Low Carb Fraud Part 2 - NuSI and Gary Taubes

Low Carb Fraud 2 – NuSI

UPDATE: NuSI have redesigned their website so some links no longer work. Maybe they didn't like getting found out?

In 2012 journalist Gary Taubes and doctor turned low carb activist Peter Attia founded the Nutrition Science Initiative (NuSI). Their objectives can be found here but the following extracts summarise the main elements:

Almost 40 years ago the Dietary Goals for the United States was established for all Americans to follow. Inconclusive scientific data were the basis for the guidelines.

DRAMATIC RISE IN OBESITY AND DIABETES RATES

Dietary guidelines have rarely been supported by research, with most studies being inconclusive. With guidelines that remain largely unchanged and no direction to Americans, obesity and diabetes rates continue to climb. The need for additional nutrition and disease research is undeniable.

NuSI wanted to ask some questions:

And all of this is done within an overarching strategy that systematically tackles the most critical questions asked by those struggling with the burden of metabolic illness —are all calories really equal with respect to weight gain? Does saturated fat cause heart disease? Why do some people get obese while seemingly eating so little? What role do the bacteria in our gut play in obesity and related disease? Only when these questions are answered, unambiguously, can we communicate broadly what we need to eat for maximum health.

One of the first issues here is there have been thousands of studies on all these areas over decades. Is it perhaps what this statement should say is we didn’t like the answers to the questions so we will ask again and hope the answer changes?

Important to this blog post is that NuSI state:

NuSI is not invested in particular outcomes. We are invested in finding scientifically sound solutions. We are also fully committed to communicating the results of this research to scientists, policy makers, advocacy groups, the media, and the general public.

My underlining.

One of the first things NuSI did was set up the Energy Balance Consortium. They wanted to test (yet again) that in terms of weight loss it was calories that matter, not whether a diet was high in fat or carbs. Could carbs be what makes people fat after all? A full breakdown of the study design is here but in general the aim was to test 2 groups of men comparing diets that were matched in terms of total calories and protein, the only difference being the amount of fats and carbs in the diet. Further aiding the quality of the study was that all participants would be confined to clinic throughout and all foods would be provided and energy expenditure would be monitored. The lead scientist was to be Kevin Hall PHD.

As the study was being run and the results analysed Gary Taubes appeared in the UK at the Epic Fitness Convention and took part in a live obesity debate with Alan Aragon. In what many have stated was like 'taking a knife to a gunfight' Taubes seemed under prepared for a scientific discussion and labelled most studies that went against the insulin theory of obesity as having questionable funding (Big Sugar). He did not understand the irony of, as a low carber, setting up an organisation to run studies because he 'knew' outside influences affected science. Clearly his low carb dogmatic belief would never influence the results of NuSI studies. Tellingly, Taubes was also asked that if the Hall study also proved that calories, not insulin, were the cause of obesity would he change his mind. To which he answered 'Probably Not'(EDIT Hall has since stated Taubes already knew the preliminary results of the study making this comment even more absurd).

Fast forward several months and social media were talking about the Hall study and the results. I rushed to the NuSI website to read the study and to my surprise it wasn’t there! Luckily I soon found it via a link on Facebook post discussing it.

Here is the abstract:

BACKGROUND:

The carbohydrate-insulin model of obesity posits that habitual consumption of a high-carbohydrate diet sequesters fat within adipose tissue because of hyperinsulinemia and results in adaptive suppression of energy expenditure (EE). Therefore, isocaloric exchange of dietary carbohydrate for fat is predicted to result in increased EE, increased fat oxidation, and loss of body fat. In contrast, a more conventional view that "a calorie is a calorie" predicts that isocaloric variations in dietary carbohydrate and fat will have no physiologically important effects on EE or body fat.

OBJECTIVE:

We investigated whether an isocaloric low-carbohydrate ketogenic diet (KD) is associated with changes in EE, respiratory quotient (RQ), and body composition.

DESIGN:

Seventeen overweight or obese men were admitted to metabolic wards, where they consumed a high-carbohydrate baseline diet (BD) for 4 wk followed by 4 wk of an isocaloric KD with clamped protein. Subjects spent 2 consecutive days each week residing in metabolic chambers to measure changes in EE (EEchamber), sleeping EE (SEE), and RQ. Body composition changes were measured by dual-energy X-ray absorptiometry. Average EE during the final 2 wk of the BD and KD periods was measured by doubly labelled water (EEDLW).

RESULTS:

Subjects lost weight and body fat throughout the study corresponding to an overall negative energy balance of ∼300 kcal/d. Compared with BD, the KD coincided with increased EEchamber (57 ± 13 kcal/d, P = 0.0004) and SEE (89 ± 14 kcal/d, P < 0.0001) and decreased RQ (-0.111 ± 0.003, P < 0.0001). EEDLW increased by 151 ± 63 kcal/d (P = 0.03). Body fat loss slowed during the KD and coincided with increased protein utilization and loss of fat-free mass.

CONCLUSION:

The isocaloric KD was not accompanied by increased body fat loss but was associated with relatively small increases in EE that were near the limits of detection with the use of state-of-the-art technology.

Full study here.

It was then that I realised why it was not on the NuSI website. It was simple, the result was not what Taubes had hoped for.  Yet these results are completely inline with decades of research on this topic.
In no time at all the prominent low cabers were out in force on blogs, podcasts and social media rubbishing the study.

Low Carb Author Dr Jason Fung stated:

"Hall’s conclusions were entirely his own opinion. He suffers so badly from confirmation bias that he may as well have written “My mind is already made up regarding the insulin hypothesis. Please do not confuse me with facts”

I do like Fung's use of scientific terminology in his blog like WTF and 'spin doctor Hall'  but the entire blog is a personal attack on Hall despite there being 11 scientists involved. Low carbers have to create a bad guy and have to leave out anything that doesn’t suite their narrative. It's a childish personal attack with little science.

In his blog response David Ludwig makes no mention of NuSI being involved. It was Kevin Hall of the National Institute of Health. Why would he not mention his mate Taubes and NuSI? He references several non-calorie, non-protein matched studies to prove the effectiveness of the low carb diet ignoring all the ones that are. I like the bit where he writes:

"The full details of the study have yet to be published in a peer-reviewed journal, but we have enough information about study design to dismiss Hall’s conclusion with confidence."

He had only read the abstract! He then criticises the design of the study (is he therefore criticising Taubes?) stating that it is subject to a myriad of influences that may confuse, obscure or exaggerate apparent relationships. He hasn’t read the study!! He doesn’t mention a single actual example of course. He doesn’t mention that these issues could positively aggerate the effect of a LCHF diet too. My favourite bit, after dismissing Calories in, Calories out earlier when Ludwig highlights that there participants weren't in calorie balanced at the start! I thought calories don’t matter? Ludwig ramblings prove that he hadn't read the study at the time of writing and even after an post update (after reading the study several weeks later) he doesn't edit out the bits that he should now know are false because they would weaken his objections.

These blog posts and others are more like a coordinated PR campaign than actual scientific discussion. Remember, the findings of this study should not have been a surprise. They echo multiple studies on the subject. Studies that never make it into Low Carb books and blog posts?

But lets step back a bit, back to Taubes. This study was funded by NuSI and the NuSI Science Board and it's Director, Gary Taubes, were involved with the study design and chose the scientists to run it. There would have been numerous meetings, emails and discussion regarding the study design before it was finalised. At any point in the process Gary Taubes could have changed the study if he believed it wasn’t fit for purpose. He could have added a control group, more participants, anything. Instead, at no point did he or any of the other prominent low cabers state any worries about the stud design once finalised. The NuSI website clearly stated in advance of the study:

The pilot study was designed to utilize the most rigorous environmental and dietary controls to isolate the effect of dietary carbohydrate and fat on metabolism.

It was only AFTER the study results were released that all of a sudden it was a badly designed study.
The Hall study was in complete alignment with many other studies that show that when total calories and protein are matched dietary composition makes no difference to weight loss. The results SHOULD not have been a surprise. In fact it was probably a pointless study in many ways because we can predict the results from all the previous studies. The only logical reason for the study was that Taubes thought the other studies had been corrupted by Big Sugar and Big Pharma. Did Taubes really expect a different study result? Was he really so blinded by his zealousy?

Yet it gets worse, despite all his involvement Taubes was later recorded at a low carb conference (yep, they have those, book tickets early as they are like the Super Bowl) being highly critical of his own study and also made claims against Kevin Hall such as the other scientists did not support the finding/conclusion. You can listen to Kevin Hall discuss the study and hear the Gary Taubes comments here. a full transcript is here. The comments:

And the results of that study were recently published in this journal, and Kevin Hall was the first author, so we brought together this group of esteemed researchers and we let them choose their principal investigators, and they chose the youngest member with the least experience to be the principle investigator because he was the most ambitious, he had the most energy, he had the most free time to put into it. He basically made the experiment work as much as it did. This could not have been done without Kevin Hall, and they were all grateful for it, but Kevin, let’s just say we have different concepts of what science is and how to do it, so when he ended up publishing the paper about two months ago, the paper basically says that the carbohydrate insulin hypothesis has been disproven, and NuSI, my organization funded so those people who don’t believe what I believe, so this is Taubes, to his credit put himself out business and I shouldn’t be giving talks like these have been disproven. Our perspective was, first of all the study didn’t even come close to disproving it, and if you read Mike Eades wrote a great blog post to this effect. If you actually look at the numbers published, they actually support what we would have predicted. And it’s strange, I was in New York about a month ago and I was meeting with two of the researchers, the senior researchers and one of them said, “The pilot study we already refuted the conventional wisdom that a calorie is a calorie,” and I said, “Well, first of all you didn’t because it wasn’t randomized so you can’t, and for that I’d like to think you did but you can’t logically. Second of all, you guys’ names are on the paper if you read the paper you’d never know from the pros that you actually had refuted the conventional wisdom,” and they said, “Well, we let Kevin be the principal investigator and Kevin got the last say in what was written,” and they signed off on it. So there is a paper out there now that if you look at the data, refutes the idea that a calorie is a calorie, which is all these hypothesis, these hypothesis testing experiments only what they do is they test the no hypothesis, the statistical analysis is based on the test of a no hypothesis, so if you look at that and you ignore the fact it’s not randomized, it refutes a no hypothesis, it’s reported as refuting what we believe.  

Kevin Hall, to his immense credit has since sat down with Taubes and the issue is over for him, Hall is a far, far better man than most. Despite this Taubes still continues to dismiss the study and bad mouth it's lead scientist online and in public.

The way in which Taubes has handled the entire issue makes my blood absolutely boil. I can understand that he wanted this study to prove the Insulin Hypotheses of Obesity, or at least not disprove it. I understand that he makes his living through low carb books and other low carb activities (fancy a Low Carb Cruise? Yes, they do them, again book early). What I can never understand is why he would not publish the full study plus the supporting documents and detailed data on the NuSI website. Yes, the study is still not on the NuSI website nearly 18 months later. Communicating research is part of the NuSI remit for a very good reason. Science should not be hidden, especially behind paywalls or in places were people may not know to look. If Taubes genuinely believes the study is flawed then fine (he is part to blame if it is, he scrutinised the study design!). He can still publish it on the NuSI website and then ask some of his low carb buddies like Noakes, Ludwig and Fung to write a 2000 word response as to why the study is wrong. He can then allow other scientists to write another 2000 word post to why the study is good. Then people can make up there own mind armed with a balance of information. Simply wiping the study from NuSI existence is not acceptable.

Science should be self correcting. It is vitally important that people question studies if and when appropriate. The more open the process is the better, the more people that see this the better. By effectively censoring the study from the NuSI website were it could be viewed easily by the general public who would probably be unaware of services such as PubMed Taubes has blocked this process. To make it worse he then goes 'offline' and criticise then study he helped set up and the scientist he helped chose to lead the study. Can anyone imagine any other common situation when the director of an organisation does this? This is anti-science, this is the very opposite of what NuSI claims to be about. Taubes is happy to write about conspiracy and corruption by others, but what is this? 18 months after the study was released we are all still at a loss. We have had prominent low cabers attacking the lead scientists and attacking a study they haven't even read. What we haven't had is an honest debate about what this study means. The public that most people in NuSI wanted to serve have been robbed of proper scientific debate. NuSI, with millions of dollars of investment is a shambles and this entire event goes against everything it is supposed to stand for. The only conclusion can be is that NuSI is a Low Carb mouth peace and the Low Carb Cult leaders are not interested in the truth. Why should they be? It would harm books sales and slash appearance fees.

PS

There has been another NuSI study looking into the carbs v fats  issue and the initial results have been sneaked out. How can I put this delicately. I do not believe this study will be published on the NuSI website either.
It's sad.

EDIT

The second NuSI study is out, it wont be featuring on their website as it yet again shows carbs are not don't make you fat.

Also, please read this fantastic post on the finances of NuSI make particular note of how much Taubes has paid himself and ask the question 'what has he done to earn it?'

http://carbsanity.blogspot.co.uk/2018/03/the-manhattan-project-of-nutrition-that.html

Update 19 Jun 2018

This article in Wired, I believe, validates what I have written:

https://www.wired.com/story/how-a-dollar40-million-nutrition-science-crusade-fell-apart/?mbid=social_twitter_onsiteshare

Additionally, Kevin Hall tweeted this timeline of events for this study:

https://twitter.com/KevinH_PhD/status/1008713794481262593

UPDATE May 2020

The NuSI website has been completely changed since I wrote this blog. There is a definite diet them though: