Last minute notice for those of you in Seattle tomorrow evening. Gary Taubes will be here at Elliot Bay Books to talk about his new book Why We Get Fat: And What to Do About It.

Here are the particulars:

Tuesday 02/08/2011 7:00 pm (Tomorrow at the time of this writing)

Elliot Bay Books
1521 Tenth Avenue
Seattle WA 98122

More info:
Why We Get Fat: And What to Do About It (Knopf) is acclaimed science writer Gary Taubes’ no-beating-around-the bush examination of why so many today are seriously overweight. A three-time recipient of Science in Society Journalism Awards, and presently a Robert Johnson Foundation Investigator in Health Policy Research at the University of California, Berkeley, he builds on the strong base of material he presented in his Good Calories, Bad Calories—which Michael Pollan said was "a vitally important book, destined to change the way we think about food." Part of that thinking is seeing the problem lying in particular kinds of carbohydrates, not fats, and not in calories per se.

I’ll be there! Hopefully you can make it as well.


Insulin MoleculeIn the first of several posts on Gary Taubes’ new book Why We Get Fat: And What to Do About It, I focus on the very brief introduction to the book where he sets out his central premises that explain the central issue raised in the title: why *do* we get fat?

They are stated very simply. So simply they may be hard to grasp. Here they go:

  1. When Insulin levels are elevated, we accumulate fat in our fat tissue; when these levels fall, we liberate fat from the fat tissue and burn it for fuel
  2. Our insulin levels are effectively determined by the carbohydrates we eat – not entirely, but for all intents and purposes.

Simple, right?

What’s missing: talk of calories expended or calories consumed. the need for fat-burning exercise, staying just a little bit hungry all the time. All these assumptions will be addressed systematically, but the two paragraphs above essentially explain the ‘Why" to the whole getting fat thing.

There is one more section in the introduction that bears pulling out here:

The science tells us that obesity is ultimately the result of a hormonal imbalance, not a caloric one – specifically, the stimulation of insulin secretion caused by eating easily-digestible, carbohydrate-rich foods

Just like the body ‘grows’ early in life in response to hormonal cues (i.e. the presence of growth hormone), fat tissue ‘grows’ later in life in response to hormonal changes (principally, insulin).

Next Post: Section 1: dismantling the going assumptions

I’ve been scolded repeatedly over the last month or so about the unconscionable neglect of my blog. What can I tell you? Well, I’m back now!

Not that I’ve been waiting for an excuse to blog. There has been a lot to say, just hadn’t gotten around to saying it. However, the big impetus for me has been the release of the most anticipated book on nutrition in the last couple of years. I’ve posted regularly on the work of Gary Taubes, author of Good Calories, Bad Calories. At the risk of repeating myself, GC, BC was a turning point for me in that it opened my eyes to a completely new way of looking at diet and nutrition, and did so in a thorough and convincing way. While the book was not a diet book (no recopies there) I changed my diet to adhere to the general principles laid out in the book (eating meats and leafy vegetables until satisfied, eliminating sugars and starches, limiting fruit, etc.) and lost 20 pounds without any additional changes (i.e. no exercise).

While I still recommend GC, BC, it is admittedly a challenge to take on. It’s over 600 very densely-packed pages with lots of biology, biochemistry and medical terminology. Of all those to whom I’ve recommended the book, only a handful (3?) have reported they actually read it. Given it was so important and influential, Gary (we’re on a first-name basis, these days) got repeated requests for a ‘readers-digest’ version of GC, BC that more people would actually read.

In December, the much anticipated condensed release of the last ten years of Gary’s work was published:

Why We Get Fat: And What to Do About It (Borzoi Books)
The much-anticipated condensed version of the groundbreaking work begun almost ten years ago with his New York Times "Big Fat Lie" article and the epic "Good Calories, Bad Calories."

For all the times I’ve recommended GC, BC, replace that recommendation with Why We Get Fat. Not only is the book much more condensed and simplified, it also has the benefit of the previous three years since GC, BC was published. The message is essentially the same – just re-emphasized:

  • The principal driver of fat storage is chronic insulin elevation and chronic insulin elevation is driven by consumption easily-digestible carbohydrates
  • The presumption ‘calories-in, calories-out’ is the principle explanation of why we get fat is an over-simplification and says nothing about a causal relationship between what we eat and why we get fat

That’s enough for this post as I plan to have a series of posts on this book planned. It’s that important.

More very soon.

An article on the NPR blog caught my eye today:

Americans Exercise More, But Still Get Fatter

Well, the headline got it right, but when you read the post, you get the same yadda, yadda about ‘lowering caloric input,’ ‘avoiding fat,’ and ‘exercising more.’

Just another reminder to look the other way when you hear the conventional wisdom. There is a new wave coming. Stick with me and I’ll keep you right out front on the leading edge.

Interestingly, the article does not appear with the link above any more. Here’s the article I coped from my

Our workouts aren’t keeping up with our pig-outs.

That fitness routine is soooo not working. More Americans are spending some of their leisure time exercising, yet folks just keeps piling on the pounds.

Here are the cold, hard facts. About 35 percent of adults engage regularly in physical activity when they’re not working, according to estimates based on a 2009 nationwide survey. That’s up from 32 percent in 2008.

Now, what’s the scale tell us? Not good. More people in the U.S. are obese than ever. In 2009, about 28 percent of people in the U.S. were obese, up a fraction of a percent from 2008.

But hop in the Wayback Machine and check the weights in 1997. Nineteen percent of people in the U.S. were considered obese then.

There’s not a moment to lose in doing something to reverse the weight trend. A recent study found that a substantial decline in the rate of heart attacks could be fleeting as obesity and diabetes become more prevalent.

Exercise can only burn so many calories. Eating better is crucial. Recommendations for new nutritional guidelines would cut saturated fats even more than in the past and promote healthier foods, like fruits and vegetables.

But maybe you want to try some more reps of that time-honored weight-loss exercise move — pushing back from the dinner table.

What you *really* need to do to be healthy (which, by the way, will lead to healthy weight) is drastically reduce carbohydrate consumption (eliminate sweets and processed carbs), get your inflammation down (principally by upping your Omega-3 and reducing your Omega-6), getting your Vitamin D in a good range (50ng/ml, remember?) and lifting heavy things on a regular basis (see my BBS posts).

None of this aerobics and calorie restriction, OK?

I’ve been getting lots of encouraging comments from friends and acquaintances recently now that I’ve committed to posting more often. One of the comments I’ve been getting though is to have a simple, one-pager that lists the ‘foods to seek out’ and ‘foods to avoid’ and includes a few general meal selections as well.

Seems like a simple thing, huh? Well, I do think it’s pretty simple to avoid food that quickly raises your blood glucose or otherwise results in the creation of fat (recent post on fructose is highlights that heretofore not-well-understood phenomenon). But every time I tell someone that I get quizzical stares and incredulous furrows in the brow. “There’s got to be more to it than that!” is the general thinking.

Then I go to a few of my favorite sites and find they don’t really have a simple one-pager suitable for posting on the ‘fridge either.

Seems like some white space I can fill in.

Well, not exactly me … it’s not like I’m creating this material out of whole cloth, it’s a compilation of lots of points of view, with my own little twist in there for good measure.

So, here’s my first stab at such a list – suitable for framing (or lining the bird cage as the case may be). Once I get it refined, I’ll post it as a .pdf in a more visually pleasing form.

While you already know these are my personal views and I’m not credentialed in any way. You should also know that if you’re allergic or have any other negative reaction to any of these foods, you should use your better judgment and avoid them.

Foods to seek out:

Food item Why? Notes
Beef, pork, lamb, chicken, fish, shellfish Best source of protein containing a full spectrum of amino acids. Fat in animal proteins (saturated and mono-unsaturated,typically) are your metabolic friends. Don’t cut out the fat. Enjoy the nutritious and satiating food you were meant to eat.
Dairy products Other good sources of calories and good fats. While they do contain sugars (lactose), they only moderately raise blood glucose. Milk, cheese, butter, mayonnaise etc. Do not choose low fat products or sugar-added products.
Ham, sausage and other processed meats Protein is good. While there are some concerns with some processed meats, if you choose them carefully, they can be enjoyed in good health. Avoid processed meats with carbohydrate content exceeding 5g per 100g.
Eggs The perfect protein. Better to choose organically grown eggs. Typical practices result in eggs that are too high in pro-inflammatory Omega-6 fats.
The ‘dangers’ of dietary cholesterol are wildly exaggerated.
Seasonings Enjoy your foods. Herbs, spices, stock, salt and pepper according to taste.
The ‘dangers’ of salt are also exaggerated. Not wildly so (like cholesterol) but moderate salt intake when it’s conscious is not a danger. The bigger danger is when you take in all the salt unconsciously by eating lots of processed foods.
Sauces Enjoy your foods. Be sure these sauces have low carbohydrate content. Avoid sweet sauces (sugars) and heavy gravies (flour).
Vegetables Loads of vitamins, minerals. Beneficial dietary fiber. Be sure to gravitate to the deeply pigmented (dark, bright), fibrous vegetables and you can’t go wrong.
Dressings More food enjoyment. Oil and vinegar or mayonnaise.
Oils Beneficial fats. Make sure they’re cold pressed oils (olive, linseed and coconut oil).
Supplements Vitamin D and Omega-3.

Unless your diet contains a good supply of fish with a high fat content you may need a supplement of the essential polyunsaturated fatty acid omega-3, e.g. in fish oil.

Practically all people living typical modern lives (no matter your latitude) need to supplement with vitamin D. Seek to get your circulating vitamin D (25(OH) Vit D) up to 50 ng/ml.

 Foods to avoid:

Food item Why? Notes
Potato based products High glycemic load (raises blood glucose). This includes mashed, roasted and baked potato. Also includes any kinds of potato-based chips.
Corn High glycemic load (raises blood glucose). Most people have no idea how ubiquitous corn is in the Standard American Diet (SAD).
Rice High glycemic load (raises blood glucose). Includes ‘milk.’ And, no, brown rice is not appreciably better.
Annual Grasses High glycemic load (raises blood glucose). Many are adversely affected by gluten and other proteins in grasses. Wheat, barley, etc. Which means avoiding breads, pasta, bread, crackers, breakfast cereals, etc.
My experience is this is the hardest thing for most people to give up.
What do we call it when people just keep doing things they know are bad for them because of some uncontrollable compulsion?
Sugar High glycemic load (raises blood glucose). Stimulates liver to produce fat. Sweets, cakes, pastries, soft drinks, juice.
See the ‘addiction’ reference above.
Chemically- processed vegetable and nut oils They contribute to an increased risk for heart and artery problems, diabetes, overweight, cancer, allergies etc. Include margarine, poly-unsaturated fatty acids (corn oil, sunflower oil, etc.). When chemically processed (as opposed to cold-pressed), these oils rich in omega-6 fatty acids which are inflammatory and detrimental to your health.
Soy Enhances estrogen dominance, impairs thyroid function, blocks mineral absorption. Take a moment to read an eye-opening post on the dangers of soy.

This seems like a hefty-enough post for now. Will follow up soon with some some of the specific choices I make on a day to day bases and begin to address some of the biggest stumbling blocks for most people (sugars, breads, grains).

Much of this list of recommendations was sources from:

Dr. Annika Dahlqvist: Low-Carb/High-Fat physician advocate in Sweden
Mark’s Daily Apple: The Primal Blueprint
New Atkins for a New You

See "King Corn" - Movie Finding reports that demand for high-fructose corn syrup is declining precipitously around the world. Just one look at this Forbes article (Sourced from Associated Press) and they appear to be doomed, I tell you, doomed!

While I’m all for less consumption of corn  syrup in all its form (high-fructose or otherwise), I wonder if we’re just going back to the good ol’ ‘natural’ sugar. That the fructose/glucose mix of sugars (whether cane or beet) is virtually equivalent to corn syrup is still lost on most people. The encouraging sign is the whole Sweet Surprise campaign (can’t bring myself to link to it … do a search if you want to find it) might possibly wind up backfiring on the whole lot of sweeteners given that the one accurate claim of the campaign – that corn syrup is not that different from sugar – is one that is likely to stick.

If you’re interested in an eye-opening look at the whole corn shtick, check out the movie King Corn. Two college buddies from the east coast find out sets of their respective grandparents came from the same little town in Iowa and they set out to discover their roots and learn all you never wanted to know about the brave new agribusiness world of corn production. You’ll be interested (but, perhaps, not surprised) to find that corn functions more like a raw material used in the production of other things that it functions like a ‘food.’ Available on demand at Amazon, Netflix and other places, I’m sure. Perhaps even at your local library?

CaloricBalanceFEH A little over a month ago I began an exchange with a blogger (James Krieger) who saw fit to award Gary Taubes with a mocking BullS*#tter of the day award. You see, James is an unwaveringly committed to the principle of caloric balance: the principal cause of fat storage is that we simply consume more calories than we burn. To refute the carbohydrate hypothesis (the principal reason we get fat is because of the consumption of easily-digestible carbohydrates) put forth in Gary Taubes’ Good Calories, Bad Calories, James creates his own ‘predictions’ he inferred from the hypothesis and, as one might expect, successfully dismantled each of the straw men he constructed. Touche.

As you may have seen in previous posts, I’m not convinced the simple caloric balance rubric works in cases where the calories that are consumed are in the form of easily-digestible carbohydrates (sugars, white bread, etc.). While he does acknowledge that different macronutrients work differently in the body, his point is that as long as there is a caloric deficit, we won’t have enough calories to make fat.

My bottom line on this line of reasoning is that there may well be some merit to the idea that as long as you live in a caloric deficit, you are not likely to retain fat. For the sake of this discussion, let’s accept this premise. For practical purposes, in an environment where there is relatively abundant, cheap sources of refined carbohydrates, it is TBU: True, but useless. The overwhelming majority of people are not going to voluntarily stay in caloric deficit their entire lives, so why orient your recommendations around an unsustainable approach? Especially since there is convincing and ever growing evidence that if one pursues long-term carbohydrate restriction it is possible to avoid getting fat without having to consciously restrict calories.

Since the original post is no longer up and the blog on which is was originally posted has been retired in favor of a new one (good move on his part, I’d say), I include the full exchange (very long, warts and all) here for posterity.


Keith said…
Having read Good Calories back in 2008, and having read your blog, I’m puzzled by the ‘conclusions’ you extrapolate from the carbohydrate hypothesis. Since I was sure I hadn’t seen these conclusions stated, I re-read the portion of GCBC that laid out the hypothesis (pages 355 to 447, for those of you following at home) and was unable to find these ‘conclusions’ you state.

Now, it is fair to say that the carbohydrate hypothesis stated in the book was short on specific conclusions. For me, that was a good thing and apparently by design. The intent appeared to be to provide as much objectively verifiable information as possible and have that lead the way to re-thinking the conventional wisdom about caloric balance (among other things) so that the hypothesis may be tested clinically.

That said, it seems the burden would be first on you to provide the references for these ‘conclusions’ you offer. They may well be reasonable conclusions – as many other conclusions may be. But they are *your* conclusions, not the author’s because he didn’t state them. I submit if you are not able to find these conclusions stated by the author, then perhaps you did erect straw men to further your own rhetorical ends.

The other observation I have to share is a bit broader in scope. I find the notion of a self-appointed ‘bullshit detective’ (one wonders if this office comes with a sash … and huge epaulets) – especially on issues as complex and multi-faceted as human nutrition to be rather tedious. While I realize some find it good sport to leap to ad hominem attacks, I personally find it rather pointless.

You obviously have a lot of passion and a strong background in these issues. I am sure many people are helped in your practice. I’m at a loss, though, as to how personal attacks help us learn what we need to learn to help people get better or avoid falling into a state of disease in the first place.

Can’t we just argue the facts and leave the middle school stuff somewhere else.
April 26, 2010 1:02 AM

James Krieger said…
They aren’t conclusions. They are predictions that naturally follow if the carbohydrate hypothesis were true. Then it’s a matter of whether those predictions hold under experimental conditions.

Regarding my style of blog, people have varying opinions on it. I will eventually be scrapping this blog and starting a couple other ones which won’t have the same style.
April 26, 2010 6:42 PM

Keith said…
I stand corrected. Predictions, not conclusions. Thank you.
The original question remains, however. Where does the author state the predictions you cite.

I still can’t find them.
April 27, 2010 3:54 PM

James Krieger said…
That’s the whole point of my post…that Taubes doesn’t approach the carbohydrate hypothesis like a scientist and actually test the hypothesis by making testable predictions and seeing if they hold under experimental conditions. I came up with the predictions because they are predictions that must hold true if the carbohydrate hypothesis were true.

Basically my whole point is that Taubes never attempts to falsify the carbohydrate hypothesis, which is exactly what he should be doing. Instead he only looks for confirmatory data (and even some of his confirmatory data is flawed, like the data that uses self-report of food intake).
April 27, 2010 7:05 PM

Keith said…
Predictions out of whole cloth
Thank you, James. That does clarify. So you did not obtain these predictions from the author.

You take nearly 100 pages of carefully crafted and researched prose and condense it down to an elevator pitch. You construct predictions out of whole cloth predicated on an incomplete understanding of the hypothesis. You take care to construct these predictions to be imminently falsifiable and you dash your hastily-constructed straw men almost as quickly as to stand them up. By way of just one example, you assert a prediction about fructose that is in opposition to what the author clearly states in his hypothesis … and he does so only four pages in to the 90+ pages describing the hypothesis (you can look it up yourself – page 359). To say nothing of the more recent work by Dr. Robert Lustig on the lipogenic effects of fructose (hepatic synthesis of triglycerides, etc.). Hardly inspires confidence that you’ve really done your homework here.

It could be taken a bit more seriously if you had at least made some specific references to the text as you constructed your straw men, but you chose not to. What is most dismaying is that you clearly have the requisite cognitive ability to make a real go at challenging the hypothesis, but it doesn’t really matter if you don’t use what you have.

I don’t know if the whole of Taubes’ hypothesis is right – it has not been tested in any completely verifiable and conclusive way. The hypothesis he puts forth, however, is as complete, coherent and cogent a one on the causes of obesity that I’ve seen – and there is a large body of clinical research over many decades that comports well with the hypothesis. Moreover, the choices I have made in light of what I learned from "Good Calories, Bad Calories" have been more beneficial than I could have imagined – as has been the case for many others with whom I have shared this information.

I also know there are clinical results that support his hypothesis and some that do not. But your attempt at disproving the hypothesis fell short right out of the gate as you demonstrated an utter lack of understanding of the source material and a lack of seriousness in grappling with the issues in any depth.
April 28, 2010 11:56 PM

James Krieger said…
You take nearly 100 pages of carefully crafted and researched prose and condense it down to an elevator pitch.
Carefully crafted?
Yes, maybe carefully crafted to tell a story. But a carefully crafted story that leaves out large amounts of conflicting information isn’t correct.
Keith, it takes me just a few minutes of reading his book to find glaring ommissions and errors in it. Maybe it’s because I’ve done over 75 lectures on obesity and obesity related research so that I’m intimately familiar with the work in the area.
For example, let’s take the very beginning of Chapter 14, where, down the page, Taubes states:
"Lean people will often insist that the secret to their success is eating in moderation, but many people insist that they at no more than the lean….surprising at it seems, the evidence backs this up."
But the EVIDENCE DOESN’T BACK THIS UP. There are dozens and dozens of studies that show that overweight people don’t accurately report their food intake and consume much more than they report. But Taubes says nothing about this. He took the self report data and assumed it was accurate, when it’s clearly not.
It took me a few minutes to find this major error in such a "carefully crafted" book.
Or how about page 273 where Taubes talks about the differing tendencies of people to gain weight, and then goes onto claim on page 274 that "something more is going on than mere immoderation in lifestyle – metabolic or hormonal factors in particular. Yet the accepted definitions of the cause of obesity do not allow for such a possibility."
Yet Taubes is wrong here as well. There are dozens of studies on the phenomena of Non-Exercise Activity Thermogenesis (NEAT) and how it plays a large role in people’s differing tendencies to gain weight, and it also fits in with the concept of energy balance. Yet Taubes says nothing about this work despite the large body of data out there.
Again, it only took me a few minutes to find this.
GCBC is nothing but a story….a story that leaves out information that doesn’t fit with the story.
You construct predictions out of whole cloth predicated on an incomplete understanding of the hypothesis.
If my understanding is incomplete, then please explain where and how. Please explain why each prediction wouldn’t follow from the carbohydrate hypothesis.
By way of just one example, you assert a prediction about fructose that is in opposition to what the author clearly states in his hypothesis … and he does so only four pages in to the 90+ pages describing the hypothesis (you can look it up yourself – page 359).
I discuss the issue of fructose here:  
To say nothing of the more recent work by Dr. Robert Lustig on the lipogenic effects of fructose (hepatic synthesis of triglycerides, etc.)
Dr. Lustig unfortunately leaves out important information when discussing the effects of fructose. This is thoroughly discussed here:
The hypothesis he puts forth, however, is as complete, coherent and cogent a one on the causes of obesity that I’ve seen
But it’s not complete. It’s horribly incomplete. When it takes me a few minutes to find major errors in the book, that’s a problem.
April 29, 2010 5:58 AM

Keith said…
I get it, now …
At least I think I do. It appears you have decided that every hypothesis that does not confirm the energy balance hypothesis is wrong. OK. I am not convinced of its correctness and, as I said in a previous comment, nor am I convinced that 100% of Taubes’ carbohydrate hypothesis is correct either. I’m still learning and despite my disagreement with you, I have gained from this exchange.

Your 100% surety produces its own blind spots in entertaining another points of view. The core reason why I decided to comment on your blog was the flippant nature of it – as if you are the only one in possession of the truth. Yes, I know you’ve said ‘it’s just a tone thing, get over it,’ but it does matter. Even in your own very long treatise on how fructose is processed by the liver, you admit that some lipogenesis takes place in the absence of an insulin response, and use a single 6-day study (  to assert categorically that it is energy balance that is the key to whether fructose leads to lipogenesis. Isn’t that just another example of confirmation bias?

At the risk of conflating two issues here, my reading of Lustig is that he is very mindful of ‘dose and context’ in the context of fructose consumption, which is where he differs with Taubes’ hypothesis, instead emphasizing fructose in the presence of dietary fiber is a key element to whether the fructose becomes lipogenic (as well as the dose, of course).

Where I believe your own blinders have not allowed you to completely understand the carbohydrate hypothesis is that you (at least in this exchange) do not seem to take into account the key premise of the carbohydrate hypothesis which is that obesity is a disorder of fat metabolism which is engendered by metabolic and hormone imbalance (principally triggered by consumption of refined carbohydrates). Perhaps you have taken that on in other posts. Since I have not searched your blog exhaustively, I may have missed it. As long as you believe you have all the answers already and dismiss others points of view immediately when they disagree with yours, then decide to attack the person; it diminishes your argument for people like me. Maybe I’m just an outlier. I don’t watch ‘reality’ TV either.

Thank you for your time and I wish you – and those with whom you work to get and remain healthy – well.
April 30, 2010 9:55 PM

James Krieger said…
Even in your own very long treatise on how fructose is processed by the liver, you admit that some lipogenesis takes place in the absence of an insulin response, and use a single 6-day study ( to assert categorically that it is energy balance that is the key to whether fructose leads to lipogenesis. Isn’t that just another example of confirmation bias?
I would contend that you are creating a strawman out of the argument I’ve made, and that’s probably partly my fault as I may have not been totally clear in my presentation.
First, of course lipogenesis can occur in the absence of an insulin response. In fact, that was one of the points of my original post on Taubes. Taubes likes to demonize insulin, and one of the points of my post was that you can get fat without it.
Second, lipogenesis is not a light switch. It’s not like fructose is non-lipogenic in an energy deficit and then suddenly switches to lipogenic in an energy surplus. These states exist on a continuum, with the degree of lipogenesis changing with shifts in the degree of energy status.
You also can’t just look at lipogenesis. You also have to consider fat oxidation rates at the same time. Again, it’s a matter of balance. Sure, fructose can be lipogenic, but if the rate of fat oxidation matches the rate of lipogenesis, then there will be no fat accumulation.
The body is constantly undergoing anabolic and catabolic reactions. Tissue mass only increases if the anabolic reactions, all summed up, exceeds that of the catabolic reactions, all summed up. In this case of fat, lipogenesis must exceed the rate of fat oxidation. And this is again a matter of energy balance.
take into account the key premise of the carbohydrate hypothesis which is that obesity is a disorder of fat metabolism which is engendered by metabolic and hormone imbalance (principally triggered by consumption of refined carbohydrates)
No, I certainly do take that into account. But there are two major problems with that tenet. First, all the hormones in the world can’t make you fat if they don’t have the substrate to work with. Hormones can’t trump energy balance. They are just signaling molecules. But they can’t cause the synthesis of new tissue if there is no substrate to build that tissue with. You can bark all the orders you want to construction men, but they can’t build a skyscraper unless they’ve got the materials to do it with.
The second problem with that tenet is the implication that obesity has a single primary cause. However, the scientific literature is quite clear that there are numerous factors all contributing to obesity. Even simple things like portion sizes have been found to be contributors. You could eliminate refined carbohydrates from the diet, and you will still have an obesity problem.
May 1, 2010 7:35 AM