“I always wanted to be that person who went to the gym regularly and ate whatever they wanted, I just didn’t know this was how you got there. That person was in me all along.”

Bonnie grew up loving all kinds of foods, especially junk food. She never liked dieting and had come to accept that she would probably always be a size 12.

Fear of developing diabetes like her father eventually prompted her to create a New Year’s resolution to try to be healthier. She slowly added exercise and changed her eating habits, and the weight began to come off until she hit a summertime plateau.

Stuck at the same weight for five months, Bonnie eventually found Summer Tomato and decided to give mindful eating a try. To her surprise she learned she was eating more than double the amount of food her body actually wanted, and that she had a true love for vegetables.

Bonnie is now comfortably a size 8, though she’s not sure what her final size will be. Although she still occasionally treats herself to fast food or sweets, her preferences have changed substantially. She’s happy where she is, but feels like her journey is just starting.

When I asked her if making all these changes was difficult she said, “It was the opposite of hard. It was the opposite of restrictive.”

Links from the show:

‘The Myth of Willpower’ (chapter from Foodist) and free starter kit

The Omnivore’s Dilemma, by Michael Pollan

Roger Goes From Hating the Gym to Loving Workouts and Loses 26 lbs Without Noticing

The End of Over Eating, by Dr. David Kessler

How to Eat Half a Donut

How to Make Cauliflower Taste as Good as French Fries

Listen:

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Listen on Soundcloud

If you’d like to be a guest on the show, please fill out the form here and tell us your story.

I hadn’t planned on writing a formal review of Gary Taubes’ latest book, Why We Get Fat, because I already wrote an extensive review of his first book, Good Calories, Bad Calories, and the messages (and my criticisms) are basically the same. But after finishing the book I think Taubes is worth revisiting.

My biggest problem with Taubes’ first book is that it was very difficult to read, and that of course means most people won’t finish it. In Why We Get Fat Taubes repackages the data in a way that is much more logical and easy to digest. The book is substantially shorter, and is mostly free of the rants and tirades that peppered Good Calories, Bad Calories.

Instead, Why We Get Fat takes the reader through a clear and concise explanation of why all calories are not created equal, and that carbohydrates are the reason for the vast majority of the health and weight problems plaguing modern civilization. He also does a fantastic job demolishing the currently prevailing hypothesis that dietary fat and blood cholesterol are the causes of heart disease. They aren’t.

That so few people understand these points is why I recommend everyone read this book. It breaks my heart every time someone writes to me for nutrition advice and proudly points to their butter-less popcorn or baked chips as proof of their already “healthy” diet. Until it becomes common knowledge that fat is good for you and processed carbohydrates are the worst thing you can eat, I think this book is the best resource we have to explain it.

Still I do not agree 100% with Taubes’ conclusions. Though I do think the evidence is overwhelming that all calories are not created equal, I disagree that calories therefore do not matter and cannot be manipulated to help with weight loss. Taubes argues that how much we eat is dependent on our hormone levels (specifically insulin levels) that regulate energy balance, and that depending on this balance we naturally regulate our feeding and energy expenditure (exercise) so that we maintain our weight.

Taubes makes a compelling case that severe calorie restriction is counterproductive in weight management, and I agree. However there is some evidence that a small calorie deficit, on the order of 100-200 calories per day, is within the range of our natural homeostatic mechanisms and can be effective at controlling body weight.

In his book, Why We Eat More Than We Think (another must-read), Brian Wansink explores study after study where environmental cues are manipulated to get people to eat either significantly more, or significantly less than they believed. Importantly, the participants never reported any difference in satiation no matter how much they ate. Wansink argues that people can make small dietary changes resulting in a moderate 100-200 calorie per day deficit that does not affect hunger levels and can be used to effectively control weight.

Similarly, in The End of Overeating (here’s my review) Dr. David Kessler discusses how eating can become uncoupled from hunger when it is associated with external cues, making a strong case that some of us really do eat more than we need to. I think many of Kessler’s points about overeating are valid, particularly for emotional eaters. His argument is further strengthened by individual case studies of people who learn to eat less without experiencing sensations of starvation that are predicted by Taubes. One such example is Frank Bruni’s book Born Round (my review), in which he overcomes his weight struggles by moving to Italy and changing his relationship with food. Bruni is able to maintain his weight even after accepting the job of food critic at the New York Times.

These accounts conflict with Taubes’ argument that people overeat to satisfy a caloric deficit caused by a carbohydrate-induced faulty metabolism. Though there is good reason to believe Taubes’ metabolic hypothesis accounts for a large part of the health issues in today’s society, I think it is premature to conclude that this is the only force at work in why we get fat. Indeed, some research suggests learned feeding cues can directly impact insulin and metabolic pathways even in the absence of food. This data does not refute Taubes’ hypothesis, but rather makes it more complicated than he implies.

Even if we assume Taubes’ metabolic theory accounts for the majority of our health problems, insulin response (the ultimate cause of fat accumulation) should also be affected by eating rate and exercise, and vary among individuals. However Taubes handedly dismisses the possibility that any behavioral modification other than carbohydrate restriction can impact metabolic function because, he argues, we will modify our physical activity to adjust for any nutritional changes. His case is compelling, but not air tight, and my interpretation is that while carbohydrate consumption is clearly very important, there are likely other factors that may also be helpful in controlling metabolism and body weight.

In his book The 4-Hour Body (my review), Tim Ferriss describes how WordPress founder Matt Mullenweg lost 18 pounds by simply chewing each bite of food 20 times. Extra chewing or “masticating” was made popular as a weight loss technique in the late 1800s by Horace Fletcher and is explored in Gina Kolata’s book Rethinking Thin (not a particularly good read). Extended chewing and eating slowly are both effective at inducing weight loss, likely because they slow the glycemic response and almost always result in decreased meal size.

One of the most interesting points made in The 4-Hour Body was Ferriss’ personal glycemic response to a low-carbohydrate diet of just meat and vegetables. He claims that even with this meal he could easily spike his glucose to over 150 mg/dL (this is very high) by simply eating quickly, and that this effect could be controlled by slowing down and taking a full 30 minutes to finish a meal. Unfortunately I could not find a similar experiment in the scientific literature, but Ferriss’ observation suggests that behavioral modification can have a powerful impact on metabolic response independent of diet composition.

My final complaint about Why We Get Fat is that Taubes never considers that individual variation may preclude his theory from applying to everyone. He suggests that while some people are genetically blessed with a higher tolerance for carbohydrates, others will only thrive on an almost zero carbohydrate diet. Unfortunately this is the one part of the book he does not provide data to back up his assertions.

Though Taubes frequently argues the importance of paying attention to outliers, he never explores the possibility that some individuals may actually do better (rather than less bad) on a diet with slightly more carbohydrates. (Let’s assume for now that I mean slowly digesting, natural carbohydrates and not highly processed sugars and grains.) In a healthy person there is no reason to assume that such a diet would induce insulin resistance, and there may be some additional advantage outside of metabolic health for including such foods. I don’t think this is a possibility we should dismiss without solid evidence.

To summarize, Taubes does an excellent job describing the importance of carbohydrates in both weight management and health but oversimplifies the science, particularly neglecting the importance of behavioral factors on metabolism. However, the analysis presented in Why We Get Fat is still the most clear explanation of the relationship between metabolism and health that I’ve found and is an invaluable resource for the general public.

What did you think of Taubes’ latest book?

For The Love of Food

Welcome to Friday’s For The Love of Food, Summer Tomato’s weekly link roundup.

I’m pleased to inform you that I became an official blogger at The Huffington Post this week. My first article there was my interview with David Kessler, Learning to Eat Less: How Understanding Your Brain Can Make You Healthier. I hope to post many of my best articles there in the coming months, usually in the Living section.

Publication at Synapse has also resumed, though I have stepped down as the official science editor to focus on Summer Tomato and (ah hem) finish my lab work.

I’m also excited to announce the creation of the Summer Tomato monthly newsletter! The newsletter will include new content that is not posted here on the blog, and will feature Summer Tomato news, healthy eating tips and recipes. Newsletter subscribers will also have access to exclusive offers and discounts on future Summer Tomato material. Exciting, right?!

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Don’t forget to confirm your subscription by clicking the link in the confirmation email.

If you are wary of entering your email address, rest assured I will never sell or exchange your information and you can unsubscribe anytime. Consider this my personal spam-free guarantee. The main purpose of the newsletter is to reward loyal readers with great tips to upgrade your healthstyle. Feel free to email me any time if you are unhappy with Summer Tomato material.

This week around the web there were some interesting articles about the cholesterol-heart disease hypothesis, which you may be surprised to hear is not particularly strong. These stories may renew your interest in my post last week on How to raise your HDL cholesterol. There are also a few pieces on the role of the brain in eating behavior, which I am becoming more and more interested in (shocking, I know).

I read many more wonderful articles than I post here each week. If you’d like to see more or just don’t want to wait until Friday, be sure to follow me on Twitter (@summertomato) or the Summer Tomato Facebook fan page. For complete reading lists join me on the social bookmarking sites StumbleUpon and Delicious. I’m very active on all these sites and would love to connect with you there. (Note: If you want a follow back on Twitter introduce yourself with an @ message).

I also invite you to submit your own best food and health articles for next week’s For The Love of Food, just drop me an email using the contact form. I am also accepting guest posts at Summer Tomato for any awesome healthstyle tips and recipes you’d like to share.

This post is an open thread. Share your thoughts, writing (links welcome!) and delicious healthy meals of the week in the comments below.

For The Love of Food

• Why Cholesterol May Not Be the Cause Of Heart Disease <<Fascinating, in-depth look at some of the fallacies in the cholesterol-heart disease hypothesis. For an intense analysis of this issue definitely read the book Good Calories, Bad Calories. (The Huffington Post)
• Eating eggs might up your cholesterol. So what? <<Here’s some more info on cholesterol and heart disease, specifically how it relates to dietary cholesterol (as opposed to blood cholesterol). (Nutrition Data).
• Why we eat too much, and how to get control <<Really nice companion piece to my post on Learning to Eat Less, including some additional Kessler quotes. (CNN)
• A Cure For Cancer? Eating A Plant-Based Diet <<B.S. of the week You all know I am a huge fan of the plant-based diet, but this article in the Huffpo goes so far as to claim that all animal protein causes cancer, which is not at all supported by the data. Not surprisingly, this woman turns out to be a animal rights fanatic. I call conflict of interest. (The Huffington Post)
• Request for financial disclosure <<Speaking of conflict of interest, I love this piece by Marion Nestle about how she is in absolutely no way influenced by any outside funding. Oh the irony. (Food Politics)
• Successful Dieters Show Unique Brain Patterns <<I find this  info about dieting and the brain fascinating, but before you jump to any conclusions remember that this does not show cause and effect. (HealthDay)
• Low-Carb Mediterranean Diet Beats Low-Fat For Recent-Onset Type 2 Diabetes <<Just been warned by your doctor about the onset of type 2 diabetes? Your best bet is to eliminate all processed, refined carbs and avoid low-fat diets. (Advanced Mediterranean Diet)
• With Fancy Coffees, Calories Can Add Up <<Have I ever mentioned that I think Starbucks is as bad as soda, McDonald’s and Krispy Kreme? Well I do. (HealthDay)
• Homemade Tomato Soup <<Recipe I want to eat this more than anything. Anything. (Local Lemons)
• Family dinners work some kind of magic <<Again, let’s not confuse cause and effect, but I think this is a great argument for home cooking. (Los Angeles Times)

What great stuff did you read and write this week?

In a nation where obesity and health loom large in our public dialog, there is no escaping the simple fact that we eat too much.

On average Americans consume 500 more calories per day than we did in 1970 (more than we ever have), mostly in the form of refined and processed foods. This corresponds with a 25-30 pound increase in body weight and obesity rates near 30%.

Debates rage over the specifics of what is causing our weight and health problems, but it seems clear enough that the critical element is the amount of food we choose to put in our mouths.

But does everything we eat represent a true choice?

In his book The End of Overeating, former FDA commissioner Dr. David Kessler examines the role of the brain in eating behavior and the mechanisms involved in what he calls conditioned hypereating.

According to his findings specific combinations of sugar, fat and salt hijack the reward pathways of our brain and force us to behave more like food addicts than hungry organisms. This leads to a cycle of conditioned hypereating that makes the habit harder to break with each repeated episode.

But whether or not we are addicted to food is a point of debate. In my interview with Kessler, he made clear he does not use the word addiction for fear of oversimplifying conditioned hypereating. Our relationship with food is more complicated than it is with something like alcohol or tobacco because a human can live without cigarettes, but food is vital to survival.

When pressed to describe the neural differences between addiction and conditioned hypereating, however, Kessler conceded, “The fundamental circuits are the same.”

For this reason, treatment of conditioned hypereating can draw from the success of substance abuse treatments. These tactics involve cognitive and behavioral therapies we can use to train ourselves to override our instincts and adopt new behaviors in response to stimulus cues.

For conditioned and compulsive behavior, cognitive strategies are necessary because intuitive inclinations and “listening to your body” do more harm than good. If your body is telling you to have a cigarette, this does not mean it is in your best interest to do so.

At the FDA Kessler was instrumental in the fight to regulate tobacco, and now he believes some of the same lessons can be applied to the treatment of overeating.

“What took me a decade to understand is you need to change the valence of the stimulus.”

The positive emotional reaction associated with indulgent foods is at the center of our motivation to seek them out. Twenty years ago cigarettes had tremendous allure. But the FDA was successful at demonizing the tobacco industry, and the public no longer sees smoking as glamorous and attractive.

And smoking rates have plummeted.

Changing a conditioned behavior requires a fundamental shift in how we think about a stimulus. In conditioned hypereating the stimulus is food, which makes the task especially difficult, but not impossible.

To break the cycle of conditioned hypereating we must redirect our automatic response to the kinds of foods that cause us to overeat. Kessler calls these hyperpalatable foods, which are loaded with layers upon layers of sugar, fat and salt. The goal is to replace our automatic responses to these foods with different, equally enjoyable actions that are not detrimental to our health and do not reinforce compulsive behavior.

I asked Kessler what is the first step in controlling our eating habits and overcoming conditioned hypereating.

“I can tell you the last step. Change your relationship with food. If sugar, fat and salt are your friends, you will lose. You have to get to the point where that is not what you want.”

The End of Overeating outlines the four basic steps of habit reversal: awareness, competing actions, competing thoughts and support.

But Kessler believes the critical step is fundamentally changing the way we view what we eat, cooling down our emotional response to hyperpalatable foods. In essence, we must train ourselves to stop wanting what we believe we want.

According to the book, the first step in this transformation is becoming aware of the power food holds over us, which requires understanding how our brains work. We must recognize that when we are tempted to indulge, the urge is not generated internally but is a reaction to a cue that makes us respond automatically. You may think you are hungry, but really you are just reacting to an emotionally charged stimulus that tells you to eat.

Once you recognize a cue for what it is you have a brief moment to decide not to take the bait. To successfully divert yourself to another course of action you must have a plan ready in advance that allows you to do something completely different.

Considering alternative activities and the reasons you might prefer them can help you tremendously at this point of decision. Rather than focusing on the positive emotions you will experience by giving in to your desire for hyperpalatable foods, also remember the negative emotions that follow if you give in and the positive aspects of the alternative action.

For instance, it may help to remember that every time you get cued and give in, you are strengthening the neural circuitry that compels you to this behavior in the first place. If you even briefly entertain the possibility of indulging, you create a state of ambivalence that leads to torment, obsession and cravings. However, when you successfully divert your attention to another rewarding activity you have made a small step toward cooling down the positive valence of the food.

It is the state of mental torment and ambivalence that increases the positive emotional charge of a food, building and strengthening the neural reward circuitry that causes conditioned overeating. This may be one of the reasons dieting almost always results in long-term weight gain, since constant deprivation makes hyperpalatable foods more difficult to resist and creates severe anxiety.

Mentally, the best strategy to overcome conditioned hypereating is to develop new, positive associations with food that are independent of palatability–something you care more about than the fleeting reward of overeating. Kessler says this is a deeply personal process and must reflect an individual’s own set of values. For example, it helps some people to become vegetarian, while others value organics or local food. These decisions remove virtually all hyperpalatable food from the lives of people who choose these paths.

It also helps to develop aversions to hyperpalatable foods. Some may learn to demonize “Big Food,” while others turn away after educating themselves about health concerns. Developing a more sophisticated culinary palate can help make hyperpalatable foods less palatable. Kessler himself developed an aversion to over-sized portions, which he now sees as repulsive piles of sugar, fat and salt.

Developing positive associations with healthier foods while demonizing the hyperpalatable foods we have been conditioned to crave can fundamentally change your emotional response to stimulus cues. As you learn to recognize your brain’s response to cues, you can override conditioned behavior by consciously deciding to take alternative actions because you want to.

You will never win an internal battle with yourself. Instead use what you know about the brain’s reward system and give up trying to summon willpower to resolve the torment of conflicting desires. Reprogram your habits by closely examining your relationship with hyperpalatable food and begin making deliberate decisions that are consistent with your goals, breaking the cycle of conditioned overeating.

To read more about conditioned hypereating and habit reversal read The End of Overeating, by Dr. David Kessler.

Have you read The End of Overeating? Have you overcome conditioned hypereating?

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