're hinting at are not practical in metabolic wards.  The sort of "controlled living" study like that recent Ebbeling et.al. one seems like a workable compromise (just do some analysis of those diaries and report, in some fashion, the degree of compliance). NuSI would also have to back-pedal on this notion that the macro changes in Grey & Kipnis were insufficient to demonstrate an effect of insulin.   Because as I pointed out previously, you can't blame the obesity epidemic on an increase in carbohydrate content in the diet of only 7 percentage points, and then claim that reducing carbs to 15-20 percentage points below pre-epidemic intake is insufficient to demonstrate the effect.   Of course acknowledging this would be to eliminate the need for NuSI, but let's do the grand study anyway!

Mildly overweight 20-somethings might well be the best population with which to start -- show a tendency to put on weight under the right conditions, but haven't.  They'd also have a little "extra" fat to lose, if underfed w/o becoming underweight (which is one problem with drawing much of anything from the Minnesota Experiment).  Monitor (closely, ward) their habitual intake for an entire month to determine its average quantity and composition.  (Weigh daily to ensure weight stability).   Next design a shake & muffin style diet of equivalent caloric/macro composition and over a period of 3-4 weeks or so, begin with their current cals/comp and transition them to the test diet cals/comp.  Then switch them to a real-food test diet for a long time, 6 mos to 1 year preferably.  Using a non-descript diet to transition should help mask somewhat any placebo effects.  This study would be too long to do in cross-over fashion, so it's probably going to have to be quite large in terms of the number of participants.  But remember we're talking about the grand experiment to settle a century old question!!  

Measure everything, as directly as possible.  Weight, body composition, hormones, glucose, lipids, RMR, TDEE, RQ, inflammation markers, heck, get me a smear of gut biota too!

So here would be my proposal for one way to do this with seven study diets.  First, absolute protein consumption will be held constant throughout, on an individualized basis, at habitual diet levels.   The IC diets would maintain habitual absolute carbohydrate intake.  The LC diets will reduce absolute carb intake to some fraction of habitual levels.  The isocaloric HC would increase carbs from habitual by the same proportion they are decreased in the LC diet, and hypercaloric HC diet would add 20% surplus calories entirely as carbs to habitual carb levels.  The remaining calories in all cases will be accounted for by adjusting fat intake accordingly.  

Here's how this would look like for an average subject habitually eating a 2700 calorie "standard" 15% protein, 35% fat, 50% carb diet where LC = 2/3rds habitual levels.  (shaded block are set values)

1. Isocaloric HC
2. Isocaloric LC 
3. 80% Hypocaloric IC 
4. 80% Hypocaloric LC
5. 120% Hypercaloric IC
6. 120% Hypercaloric LC
7. 120% Hypercaloric HC

Wanting to cover all the bases, you'd have an eighth Control Group that is transitioned back to eating the habitual diet.  This would control for any effects of all that monitoring, logging, etc.   The types of foods must be comparable ... at the very least, the CG should be fed the same calories/composition of the types of foods used to comprise each "real food" study diet.  In this regard, the inclusion of a CG is most important of all ... even if this study is done in pieces.

Now I expect there to be loud cries of "it's not a real LC diet".  But, as I've pointed out repeatedly now, using a very low carb diet -- by percentage or content -- is inappropriate for testing any hypothesis as to what has caused our obesity epidemic.  Indeed even the macro percent swings produced by the reduction to 2/3rds habitual intake would result in several times the percent differential seen between the American diet from the 1970's to today.  If a shift in macronutrient composition of roughly 7% in favor of carbs v. fat is responsible for the obesity epidemic, then the differentials in carbs in this study should be sufficient to have some measurable effect.  

We don't eat percents, we eat amounts.  So to see if carbohydrates impact fat accumulation independent of calories, we need to hold those constant by amount.  If it's the carbs/insulin and not the calories, TWICHOO predicts:

• The Control Group will remain weight stable (as also predicted by CW)
• Study Group 1 will trigger their horizontal growth disorder (HGD) and gain weight/fat while Study Group 2 will lose weight/fat.  At a very minimum they will recompose if not gaining/losing net total body weight.
• Study Groups 3 would not lose weight since this group is consuming the same carbs as they were habitually consuming that will keep their HGD accumulated fat trapped in their fat tissue.  If weight is lost it will be predominately lean mass.
• Study Groups 2, 4 & 6 should all lose some comparable amount of fat mass.  They would be the same deficit carbohydrate level at different caloric levels.  If it were carbs and not calories, they should all release their HGD accumulated fat equally.  Any other mass changes would have to be lean mass.
• Study Group 5 would not gain weight, fat or otherwise.  This is the most direct test of TWICHOO dreams, that dietary fat has no impact on bodyweight/fat because it does not elicit an insulin response, that it is not overeating but {{cringe}} overstoring.  This group is consuming the same amount of carbohydrates they always did.  This is why that Control Group is important.
• Study Group 6 should lose some fat, or at the very least recompose to have more lean mass.  If Group 5 is the most direct test, Group 6 is the best challenge to TWICHOO dreams.  Do you suppose anyone reading this believes Group 6 will lose fat mass because they are only eating a relatively low level of carbohydrates?  What?  Not low enough?  Well 225g/day is well below the average SAD consumption we are told is responsible for our collective girth ...
• Study Group 7 should succumb to accelerated HGD vs. baseline, but because of the way the carb content was determined, they aren't consuming that many more carbs than the isocaloric group (473 vs. 450), so their gains should be comparable to Study Group 1's.  Remember, it's not overeating that causes the obesity epidemic, so the fact they are consuming 540 cal/day more than they were habitually consuming should have additional impact.

Does anyone believe this is what would happen here?  I don't even think Gary Taubes believes this would happen or he's managed to completely delude himself through rote and repetition of the "carbs drives insulin drives fat accumulation" meme he's been droning on and on with for the past five or so years.  So, now let me ask you this:  Do you think Gary Taubes really wants this study done?  If the results came out as TWICHOO predicts, it would settle things for once and for all.  Busts of Gary Taubes would don the halls of institutions studying obesity for centuries to come.  The USDA would immediately issue new guidelines based on The Taubeskins Diet ... Panera Bread and IHOP would be put out of business immediately, meatzas would replace pizzas on school lunch menus, and deep fried bacon wrapped dogs would replace hot dogs in a bun.  

Most importantly, Gary Taubes will be taken seriously.  But sadly, there would be no further use for NuSI because for once and for all the question has been answered.   Veil as they may with big talk about bringing together the best minds to design the best studies and fund the best science, the purpose of NuSI is to promote TWICHOO.  To cloak the dying hypothesis with legitimacy so that the franchise may live on.  Only it's even better because they get to feel good about all that philanthropy in the air.

Call me a cynic, but I'm not a big fan of non-profit advocacy groups and foundations that solicit donations in general.  A truly philanthropic act is to give of goods, services and/or funds from one's possessions.  It is not even philanthropy to direct a foundation founded with the fortunes on one's parents, grandparents or whatever.  To me a HeirFoundation head who pays him/herself an inflated salary, writes off their mansion/estate and other assorted living and travel expenses to their foundation, and presides over lavish benefits, self-flagellating dedications and fundraisers is not philanthropic.  The same goes for all of these celebrities and such that advocate for various causes, usually involving soliciting donations from you, the little person.  

So all non-profit means is that the corporation makes no profits, but the individuals working for such organizations often make far more than their for-profit private industry counterparts.  Many are nothing more than capital-sucking middle men.  The various environmental advocacy groups come to mind as we get quite a lot of them soliciting around my area.  Many of these organizations sit on large sums of money that is used, in part, to raise more money.  Someone's got to do the fundraising, someone's got to organize and supervise, and you need payroll personnel, etc.etc.  Most of the time they are raising money to lobby the government to allocate money to do something -- e.g. clean up a dump, invest in the development of alternative energy, fund studies, subsidize products directly or with tax breaks, etc.    It's always bothered me the enormous waste of capital these groups end up being all too often.  What if the organization so eager to see the Toxic Dump cleaned up just raised money to clean up the dang dump and be done with it?  What if instead of trying to lobby for taxpayer funding of alternative energy sources, they just give a chunk of $$ to a university or start up company actually developing some technology?   

Which brings me back to NuSI, because this seems to be what it will be: a capital-sucking middle man.   Or did I miss the part where they plan to build and staff an independent metabolic research facility?  Gary Taubes has known for a very long time the type of studies he now claims to want to fund.  He's said as much in his very first Jimmy Moore podcast and been bemoaning it in front of audiences at medical schools for half a decade now.  Now it might well be prohibitive to build a facility first, but why not seek out a qualified existing research group/facility and just contract them to conduct a study?   It really need not be some grand study (does anyone really expect the first study out of NuSI to be?) but just get to work.  You don't need this fluff and puff show what with advisors and maps with arrows and how you are going to be bringing scientists together (the cream of the crop!) to finally answer the real problems.  It's all big show, and a considerable amount of money is going to be wasted to compensate the members of the organization rather than realizing the main (purported) goal of enabling riskier, longer and larger studies to be undertaken.   

Because in the end, if we know nothing about Gary Taubes, it's that he thinks he knows science, and he sure as heck knows scientists.  From Journalist Gary Taubes Raises Bucks to Disprove His Diet Theory we learn that 

He [Taubes] called me a couple weeks ago to tell me a remarkable story. John Arnold, a wealthy financier, recently contacted Taubes after hearing him talk on the radio about the need for better research on diet and obesity. Arnold ... wanted to help provide funds for such research.  That conversation led to the creation of the Nutrition Science Initiative, or NuSI, ... The Arnold Foundation has put up money for NuSI’s first two years of operation.

So a billionaire has the bucks to fund whatever he wants.  He contacts Taubes and instead of Gary phoning up his creme de la creme science buddies, let's set up another organization.  Private bureaucracy is what it is.  Isn't part of the benefit of private funding to side-step the tedious process of public funding?   There's no need to do a public announcement, call for proposals, ensuring every equal opportunity "t" has been crossed and incentive "i" had been dotted.  Sounds like John Arnold trusts Taubes to pick the project ... or not?  According to the article:

NuSI collaborators—from Duke, the University of Massachusetts and other schools–are now planning rigorous tests of weight-reduction regimens. Most dietary studies, Taubes points out, rely on what subjects say about their eating and exercising rather than measuring what they’re actually doing. Some studies have observed subjects under tightly controlled conditions, with food and energy expenditures precisely monitored, but for obvious reasons such studies generally involve few subjects and don’t last long. Taubes hopes NuSI will carry out highly controlled experiment—perhaps involving special observation chambers that monitor energy expenditures—involving statistically significant numbers of subjects and lasting at least three or four months.

What was it that I was saying about "a bar too high"??  Are the studies already in the planning stage?  Exactly how much planning does it take to repeat any study plagued by whatever-shortcoming and merely fix the shortcoming to do it right??  But if Taubes is for real here, he's not only talking metabolic ward study, he's talking metabolic chambers?  Really??  Really, really???

I do believe that if NuSI does do the studies Gary envisions -- even an inferior mostly free-living study such as I described -- he will indeed be funding the studies that disprove TWICHOO for once and for all.  Therefore I fully support NuSI at this point in time.  Just put your money where the science is.   Drop the pretense of any objectivity, design *the* study to get the ball rolling, recruit a research group to do it, use Arnold's money to fund the friggin thing and GET that ball rolling.   These are critical days, after all.  

JUST DO IT