Why We Get Fat: And What to Do About It (21 page)

Among the thirty chapters, or “meditations,” in
The Physiology
of Taste
, Brillat-Savarin included two on obesity—one on cause and one on prevention. Over the course of thirty years, he wrote, he had held more than five hundred conversations with dinner companions who were “threatened or afflicted with obesity,” one “fat man” after another, declaring their devotion to bread, rice, pasta, and potatoes. This led Brillat-Savarin to conclude that the roots of obesity were obvious. The first was a natural predisposition to fatten. “Some people,” he wrote, “in whom the digestive forces manufacture, all things being equal, a greater supply of fat are, as it were, destined to be obese.” The second was “the starches and flours which man uses as the base of his daily nourishment,” and he added that “starch produces this effect more quickly and surely when it is used with sugar.”

This, of course, made the cure obvious as well. “An anti-fat diet,” Brillat-Savarin wrote, “is based on the commonest and most active cause of obesity, since, as it has already been clearly shown, it is only because of grains and starches that fatty congestion can occur, as much in man as in the animals.… It can be deduced, as an exact consequence, that a more or less rigid abstinence from everything that is starchy or floury will lead to the lessening of weight.”

As I’ve suggested before, repeating myself on the subject of repetitiousness, very little that I’ve said so far is new. That includes the idea that carbohydrates cause obesity and that abstinence from starches, flour, and sugars is the obvious method of cure and prevention. What Brillat-Savarin wrote in 1825 has been repeated and reinvented numerous times since. Up through the 1960s, it was the conventional wisdom, what our parents or our grandparents instinctively believed to be true. Then calories-in/calories-out took hold, and the diet that Brillat-Savarin recommended in 1825 and others like it were portrayed by the health authorities as faddish and dangerous—“bizarre concepts of nutrition and dieting,” as the American Medical Association described them back in 1973.

By taking this approach, the authorities successfully managed to keep many from trying the diets and certainly succeeded in preventing physicians from recommending them or supporting their use. As Dean Ornish, a diet doctor who became famous for a diet of the opposite nutritional composition (very low in fat and
high
in carbohydrates), has been fond of saying in precisely this context, we can lose weight by using any number of things that aren’t good for us—cigarettes and cocaine, for instance—but that doesn’t mean any of us should do so.

This is another of the mystifying trends in the past century of diet and nutrition. The notion of the fattening carbohydrate has indeed been around for most of the last two hundred years. Consider, for instance, two novels published nearly a century apart. In Tolstoy’s
Anna Karenina
, written in the mid-1870s, Anna’s lover, Count Vronsky, abstains from carbohydrates in preparation for the climactic horse race. “On the day of the races at Krasnoe Selo,” Tolstoy wrote, “Vronsky had come earlier than usual to eat beefsteak in the officers’ mess of the regiment. He had no need to be in strict training, as he had very quickly been brought down to the required weight of one hundred and sixty pounds, but still he had to avoid gaining weight, and he avoided starchy foods and desserts.” In 1964, Saul Bellow’s Herzog, in the novel by that name, denies himself a candy bar with identical logic, although in Herzog’s case, “thinking of the money he had spent on new clothes which would not fit if he ate carbohydrates.”

This is what doctors believed and told their obese patients. When physicians stopped believing it, a process that began in the 1960s and concluded in the late 1970s, it happened to coincide with the beginning of the current epidemics of obesity and diabetes. Considering that our physicians have mostly bought into the idea that avoiding carbohydrates as a means of weight loss is a bizarre concept of nutrition, I’d like to review the full history of the idea, so that we can all understand where it comes from and where it went.

•   •   •

Until the early years of the twentieth century, physicians typically considered obesity a disease, and a virtually incurable one, against which, as with cancer, it was reasonable to try anything. Inducing patients to eat less and/or exercise more was just one of many treatments that might be considered.

In the 1869 edition of
The Practice of Medicine
, the British physician Thomas Tanner published a lengthy list of “ridiculous” treatments that doctors had prescribed for obesity over the years. These included everything from the surreal—“bleeding from the jugular,” for instance, and “leeches to the anus”—to elements of today’s conventional wisdom, such as eating “very light meals of substances that can be easily digested” and devoting “many hours daily to walking or riding.” “All these plans,” wrote Tanner, “however perseveringly carried out, fail to accomplish the object desired; and the same must be said of simple sobriety in eating and drinking.” (Tanner did believe, however, that abstinence from carbohydrates was one method, perhaps the only one, that worked. “Farinaceous [starchy] and vegetable foods are fattening, and saccharine matters [i.e., sweets] are especially so,” he wrote.)

By that time, a French physician and retired military surgeon named Jean-François Dancel had come to the same conclusions as his countryman Brillat-Savarin. Dancel presented his thoughts on obesity in 1844 to the French Academy of Sciences and then published a book,
Obesity, or Excessive Corpulence: The Various Causes and the Rational Means of a Cure
, which was translated into English in 1864. Dancel claimed that he could cure obesity “without a single exception” if he could induce his patients to live “chiefly upon meat,” and partake “only of a small quantity of other food.”

Dancel argued that physicians of his era believed obesity to be incurable because the diets they prescribed to cure it were precisely those that happened to cause it (an argument implicit in this book, of course, as well). “Medical authors assert that food
has a most important bearing in the production of corpulence,” he wrote. “They forbid the use of meat, and recommend watery vegetables, such as spinach, sorrel, salad, fruit, &c., and for beverage water; and at the same time they direct the patient to eat as little as possible. I lay it down as an axiom, in opposition to the received opinion of centuries, that very substantial diet, such as meat, does not develop fat and that nothing is more capable of producing the latter than aqueous vegetables and water.”

Dancel based his faith in a chiefly meat diet on the work of the German chemist Justus Liebig, who was correctly arguing at the time that fat is formed in animals not from protein but from the ingestion of fats, starches, and sugars. “All food which is not flesh—all food rich in carbon and hydrogen [i.e., carbohydrates]—must have a tendency to produce fat,” wrote Dancel. “Upon these principles only can any rational treatment for the cure of obesity satisfactorily rest.” Dancel also noted, as Brillat-Savarin had and others would, that carnivorous animals are never fat, whereas herbivores, living exclusively on plants, often are: “The hippopotamus, for example,” wrote Dancel, “so uncouth in form from its immense amount of fat, feeds wholly upon vegetable matter—rice, millet, sugarcane, &c.”

The diet was then reinvented by William Harvey, a British doctor, after visiting Paris in 1856 and watching the legendary Claude Bernard lecture on diabetes. As Harvey later told it, Bernard described how the liver secretes glucose, the same carbohydrate that can be found in sugar and starch, and it’s the level of this glucose in the blood that is abnormally elevated in diabetics. This led Harvey to consider what was then a well-known fact, that a diet absent any sugar and starches would curb the secretion of sugar in the urine of a diabetic. He then speculated that the same diet might work as a weight-loss diet as well.

“Knowing too that a saccharine [sweet] and farinaceous [starchy] diet is used to fatten certain animals,” Harvey wrote, “and that in diabetes the whole of the fat of the body rapidly disappears, it occurred to me that excessive obesity might be allied to
diabetes as to its cause, although widely diverse in its development; and that if a purely animal diet were useful in the latter disease, a combination of animal food with such vegetable diet as contained neither sugar nor starch, might serve to arrest the undue formation of fat.”

In August 1862, Harvey prescribed his diet for an obese London undertaker named William Banting (whom I introduced briefly in an earlier chapter, talking about his rowing experiences). By the following May, Banting had lost thirty-five pounds—he eventually lost fifty—prompting him to publish a sixteen-page
Letter on Corpulence
that described his previous weight-loss attempts, all futile, and his effortless success when living on meat, fish, game, and no more than a few ounces of fruit or stale toast a day. (Banting’s diet did include a considerable amount of alcohol—four or five glasses of wine each day, a cordial every morning, and an evening tumbler of gin, whisky, or brandy.)

“Bread, butter, milk, sugar, beer, and potatoes,” Banting wrote, “had been the main (and, I thought, innocent) elements of my subsistence, or at all events they had for many years been adopted freely. These, said my excellent adviser, contain starch and saccharine matter, tending to create fat, and should be avoided altogether. At the first blush it seemed to me that I had little left to live upon, but my kind friend soon showed me there was ample. I was only too happy to give the plan a fair trial, and, within a very few days, found immense benefit from it.”

Banting’s
Letter on Corpulence
became an instant best-seller and was translated widely. By the autumn of 1864, even the emperor of France was “trying the Banting system and is said to have already profited greatly thereby.” Banting credited Harvey for the diet, but it was Banting’s name that entered the English language (and the Swedish) as a verb meaning “to diet,” and it was Banting who took the heat from the medical community. “We advise Mr Banting, and everyone of his kind, not to meddle with medical literature again, but be content to mind his own business,” wrote
The Lancet
, a British medical journal.

Still, when the Congress of Internal Medicine met in Berlin in 1886 and held a session on popular diets, Banting’s diet was considered one of three that could now reliably be used to reduce obese patients. The other two were minor variations developed by renowned German physicians—one prescribed even more fat, and the other (based on Dancel’s work) less fluid, leaner meat, and exercise. Both allowed unlimited meat consumption but prohibited starches and sweets almost entirely.

When Hilde Bruch recounted this history in 1957, she noted that the treatment of obesity hadn’t changed much in the intervening decades. “The great progress in dietary control of obesity was the recognition that meat, ‘the strong food,’ was not fat producing,” she wrote; “but that it was innocent foodstuffs, such as bread and sweets, which lead to obesity.”

It’s hard to imagine today how widely held was this notion, considering the attempts by the authorities in the last forty years to tar it as a recurring fad. Let me list some examples of the advice on weight loss taken from the medical literature up through the 1960s.

In the 1901 edition of
The Principles and Practice of Medicine
, William Osler, considered the father of modern medicine in North America, advises obese women to “avoid taking too much food, and particularly to reduce the starches and sugars.”

In 1907, James French, in
A Text-book of the Practice of Medicine
says, “The overappropriation of nourishment seen in obesity is derived in part from the fat ingested with the food, but more particularly from the carbohydrates.”

In 1925, H. Gardiner-Hill of London’s St. Thomas’s Hospital Medical School describes his carbohydrate-restricted diet in
The Lancet:
“All forms of bread contain a large proportion of carbohydrate, varying from 45–65 percent, and the percentage in toast may be as high as 60. It should thus be condemned.”

Between 1943 and 1952, physicians from the Stanford University
School of Medicine, Harvard Medical School, Children’s Memorial Hospital in Chicago, and from Cornell Medical School and New York Hospital independently published their diets for treating obese patients. All four are effectively identical. Here are the “General Rules” of the Chicago version:

And here’s the obesity diet published in the 1951 textbook
The Practice of Endocrinology
, coedited by seven prominent British physicians led by Raymond Greene, probably the most influential twentieth-century British endocrinologist (and brother of the novelist Graham Greene):

Foods to be avoided:

You can eat as much as you like of the following foods:

Welcome to what was once the conventional wisdom. It was so ingrained that when the U.S. Navy was steaming west across the Pacific in the endgame of World War II, the official
U.S. Forces’ Guide
warned soldiers that they might have “trouble with girth control” in the Caroline Islands, an archipelago northeast of New Guinea, because “the basic food the natives eat is starchy vegetables—breadfruit, taro, yams, sweet potatoes, and arrowroot.”