Stossel's Food Bunk I ~ Paging Dr. Attia!

Gary Taubes and Peter Attia were among the guests on a John Stossel program entitled Food Bunk a little while ago.  You may still be able to catch reruns if you so desire.   Long story short, Stossel discusses the role of government in regulating and recommending foods and nutrition.  It's worth a watch if you can find it, more for some of the other guests and information.  But thanks to Eenfeldt, I was made aware of the 8-minute appearance of the Lipidic Duo of Taubes and Attia, speaking of course on how our government is/was wrong about fats and the nutritional guidelines.  (I've decided I need a new Lego superhero look for Attia, the old one just had too much hair, please excuse the coloring on the face/head there, it was a quick job.)

Peter Attia is a doctor!  A hot shot Stanford educated MD, as Stossel points out, who did his residency at Johns Hopkins!

Stossel mentions Peter Attia is a doctor who went to Stanford (again), but Attia {paraphrasing}:  "Everything I learned about nutrition in medical school was wrong"

Taubes {paraphrasing}:  "Did Peter lose weight on low carb because he's some weird Stanford educated doctor, or is there something to my whacky theories?"

OK folks, that was three, count 'em, three, times that it was mentioned that Peter Attia is a doctor!  I might be imagining things here, but I perceived a slight flinch the first time Stossel mentioned this.  That's because, as I've pointed out, Attia is not a practicing doctor, nor has he ever been one after completing his residency and apparently a fellowship.  He, by his own account, left medicine.

I think this is important folks.  In this community we have various types of experts and celebs, and a fair number of them garner some clout because of the letters MD.  I do not want to downplay the value of such a degree -- you have to be "smarter than the average bear" to get into medical school, and smarter still to get into Stanford.  But as Attia, and Vernon, and Kruse, and Shanahan, and all the rest of these folks remind us again and again, the "knowledge" they are touting and sharing was NOT taught in medical school.  I realize everyone likes to feel smarter than their doctors who learned nothing about nutrition because they've read a book by someone who attended a few hours of classes in some generally unaccredited program ... or worse still, read GCBC.  But if you think your doc learned nothing in med school, as the guru docs keep telling you they didn't, then the education half of the MD  is irrelevant and one needs to look beyond the education per se to what the person has done with said education/background.  

In this regard, the doctors Eades and all the docs listed in my previous paragraph except Attia have clinical experience, some decades, on their resumes.  In Vernon, Shanahan, both Eades, and let's add Rosedale and Phinney to the list, we have doctors who have worked with patients directly as weight loss physicians.  Whether there's follow-up and accountability or not, we often hear about the numbers of patients they've treated and the results attained.  This much is unassailable "expertise" to the extent that it is related forthrightly.  Unfortunately most of these folks like to pose as scientists when they advocate for LC, and in each of the named cases, have provided significant material for this blog to debunk.    

But Peter Attia not only doesn't have a decade of clinical practice to ply off of, he appeared to be rather proud of that fact in a comment he made here a little ways back:

I actually did 5 years of surgical residency and a 2 year fellowship in surgical oncology. Perhaps this isn't enough clinical training to be a “real” MD, in your opinion, but I'm not sure what 10 more years of clinical practice would have taught me other than the conventional wisdom I learned about in medical school was probably wrong for most people, myself included. Does one need an MD or a PhD to have a point of view on this topic, or even to have something valuable to say?

Like Kruse, Attia is (was) a surgeon.   In his JumpStart MD presentation, Attia discusses his disenchantment with medicine and why he left it.  In a nutshell he felt he was always treating the result and not involved in preventing diseases.  I might suggest that if that is where his passions lied, cutting out cancers may well not have been the likely choice of specialty, because by the time you see the patient they are long past the prevention stage, duh!  But while his motivations and aspirations are irrelevant, it is relevant that he doesn't have the years of treating patients to bolster his case.

I find it truly horrifying that any doctor would learn their biochemistry/physiology (or relearn it or whatever) from a science journalist.  Any science journalist.   Attia has an interesting background with math/engineering undergrad before going to medical school.  He didn't have the "luxury of the premed education", which I take to mean he didn't get much if anything in the way of life sciences until medical school.  He was looking forward to medical school because finally he hoped to learn all the things he had been trying to read about on his own and "not getting anywhere".  His words.

And yet he describes med school as a social bonanza but "intellectually it was the low point of [his] life".  Doesn't that make you feel good about going to the doctor next time?!   OK, let me get this straight.  He talks about being interested in this stuff since he was like 13 and excited to finally learn it in medical school.  It's Gary Taubes who finally sets the intellectual gears in motion which is troubling in and of itself.  The ever inquisitive doctor reads the typical passage in his biochemistry book (Stryer, same author, later edition than one of my undergrad biochem texts) and decides to do what?  Investigate further in more formal academic channels?  No.  He decides he must meet with a science journalist to discuss all the questions GCBC left him with!  This is especially disturbing because Gary Taubes' journalism on the matter consisted mostly of decades old text books, interviews with scientists he openly disrespects and, when referenced, speculative peer review literature he fails to follow up on past the early 80's.

I think I'm beginning to understand how Gary Taubes is more influential in the medical community than in the scientific one if Attia's musings on the medical profession are at all representative.  He weaves a very convincing tale, and does so with the sort of authoritative tone that leads one to trust he's telling it straight.  If you read GCBC, as someone once said, you're probably spitting so many nails at "the establishment" after Part I, he has you primed to believe just about anything come the sections on insulin and obesity.  Throw in a few cherry-picked quotes from big name scientists in the field, and who would question it?  I would hope more doctors would, however.  If only because it makes no sense on such a basic level.  Most of these doctors are around my age or older and thus grew up during this obesity epidemic.  They all know we as kids ate carbohydrates and didn't get fat.  Even sugar, refined starches, and the supposedly microbiota-altering acellular carbs.  They also, hopefully, are worldly enough to see that while we have the so-called paradoxes where folks like the French eat more fat yet are slimmer, we also have those same paradoxes for carbs.  I would argue billions more.  

Not only did Attia bite on Taubes' offerings, he littered GCBC with post-it tabs and highlighted passages and had 20 pages of questions for Gary!  Really??  It is for this reason that I remind my readers about Attia's qualifications.  He's certainly not heading NuSI in the capacity of doctor to right the wrongs of government botched food science.  Sorry, John Stossel.  This wouldn't be all that shockingly appalling were it not for the fact that towards the end of Part I of the JSMD lecture (video above), Dock-Tor Attia manages to get some very basic and uncontroversial concepts in biochemistry/metabolism of fats so flat out wrong.  That's what you get, I suppose, when you've forgotten everything you learned in medical school and listen to Taubes and Volek ... or perhaps he was just high on waxy maize at the time of this talk.   Who knows, I think this was before he took up the UCAN.  It is inexcusable, especially in the context of his bashing of all those people who just never "understood the ramifications" of all the book learning.  Sigh.  We need to declare war on insulin!!!  I think I'll probably have to blog more on this some day....

So basically in Peter Attia, MD, we have just another n=1 "LC Success Story" type going off about his own self-experimentation and experience.  So what is that, and what does he tell Stossel's audience?:

Peter Attia used to believe all of what he learned and shared it with his friends, and applied it to himself, and then found himself 40 lbs overweight eating what were supposedly good foods for him.  

Peter Attia got more "not thin" eating whole grains.

That's not exactly true by his own account.  Here's his weight loss timeline:

• September 2009 – I eliminated most sources of sugar in my diet (for a definition of “sugar” click here) six days per week. One day per week I let myself eat whatever I wanted.
• February 2010 – I switched all white sources of carbohydrates to brown sources whenever possible (e.g., brown rice over white rice, brown pasta over white pasta), switched over to carbs that were higher in insoluble fiber, and eliminated sugar altogether.

He continued this through 2010.  

• January 2011 – I reduced starch intake to one serving per day, but continued to eat fruits and vegetables in an unrestricted manner.
• May 2011 – Reduced carbohydrate intake to less than 50 grams per day and reduced protein intake to approximately 120 grams per day, entering a state of nutritional ketosis.

There's a more detailed progression around the 10 min mark of Part 2 of the JumpStart video.  I would note as well, that he provides some body composition data around the 12:15 mark.  I note that in May of 2010 he's 172 and 23 lbs body fat, and in August of 2011 he's 170 and 13 lbs body fat.  Yeah, his composition is better, but one can't separate that from changes in his fitness routine.  I would also note that he regained a tad between the 9/10 and 1/11 scans, looks like 3 lbs, while he was still eating the evil "brown carbs" in dangerous terroir, and yet his fat mass remained at 24 lbs so insulin wasn't locking away his fat but rather he built a bit of lean mass.  Now clearly he's achieved some interesting body mass changes since going nuttyK, but again, anyone who peruses his site can tell he's dedicated himself to more than just an extreme diet to accomplish this.

But something else strikes me and I'm pretty sure many of you astute readers have spotted this as well.  It's a tale we hear quite often -- I was eating all the right things! -- In the context of the Stossel show, he was eating what he'd learned to eat because the government told him to eat that way so that's what the medical school he attended taught him.  Was he?  NO.  If I've said it once, I've said it 1000 times, pretty much everyone who claimed to eat the food pyramid did not.  And if we can't count on a *doctor*, educated at Stanford no less, to supplement his food choices with just a little knowledge of basic nutrition outside of what the government tells us -- e.g. nutritionally potatoes are a starch and not a "veggie" in the spirit of the USDA guidelines intent -- maybe we're all doomed!   I learned that about as long back as I have memories ... Thanks Mom!  

But if someone makes a major dietary change, to cut out sugar except for one day a week, what does that tell you?  He was eating a considerable amount of sugar before.  This is not what the government tells us, right or wrong.  He said he wasn't a candy fiend beforehand, and yet he must have been eating some considerable amount for it to make a difference and have him feeling better in a few months.  And then five months later he makes a second major dietary change switching out refined "white" starches for "brown".  In other words, he was not eating "whole grains" or "mostly complex carbs" after all.  Again, we can leave the argument on the wisdom of grain consumption aside for now as it is irrelevant.  The point is Peter Attia was eating the true SAD -- junky refined starches and sugary foods.  Michael Phelps lite if you will.  Which just goes to show that you can gain weight on a low fat diet (if it was indeed as low fat as he claims) and exercising 2-3 hours/day if you eat a lot of calorie-dense refined carb crapola.  But make no mistake about it, his diet circa September 2009 was not by anyone's definition healthy.   How can he claim he was eating mostly "good", "complex carbs" before, then make a big deal about changing his diet by cutting out sugar and then refined starches?   

Let's be clear, I'm not accusing him of lying.  I save charges like that for where they are truly warranted.  Rather, I believe he's probably suffering from LCIA (low carb indoctrinaire's amnesia).  There are no scientific studies on this, good or otherwise, but anecdotally, LCIA afflicts over three-quarters of first time LC success stories, and persists in over half of long term adherents, successful or otherwise.  This form of amnesia causes low carbers to misremember the quality and quantity of their diet before they read the low carb Bible and joined the converted.  The SAD is not the USDA-FoodPyramid-MyPlate.  In Attia's case, according to his website, even when he went LC, he was not LC by any standard as his carbs were scarily close to 300g, and well over that 151st gram!  And yet the results he discussed at JumpStart MD were from before he went nuttyK. 

Here's where I'd be concerned were it me.  He very seriously looks at the audience and sums up that he increased his calories from around 3000 to 4500 cal/day.  That's a lot, both in terms of calories (1500) and percentage (50%).  And he didn't exercise any more.  But he lost weight.  Well, you got me there Peter.  You are either Mighty Metabolism Mouse in human form, or you have a serious fat malabsorption issue, and neither is good.  I note with all his testing and taking pictures of his food and having someone else analyze it, he never had his RMR tested.  He has essentially preserved his lean mass, but now requires 50% more energy to fuel it with ketones.   That sounds intelligent ...  He launches into the anti-CICO rant.  

But it gets good here -- The SCIENTIST Attia has concluded that the difference here is that his resting metabolic rate has gone up.  He goes into this in detail, so I'm not misunderstanding him, and says his calories burned in digestion, exercise and daily living activities are constant and RMR must have gone up.  And oh!  You can get this measured.  But did he?  Apparently not as he offers no "proof" and makes no mention as he does with body composition and his lipid profile.  No, instead he just offers us  the fuel partitioning argument and how he's now burning more fat at rest because of his low insulin levels.  He wouldn't have to guess if he had his metabolic rate measured.  Or how about his caloric expenditure with exercising.  He's altered that routine so it's awfully unscientific of him not to have assessed that.  He offers up no study that shows even a correlation between fasting insulin and metabolic rate.   All of the arguments, even he essentially makes this one, are for changing energy substrate, not amount, so he's burning fat instead of glycogen, not that he's burning more.   

I wonder why if this has been so great, he has increased starch consumption in the form of nuts and UCANned corn (© Lerner).  These will provide glucose to burn irregardless of whether or not they spike insulin.  

Speaking of doctors, however, I'd love to see him and L.Ron duke it out!  Peter is singing the glories of nuttyK on the premise that he needs to eat more, a ridiculous amount more, to maintain his weight but he's leaner, while Rosedale will tell you that you want a lower metabolic rate and this is the beauty of carb restriction.  Rosedale thinks it is preferable to run a little on the cold side and idle-your-engine through life, and you'll live longer like a teeny e. coli consumer.  

OK, I'm breaking up now, so back to Stossel to tidy up and put the lid on this first installment.  Stossel seems most impressed that Attia lost weight eating fat.  Attia leans back and models his midsection as proof.  C'mon John.  You've been around long enough to know that people can lose weight on the Atkins diet.  Surely somewhere along the line in your storied career you looked into the diet industry.  If you want to counter the validity of government "approved" science, you and your producers can do better than to come up with these two posing as arbiters of what is "good science".  But at least they won't be wasting your, my and everyone's taxpayer dollars to fund their research, and at least you, me and everyone else are not paying their salaries.  Oh ... except NuSI is a 501(c)3 so we probably paid for part of their trip out to appear on your show in the form of a tax write off.   When the first annual reporting of where the money is going comes out, maybe John will be interested in that  ;-)

More on that science and Gary's performance next time!