The personal blog of Peter Attia, M.D.

The Fat Trap, NYT Magazine article – thoughts and comments

The Fat Trap, NYT Magazine article – thoughts and comments
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On January 1, NY Times wellness columnist, Tara Parker-Pope, wrote an article in the NYT Magazine titled The Fat Trap, and many of you forwarded it on to me. This was an excellent piece and I suspect it will be one of the most read pieces this year in the wellness space.

Ms. Parker-Pope acknowledges that weight loss is very difficult and the rate of recidivism for overweight people who lose weight is upsettingly high.  The article searches for clues as to why this happens. If you haven’t already read it, I think it’s worth reading, if for no other reason than to understand why conventional thinking is not solving this problem.

Reading the article actually stirred up a lot of emotion in me for many reasons.  The first emotion, believe it or not, was shame for all the years I silently judged those who were obese, particularly during my time in medical school and residency.  While I was overweight myself, I wasn’t technically “obese,” and I couldn’t understand how someone could be so lazy or gluttonous.  I knew this didn’t apply to me, of course, because I was eating “healthy” foods and exercising for hours a day – but somehow I assumed everyone else who was overweight sat on a couch eating junk food all day.

This article wasn’t the first time I was reminded of my former bias – that honor goes to my friend Gary Taubes, whose books Why We Get Fat and Good Calories, Bad Calories, do justice to this notion.  Reading Gary’s work for the first time was when it really hit home that most obese people were quite similar to non-obese people in terms of caloric intake.  The article also reminded me of the social difference experienced by overweight people.  I recalled a recent conversation with a friend – in her 40’s and probably 30 or 40 pounds overweight – over breakfast in a crowded restaurant.  As I was inhaling my bacon and eggs and asking for heavy cream (instead of half-and-half) for my coffee, she explained to me that it was easy for me to eat that way since I was now lean.  If she ate my meal, instead of her oatmeal and raisins, heads would have been turning and other patrons would have been mumbling under their breath, “No wonder she’s fat…geez…look what’s she’s eating…”  So while we both agreed she may be better off eating my breakfast instead of hers (assuming she’s insulin resistant), the pressure to eat a “healthy” low-fat, high fiber diet was enormous.

I do not know Ms. Parker-Pope, but I really empathize with her and respect her a great deal for admitting what I can only imagine was difficult – despite all of her diet- and exercise-related consciousness and erudition, she remains 60 pounds overweight.  I fully agree with Ms. Parker-Pope’s assertion that obesity is categorically not an issue of weak will, and I’m encouraged that she feels a sense of renewed optimism in her own journey.

There were two aspects of this article, however, that seemed missing to me. First, it focused a great deal on hormones that almost certainly play some role in obesity – leptin, peptide YY, ghrelin – but not once in over 5,000 words was the hormone insulin mentioned.  The reason this surprised me is not because I fixate on insulin, and therefore assume others should.  I’d like to believe I’m not that myopic. It’s because I’m reminded of how confused mainstream nutrition and obesity research is.  All of these other hormones – leptin, peptide YY, ghrelin – are reported to play a role in appetite.  The notion that “the answer” to treating obesity lies in manipulating these hormones suggests folks still think obesity is a disease of over-eating rather than a disorder of abnormal fat accumulation.  This distinction is not subtle, as I try to point out in the posts The great medical disconnect and Revisit the causality of obesity.  If you believe obesity is caused by overeating then it makes sense to study hormones that govern hunger.  Certainly hunger matters, and a person who is constantly hungry is likely to overeat, but the fact that this article doesn’t even suggest a role for elevated insulin levels strikes me as missing something.

Richard Feynman, who is perhaps one of my favorite people on the list of folks I’ve never met, said it best, “The truth always turns out to be simpler than you thought.”  If levels of leptin, peptide YY, and ghrelin are out of balance in people who overeat, what is the cause?  It seems the cause of leptin, peptide YY, and ghrelin dysregulation must be something that exists today, but that did not exist to the same degree, say, 50 years ago, right?  Fifty years ago, diabetes incidence was 20% of what it is today.  Fifty years ago, obesity rates were 30% of what they are today.  I’m going to write a great deal more about genetic influences on obesity at a later date, but these genetic differences are between people (i.e., the difference between someone like me who gets fat looking at carbs versus my wife who can eat them all day long and never gain a pound).  These differences, however, do not even begin to explain the difference between the entire U.S. population in 1960 versus the U.S. population today.  That’s the question, I suspect, we need to be asking.

It is wonderful that today we have the advanced tools of molecular biology and epigenetics to delve into the most nuanced mechanistic and molecular rationales for biology.  However, it creates a bit of a distraction when we forget the reason we’re doing it. The reason we’re trying to “figure this out” is to treat and prevent obesity and the associated diseases of metabolic syndrome.  Think about this at the highest level: 50 years ago these diseases were far less common than today.  200 years ago they were exceedingly rare.  Over such time periods there has been very little, if any, genetic drift (i.e., shift in our genetic make-up), so the log-increase – literally a full logarithm increase – in obesity during a period of time in which we have not genetically changed, leaves us searching for an environmental, rather than genetic, explanation or at least that’s what we should be searching for.

Think of it this way: In an effort to prevent death from lung cancer, is it more important to know that smoking leads to lung cancer (i.e., before the introduction of cigarettes lung cancer was virtually unheard of, yet today it is the most common cause of cancer death in both men and women), or is it more helpful to know that smoking may alter the nicotinic acetylcholine receptor gene cluster on chromosome 15? Sure, it is nice to know the latter, but knowing the former is what matters.  You prevent lung cancer by not smoking, not by creating a drug to interfere with the genetic pathway that smoking interferes with.  The genetic explanations of obesity matter, for sure, and they may one day explain the differences between people like me and people like my wife (who weighs 110 pounds soaking wet and can eat cookies all day), but it’s not the most important question, and it’s not going to help someone like Ms. Parker-Pope and the people I know she wants to help.  A tragic trend in health sciences is the avoidance of obvious (but “non-sexy”) solutions to problems in favor of nuanced (but “sexy”) ones.  If you want to study obesity and get a large grant, you’d better study leptin over insulin or simple macronutrient manipulations.  If you want to treat obesity, you’d better think of a drug to alter appetite over figuring out how food choices impact the hormonal/enzymatic regulation of your fat tissue and, as compensation, perhaps, your appetite.

The second reason I was a bit puzzled by this article, which is actually a subset of the first reason, is that it continues to propagate the notion that the obesity epidemic is caused by caloric imbalance.  If you subscribe to the caloric imbalance hypothesis you end up assuming, that dietary fat is “bad” because, gram-for-gram, it contains more calories than protein or carbohydrate.  You’ll recall, from the definition of a calorie, that the ONLY thing the caloric difference tells us is this: burning a fixed amount of fat will generate more heat than burning an equal amount of protein or carbohydrate. Is this relevant?  I guess it depends on your application.  It would be relevant if you were looking for lamp fuel to keep your cabin lit circa 1850, which is why we made kerosene out of whale blubber before we discovered electricity.  But when you stop to consider how delicate the balance is between how many calories we eat versus how many we store (for a quick primer on this, refer to the post You are not what you eat), it’s hard to convince yourself that the energy density of food is the driver of obesity.

A lot of people ask me if I get angry when I read articles like this one.  I think angry is the wrong word.  These articles upset me, but not because I think there is a grand conspiracy out there trying to make people fat.  If that were the case, I’m sure Ms. Parker-Pope would expose the guilty doctors, scientists, and policymakers.  Keep Hanlon’s razor in mind – Never attribute to malice that which is adequately explained by stupidity.  What disappoints me is that every 7 seconds someone in the world dies from a complication related to diabetes.  This is entirely preventable, and these people do not need to suffer this way and succumb to this disease.  Ms. Parker-Pope’s mother did not need to suffer the way she did or be denied her final request. And that breaks my heart. I’d be willing to bet anything her mother was not lazy or gluttonous in the slightest.

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About the Author:

Peter Attia, M.D., is a physician in private practice in NYC and CA. His practice focuses on longevity and healthspan. His clinical interests are nutrition, lipidology, endocrinology, and a few other cool things.

Discussion

  1. Lardlad  January 6, 2012

    Fear of CHD is another one. I know it was why I shunned fat for years. Gary’s books turned it around though. This is the kind of information that needs to get out there and turn it around for other people. Keep it coming!

    (reply)
    • Peter Attia  January 6, 2012

      Yes, fat-phobia is a big issue to overcome. It was certainly the toughest problem for me to get my head around. It really took me a full year to work through all of the science and gain a level of comfort with this. The part that made it “easy,” of course, what that the numbers didn’t lie. The more I reduced my carb intake and replaced them with – primarily – saturated fat, the more triglycerides went down and my HDL went up (not to mention the leaner I got).

    • Jill  January 8, 2012

      Hello Peter. I had the same experience. One day I had rump steak with the fat on, and stir fried leafy greens for lunch. Glucose level 4.9. A few days later, baked beans from a can on home made bread, two pieces of fruit. Glucose 11.2. I enjoy my protein and fat diet. I don’t miss carbs at all. I have been goal weight for 18 months. Thanks for the interesting information. Regards J

    • Peter Attia  January 9, 2012

      Congratulations, Jill. Keep it up.

  2. Tony Ricci  January 8, 2012

    Peter,

    I can write extensively on why this is a strong, well articulated response, but of greatest importance is the tone of this article, which is excellent. It is one that is hard to create through text and much easier through speech; which is informative, engaging, but a sense that you like the person writing, that while his position is scientifically well substantiated, he is not argumentative and his intents are genuine.

    While this is less important amongst our peers, it vital to those with little knowledge, afraid of their own physical condition and desperate for guidance from someone they detect as both knowledgeable and genuine. This is of course 70% of America.

    What I have learned in years of disseminating messages on this subject is that sometimes it is better to be liked, than be good. But if you want a message that transforms lives, be both. Few nutritionists, physicians and scientists can do both. You have both qualities and this is the only way to take a message beyond the combative confines of our disciplines.

    Tony Ricci, MS, CSCS, LDN, CISSN, CNS

    (reply)
  3. Donna  January 14, 2012

    Peter–I just found your blog, and i wanted to encourage
    you to keep it up. My eating pattern has evolved to this over about
    five years, and now it is easy and natural. It is irritating to read how difficult losing weight is suppose to be–this is easy. I’ve lost 30 pounds. Exercise, triathlons, etc.alone didn’t work. Unfortunately, while I’ve told friends and family about why eating this way is better for one, I don’t think I’ve convinced anyone–they just think I’m a little odd! It’s so frustrating that no one will listen. I’m 68 and to me the trade off between loss of vision, dementia, neuropathy, loss of mobility, etc. and sugar is simple–I can’t understand why others don’t agree. So, keep up the good work–You can be very helpful to lots of people, assuming they will listen! D.

    (reply)
    • Peter Attia  January 14, 2012

      Donna, you’re absolutely correct about what works what doesn’t. So happy for you. I agree with you wholeheartedly on the importance of taking a long-term view of disease prevention. Seems obvious, huh? Thank you so much for your support.

  4. Jeanne Shepard  January 23, 2012

    This is all great, except for us peri-menopausal women, who have lost weight on low carb diets over the years, only to gain it back and more, and find it harder and harder to lose the weight again.
    I’m happy that my lipid profile and A1C is good, and that I’m healthy, but I ‘d like to be able to lose that extra 40 lbs.

    (reply)
    • Peter Attia  January 23, 2012

      You sure make a good point – that damn pesky estrogen hormone. I have to be honest with you, Jeanne, I just haven’t seen enough really good data to understand this well enough. One of the exact questions Gary and I want to answer through research we hope to fund is exactly this point in exactly this patient population. Sorry for not “knowing” the right answer. I will say that it’s always beneficial to avoid sugar and highly refined carbs, though.

    • Leighan Meddick  February 18, 2012

      I hope to God that you and Gary gain as much funding as you need, because I am 100% certain that whatever information you find, you two would be some of the only people I’d trust to purvey it honestly.

      The great thing about Gary is he is all about the science, not whether he’s right or wrong. I am sure you are exactly the same too from reading your articles. This is why I think it’s so important you receive the funding, and if I was rich I’d donate as much as I possibly could. If I had 100 million I’d literally donate 95 of it to you both. It’s about time we had the answers!

    • Peter Attia  February 18, 2012

      Leighan, thanks so much for such kind words of encouragement. We are very excited about what NuSI aspires to do in terms of cleaning up the science of nutrition. Please stay tuned!

  5. Mimi Daly  January 23, 2012

    As a menopausal woman I have to comment that my experience has been the opposite of Jeanne’s. In fact, although I don’t doubt that she lost weight on her low carb diet, because why would she lie — I have to assume there’s another factor at work. My story is that I gained weight steadily during perimenopause and by the time I had my last period I had gained 20 pounds. I was eating a mostly vegetarian diet of beans, tofu, eggs once a week (because I didn’t realize it was okay to eat them more often), whole grains and vegetables, and on the weekends the occasional chicken breast or fish filet. When I became a Paleo eater three years ago the weight simply vanished from my frame and I now weigh the same as I weighed in my 20’s. I have no interest in returning to my old habits and am happy to report that the food cravings are gone. The Paleo diet has cleared up joint pain and a couple of other issues too. I know it’s all anecdotal, but Peter, I didn’t want you to get the impression that we menopausal women don’t profit from eliminating carbohydrates. I definitely did.

    I’d like to add that I’m delighted to see so many health professionals, including yourself, endorsing Gary Taubes’ work. Your petition regarding that NYTimes article is most encouraging. FINALLY — FINALLY — maybe we are beginning to get beyond the stupid, erroneous, persistent misinformation about fat regulation that has plagued us for the past 60 years. Today, that TV chef Paula Dean came out and revealed that she has Type II diabetes. Don’t you just want to call her up and say, WAKE UP and DUMP the CARBS?!@!?

    (reply)
    • Peter Attia  January 23, 2012

      Mimi, thanks so much for sharing your story. It really goes to show how subtle these nuances are and how “we” need to get away from a one-size-fits-all mentality about nutrition – even low-carb nutrition. Yes, I believe everyone would be better off without any sugar and highly refined carbs. But what about dairy? What about artificial sweeteners? What about land versus water protein? It’s really this second- and third-order stuff I get excited about when I work 1-on-1 with people. Also, thank you for support of our petition. Finally, I don’t know Ms. Dean, but I would love the opportunity to help her.

    • Alexandra Mazzeo  January 24, 2012

      “Today, that TV chef Paula Dean came out and revealed that she has Type II diabetes. Don’t you just want to call her up and say, WAKE UP and DUMP the CARBS?!@!?”

      Unfortunately there are many, many people out there, some of them really smart, who think Paula Deen’s diabetes is the result of too much FAT. All that butter! All that lard!I’m afraid her announcement will strengthen, not weaken, the low-fat message, especially when people go to the American Diabetes Association web page looking for advice and find that it recommends a low fat diet with plenty of “healthy whole grains.”

    • Peter Attia  January 24, 2012

      What’s most sad is that people like Ms. Dean are confused. Our medical establishment and policy makers have failed to provide the correct information and recommendations. If that’s not bad enough, they have created a system of what I refer to as poor “food infrastructure,” where the default eating habits of folks are bad. This is probably the greatest single driver of the fact that 67% of Americans are overweight. Americans are not too lazy or too stupid, as some like to suggest. We’ve been misled and placed in an environment that almost assures failure for 2/3 of people, unless you take profoundly conscious and deliberate actions.

    • Debbie  March 27, 2012

      I’d like to respond to Mimi and Leslie. I’m over 50, lost and have kept off a great deal of weight – 80 pounds – for over 20 years, and am still learning and struggling with how to eat and feel good. Mimi, your story is so encouraging. And, Leslie, I also am so angry that while I lost my weight on a low-carb diet, sort of a modified WW, over the years as a result of the high-carb/low-protein message, came to believe I didn’t need much protein and fat, and probably did myself some harm. I am a carb craver; I spent years, keeping my weight off, eating hard candies, sugared and sugar-free. I still crave that – I’d rather eat a huge salad with vegetables and protein mixed in, than a big steak or piece of fish. I actually dislike most red meat. Reading Gary Taubes was illuminating and shocking. I made a huge change in my diet, but wonder if it’s been huge enough. I’m still eating the big bowl of salad, only now I’m eating more protein in it and more olive oil. But – I wonder if it’s enough protein. I don’t feel as great as Mimi says she does! And I’m not skinny – I’d love to lose another 10 pounds – but maybe that’s unrealistic. I was obese, after all, and Mimi wasn’t. Maybe I drink too much coffee with too much half & half. We are all different. But, Mimi, if you could share with us what you eat, it would be lovely. Thanks so much for your post. Very encouraging!

  6. Margaretrc  January 23, 2012

    Just want to add my 2 cents’ worth. I, too, am post menopausal (65) and have successfully lost a little weight and, more importantly, quite a bit of fat, over the past 9 months by restricting my carbohydrate consumption. I’m convinced that everyone can benefit, at least where health is concerned, from some type of carbohydrate restriction, though exactly how/how much needs to be tailored to fit the individual. This is not to diminish the issues raised by Jeanne, just emphasize that lack of success is not a reason to go back to old dietary habits, rather a reason to experiment further and find what works optimally for the individual–and perhaps accept that genetics, age, and gender do have influence and not everyone is going to be able to return to the figure they had when they were in their 20s. I certainly didn’t, but am happy with the result and plan to continue this way of eating forever even if I don’t lose another pound.
    Paula Deen is a celebrity chef famous for her recipes high in sugar, flour, and fat–mostly butter and lard. Of course the media are blaming the fat for her development of diabetes and there is a huge need to counteract that propaganda and lay the blame where it belongs–on the sugar and starch.
    Keep up the good work. It is nice to have another M.D. in our camp. I’m so tired of hearing/reading something on the order of “saturated fat is bad, it’s about calories in/calories out, etc. and I’m a doctor (dietician, nutritionist, etc.), and you’re not, so clearly I know more than you.”

    (reply)
    • Peter Attia  January 24, 2012

      Thanks so much for your insights. I look forward to the day when I can really understand all of the individual difference between folks. Yes, the irony of the Paula Deen thing is, of course, the culpability of fat instead of sugar. One step at a time. We’ll get there.

  7. Fay  March 13, 2012

    I was reared on a low fat diet because my father was diagnosed with high cholesterol. The only time I ever got eggs and bacon was on Christmas Day. My father still developed heart disease an died of it. I low carb now and my cholesterol is excellent. Health care professionals in the UK are still telling me I don’t eat enough carbs. I ask: “Would you give me strawberries or peanuts if I had an allergy so why when I have diabetes are you telling me to eat carbs ?” I call it the Goldfish Effect because they all stare at me open mouthed and don’t know what to say !

    (reply)
    • Liz  April 24, 2013

      Fay, that’s a great response, hope I can remember it when I need it! Well done you!

  8. Lesley  March 27, 2012

    Peter, thank you so much much for your wonderfully informative website. I am a fellow physician, and have been overweight and progressively obese since my teens, despite many attempts to lose weight. It has always been clear to me that I eat a very similar diet to my non obese friends and colleagues despite the mantra of calories in calories out, and I had concluded that there was something very flawed in this reasoning. Everyone else of course does unfortunately presume that you are gluttonous and lazy, which is a heavy burden of disapproval to bear. If I could have one thing come out of this change in thinking it would be to hope for greater understanding and compassion for our fellow human beings by the general community. Not one obese person I know does not think critically about every single thing they eat. In January this year I rediscovered low carb diets, and the wealth of information now out there on the role of Insulin in promoting fat accumulation. I read Gary Taubes books, started a ketogenic low carb diet and have never felt better. The weight is coming off slowly, my blood pressure has improved, i have more energy and my rosaceae, mysteriously, has cleared. I am sure it is a disease preventing change, if not life saving. I studied much of this years ago in intermediary metabolism, but unfortunately the penny did not drop, I wish it had! As you did, I have been obsessively scouring the online and scientific literature. There really are some excellent and informative blogs on this issue, many listed on your links, for which I, and friends also on this journey, are very grateful. I do however feel profoundly disappointed and let down by my colleagues in the general medical community, not only for the misinformation put about about diet for the last thirty years, but also for the damage done to our health as a result. I am sad and angry that people who need this information are not getting it and are developing chronic diseases as a result. We are fortunate to be Internet savvy, but there are many who are not, and publications like Gary’s book are very important in reaching a wider audience. Besides changing dietary guidelines we also need to get into some preventative medicine and start identifying patients with components of metabolic syndrome and intervening. Besides the obese the families of type 2 diabetics as well as hypertensives would be a good place to start screening, and it would be great if all of this could occur in a much more supportive and less judgmental framework, and in a much more rigorous and complete fashion. There is a very concerning complacency around this from physicians, and it is really an urgent issue to address. Again, thank you for the website, it is really good to have such a well written scientific discussion on nutrition issues available.

    (reply)
    • Peter Attia  March 27, 2012

      Lesley, thanks for sharing your story. Please do all you can to ensure the folks who need to hear this message have an opportunity to do so.

  9. Lesley  March 27, 2012

    Peter, thanks for responding, I plan to, starting with patients, family and friends, but I also like your ideas on a top down, bottom up approach, and am considering how best we can try and influence government thinking and dietary guidelines. Any thoughts on this? There is considerable research supporting low carbohydrate diets, do we need more, or do we have sufficient level 1 evidence to rewrite the guidelines in your opinion? I realize in saying this that the current guidelines have been one long poorly considered experiment with disastrous effects. In the USA it is obvious that the USDA should have no role either in the future development of any guideline! sadly too you have exported the standard American diet, so an audience beyond the USA has a stake in overturning this dogma.

    (reply)
    • Peter Attia  March 28, 2012

      I think it’s safe to say we don’t have level 1 evidence for much, if anything, in nutrition. People like me interpret the current evidence and feel very confident in the “answer,” while others view the evidence and take a completely opposite view. We can’t both be right. NuSI aspires to be an integral part of the solution to this obvious problem. The question, of course, is how can NuSI harness the energy and passion of folks like you to change the world by introducing rigorous science to an otherwise emotional debate?

  10. Lesley  March 29, 2012

    Agree, it’s time to move the discussion beyond n=1 and gather some rigorous data, which is the only way we will convince colleagues. Meanwhile there is a grass roots movement away from current guidelines. we clinicians need to start engaging with this as an alternative to the current failed hypothesis. .I have also been speaking to a colleague and she is looking at trialling a low carb diet in her steroid dependent obese patients with auto- immune conditions., many of whom are quite resistant to weight loss as you would know. That could certainly be a very interesting group to look at.

    (reply)
  11. Sanjay  November 28, 2013

    Hi

    I have been following your blog with a great deal of interest and have a very basic, maybe silly, question. I didn’t know where else to ask it, so I’m putting it here.

    You say that obesity is primarily caused by cells becoming insulin resistant and thus glucose is stored as fat in the cells by insulin. If that is correct then how is obesity relaed to diabetes? By definition, the pancreas in diabetics can’t produce sufficient insulin, so going by the above logic glucose should not be stored as fat in the cells in case of diabetics and they should not be obese, all other things being equal. Where am I going wrong here? Also, as I diabetic (Type 2), I’m taking heavy medication to control it. So, am I causing myself to become fat that way?

    Best Regards
    Sanjay

    (reply)
    • Peter Attia  November 30, 2013

      Sanay, it may be the case that IR is restricted to insulin facilitated glucose uptake and not to insulin’s effects on fat metabolism. In particular, it’s clear that less insulin is needed to inhibit lipolysis that to stimulate glucose uptake. Frayn and colleagues (DIABETES, VOL. 60, OCTOBER 2011) make this point quite well albeit not explicitly. Basically, obese people do not mobilize FFAs from adipose more readily and in fact may mobilize less, which fits the “overeat in compensation for sequestering energy in fat stores” model described so well by Mark Friedman.
      Someone with T2D should be greatly restrictive of carbohydrate and, hence, insulin demand.

    • Yossi Mandel  December 1, 2013

      I’m assuming we should look at that study explaining the fine details of insulin effect in any case, but isn’t the statement of ” the pancreas in diabetics can’t produce sufficient insulin” only true towards the end of the T2D progression, where type 2 is becoming insulin dependent as the beta cells have died off of insulin overproduction? The progression being:
      Glucose consumption rises
      Insulin production increases
      Cells become insulin resistant
      Cycle of pancreas pumping out ever higher levels of insulin and cells becoming even more resistant
      Beta cells begin to die off
      Insulin dependence etc.
      Which is why there is an initial weight loss in some diabetics due to insulin resistance.

      Meaning, diabetes is a disease of insulin resistance, not insulin underproduction.

      If the heavy medication is one that spurs insulin production in the pancreas, then the greater danger might be that it is killing beta cells more quickly than diabetes alone.

    • Yossi Mandel  December 2, 2013

      The hammer of amazement keeps on hitting me over the head. While I was reading that study you referenced in Diabetes Journal, I decided to take a look around at their research as most of their articles are free, and lo and behold in their very first issue in 1952 they have a biography of Arnoldo Cantani (late 1800s) as a pioneer of diabetes treatment – who used the treatment that you are advocating now, which is considered heresy!

      Quotes:

      “Excessive eating of starch and sugar is the preeminent or at least the exciting cause of diabetes.”
      “The remedy for diabetes is not in the drugstore but in the kitchen.”

      http://diabetes.diabetesjournals.org/content/1/1/63.full.pdf – it provides some neat details of his treatments of patients.

    • Peter Attia  December 2, 2013

      A true classic. Thanks for digging this one up!

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