Calories ... and Taubes, NuSI, Ludwig & Co.

Bump!

Over on Twitter I was made aware that Dr. David Ludwig is coming out with a new book in January (HT Steven Snyder @NoGimmicksNutri) mentioned in this Time piece:  You Asked: Should I Count Calories?   The book is to be called Always Hungry (affiliate link if you're going to buy it anyway!)  This is a similar title to the NYT editorial Ludwig co-wrote with NuSI's VP of Research last year, discussed in this post.  I also have a friend who attended an obesity conference recently at which Ludwig presented much of the same ideas.  It is repackaged TWICHOO (Taubes Wrong Insulin-Carbohydrate Hypothesis Of Obesity), and what is most galling about all of this is that much of Ludwig's own research counters this ... Yet he perpetuates it?  From the article:

“People think overeating makes you fat, when really it’s the process of getting fat that makes you overeat,” says Dr. David Ludwig, a professor of nutrition at the Harvard School of Public Health.

Ludwig’s forthcoming book, Always Hungry, unpacks and refutes many of the damaging misconceptions people have about calories and weight management. “When you’re gaining weight,” he says, “something has triggered your fat cells to store too much energy, which doesn’t leave enough for the rest of the body.” That “something” is often the hormone insulin. When your body’s insulin response is out of control, “cutting back on calories can make the problem worse,” Ludwig says.

On the other hand, eating the right kinds of foods can temper your body’s insulin response and cause fat cells to settle down. “The cells open up and release their energy, which floods back into the body,” Ludwig says. “Hunger decreases, metabolism speeds up and weight gain isn’t a struggle because you’re working with rather than against your body.”

Wouldn't it be nice if his research supported these claims?  Search this blog on Ebbeling, his co-investigator on the *single study* from which two, and now three papers have been written (HT Erik Arnesen @erik_arnesen, I will get to that third one here on the blog shortly!) for more on this, but I want to link the three most relevant here:

1. The Myth of Starving Cells II and NEFA Levels Again
2. The Circulating "Food" Supply and The Failed Internal Starvation Hypothesis
3. Thirty Years of Glycemic Index Dogma, and The American GI Man

I also have a post in the works stemming from the recent activities of Nina Teicholz, her Nutrition Coalition, and the involvement of Laura and John Arnold (individually and as a Foundation) in this whole Dietary Guidelines political firestorm.   When that's published, this link will go live:  Revisiting NuSI, Its Funding, and Its Mission.   It is all just a little tooo cozy at this point, and the real issue weighing on my mind is how hypocritically opaque it all is.    

Lastly, since writing this post, I have collected additional evidences of "collaboration" between NuSI and David Ludwig who is a principal investigator on their largest (funding-wise) study.   Whatever you may think of industry funding, this level of involvement in all of this seems more than a bit out of the ordinary.  

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) funded that study.  NuSI is funding FA-squared, part of which is called Metabolic Fuels Study over on clinicaltrials.gov.  

The challenge in maintaining long-term weight loss is well known, however new research suggests diet quality may be the driving factor. A pilot study {clinicaltrials.gov link edited in} from our group demonstrated that a higher carbohydrate-containing diet was associated with lower total energy expenditure during weight loss maintenance (Ebbeling et al).  These findings will be confirmed in the ongoing Framingham State Food Study (NCT02068885): Following weight loss on a standard diet, 150 overweight or obese adults (aged 18 to 65 years) will be randomized to one of three weight-loss maintenance diets varying in carbohydrate to fat ratios for 20 weeks.

However, the specific mechanisms underlying the calorie-independent effects of diet remain unclear. Another study from our group demonstrated lower energy availability (calculated based on caloric content of circulating metabolic fuel concentrations) in the fasting and late post-prandial periods in 8 overweight or obese young adults who were maintained on a low-fat (high-carbohydrate) diet (Walsh et al). We hypothesize that this lower metabolic fuel availability on a high carbohydrate diet results in part from increased anabolic changes within the adipocyte, favoring fat storage in preference to oxidation.

Remember, lower fuel availability had nothing to do with hunger and was observed in a weight maintaining state on each diet.   But to repeat:

"the specific mechanisms underlying the calorie-independent effects of diet remain unclear"

That's odd.  How is it then that Ludwig has already written the book on this?  Boggles the mind.   Without further ado ...

---

Originally published 7/13/2014

Preface

This is going to be a bit of a ramble ... one of those "oh the odd coincidences of blogging life" type posts.  It was brought on by my post citing ItstheWooo's use of traditional ELMM methods to lose and control her weight and her irrational -- I think we're up to five posts now -- tirade in response.  Sigh.  When Calorie Gate's Adam Kosloff posted the 11 "experts" post, it got rather more roundly shared about the internet than usual thanks to someone's brain fart over at Whole9.  Now Kosloff didn't see fit to actually link to the sources of his copious quotes (bad Yalie), but I recognized my wording amongst Wooo's diatribe:

“Ya know blog, I’m not sure if [the CICO advocates] are actually purposefully pretending to misunderstand the hormone hypothesis argument, or if they really are too stupid to understand it. I just can’t tell. In my view it is beyond evident physiological factors are responsible for fat mass gain; calories and the mechanisms to obtain them (sloth/gluttony) are merely reactive to the body state which is controlled by baseline physiology.  So, when [the CICO advocates] for years and years and *years* keep writing mind numbingly stupid shit like this:

‘We again are asked to ignore the obvious — that Americans are definitely eating more, on average, with no concurrent need for those calories, and likely moving a bit less as well.’

I just don’t know what to think anymore. Are they morons? Are they so, so stupid they really can’t see the inverse projection of this system, which much more intelligent people have gone to great lengths to simplify and make child-friendly illustrations for them? Are they *pretending* not to understand because they have a vested interest in eating as much neurotransmitter plastering glucose/insulin whenever they want? Are they so rigid minded and dogmatic, not unlike a cartoonish villian such as Javert, that they can’t at all waver from their convictions no matter how ridiculous those convictions reveal themselves to be?”

Without links I was left to Google to track down where I said that and it turns out it was here:  Will NuSI clear the bar?   That post was written almost a year ago, and while I don't think my words above need any context, the article was a response to yet another editorial by Gary Taubes promoting NuSI and how we will one day know the answer to obesity and the mystery that is Donald Trump's hair.  My synopsis:

We get the rehashing of how WWII stopped Bergmann and Bauer's Lipophilia Hypothesis from becoming the working hypothesis for obesity, and yet another primer on calories vs. carbohydrates. We again are asked to ignore the obvious -- that Americans are definitely eating more, on average, with no concurrent need for those calories, and likely moving a bit less as well. The obesity epidemic that supposedly was instigated by the low fat craze is blamed on the fact that much of our additional caloric load is in the form of carbohydrates. This is not supported by one of Gary Taubes' own paradoxical cultures, the Pima, who did not eat a low carb diet prior to the 1900's, let alone billions of humans all over the globe. Or .... despite the "modern paleo's" insistence, the paleolithic diet in the literature -- both cited for the basis of the diet and that used in clinical trials.

Horrible stuff I tell ya.  Can someone please explain to me why, if we are unquestionably eating more as a country, we need to look further for the cause of the rising obesity rates?  Taubes says we're eating more because we're growing fatter, but that makes no sense.  Sorry, but some en masse hormonally induced horizontal growth disorder is not possible, nor is it explained by any honest accounting of all of the evidence.    Before going off on another rant against me and things I have NOT said, how about you address this concept:  Americans are eating more.  We weigh more as a result.  If you want to make it into some moral judgment, be my guest.  I am not.   How does the *fact* that we are eating more without any increase in the need for those calories (and likely less need for them) not explain the obesity epidemic??  Three, two, one ....

With that introduction ...

Gary Taubes is an intriguing man.  Sometimes I do wish I had the stalking and sleuthing abilities so many ascribe to me to figure out what makes the guy tick, but alas I do not.   Have you ever wondered how it was that Gary Taubes received a three-quarter of a million dollar advance to write Good Calories, Bad Calories ... from Knopf?  I realize Knopf is a subsidiary of a larger publishing house, but still.  Taubes' book Nobel Dreams was published in the late 1980's, and it hardly made him a household name.  Despite being in my general field of interest, I never heard of the book back when, it does not appear to have sold all that incredibly well, and it doesn't appear to have been all that well received by this reviewer in the NYT:

... Yet, disappointingly, ''Nobel Dreams'' does not appall us. Despite all the cues to shock and cynicism that Mr. Taubes has planted in his text, its effect is strangely muted. Indeed, it requires an effort even to lift an eyebrow. First, Mr. Taubes never makes of Carlo Rubbia the monster that his drama seems to require. The case against Mr. Rubbia often seems lame and petty: ''He was considered one the three toughest men to work for at CERN,'' writes Mr. Taubes, speaking of the European Center for Nuclear Research, ''and as far as I can tell, few physicists who worked for him liked him.'' ...

... More damagingly, Mr. Taubes -who studied physics at Harvard, aeronautical and astronautical engineering at Stanford and journalism at Columbia - fails to make satisfyingly clear what Carlo Rubbia and his team of physicists were up to. ...

... Foreseeing long before the end of the book how the story is going to turn out, we find it increasingly hard to pay attention. This seems a shame, because the author appears to have had a compelling story to tell. But something seems to have distracted him as well - some urge to strut instead of inform. Instead of a conduit, he acts as an obstruction. Or in the jargon of physics, he decays instead of conducting.

I'm aware of articles published in the interim, but there are no other books to be found bearing Taubes' name.  [Edit: thanks to Glenn in comments, I'm corrected  There was another book in 1993]  And then,  some 15 years later, Gary Taubes writes two articles, the second of which seems more popularly designated as "the article", a NYT Magazine piece entitled:  What if It's All Been a Big Fat Lie?  Taubes opens with:

If the members of the American medical establishment were to have a collective find-yourself-standing-naked-in-Times-Square-type nightmare, this might be it. They spend 30 years ridiculing Robert Atkins, author of the phenomenally-best-selling ''Dr. Atkins' Diet Revolution'' and ''Dr. Atkins' New Diet Revolution,'' accusing the Manhattan doctor of quackery and fraud, only to discover that the unrepentant Atkins was right all along. Or maybe it's this: they find that their very own dietary recommendations -- eat less fat and more carbohydrates -- are the cause of the rampaging epidemic of obesity in America. Or, just possibly this: they find out both of the above are true.

I've read this piece a few times over the years.  In some ways it lacks even Taubes usual "flair" for lack of a better word.  Not only that, but to this day Atkins has never been shown to have been "right all along".   Indeed he's pretty much been shown to be wrong.   Did anyone really find that single article so compelling as to warrant a $700,000+ advance to write a science book?  Perhaps we'll get the scoop in a decade or so when he writes his memoirs ...   It's just odd ... such advances are for superstars writing sure-bet #1 best sellers.   So then I click on page 2 of Big Fat Lie, and something jumps off the page at me:

The science behind the alternative hypothesis can be called Endocrinology 101, which is how it's referred to by David Ludwig, a researcher at Harvard Medical School who runs the pediatric obesity clinic at Children's Hospital Boston, and who prescribes his own version of a carbohydrate-restricted diet to his patients. Endocrinology 101 requires an understanding of how carbohydrates affect insulin and blood sugar and in turn fat metabolism and appetite. This is basic endocrinology, Ludwig says, which is the study of hormones, and it is still considered radical because the low-fat dietary wisdom emerged in the 1960's from researchers almost exclusively concerned with the effect of fat on cholesterol and heart disease. At the time, Endocrinology 101 was still underdeveloped, and so it was ignored. Now that this science is becoming clear, it has to fight a quarter century of anti-fat prejudice.

Ludwig has made a lot of waves of late, co-authoring a NYT opinion piece Always Hungry? Here's Why,  and a corresponding editorial in JAMA Increasing Adiposity. Consequence or Cause of Overeating? with NuSI VP of Research, Mark Friedman.   The obesity clinic is now the New Balance obesity clinic ... I guess since they're a sneaker and fitness apparel company such corporate sponsorship is OK, but I wonder where the line will be drawn in this regard if this is some new trend ;-)

But anyway .... I was curious to see if Ludwig was quoted in GCBC.  Search initiated .... nothing.  Searched WWGF, ditto.   I'm not sure why I searched on Friedman's name but here's an interesting thing that turned up when I did.  From GCBC:

Drafts of this book were read in part or in whole and corrections suggested by Robert Bauchwitz, John Benditt, Kenneth Carpenter, Michael Eades, Richard Feinman, Mark Friedman, Richard Hanson, David Jacobs , Cynthia Kenyon, Ron Krauss , Mitch Lazar, Jamie Robins, Bruce Schechter, Jeremy Stone, Clifford Taubes, Nina Teicholz, and Eric Westman.  I am deeply grateful to all these individuals for their time , their efforts, and their acumen . Any errors in either fact or form, however, remain mine alone.   {KL 13153}

Either that Men's Health article is even more fishy for plagerism (sic, intentional) or maybe Nina Teicholz did the writing for Taubes' book?  The mind boggles at the appropriateness of the IHC acronym once again ...

But let's get back to Ludwig.  He was implied to be on board with the Endocrinology 101 over a decade ago.  A big wig researcher at Haahvaahd.  Why wasn't HE in the book?  In the intervening years Ludwig has enjoyed scientific comfort in continual NIH funding on low glycemic index diets.   Perhaps it was because he was busy researching and writing a book called Ending the Food Fight:  Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World , published in 2007.   This book was loved by seemingly one and all:  Willett, Nestle, Pollan, Weil, Hyman, Agatston and Brownell.  That website (ht CharlesG) is a wealth of information.  

Ludwig has been on the insulin kick for a long while, but he has not taken anything even remotely resembling the Atkins approach.  He's America's Jenny Brand-Miller and he's about low-glycemic index, but the book is also not just about diet, but activity and forming good habits.  From the Q&A:

What is Ending the Food Fight about?

Ultimately, the solution to obesity is simple: eat less and exercise more. However, for the vast majority, and especially children, this simple solution hasn’t worked. ... [talks about other factors besides diet]

... Bookstore shelves are lined with simplistic weight-loss plans addressing just part of the problem. But even the best possible diet won’t work if people can’t (or lack the motivation to) follow it. Conversely, the best possible behavior change plan will ultimately fail if it advocates a diet that exacerbates hunger and diminishes energy level. Ending the Food Fight aims for a comprehensive solution. First, we must make peace within ourselves by learning to eat in a way that works with our basic biology. Next, parents must learn effective, age-appropriate strategies so that they and their children work together, not fight. In our present “toxic” environment, the family is the last bastion of protection for the children. Finally, having brought healing to our children within the family, we must turn our efforts outward, making changes in society that will support a healthful lifestyle for all of us. Then we can lay down our arms as the food fight ends.

Where have previous weight-loss diets gone wrong?

For much of the last half-century, the most common approach to preventing and treating obesity has been a low-fat diet. It seemed to make sense: if you don’t want fat on your body, don’t put fat into your body. The problem is that it didn’t work. Recent research from our group and others has shown that the relative amount of fat in the diet isn’t an important determinant of body weight. And low-fat diets have been notoriously unsuccessful. In the past five years, the pendulum has swung very far in the other direction, with the enormous popularity of the Atkins’-type, very low carbohydrate diets. These diets do produce significant weight loss for a few months. However, studies show that by one year, much of the weight is regained. How long can one go on bacon double-cheeseburgers, hold the bun? The basic problem with many diets is that they lack an accurate understanding of how food affects our hormones and metabolism, and ultimately our well-being. Diets that restrict an entire class of nutrients, fat or carbohydrate, produce biological and psychological deprivation that we can ignore for only a short time. Instead, we advocate a low-glycemic diet designed to stabilize blood sugar and insulin after the meal, promoting long-term satiety and supporting metabolism. This approach, focused on nutrient quality rather than quantity, offers the widest possible range of food choices, providing a sense of abundance instead of deprivation. Dozens of scientific studies suggest that this approach may be remarkably effective, not just for weight loss, but also to prevent heart disease and diabetes.

Now, perhaps it's because Taubes didn't include Ludwig in GCBC, but man did Teicholz ignore him when she wrote:

Despite the no-love-lost nature of the relationship between Taubes and mainstream nutrition experts, much of what he wrote seemed so eminently believable that it was almost immediately adopted ...  Researchers around the country who had read and digested Taubes’s work were suddenly studying sucrose, fructose, and glucose, comparing them to each other and looking at their insulin effects.  ... The science on these different types of refined carbohydrates is still in its infancy, so we don’t really know if all carbohydrates play a role in obesity, diabetes, and heart disease, or if some types are worse than others.      {The Big Fat Surprise, Kindle Location 5447}

This was written sometime in 2013.  She acts like nobody ever did any research into this stuff before the Great Gary came on the scene and then they jumped into action!   Ludwig had been doing research on this before Gary wrote his articles, and could be described as a publishing machine by the time GCBC came out.  Let's not forget that he was prescribing what Taubes described as his own carb-restricted diet to his patients.   Nah .... Taubes started it all.

Another fun internet coincidence, I looked at PubMed and then Google Scholar, and here's one of the first (relevant) studies bearing Ludwig's name I could find:   High Glycemic Index Foods, Overeating, and Obesity (1999, his earlier work was not diet related, see for example 1987).  

Also from the Ludwig site, I found this appearance on Dateline NBC.  Feel free to watch the whole thing -- if you're into Evil Big Bread and lobbying, there's some footage for ya -- but I've just clipped out a few parts of this January 2004 show.

Not Atkins ... Sure about that? .... Sure!   

Oh yeah, that's the study that J.Stanton called "well controlled" that I discussed here.  When looking to see if the Ludwig video was on YouTube, guess who popped up talking about bread? 

Obesity Should Be Solved By Now!

Did you see the line of diet books there?  South Beach, Zone, Protein Power and Atkins.  The hey day.  Remember those days?  So we were told to cut carbs and we all did it!  And yet it didn't help in the long run.  No I am NOT talking about me, or you, or anyone else individually.  I'm talking about the American people, because that is who Taubes is talking about.   At the bidding of Ancel Beelzebub Keys, life-force sustaining saturated fats were stripped from our diets and replaced with killer white bread topped with cocaine sugar.   Why, oh why, didn't we all keep doing the Atkins thing?  Evil Bread?  Did you note in my clip that the Bon Appétit lady talked about being raised on white bread?  I think its safe to say she was raised in the 1950s.  

They also included The Zone amongst the LC diet books.  Ludwig's version of low-GI in 1999 was Zone macros (30P-30F-40C) so I'd say Sears' endorsement of Ludwig is appropriate, but that diet really isn't low carb -- except that it IS by comparison to what Americans have eaten for, like, ever (we're not going there to the Native Americans today, but LC for most of them as well).   

Ludwig has a pretty famous 2007 study where those with higher-than-median 30-min OGTT insulin levels fared better on his low-GI diet, but overall, there was no difference in weight loss between groups.  Again, we're talking recommendations that would be prudent to make to the benefit of the majority of a population, not specific individuals.  Taubes is gunning for sweeping change to counter a NON-EXISTENT culprit.  

Fast Forwarding Thru to NuSI

• 2008 Eades' blog is tops, Taubes rises to fame in cultosphere
• 2009 Low Carb is da bomb, Mark Sisson throws his hat in the ring blaming insulin
• 2010  Cracks in the hypothesis start to widen and ... one by one adherents begin to jump ship ... An anonymous bunny eared blogger reads some old references and finds some disturbing errors and inconsistencies.  Gary Taubes starts blogging.
• 2011  A disastrous year for TWICHOO.  WWGF is a relative flop for the great science journalist. Taubes tanked on Oz.  Many more defections ensued.  Stephan Guyenet kills TWICHOO in front of the first crowd of "ancestral health" enthusiasts. 

NuSI is Born  

The year 2012 began with a very strange publicity stunt.  A petition, started by Peter Attia, with Gary Taubes and cosigned by a veritable who's who of anybody left in low carb.  Against a food?  A company?  No, against Tara Parker Pope of the NYT for daring to write that losing and maintaining weight loss is difficult.  If ONLY she would just go low carb ... right?

The formal announcement about the formation of NuSI came sometime in late summer/fall of 2012.  To much fanfare, they were going to do GOOD science.  They set that bar very very high.  You see, bad science was any study that was too small OR too short OR free-living OR failed to manipulate carbohydrate levels as the macronutrient of interest (not much concern over controlling calories but ...).  This bad science would, by the way, also include all of that rigorous Atkins-funded work Teicholz presents as top-of-the-line rigorous research.   I blogged about NuSI's ambitions and such here.

So the formation of NuSI went quietly along.  Every now and then Gary Taubes would pop his head up to write an article here or there.  Each of these articles was the same old same old, but with the new twist that NuSI was formed to fix it all!  

There's a Point Here .... Ludwig

So I wrote the Will NuSI Clear the Bar? post last August NuSI was just unveiling the research they were going to fund.  The post talked about another study, but they are about to begin (presumably recruiting) a new study in Boston, led by ... drumroll ... David S. Ludwig.  

The same scientist who was not all that fond of Atkins is all aboard the NuSI train and heading up a new and different kind of *real science* study thanks to a generous hedge fund billionaire.  What kind of real science?  The stuff that will answer for once and for all what the cause of all this obesity and disease is?  Let's look at this amazing new study shall we?

Current research and public health policy on obesity is largely based on the hypothesis that the fundamental cause of the condition is an energy imbalance between calories consumed and expended. By this hypothesis, the interaction between diet and body fat is determined by the caloric content of the foods consumed, while the macronutrient content of the diet (the proportion and type of carbohydrates, fats and protein) has no meaningful effect. This is often summed up by the assertion that a “calorie-is-a-calorie,” shorthand for the hypothesis that a calorie’s worth of protein has an equivalent effect on the accumulation and storage of fat in the human body (on “adiposity”) as does a calorie of carbohydrate or a calorie of fat. An alternative hypothesis is that the macronutrient composition of the diet influences adiposity through its effect on the hormones that regulate uptake of fat (technically “fatty acids”) by fat cells and their subsequent mobilization and use for fuel (that is, oxidation).

So we are going to do a 6 month metabolic ward study where 100 subjects will be randomized to two groups and fed isocaloric diets of 20% protein while half the subjects get 20% fat and 60% carb and the others 20% carb and 60% fat.  Food quality will be similar in terms of real, minimally processed foods.   

Oh sorry, that's not what they plan to do with 150 subjects randomly assigned to three groups of 50 ...

Phase I:  Standard American weight loss diet, 12 weeks, all subjects

45% carbohydrate, 30% fat, 25% protein; 40% below subjects’ calculated caloric needs for weight stability, minimum 1,200 kcal (“calories”) per day

For the first 12 weeks, participants in the study eat a diet modeled after what the average American eats, but at 40% below their calculated energy needs (by doubly labeled water). During this period, they are expected to lose 12% of their baseline weight.

Why are we not doing the weight loss phase on various different diets? I thought reducing calories was a failed weight loss approach. Why are we expecting them to lose 12% of their baseline weight? It's not the quantity of calories, it's the quality. How is this going to tell us anything about hormonal effects of fatty acid accumulation in adipose tissue. Hmmm?????

Phase II: Maintenance Diets, subjects randomized to one of the following diets, 20 weeks.

Low-fat:  60% carbohydrate, 20% fat, 20% protein;  Diet is rich in vegetables and whole grains and limits sugars and red meat.

Low-glycemic index:  40% carbohydrate, 40% fat, 20% protein (glycemic index 30-35); Diet replaces some grains, especially refined grains, with slowly digested (low-glycemic index) vegetables, legumes, and fruits.

Very low-carb: 15% carbohydrate, 65% fat, 20% protein;  Diet severely restricts carbohydrates and replaces them with fat, but keeps the carbohydrate load high enough to avoid ketosis.

For all diets:  caloric load continuously adjusted to maintain weight stability 

All meals are provided to the participants and they are closely monitored to assure that they eat all that they’re given. Throughout this 20-week period, participants are weighed daily. If their weight fluctuates, the caloric content of their diet is adjusted upward or downward to compensate, while always staying within the macronutrient prescription of their assigned diet. The goal is to ensure that the participants remain weight-stable, with less than 2 kg of total change, over the 20 weeks.

After the 20-week weight maintenance phase, the participants remain on their assigned diets, but are allowed to eat as much or as little as they like for 2 more weeks. The amount of food they eat is then quantified.

Again I ask why the calorie adjustment? Shouldn't we do each diet at the weight maintaining calories (there's that calorie word again, funny how you can't get around it) and see who maintains, loses or gains? But first I ask, does this study sound familiar? It should, it is somewhat a repeat of the Ebbeling/Ludwig study from 2012. They are fixing a few things (like controlling for protein), but ...   From What we really learn from Ebbeling et.al.:  I really hope they plan on addressing the differences if any between intake and doubly-labeled water expenditures before wasting all this money.  Either there's still a lot of cheating going on despite the near-metabolic ward (though still free living) conditions, or the "state of the art" has some problems that could render any seemingly meaningful results a wash.

This study hardly seems groundbreaking is the major point.  Sure, if it turns out well we could learn some things the last one didn't tell us.  There are more subjects for a longer time frame vs. smaller group/cross-over study for shorter periods.  

But let's assume this goes entirely as planned.  And Gary Taubes is right.    As with the first study, the subjects will lose over 10% of initial body weight on a relatively high carb (45% is now "standard American weight loss diet?) high protein, low fat diet.  This is taken as a given, and yet is in opposition to TWICHOO.  What does it tell us that the researchers are even doing this?  Weight loss has been studied to death.  This is new?

The study will provide insight into the effects of dietary macronutrient composition on adiposity during enforced weight maintenance. Differences in voluntary food intake over the final 2 weeks of the study will provide insight into the effect of diet composition on appetite and hunger during weight maintenance.

I don't really see how.   Like I said, even if this goes as planned.  Depending on initial intake, reducing calories to 60% baseline (for example from 2500 to 1500) is steep and in the last study they then increased calories to maintain the reduced rate.  That's a lot of adjusting but maybe their closer to 2000.  Then 5 months switching diets -- in the case of VLC the most radical of all.    In the end this is a free-living study so even if there is a 300 cal/day difference by the end of 20 weeks, as was the reported differential the last time,  there can be no definitive conclusions.  

If they determine energy expenditure by the caloric intake, well, here I thought one of the reason calories don't count is that they are inaccurate anyway?!   That's more a minor point, but just to demonstrate that the arguments about CICO won't go away, especially since no matter how well monitored, this remains a free-living study.

But ... The Funding ...

One of the things Teicholz laments in her book is the lack of interest by the NIH in funding research on the Atkins diet.  This is why researchers had to basically have their arms twisted to accept funding from the Robert and Veronica Atkins Foundation.  

“When an unscientific fear of dietary fat pervades the culture so much that researchers who are on study sections that provide funding will not allow research into high-fat diets for fear of ‘harming people,’ ” as we’ve seen at the NIH and AHA, “this situation will not allow science to ‘self-correct.’ A sort of scientific taboo is created because of the low likelihood of funding, and the funding agencies are off the hook because they say that researchers are not submitting requests for grants.” While Volek and his colleagues have long urged the nutrition mainstream to take a “more unbiased, balanced” approach to the low-carbohydrate diet, they remained reluctant to recommend the regime to the entire American population, because it had not yet been subject to a long-term clinical trial.  {KL 5382}

Teicholz goes on to discuss the Israeli study headed by Iris Shai (Teicholz's discussion of which is well documented here).   In usual name-dropping fashion, 

Meir Stampfer, said that she had initially planned to include only the first two arms. After hearing Eric Westman give a talk at Harvard in 2004 and reading some of the recent low-carbohydrate trials, however, she decided to include the Atkins regime as well. XX  {KL 5396}

The discussion of Shai, in this context of the frustrated researcher unable to get funding to text the diet, is rather suspicious in its use of footnotes.  Rather than discussing all of the studies that had included an Atkins-style diet, or at least summarizing them, 

Given the context of funding or lack thereof, especially with her insinuations of bias in the NIH and AHA, footnote XX is Teicholz's way of hiding key information in plain site.  That information being:

XX: For this reason, the study was funded in part by the Atkins Foundation.   {KL 5772}

I have mentioned this before and will stress it again.  The footnotes of this nature are included at the end of each chapter.  In the electronic book, they are at least hotlinked so that the reader can click, read the note, then click back to the text.  In the hardcopy form, the reader would need to find the last page of the chapter and physically flip back and forth.  It is doubtful most read these footnotes.  One is left with the impression that there was only one trial that included the eminent Meir Stampfer (identified as a Harvard nutrition professor).  The discussion finishes with mention of two more longer term studies as evidence of the safety of the diet and that Westman, Volek and Phinney had concluded the diet had reached the threshold to be "recommended to the public more broadly".   This statement is also accompanied by a footnote:

XXII: In 2010, Phinney, together with Volek and Westman, wrote a new Atkins diet book called The New Atkins for a New You: The Ultimate Diet for Shedding Weight and Feeling Great (New York: Touchstone, 2010), which sold more than half a million copies in two years. Phinney and Volek also self-published two books on the low-carbohydrate diet.   {KL 5783}

The chapter -- clearly erroneously titled Why Saturated Fat is Good For You -- moves on to hail the awesomeness that is Gary Taubes:

... whatever scientific progress has been made toward our greater understanding of carbohydrates generally in recent years has clearly been due to Taubes’s work. “This has been his most important contribution to the field,” said Ronald M. Krauss, .... For a journalist, it was an astonishing coup in the world of science. In 2013, Taubes became one of the rare journalists to write a peer-reviewed article for the highly respected scientific publication, the British Medical Journal. Yet given the stranglehold that Keys’s ideas have held on nutrition researchers for so many decades, it is perhaps inevitable that an alternative hypothesis had to come from an outsider. XXVI   {KL 5471}

XXVI: In 2012, Taubes and the doctor Peter Attia founded a not-for-profit group called the Nutrition Science Initiative (NuSI) with a $ 40 million grant from the Laura and John Arnold Foundation. It aims to conduct high-quality scientific research on issues that the NIH and AHA have been reluctant to fund. ...  {KL 5795}

Leaving aside Krauss' own NIH/AHA cred, according to Ludwig's NuSI bio:

Dr. Ludwig has received 16 years of continuous funding from the National Institutes of Health, totaling over $25 million in grants and has published an astonishing 42 articles in New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), and Lancet.

And yet

... pioneering researchers of the Atkins diet continued to expand their work throughout the 2000s, conducting trials on a range of subjects: men and women, athletes, and those suffering from obesity, diabetes, and metabolic syndrome. XV  {KL 5366}

XV: A portion of this work was funded by the Robert C. and Veronica Atkins Foundation, which was set up in 2003 with a $ 40 million grant from Atkins to finance research following his death. Although these low-carb researchers were understandably reluctant to accept financing from a foundation with a clear agenda, there were no alternatives, since the NHLBI and AHA have long considered a high-fat diet too unhealthy even to be studied and have therefore funded no trials on it. ...   {KL 5748}

Yeah, it's not like any mainstream government bodies fund research into the low carb diet (often Atkins):  Foster et.al. NEJM 2003 (NIH) ; Dansinger et.al. JAMA 2005 (NIH) ; Gardner et.al. JAMA 2007 (NIH) ; Sacks et.al. NEJM 2009 (NHLBI & NIH) ; Foster et.al. Ann Int. Med. 2010 (NIH).  Of course none of these made the main text of the book because they failed to support Teicholz's assertions of Atkins=best, some made the footnote, others weren't mentioned at all.

But Does Funding Source Matter?

In general, yes and no.  By that I mean that ultimately the data are what they are, and barring outright fraud, that remains.  The peer review genre has been embarrassed a lot of late, and this is disturbing to say the least, but if the integrity of the data reported cannot be challenged, then it is what it is.   I think the most fair criticisms are of publishing bias -- that is, if the results don't support the funding body's objective, they are rarely published up.  This is not a good thing, but for private organizations it makes no sense to publish things up and there is no legitimate means to force this.  This is not about drug approvals and such where every bit of study is supposed to be divulged to the FDA no matter how negative.  

So yes, studies funded by particular industries are always subject to a little extra scrutiny ... but at the end of the day if all a critic of the study results can do is point a finger and say "but _____ industry funded", I'm actually more inclined to believe those results have merit.  After all, if the results were faked or wrongly interpreted, it should be child's play to pull it apart on the science.  

And here is where it got a little interesting because I searched The Big Fat Surprise for Ludwig's name ... after all, the Ebbeling/Ludwig study was published long before Teicholz rededicated herself to finishing her decade long endeavor.  No mention of that study at all.  But ... here Ludwig does show up ... as a co-author on a paper talking about funding sources and bias.

Lesser, Lenard I., Cara B. Ebbeling, Merrill Goozner, David Wypij, and David S. Ludwig. “Relationship between Funding Source and Conclusion among Nutrition -Related Scientific Articles.” PLoS Medicine 4, no. 1 (January 2007): 41– 46.  {KL 8840}

Teicholz's book is littered with insinuation and worse about industry and government organizations and the like.  Some may be worthy of note, some out right legitimately nefarious (but you'd be hard pressed to find the truth or the difference in this hatchet job of a book).  The conclusions of Lesser et.al. including Ebbeling and Ludwig?

Industry funding of nutrition-related scientific articles may bias conclusions in favor of sponsors' products, with potentially significant implications for public health.

Oh really?

In 2012, the mainstream NIH funded Ebbeling/Ludwig study was published that showed two things using a direct measurement.

• Cut calories and assist in compliance, subjects lost weight.
• Keep calories stable and manipulate calorie "quality" and subjects remained weight stable. 

This conflicted with their indirect measurements showing energy expenditure was greater on the low carb diet.  They spun this as best they could to get the buzz.  Do you think Ludwig was already in talks with Taubes?  Friedman?  Maybe?  After all, in short order after the publication, Gary Taubes was back in his old stomping grounds at the New York Times penning yet another article about the same old same old.

What Really Makes Us Fat

... But not everyone buys this calorie argument, and the dispute erupted in full force again last week. The Journal of the American Medical Association published the results of a clinical trial by Dr. David Ludwig of Boston Children’s Hospital and his collaborators. While the media tended to treat the study as another diet trial — what should we eat to maintain weight loss? — it spoke to a far more fundamental issue: What actually causes obesity? Why do we get fat in the first place? Too many calories? Or something else? ...

... What was done by Dr. Ludwig’s team has never been done before. First they took obese subjects and effectively semi-starved them until they’d lost 10 to 15 percent of their weight. Such weight-reduced subjects are particularly susceptible to gaining the weight back. Their energy expenditure drops precipitously and they burn fewer calories than people who naturally weigh the same. This means they have to continually fight their hunger just to maintain their weight loss. ...

... The results were remarkable. Put most simply, the fewer carbohydrates consumed, the more energy these weight-reduced people expended. ...  On the very low-carbohydrate diet, Dr. Ludwig’s subjects expended 300 more calories a day than they did on the low-fat diet and 150 calories more than on the low-glycemic-index diet. ...

There's just one problem, throughout these remarkable findings, the subjects didn't gain or lose weight and the individual results were ALL over the map.  Wild swings, etc.  (As an aside, an article discussing food Calories and science that doesn't mention Atwater is just a disgrace.  Period.  )

If we think of Dr. Ludwig’s subjects as pre-obese, then the study tells us that the nutrient composition of the diet can trigger the predisposition to get fat, independent of the calories consumed.

Only they weren't pre-obese and they didn't gain weight while calories were held constant.   But here's the kicker:

Dr. Ludwig’s results are by no means ironclad. The diets should be fed for far longer than one month, something he hopes to do in a follow-up study.  As in any science, these experiments should be replicated by independent investigators.  We’ve been arguing about this for over a century. Let’s put it to rest with more good science. The public health implications are enormous.

Within the next two months or so ...

... The NuSI funded study, lead by a researcher who is now authoring editorials in support of Gary Taubes hypotheses with a member of the funding agency, will get under way.

Follow the money.  This stinks.