Both low- and high-carb diets can create hazard of early death, study detects

Eating a moderate amount of carbohydrates best for healthy lifespan, say researchers

Eating either a low-carb diet or a high-carb diet creates the risk of an early death, according to a major new study which will dismay the many people who have ditched the likes of bread, rice and potatoes for weight loss or health reasons.

Researchers who pooled the results of eight big studies have found that eating a moderate sum of carbohydrates is best for a healthy lifespan. Less than 40% or more than 70% of calories from carbohydrates carried a higher risk of mortality.

Not all low-carb diets are equal, however. People who ate a lot of meat and fats instead of carbohydrates, such as lamb, chicken, steak, butter and cheese, had a higher mortality risk than those who got their protein and fats from plant-based foods such as avocados, legumes and nuts. Popular weight loss diets such as Atkins and Dukan include a substantial amount of meat-based foods.

Quick guide

Carbohydrates in your diet

Low carb diets have become a trend. Cutting the carbs can lead to weight loss for a few weeks, but while there are bad carbs we don’t need, such as sugary beverages and sweets, there are also good “starchy” carbs that we do, because they are high in fiber and vitamins and minerals and give us a slow and steady release of energy throughout the day. These include wholewheat pasta and flour, vegetables with their skins on, and beans and lentils.

Low carb diet

Low carb diets have become very popular for weight loss, but you have to make up for the loss of filling carbs with extra protein and fats. Low carb diets tend to advocate animal proteins and fats, like steak and cheese. While they don’t include sugary treats and soft drinks, they are also usually light on vegetables and fibre. Popular low carb diets include: Atkins, Paleo, South Beach, Dukan and ketogenic.

High carb diet

Not a weight loss diet, clearly, but a way of life. The general diet of people in Asian countries, particularly those with low incomes, tends to be high in carbs because of the amount of white rice that is eaten. Those in more affluent western countries who eat a lot of carbs are likely to be overdoing the sugary beverages and snacks.

Moderate carb diet

Most people in the western world get around half their calories from carbohydrates, which is how it should be, say nutritionists. That’s 50 -5 5% of your energy from carbs. The issue, however, is over which carbs these are. The famously healthy Mediterranean diet, for example, contains lots of fibre-rich whole grains and beans. A diet in which the carbs come from biscuits and soft drinks and has little in the way of fruit and veg is not good, however moderate the carbohydrate uptake is.

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” Low-carb diets that replace carbohydrates with protein or fat are gaining widespread popularity as a health and weight loss strategy ,” said Dr Sara Seidelmann, a clinical and research fellow in cardiovascular medication from Brigham and Women’s Hospital inBoston, who led the research published in the Lancetpublichealth journal.

” However, our data suggests that animal-based low-carbohydrate diets, which are prevalent in North America and Europe, might be associated with shorter overall life span and should be discouraged. Instead, if one chooses to follow a low-carbohydrate diet, then exchanging carbohydrates for more plant-based fats and proteins might actually promote healthy ageing in the long term .”

Seidelmann, who is both a cardiologist and a nutritionist, told the Guardian the team had published a substantial body of work” to exhaustively answer a question and not simply offer merely one piece of the picture “.

” Nutrition is high up on everybody’s intellect but there is such embarrassment about what we should eat. One day, a study is coming out telling us high carb is better, another day a study is telling us low carb is better .”

Trials to compare low-carb and high-carb diets immediately are not possible, because they have to be carried out over many years and people find it hard to stick to a diet over any duration of period. Instead, her squad carried out observational research with more than 15,400 people, aged 45 to 64, from diverse socio-economic backgrounds from four US communities who were enrolled in the atherosclerosis risk in communities study. Those people filled out questionnaires on their eating patterns on two occasions, six years apart. Their health was followed up for 25 years, allowing for factors that might alter the results, such as smoking, income and diabetes.

These results were pooled with seven other observational studies carried out in various regions of the world, involving a total of more than 430,000 people.

They found that 50 -year-olds eating a moderate carb diet, with half their energy coming from carbohydrates, had a further life expectancy of 33 years, which was four years longer than those on low-carb diets and one year longer than those who feed a high-carb diet.

The writers said they could not prove cause and effect, because of the nature of the studies. However, they said people who embraced western-type diets that heavily restricted carbohydrates often ate fewer veggies, fruit, and grains and more animal proteins and fats. Some of those animal products have been implicated in stimulating inflammatory pathways, biological ageing and oxidative stress, and could be a contributing factor to the increased risk of mortality.

High-carb diets are common in Asian and poorer nations, they said, where people eat a lot of refined carbohydrates such as white rice. Those also contribute to a chronically high glycaemic load and worse metabolic outcomes.

” These findings bring together several strands that ought to have controversial. Too much and too little carbohydrate can be harmful but what counts most is the type of fat, protein, and carbohydrate ,” said Walter Willett, a prof of epidemiology and nutrition at Harvard T H Chan School of Public Health and the co-author of the study.

Low-carb diets are popular for weight loss because they work quite well in the short term, said Seidelmann, and they are usually meat-based. The study was not set up in a way that would make it possible to compare moderate carb with low-carb plant-based diets but, said Seidelmann,” the more plant-based[ the diet was ], the lower the mortality “.

” No facet of nutrition is so heatedly argued on social media than the carb versus fat debate, despite the long term evidence on health benefits firmly supporting the higher carb argument ,” said Catherine Collins, an NHS dietitian.

The” cult of low carb high fat eating” was based on a lifestyle choice and the flimsiest of evidence, she said. Its devotees were” at odds with advice from WHO and government health bodies globally- including the UK’s Public Health England- that recommend a carb intake to provide around half our daily calorie needs “.

She added that it the findings raise questions about the current hyping of low-carb diets for people with diabetes.” The feting and promotion of GPs promoting often bizarre low carb diets to manage diabetes has gained much media traction ,” she said.” If nothing else, this study offer some redress to this one-sided debate, and adds caution to such practice for long term management .”

In a commentary in the publication, Dr Andrew Mente and Dr Salim Yusuf, from McMaster University in Canada, said it was not possible to rule out altogether all the factors that might skewed the results, but that the findings were that logical and moderate carbohydrate intake was likely to be better for people than low or high-carb diets.

” Essential nutrients should be consumed above a minimal level to avoid deficiency and below a maximal level to avoid toxicity. This approach maintains physiological processes and health( ie, a so-called sweet spot ). Although carbohydrates are technically not an essential nutrient( unlike protein and fats ), a certain amount is probably required to meet short-term energy demands during physical activity and to maintain fat and protein uptakes within their respective sweet places ,” they wrote.

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Forget the headlines – the best diet is the one that works for you | Gideon Meyerowitz-Katz

Do whole grains avoid diabetes? Is moderate drinking good or bad for you? Nutritional studies are more complex than you are told

There’s a news cycle that we have all become attuned to. It’s what has led various publications to conclude that broccoli is both cause and avoiding cancer, that chocolate is a weight-loss food and a diet murderer, and that diet soft drink, against all odds, are causing people to gain weight.

This is the world of nutritional epidemiology. And it is complex.

Most recently we’ve been told that whole grains- the minimally-processed foods such as rye bread that contain high levels of fibre- are the key to preventing diabetes.

And while there is no argument that whole grains are good for you, or at the very least far better than the highly-processed alternatives, the claim that they avoid diabetes is much harder to justify.

Nutritional epidemiology is fascinating, but many people who comment on it do not discuss the above intricacies of the situation. Which is a problem, when an entire field is built on nuance.

Grains are good

The most recent study was a piece of epidemiological magnificence. The researchers took a large sample of people who had given information on how many grains they eat, and seemed to see if grain intake was correlated with diabetes. They also controlled for a number of factors, including age, gender, and socio-economic status, making their results actually quite good.

The study found that people who ate more whole grains, including with regard to rye bread, were less likely to get diabetes. There was even what’s known as a biological gradient- the more grains the study participants ate, the less likely they were to get diabetes.

If this sounds very convincing, that’s because it really was an excellent study.

But there are some important restrictions that most people did not discuss and that mean that it may have very little relevance to your life at all.

Fine-grained approach

The biggest issue with all nutritional epidemiology studies is something known as residual confounding. Confounding is the process that occurs when issues external to a study are not taken into account. So, for example, if you are studying the rate of deaths caused by falling out of an airplane, but don’t know how many of your participants were wearing parachutes, you might conclude that actually it’s pretty safe. The problem with epidemiological trials like this is that you can account for many factors but you just can’t account for everything.

The recent study on grains accounted for a lot of things, but ultimately there are likely still residual the matters that they just can’t address. The people in this study who eat more grains were thinner, better-educated, more active, less likely to smoke, and other good things, than the ones who ate the least grains. It is highly likely that there exist residual factors that the researchers could not takes into consideration that may have caused the people who eat the most grains to be healthier — and thus, less likely to have diabetes — than the people who feed less grains.

There were other points in the study that make interpreting somewhat problematic. For one thing, the absolute danger discrepancies between the highest and lowest grain uptake groups was just 4 %, which is much less than the relative difference reported on in the majority media narratives. This was also a study in Danish people over the age of 50, which means that it’s very difficult to generalise the findings to people living elsewhere.

And sadly, this sort of intricacy is common. Misunderstanding happens all the time.

Nutritional nonsense

Remember the recent stories about cheese protecting against all-cause mortality? Or the news that high-carb diets were bad followed six months later with the contradiction that they were actually good? Or hearing that moderate drinking is both good and bad for your health?

All of these conclusions were derived from similar studies.

Most of them are wrong.

The problem here is that nutritional epidemiology is a really complex field. Construing results isn’t something you can easily do, especially based on one study. Whether cheese protects against all-cause mortality — the evidence very unclear — is a difficult question, fraught with confounders. The same is true for grains: it is extremely likely that someone who replaces the white bread in their diet with rye will be enhanced their health, but if you already eat mostly fresh fruit and veggies it’s unclear whether adding whole grains will help. You might just be healthier because you are rich enough to afford whole grains rather than regular wheat, and this comes with a host of health benefits.

And this is in one of the strongest the sectors of nutritional epidemiology: leaving this particular study aside, there is strong and consistent evidence that eating whole grains in your diet is associated with a range of good health outcomes.

Ultimately, the point is that these large studies, while interesting to epidemiologists like me, are not really that important for any individual person’s life. Whole grains are a part of many healthy diets, but it’s hard to generalise that to everyone.

The best diet is the one that works for you. If you need help with that, big epidemiological trials will, at best, confound you. Talk to a registered dietitian. They go through lengthy degrees and training to give you the best advice possible on your diet.

Just don’t listen to the headlines. Even if they’re right, they are probably wrong for you.

* Gideon Meyerowitz-Katz is an epidemiologist working in the field of chronic disease

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Why we fell for clean eating

The long read: The oh-so-Instagrammable food movement has been thoroughly debunked but it shows no signs of going away. The real question is why we were so desperate to believe it

In the spring of 2014, Jordan Younger “ve noticed that” her hair was falling out in clumps.” Not cool” was her reaction. At the time, Younger, 23, believed herself to be eating the healthiest of all possible diets. She was a” gluten-free, sugar-free, oil-free, grain-free, legume-free, plant-based raw vegan “. As The Blonde Vegan, Younger was a “wellness” blogger in New York City, one of thousands on Instagram( where she had 70,000 followers) rallying under the hashtag #eatclean. Although she had no qualifications as a nutritionist, Younger had sold more than 40,000 copies of her own $25, five-day “cleanse” programme– a formula for an all-raw, plant-based diet majoring on green juice.

But the “clean” diet that Younger was selling as the route to health was making its inventor sick. Far from being super-healthy, she was suffering from a serious eating disorder: orthorexia, an preoccupation with ingesting merely foods the hell is pure and perfect. Younger’s raw vegan diet had caused her periods to stop and devoted her skin an orange tinge from all the sweet potato and carrots she ingested( the only carbohydrates she permitted herself ). Eventually, she tried psychological assistance, and began to slowly widen the repertoire of foods she would allow herself to feed, beginning with the fish. She recognised that their own problems was not her veganism, per se, but the particularly rigid and restrictive diet regime she had imposed under herself.

As Younger slowly recovered from her eating disorder, she faced a new dilemma.” What would people believe”, she agonised,” if they knew the Blonde Vegan was feeing fish ?” She levelled with her adherents in a blogpost entitled Why I’m Transitioning Away from Veganism. Within hours of announcing her new diet, Younger was receiving irate messages from vegans demanding fund back from the cleanse programmes and T-shirts they had bought from her site( featuring slogans such as” OH KALE YES “).

She lost followers “by the thousands” and received a daily raft of angry messages, including death threats. Some responded to her confession that she was suffering from an eating disorder by accusing her of being a” fat piece of lard” who didn’t have the discipline to be truly “clean”.

For as long as people have feed food, there have been diets and quack remedies. But previously, these existed, like conspiracy hypothesis, on the fringes of food culture.” Clean feeing” was different, because it established based as significant challenges to mainstream ways of eating, and its wild popularity over the past five years has enabled it to move far beyond the fringes. Powered by social media, it has been more absolutist in its claims and more popular in its reaching than any previous school of modern nutrition advice.

At its simplest, clean feeing is about ingesting nothing but “whole” or “unprocessed” foods( whatever is meant by these deep equivocal terms ). Some versions of clean eating have been vegan, while others espouse various meats( preferably wild) and something mysteriously called ” bone broth“( stock, to you and me ). At first, clean eating sounded modest and even homespuns: rather than counting calories, you would eat as many nutritious home-cooked substances as possible.

But it quickly became clear that” clean eating” was more than a diet; it was a belief system, which propagated the idea that the way most people feed is not simply fattening, but impure. Seemingly out of nowhere, a whole cosmo of coconut oil, dubious promises and spiralised courgettes has emerged. Back in the remote mists of 2009, James Duigan, owned of The Bodyism gym in London and sometime personal trainer to the model Elle MacPherson, published his first Clean and Lean book. As an early adopter of #eatclean, Duigan notes that he “battled” with his publisher” to include ingredients like kale and quinoa, because no one had ever heard of them “. Now quinoa is in every supermarket and kale has become as normal as lettuce.” I long for the working day when clean eating entailed not getting too much down your front ,” the novelist Susie Boyt joked recently.

Jordan Younger, AKA The Balanced Blonde, formerly The Blonde Vegan. Photograph: Whitford/ BFA/ Rex/ Shutterstock

Almost as soon as it became ubiquitous, clean eating triggered a backlash. By 2015, Nigella Lawson was speaking for many when she expressed “disgust” at clean feeing as a judgmental sort of body fascism.” Food is not dirty”, Lawson wrote. Clean eating has been attacked by critics such as the baker and cookbook writer Ruby Tandoh( who wrote a much-shared article on the subject in Vice magazine in May 2016) for being an provocation to eating disorders.

Others have pointed out that, as a method of healthy eating, it’s founded on bad science. In June, the American Heart Association suggested that the coconut petroleum beloved as a panacea by clean eaters actually had” no known offsetting favourable effects”, and that eating it could result in higher LDL cholesterol. A few weeks later, Anthony Warner- a food consultant with a background in science who blogs as The Angry Chef- published a book-length assault on the science of clean eating, calling it a world of” quinoa bowl” and “nutribollocks” fuelled by the modern info age.

When Dr Giles Yeo, a geneticist at the University of Cambridge, presented an episode of the BBC’s Horizon this year that examined the scientific evidence for different schools of clean eating, he found everything from innocuous recipes to serious malpractice.

He reported on the” alkaline diet” of Dr Robert O Young, who peddled the idea that disease is caused by eating “acidic” foods. After being diagnosed with terminal cancer in her 20 s, Naima Houder-Mohammed, an officer in the British army, paid Young more than $77,000 for treatment( including meals of avocado, which Young calls” God’s butter “) at his” pH miracle” ranch in the US in 2012. She died subsequently that year. Separately, Young was incarcerated in June this year after being convicted of charges including practising medicine without a licence. While he may represent an extreme case, it is clear that many wellness gurus, as Yeo’s programme concluded, tell a” troubling narrative” founded on falsehoods.

As the negative press for clean feeing has intensified over the past year, many of the early goddesses of #eatclean have tried to rebrand- declaring they no longer use the word “clean” to describe the recipes that have sold them millions of books. Ella Mills- AKA Deliciously Ella, the food writer and entrepreneur whose coconut-and-oat energy balls sell for PS1. 79 apiece in British supermarkets- said on Yeo’s Horizon programme that she felt that the word “clean” as applied to eating originally entailed nothing but natural, real, unprocessed food.” Now, it means diet, it entails fad ,” she complained.

But however much the concept of clean eating has been logically refuted and publicly vilified, the thing itself shows few signs of dying. Step into the cookbook section of any volume store and you will see how many recipe writers continue to promise us inner purity and outer beauty. Even if you have never knowingly tried to” feed clean “, it’s impossible to avoid the trend wholly, because it changed the foods available to all of us, and the style they are spoken of.

Avocados now outsell oranges in the UK. Susi Richards, head of product development at Sainsbury’s supermarkets, told me earlier this year that “shes been” taken aback by the pace at which demand for products fitting with the clean eating lifestyle have grown in the UK. Families who would once have eaten potato waffles are now experimenting with lower carb butternut “squaffles”( slicings of butternut squash cut to resemble a waffle ). Nutribullets– a brand of compact blenders designed for building supposedly radiance-bestowing juices and smoothies- are now mentioned in some circles as casually as wooden spoons.

Why has clean eating demonstrated so difficult to kill off? Hadley Freeman, in this paper, identified clean eating as part of a post-truth culture, whose adherents are impervious, or even hostile, to facts and experts. But to understand how clean eating took hold with such perseverance, it’s necessary first to consider just what a terrifying thing food has become for millions of people in the modern world. The interesting question is not whether clean feeing is nonsense, but why so many intelligent people decided to put their religion in it.

We are not the only generation to have appeared in disgust at an unhealthy food surrounding and wished that we could replace it with nutrients that were perfectly safe to feed. In the 1850 s, a British chemist called Arthur Hill Hassall became convinced that the whole food supply of London was riddled with toxins and fakery. What’s more, he was right. Hassall had done a series of investigations for the medical periodical the Lancet, and found that much of what was for sale as food and drink was not what it seemed: “coffee” made from burnt sugar and chicory; pickles dyed green with poison copper colourings.

Years of exposing the toxic deceptions all around him seems to have driven Hassall to a country of paranoia. He started to see poison everywhere, and decided that the answer was to create a define of totally uncontaminated food products. In 1881, he set up his own firm, The Pure Food Company, which would only use ingredients of unimpeachable quality. Hassall took water that was ” softened and purified” and combined it with the finest Smithfield beef to attain the purest beef jelly and disgusting-sounding” fibrinous meat lozenges”- the energy balls of Victorian England. The Pure Food Company of 1881 sounds just like a hundred wellness food businesses today- except for the fact that it collapsed within a year due to lack of sales.

We are once again living in an environment where ordinary food, which should be something dependable and sustaining, has come to feel noxious. Unlike the Victorian, we do not fear that our coffee is fake so much as that our entire pattern of eating may be bad for us, in ways that we can’t fully identify. One of the things that constructs the new wave of wellness cookbooks so appealing is that they assure the reader that they offer a new way of feeing that comes without any anxiety or guilt.

The founding principle of these modern wellness regimes is that our current style of feeing is slowly poisoning us.” Much of the food on offer to us today is nutritionally substandard ,” write the Hemsley sisters, best-selling champs of “nutrient-dense” food. It’s hard to disagree with the proposition that modern diets are generally “substandard”, even if you don’t share the Hemsleys’ solution of running “grain-free”. ” All of these diets have a kernel of truth that is spun out into some bigger fantasy ,” Giles Yeo says- hence their huge appeal.

Melissa and Jasmine Hemsley. Photo: Nick Hopper

Clean eating- whether it is called that or not- is perhaps best seen as a dysfunctional response to a still better dysfunctional food supply: a dream of purity in a toxic world. To walk into a modern western supermarket is to be assailed by aisle upon aisle of salty, oily snacks and sugary cereals, of “bread” that has been neither demonstrated nor fermented, of inexpensive, sweetened drinks and meat from animals kept in inhumane conditions.

In the postwar decades, most countries in the world underwent what the prof of nutrition Barry Popkin calls a” nutrition transition” to a westernised diet high in sugar, meat, fat, salt, refined petroleum and ultra-processed concoctions, and low in veggies. Affluence and multi-national food companies replaced the thirst of earlier generations with an unwholesome banquet of sweet beverages and convenience foods that teach us from a young age to crave more of the same. Wherever this pattern of feeing travelled, it brought with it dramatic rises in ill health, from allergies to cancer.

In prosperous countries, large numbers of people- whether they wanted to lose weight or not- became understandably scared of the modern food supply and what it was doing to our bodies: type 2 diabetes, obesity and cardiovascular disease , not to mention a host of other complaints that are influenced by diet, ranging from Alzheimer’s to gout. When mainstream diets start to sicken people, it is unsurprising that many of us should seek other ways of eating to keep ourselves safe from harm. Our collective anxiety around diet was exacerbated by a general impression that mainstream scientific advice on diet- inflated by newspaper headlines- could not be trusted. First these so-called experts tell us to avoid fat, then sugar, and all the while people get less and less healthy. What will these “experts” say next, and why should we believe them?

Into this atmosphere of nervousnes and disarray stepped a series of guru offering messages of wonderful simplicity and reassurance: feed this style and I will attain you fresh and healthy again. It is very hard to pinpoint the exact moment when” clean eating” started, because it is not so much as a single diet as a portmanteau word that has borrowed notions from numerous pre-existing diets: a bit of Paleo here, some Atkins there, with a few remnants of 1960 s macrobiotics thrown in for good measure.

But some time in the early 2000 s, two distincts but interrelated versions of clean eating became popular in the US- one on the basis of the creed of “real” food, and the other on the idea of “detox”. Once the concept of cleanliness had entered the realm of eating, it was only a matter of time before the basic notion spread contagiously across Instagram, where fans of #eatclean could share their artfully photographed green juices and rainbow salad bowls.

The first and more moderate version of “clean” food started in 2007, when Tosca Reno, a Canadian fitness model, published a book called The Eat-Clean Diet. In it, Reno described how “shes lost” 34 kg( 75 lb) and transformed her health by avoiding all over-refined and “processed foods”, especially white flour and sugar. A typical Reno eat-clean meal might be stir-fried chicken and vegetables over brown rice; or almond-date biscotti with a cup of tea. In many styles The Eat-Clean Diet was like any number of diet volumes that had come before, advising plenty of vegetables and modestly portioned, home-cooked meals. The difference, which Anthony Warner calls a piece of “genius” on Reno’s part, was that she presented it, above all, as a holistic route of living.

Meanwhile, a second version of clean eating was spearheaded by a former cardiologist from Uruguay called Alejandro Junger, the author of Clean: The Revolutionary Program to Restore the Body’s Natural Ability to Mend Itself, which was published in 2009 after Junger’s clean detox system had been praised by Gwyneth Paltrow on her Goop website. Junger’s system was far more stringent than Reno’s, requiring, for a few weeks, a revolutionary elimination diet based on liquid meals and a total exclusion of caffeine, alcohol, dairy and eggs, sugar, all veggies in the” nightshade family”( tomatoes, aubergines and so on ), red meat( which, according to Junger, makes an acidic” inner surrounding “), among other foods. During this stage, Junger advised a largely liquid diet either composed of home-made juices and soups, or of his own special pulverized shakes. After the detox period, Junger advised very cautiously reintroducing” toxic triggers” such as wheat (” a classic trigger of allergic responses “) and dairy (” an acid-forming food “).

Photograph: Alexandra Iakovleva/ Getty

To read Junger’s book is to feel that everything edible in our world is potentially toxic. Yet, as with Arthur Hassall, many of Junger’s dreads may be justified. Junger writes as a doctor with first-hand knowledge of diet-related epidemics of” cancer, cardiovascular disease, diabetes and autoimmune cancer “. The volume is full of case examines of individuals who follow Junger’s detox and emerge lighter, leaner and happier.” Who is the candidate for using this programme ?” Junger asks, responding:” Everyone who lives a modern life, fees a modern diet and occupies the modern world .”

To my surprise, I discovered myself compelled by the messianic tone of Junger’s Clean- though not quite obliged enough to pay $475 for his 21 -day programme( which, in any case, doesn’t ship outside of North America ), or to give up my daily breakfast of inflammatory coffee, gut-irritating sourdough toast and acid-forming butter, on which I feel amazingly well. When I told Giles Yeo how seductive I found Junger’s terms, virtually despite myself, he said:” This is their magic! They are all charismatic human beings. I do think the clean-eating guru believes in it themselves. They drink the Koolaid .”

Over the past 50 years, mainstream healthcare in the west has been inexplicably blind to the role that diet plays in preventing and alleviating ill health. When it started, #eatclean spoke to growing number of people who felt that their existing style of eating was causing them problems, from weight gain to headaches to stress, and that conventional medicine could not assistance. In the absence of nutrition guidance from doctors, it was a natural step for individuals to start experimenting with cutting out this food or that.

From 2009 to 2014, the number of Americans who actively avoided gluten, despite not suffering from coeliac illnes, more than tripled. It also became fashionable to drink a whole pantheon of non-dairy milks, ranging from oat milk to almond milk. I have lactose-intolerant and vegan friends who say that #eatclean has made it far easier for them to buy ingredients that they once had to go to specialist health-food stores to find. What isn’t so easy now is to find dependable information on special diets in the sea of half-truths and bunkum.

Someone who find how quickly and radically #eatclean changed the market for health-food volumes is Anne Dolamore, a publisher at the independent food publishers Grub Street, based in London. Dolamore has been publishing health-related food books since 1995, a day when “free-from” cooking was a tiny subculture. In the days before Google, Dolamore- who has long believed that” food is medicine”- felt that books on special diets by authors with” proper credentials” could serve a useful intent. In 1995, Grub Street published The Everyday Diabetic Cookbook, which has now been sold over 100,000 copies in the UK. Other successful books followed, including The Everyday Wheat-Free and Gluten-Free Cookbook by Michelle Berriedale-Johnson, published in 1998.

In 2012, the market for “wellness” cookbooks in the UK abruptly changed, starting with the surprise success of Honestly Healthy by Natasha Corrett and Vicki Edgson, which sold around 80,000 transcripts. Louise Haines, a publisher at 4th Estate, recalls that the previous big tendency in British food publishing had been cooking, but the baking boom” died overnight, virtually, and a number of sugar-free books came through “.

At Grub Street, Anne Dolamore watched aghast as bestselling cookbooks piled up from a” never-ending stream of blonde, willowy’ authorities ‘, many of whom seemed to be devising diets based on little but their own limited experience “. If Junger and Reno laid the groundwork for” feed clean” to become a vast worldwide trend, it was social media and the internet that did the remainder. Almost all of the authors of the British clean feeing bestsellers started off as bloggers or Instagrammers, many of them beautiful women in their early 20 s who were genuinely convinced that the diets they had devised had cured them of various chronic ailments.

Keep your chia seed smoothies off my Instagram feed

Every wellness guru worth her Himalayan pink salt has a tale of how changing what you eat can change your life.” Food has the power to build or break you ,” wrote Amelia Freer in her 2014 bestseller Eat. Nourish. Glow.( which has sold more than 200,000 copies ). Freer was leading a busy life as a personal assistant to the Prince of Wales when she realised that her belly” appeared and felt as if it had a football in it” from too many snatched dinners of cheese on toast or” factory-made food “. By giving up “processed” and convenience food (” margarine, yuck !”) along with gluten and sugar, Freer claimed to have found the secrets to” appearing younger and feeling healthier “.

Perhaps the best-known diet-transformation tale of all is that of Ella Mills- possessor of more than a million Instagram followers. In 2011, Mills was diagnosed with postural tachycardia disorder, a condition characterised by dizziness and extreme wearines. Mills began blogging about food after discovering that her symptoms radically improved when she swapped her sugar-laden diet for” plant-based, natural foods “. Mills- who used to be a model- stimulated following a “free-from” diet seem not drab or deprived, but profoundly aspirational. By the time her first volume appeared in January 2015, her vast following on social media helped her to sell 32,000 transcripts in the first week alone.

Amelia Freer. Photograph: S Meddle/ ITV/ Rex/ Shutterstock

There was something paradoxical about the route these books were marketed. What they were selling purported to be an alternative to a sordidly commercial food industry.” If it’s got a barcode or a’ promise ‘, don’t buy it ,” wrote Freer. Yet clean eating is itself a wildly profitable commercial enterprise, promoted employing photogenic young bloggers on a multi-billion-dollar tech platform. Literary agent Zoe Ross tells me that around 2015 she began to be pointed out that” the market was scouring Instagram for copycat acts- specifically really pretty, very young girls pushing curated food and lifestyle “.

After years on the margins, health-based cooking was finally getting a mass audience. In 2016, 18 out the 20 top sellers in Amazon UK’s food and drink volume category had a focus on healthy eating and dieting. The irony, however, was that the kind of well-researched books Dolamore and others once published no longer tended to sell so well, because health publishing was now dominated by social media celebrities. Bookshops were heaving with so many of these “clean” books that even the authors themselves started to feel that there were too many of them. Alice Liveing, a 23 -year-old personal trainer who writes as Clean Eating Alice, argued in her 2016 book Eat Well Every Day that she was ” championing what I feel is a much-needed breath of fresh air in what I think is an incredibly saturated marketplace “. To my untrained eye, browsing through her book, Alice’s fresh approach to diet appeared very similar to countless others: date and almond energy balls, kale chips, beetroot and feta burgers.

Then again, shouldn’t we devote clean eating due credit for achieving the miracle of turning beetroot and kale into objects of desire? Data from analysts Kantar Worldpanel show that UK sales of fresh beetroot have risen dramatically from PS42. 8m in 2013 to PS50. 5m in 2015. Some would argue that, in developed nations where most people eat shockingly poor diets, low in greens and high in sugar, this new union of health and food has done a modicum of good. Giles Yeo- who expended some time cooking a spicy sweet-potato dish with Ella Mills for his BBC programme- agrees that many of the clean eating recipes he tried are actually” a tasty and cool route to cook veggies “. But why, Yeo asks, do these authors not simply say ” I am publishing a very good vegetarian cookbook” and be brought to an end, instead of constructing larger claims about the power of veggies to beautify or avoid disease?” The poison comes from the fact that they are wrapping the whole thing up in pseudoscience ,” Yeo says.” If you base something on misrepresentations, it empowers people to take extreme actions, and this is where the damage begins .”

You can’t discovered a new religion system with the words” I am publishing a very good vegetarian cookbook “. For this, you need something stronger. You need the assurance of make-believe, whispered sweetly. Grind this cauliflower into tiny pieces and you are able to make a special kind of no-carb rice! Avoid all sugar and your skin will shimmer! Among other things, clean eating corroborates how vulnerable and lost tens of thousands of us feel about diet- that is actually means how lost we feel about our own bodies. We are so unmoored that we will set our faith in any master who promises us that we, too, can become pure and good.

I can pinpoint the exact moment that my own feelings about clean feeing changed from ambivalence to outright dislike. I was on stage at the Cheltenham literary festival with dietician Renee McGregor( who works both with Olympic athletes and eating disorder sufferers) when a crowd of around 300 clean-eating fans started jeering and wailing at us. We were supposedly taking part in a clean-eating debate with “nutritionist” Madeleine Shaw, author of Get the Glow and Ready Steady Glow.

Before that week, I had never read any of Shaw’s work. As I flicked through Ready Steady Glow, I was reasonably endeared by the upbeat tone (” stop depriving yourself and start living “) and bright photographs of a beaming Shaw.” I often surprise myself by receiving new things to spiralise” she writes, introducing a” sweet potato noodle” salad. Cauliflower pizza, in her position, is” quite simply: the best invention ever “.

But underneath the brightness there were notes of restriction that I found both worrying and confused.” As ever, all my recipes are sugar-and-wheat free”, Shaw announces, only to devote a recipe for “gluten-free” brownies that contains 200 g of coconut sugar, a substance that costs a lot more than your average white granulated sugar, but is metabolised by the body in the same way. I was still more alarmed by step four in Shaw’s nine-point food ” doctrine”, which says that all bread and pasta should be avoided: they are” beige foods”, which are” full of chemicals, preservatives and genetically manipulated wheat”, and” not whole foods “. Shaw’s book makes no distinction between a loaf of, say, bleached sliced white, and a homemade wholemeal sourdough.

When we satisfied on stage in Cheltenham, I asked Shaw why she told people to cut out all bread, and was startled when she denied she had said any such thing( rye bread was her favourite, she added ). McGregor asked Shaw what she entailed when she wrote that people should try to eat only” clean proteins “; meat that was ” not deep-fried” was her instead baffling respond. McGregor’s main concern about clean eating, she added, was that as a professional treating young person with eating disorders, she had watched first-hand how the rules and restrictions of clean feeing often segued into debilitating anorexia or orthorexia.

Madeleine Shaw promoting her volume Get the Glow. Photo: Joe Pepler/ REX/ Shutterstock

” But I only find the positive”, said Shaw , now wiping away tears. It was at this point that the audience, who were already restless whenever McGregor or I spoke, descended into outright hatred, shouting and hissing for us to get off stage. In a volume shop after the event, as fans came up to Shaw to thank her for giving them” the glow”, I too burst into tears when person or persons jabbed her thumbs at me and said I should be ashamed, as an” older females”( I am 43 ), to have criticised a younger one. On Twitter that night, some Shaw fans constructed derogatory remarks about how McGregor and I appeared, under the hashtag #youarewhatyoueat. The implication was that, if we were less photogenic than Shaw, we clearly had nothing of any value to say about food( never mind the fact that McGregor has degrees in biochemistry and nutrition ).

Thinking about the event on the develop home, I realised that the crowd were angry with us not because they disagreed with the details( it’s pretty clear that you can’t have sugar in “sugar-free” recipes ), but because they detested the fact that we were arguing at all. To insist on the facts of the case made us come across as cruelly negative. We had punctured the happy belief-bubble of glowiness that they had come to imbibe from Shaw. It’s striking that in many of the wellness cookbooks, mainstream scientific proof on diet is seen as more or less irrelevant , not least because the gurus watch the complacency of science as part of what built our diets so bad in the first place.

Amelia Freer, in Eat. Nourish. Glow, admits that” we can’t prove that dairy is the cause” of ailments ranging from IBS to joint pain, but concludes that it’s” surely worth” cutting dairy out anyway, just as a precaution. In another context, Freer writes that” I’m told it takes 17 years for scientific knowledge to filter down” to become general knowledge, while advising that gluten should be avoided. Once we enter the territory where all authority and expertise are automatically suspect, you can start to claim almost anything- and many #eatclean authorities do.

That night in Cheltenham, I find that clean feeing- or whatever name it now runs under- had elements of a post-truth cult. As with any cult, it could be something dark and divisive if you got on the wrong side of it. After Giles Yeo’s BBC programme was aired, he told me he was startled to find himself subjected to relentless online trolling.” They said I was funded by big pharma, and therefore obviously wouldn’t see the benefits of a healthy diet over medication. These were outright lies .”( Yeo is employed by the University of Cambridge, and funded by the Medical Research Council .)

It’s increasingly clear that clean eating, for all its good aims, can cause real harm, both to truth and to human beings. Over the past 18 months, McGregor says,” every single client with an eating disorder who strolls into my clinic doors is either following or wants to follow a’ clean’ way of eating “.

In her new book, Orthorexia, McGregor observes that while eating disorder long predate the #eatclean trend,” food regulations”( such as eating no dairy or avoiding all grains) easily become” a guise for restricting food uptake “. Moreover, they are not even good rules, based as “theyre on”” unsubstantiated, unscientific asserts “. Take almond milk, which is widely touted as a superior alternative to cow’s milk. McGregor considers it as little better than” expensive water “, containing just 0.1 g protein per 100 ml, compared with 3.2 g per 100 ml in cow’s milk. But she often discovers it very difficult to convince her clients that restricting themselves to these “clean” foods is in the long run worse for their health than what she calls” unrestrained feeing”- balanced and varied meals, but no anxiety about the odd ice cream or chocolate bar.

Clearly , not everyone who bought a clean-eating book has developed an eating disorder. But a motion whose premise is that normal food is unhealthy has already had muddied the water of” healthy eating” for everyone else, by planting the idea that a good diet is one founded on absolutes.

The true calamity of clean eating is not that it is entirely false. It is that it contains” a kernel of truth”, as Giles Yeo puts it.” When you strip down all the pseudo gibberish, they are absolutely right to say that we should feed more vegetables, less refined sugar and less meat ,” Yeo said, sipping a black coffee in his office at the Institute of Metabolic Science in Cambridge, where he spends his days researching the causes of obesity. Yeo agreed to that clean eaters that our environment of inexpensive, plentiful, sugary, fatty food is a recipe for widespread obesity and ill health. The problem is it’s near impossible to pick out the sensible bits of” clean feeing” and ignore the rest. #Eatclean built healthy eating seem like something” expensive, exclusive and difficult to achieve”, as Anthony Warner writes. Whether the term “clean” is use or not, there is a new puritanism about food that has taken root very widely.

A few weeks ago, I overheard a fit, middle-aged human at the gym castigating a friend for not feeing a better diet- a conversation that would once have been unimaginable among men. The first human was telling the second that the” skinny burgers” he preferred were nothing but” shitty mince and marketing”- and arguing that he was able to get almost everything he needed from a diet of veggies, cooked with no petroleum.” Fat is fat, at the end of the working day ,” he concluded, before bemoaning the “idiots” who tried to eat something wholesome like a salad, then ruined everything by adding salt.” If you have one bad diet day a week, you undo all your good work .”

The real question is how to fight this kind of diet absolutism without bouncing back to a mindless festivity of the modern food environment that is demonstrably stimulating so many people sick. In 2016, more than 600 children in the UK were get registered as living with kind 2 diabetes; before 2002, there were no reported cases of children suffering from the condition, whose causes are diet-related.

Our food system is in desperate need of reform. There’s a threat that, in fighting the nonsense of clean eating, we end up looking like apologists for a commercial food supply that is failing in its basic undertaking of nourishing us. Former orthorexia sufferer Edward L Yuen has argued- in his 2014 book, Beating Orthorexia- that the old advice of” everything in moderation” no longer works in a food environment where eating in the “middle ground” may still leave you with chronic diseases. When sections are supersized and Snickers bars are sold by the metre( something I find in my local Tesco recently ), eating “normally” is not necessarily a balanced alternative. The answer isn’t yet another perfect diet, but a shift in our idea of what constitutes normal food.

Sales of courgettes in the UK rose 20% from 2014 to 2015, fuelled by the rise of the spiraliser. But overall consumption of vegetables, both in the UK and worldwide, is still vanishingly small( with 74% of the adult UK population not managing to feed five a day ). That is much lower than it was in the 1950 s, when freshly cooked daily snacks were still something that most people took for granted.

Among the affluent classes who already feed a healthier-than-average diet, the Instagram goddesses generated a new model of dietary perfection to aim for. For the rest of the population, however, it simply placed the ideal of healthy food ever further out of reach. Behind the shiny covers of the clean-eating volumes, there is a harsh form of economic exclusion that says that someone who can’t afford wheatgrass or spi

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The Mysterious Virus That Could Cause Obesity

Randy is 62 years old and stands tall at six foot one. He grew up on a farm in Glasford, Illinois, in the 1950s. Randy was raised with the strong discipline of a farming family. From the time he was five, he would get out of bed at dawn, and before breakfast hed put on his boots and jeans to milk cows, lift hay, and clean the chicken coops. Day in and out, no matter the weather or how he felt, Randy did his physically demanding chores. Only when his work was complete would he come into the kitchen for breakfast.

Tending to the chickens was hard workit involved getting into the pen, clearing birds out of their dirty cages, and shooing them into a holding enclosure. This process was always a little scary because the animals could be quite aggressive after being cooped up all night. On one of these occasions, when Randy was 11, a particularly large and perturbed rooster swung its claw and gave him a good spurring on his leg. Randy felt the piercing of his skin and squealed in pain. He said it felt like being gored by a thick fishhook. The rooster left a long gash, and blood streamed down Randys leg to his ankle. He ran back to the house to clean the wound, as chickens are filthy after a night in their cages.

Excerpted from The Secret Life of Fat: The Science Behind the Body’s Least Understood Organ and What It Means for You by Sylvia Tara.W. W. Norton & Company

Some days later, Randy noticed a change in his appetite. He was constantly hungry. He felt drawn to food and thought about it all the time. He started eating in between meals and overeating when he finally sat down to dinner. Randy had always been a skinny kid, but in the course of the next year, he gained about 10 pounds. His parents thought it might be puberty, though it seemed a little early. His pudginess was also unusual given that everyone else in the family was thin. Randy was no stranger to discipline. He forced himself to eat less, switched to lower-calorie foods and exercised more. But by the time he was a teenager, he was bouncing between 30 and 40 pounds overweight. He says, I gained all of this weight even though these were some of my most active years on the farm.

Randys family supported his efforts to control his weight. They made lower-calorie foods, gave him time to exercise, and didnt pressure him to eat things he didnt want. However, he continued to struggle with his weight through college. Randy kept thinking back to the moment everything changed. He had been the skinniest kid among his friends. And then he got cut by that chicken.

The Curious Case of Indian Chickens

In Mumbai, India, Nikhil Dhurandhar followed his father Vinods footsteps in treating obesity. But Nikhil ran into the same obstacle that had bedeviled obesity doctors everywhere. The problem was that I was not able to produce something for patients that could have meaningful weight loss that was sustainable for a long time, he says. Patients kept coming back.

Fate intervened in Dhurandhars life one day was when he was meeting his father and a family friend, S. M. Ajinkya, a veterinary pathologist, for tea. Ajinkya described an epidemic then blazing through the Indian poultry industry killing thousands of chickens. He had identified the virus and named it using, in part, his own initialsSMAM-1. Upon necropsy, Ajinkya explained, the chickens were found to have shrunken thymuses, enlarged kidneys and livers, and fat deposited in the abdomen. Dhurandhar thought this was unusual because typically viruses cause weight loss, not gain. Ajinkya was about to go on, but Dhurandhar stopped him: You just said something that doesnt sound right to me. You said that the chickens had a lot of fat in their abdomen. Is it possible that the virus was making them fat?

Ajinkya answered honestly, I dont know, and urged Dhurandhar to study the question. That fateful conversation set Dhurandhar on a path to investigate as part of his PhD project whether a virus could cause fat.

Dhurandhar pushed ahead and arranged an experiment using 20 healthy chickens. He infected half of them with SMAM-1 and left the other half uninfected. During the experiment, both groups of chickens consumed the same amount of food. By the end of the experiment, only the chickens infected with the SMAM-1 virus had become fat. However, even though the infected chickens were fatter, they had lower cholesterol and triglyceride levels in their blood than the uninfected birds. It was quite paradoxical, Dhurandhar remembers, because if you have a fatter chicken, you would expect them to have greater cholesterol and circulating triglycerides, but instead those levels went in the wrong direction.

To confirm the results, he set up a repeat experiment, this time using 100 chickens. Again, only the chickens with the SMAM-1 virus in their blood became fat. Dhurandhar was intrigued. A virus, it seemed, was causing obesity. Dhurandhar thought of a way to test this. He arranged three groups of chickens in separate cages: one group that was not infected, a second group that was infected with the virus, and a third group that caged infected and uninfected chickens together. Within three weeks, the uninfected chickens that shared a cage with infected ones had caught the virus and gained a significant amount of body fat compared to the isolated uninfected birds.

Fat, it seemed, could indeed be contagious.

Now, Dhurandhar is a man of science. He is rational and calm. But even he had to admit that the idea was startling. Does this mean that sneezing on somebody can transmit obesity? This now seemed possible in animals, but what about humans? Injecting the virus into people would be unethical, but Dhurandhar did have a way to test patients to see if they had contracted the virus in the past.

Dhurandhar says, At that time I had my obesity clinic, and I was doing blood tests for patients for their treatment. I thought I might just as well take a little bit of blood and test for antibodies to SMAM-1. Antibodies would indicate whether the patient was infected in the past with SMAM-1. The conventional wisdom is that an adenovirus for chickens does not infect humans, but I decided to check anyway. It turned out that 20 percent of the people we tested were positive for antibodies for SMAM-1. And those 20 percent were heavier, had greater body mass index and lower cholesterol and lower triglycerides compared to the antibody-negative individuals, just as the chickens had. Dhurandhar observed that people who had been infected with SMAM-1 were on average 33 pounds heavier than those who werent infected.

The Pounds Keep Coming

While Nikhil Dhurandhar was in India pursuing his curiosity about fat, Randy was looking for solutions of his own. After a brief stint as a teacher he moved back to the family land in 1977 because he loved farming.

Randy married and had four children. At family dinners and holiday gatherings, he ate alongside everyone else, but tried eating less than the others. Still, his weight ballooned; by his late 30s he had topped 300 pounds. He remembers feeling hungry all the time, though even when he abstained it didnt help him lose weight. I could have several good weeks of eating stringently, much less than others around me, but if I went off my diet for just one mealboom, the weight would come back.

The effort to control his eating, even when it was successful, made Randy miserable: I cant tell you what it is like to be hungry all the time. It is an ongoing stress. Try it. Most people who give advice dont have to feel it.

In the fall of 1989, Randy applied for a commercial drivers license. The application required a medical exam. After his urine test, the nurse asked Randy if he felt all right. Normal for the day, he replied. But the nurse told Randy he would have to give a blood sample because she thought the lab had spilled glucose solution into his urine sample. The blood work showed that Randys glucose level was near 500 mg/dL (a normal reading is 100). The lab hadnt made a mistake with the urine sample after all; Randys numbers were just off the charts. Alarmed, the nurse notified Randys doctor, who then tested him for fasting blood sugar levels. The results showed that Randy had insulin resistance and severe diabetes.

At 40 years old and 350 pounds, Randy was in trouble. If he didnt fix this problem soon, he would start to develop serious complications of diabetes, including cardiovascular disease and nerve damage.

Having tried and failed multiple diets, Randy and his doctor decided the best hope was a hospital program for severe diabetics. The staff tested Randys blood frequently to determine the optimal dosage and timing of insulin injections to regulate his blood sugar. Randy learned about the Diabetic Exchange diet, which allots patients a specific number of servings of meat, carbohydrates, vegetables, and fat. He cut out all refined carbohydrates, including bread. He says, I havent had a slice of bread or piece of pizza in years.

But would even this program be enough? Randy had always had a difficult time controlling his weight, though not for lack of trying. He had been fighting fat since his childhood by controlling portions, exercising, and avoiding social eating. But his discipline was no match for his own fat. Randy had to get his weight under control permanently. The hospital environment was helpful. However, despite strictly adhering to the diet, he only dropped a few pounds.

The Virus in Americans

After taking on a postdoctoral fellowship at the University of Wisconsin, Madison under Dr. Richard Atkinson, Dhurandhar was excited to finally be at liberty to pursue what he loved. He had an intense curiosity about viruses and was eager to get started finding answers. However, when he tried to get samples of the SMAM-1 virus that he had worked with in India, the U.S. Department of Agriculture refused to grant him an import license. He was deeply disappointed.

Unable to get SMAM-1, Dhurandhar approached a company that sells viruses for research. Their catalog listed some fifty human adenoviruses. He says, I was going to order the human adenovirus, but there was no the adenovirusthere were 50 different human adenoviruses! So I was stuck again. I wondered how do I go about this? Should we start number one, number two, number three, number 50, 49, 48? So [with] a little bit of guesswork and mostly luck, we decided to work with number 36. We liked number 36 because it was antigenically uniquemeaning it did not cross react with other viruses in the group, and antibodies to other viruses would not neutralize it.

That was a serendipitous choice. It turned out that Ad-36 had similar qualities to SMAM-1 in chickens. Atkinson thought Ad-36 might very well be a mutated form of SMAM-1. When Dhurandhar infected chickens with Ad-36, their fat increased and their cholesterol and triglycerides decreased, just as had happened with SMAM-1. Dhurandhar wanted to make sure he was not getting a false positive, so he injected another group of chickens with a virus called CELO to ensure that other viruses were not also producing fat in chickens. Additionally, he maintained a group of chickens who had not been injected with anything. When he compared the three groups, only the Ad-36 group became fatter. Dhurandhar then tried the experiments in mice and marmosets. In every case, Ad-36 made animals fatter. Marmosets gained about three times as much weight as the uninfected animals, their body fat increasing by almost 60 percent!

Now came the big question: would Ad-36 have any effect on humans? Dhurandhar and Atkinson tested over 500 human subjects to see if they had antibodies to the Ad-36 virus, indicating they had been infected with it at some point in their lives. His team found that 30 percent of subjects who were obese tested positive for Ad-36, but only 11 percent of nonobese individuals dida 3 to 1 ratio. In addition, nonobese individuals who tested positive for Ad-36 were significantly heavier than those who had never been exposed to the virus. Once again, the virus was correlated with fat.

Next, Dhurandhar devised an even more stringent experiment. He tested pairs of twins for presence of Ad-36. He explains, It turned out exactly the way we hypothesizedthe Ad-36 positive co-twins were significantly fatter compared to their Ad-36 negative counterparts.

Of course, its unethical to infect human subjects with viruses for research, so the study cant be perfectly confirmed. But, Dhurandhar says, This is the closest you can come to showing the role of the virus in humans, short of infecting them.

A New Way to Manage FatStop the Blame

Randys physician had been treating him for years and knew that his patients struggle was difficult and ongoing. The physician referred Randy to an endocrinologistRichard Atkinson at the University of Wisconsinwho was having some success with difficult obesity cases.

Randy went to see Atkinson, knowing that if he didnt get his fat under control, it was going to kill him. The first thing Randy noticed about Atkinson was that he was kind. He didnt make Randy feel guilty about his weight. Other places put the blame on you, Randy says. They go back into your past, what did you do to get here. It is very judgmental. Atkinson did none of that. He said okay we are here now, how do we fix it? He was very future oriented.

Atkinson had designed a long-term program to treat obesity. He explained to his patients that obesity is a chronic disease and they would be in treatment forever. In the first three months of the program, patients would meet several days per week and attend a lecture explaining obesity and the underpinnings of fat. After that, visits decreased to one every one to two weeks, then one every one to two months. Those who started regaining weight were asked to resume more frequent visits. Subjects had to commit to the full program in order to enroll.

Atkinson also introduced Randy to his new postdoctoral assistant, a young scientist from India, Dr. Nikhil Dhurandhar. Dhurandhar examined Randy and studied his blood samples. Randy tested positive for antibodies to Ad-36, meaning he had likely been infected with the virus at some point in the past. Randy remembered being scratched by that rooster as a child, and that afterward his appetite exploded and he started gaining weight quickly. His troubles with food and rapid fat accumulationhe understood it all now. If he was like the chickens, the marmosets, the twins, and the other humans in the study, then his infection with Ad-36 was helping his body to accumulate fat. He says, What Atkinson and Dhurandhar did for me changed my life. They made everything make sense. It was very liberating and very empowering.

How Does a Virus Lead To Fat?

How would a virus like Ad-36 cause fat? Atkinson explains, There are three ways that we think Ad-36 makes people fatter:
(1) It increases the uptake of glucose from the blood and converts it to fat; (2) it increases the creation of fat molecules through fatty acid synthase, an enzyme that creates fat; and (3) it enables the creation of more fat cells to hold all the fat by committing stem cells, which can turn into either bone or fat, into fat. So the fat cells that exist are getting bigger, and the body is creating more of them.

The researchers acknowledge that the rooster scratch may have been the start of Randys infection. But they are cautiousthe transmissibility of Ad-36 from chickens to humans has never directly been studied.

Though Dhurandhar and Atkinson have conducted several strong studies showing the contribution of Ad-36 to fatness, skepticism remains. Atkinson says, I remember giving a talk at a conference where I presented 15 different studies in which Ad-36 either caused or was correlated to fatness. At the end of it, a good friend said to me, I just dont believe it. He didnt give a reason; he just didnt believe it. People are really stuck on eating and exercise as the only contributors to fatness. But there is more to it.

Dhurandhar adds, Theres a difference between science and faith. What you believe belongs in faith and not in science. In science you have to go by data. I have faced people who are skeptical, but when I ask them why, they cant pinpoint a specific reason. Science is not about belief, it is about fact. There is a sayingIn God we trust, all others bring data.

Reprinted with permission from The Secret Life of Fat by Sylvia Tara. Copyright 2016 by W. W. Norton & Company.

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