Good Calories, Bad Calories

intricate and extraordinarily robust regulatory system of hormones, enzymes, and the nervous system to accomplish this task. If the necessary fuel fails to reach the cells, the body compensates. The crucial factor is not how much is eaten—how many calories are consumed—or how much is expended, but how those nutrients or the energy they contain is ultimately distributed, how those calories are utilized and made available when needed. It’s not the energy balance that is driving this system, but the distribution of that energy, the demand for energy at the cellular level.

Chapter Eighteen

FATTENING DIETS

Oversupply of food does not necessarily produce excessive nutrition. The appropriation depends in part on the character of the food and the ease or difficulty with which it is converted into a condition suitable for absorption, in part on such extrinsic and intrinsic influences as heredity, age, sexual and psychical habits, exercise and sleep; but to a great extent also on personal peculiarities of the metabolic processes….

JAMES FRENCH, The Practice of Medicine, 1907

IN 1857, JOHN HANNNING SPEKE AND Richard Burton set off through West Africa to search for the source of the Nile River. After Burton fell ill, Speke discovered the river’s origin on his own. When he returned to the region five years later, according to his memoirs, he heard about the custom of local Abyssinian nobility to fatten up their wives to “such an extent that they could not stand upright.” He went to see for himself. “There was no mistake about it,” he recalled. “On entering the hut I found the old man and his chief wife sitting side by side on a bench…. I was struck with the extraordinary dimensions, yet pleasing beauty, of the immoderately fat fair one his wife. She could not rise; and so large were her arms that, between the joints, the flesh hung down like large, loose stuffed puddings.” Two weeks later, when Speke visited “another one of those wonders of obesity,” he took the opportunity to measure her. Her chest was fifty-two inches around. Her arms were nearly two feet in circumference and her thighs over two and a half feet.

With the notable exception of the current prevalence of obesity in Western societies, there is little reason to believe that fattening up the constitutionally lean is any easier than inducing leanness in the obese. For successful fattening, the excess calories consumed have to be stored as fat, rather than expended in metabolism or physical activity or stored as muscle. This isn’t a given, considering these alternative uses for the calories. Continuing to consume excess calories is necessary, too—the person being fattened has to continue eating long after becoming sated—and these calories also have to be stored as fat.

In the early 1970s, the British physician John Garrow attempted to add twelve hundred calories a day to his daily diet, hoping to sustain it for a hundred days. After failing with several methods, he found that he could accomplish his goal by keeping chocolate biscuits on hand and, “whenever the prospect didn’t seem too revolting, eating however many of these biscuits that I could.” He managed to gain fifteen pounds in sixty days and then gave up the experiment and lost the weight in fifty days. “I learned that for me it is difficult to move my weight at all rapidly in any direction,” he said, “and I saw absolutely no reason to suppose that obese people would find it easier than I did.”

Various foods have been used to induce extensive fattening. The tribes that Speke visited relied on milk to fatten their women. In the mid-1970s, the French ethnologist Igor de Garine documented two male fattening sessions of the Massa tribe of northern Cameroon. In an individual ritual, the man ingests both milk and a porridge made from sorghum, a cornlike grain that provides, like sugarcane, a sweet syrup from the stalk. In 1976, Garine reported, one Massa tribesman gained seventy-five pounds on this ceremonial binge, apparently averaging ten thousand calories a day throughout. In a group fattening ritual, the men consume thirty-five hundred calories a day, rather than their usual twenty-five hundred, the excess consiting of milk and porridge. The weight gain tends to be fifteen to twenty pounds. The Massa are cattle herders, and their staple diet is primarily milk. This fattening, therefore, is accomplished by the addition of carbohydrates almost exclusively—one thousand to seventy-five hundred calories a day of sorghum.

The sumo wrestlers of Japan, whose weight commonly exceeds three hundred pounds, typically reach that level by their early twenties. In 1976, a University of Tokyo collaboration, led by Tsuneo Nishizawa, published an article in The American Journal of Clinical Nutrition that still constitutes the most comprehensive analysis in the English medical literature of the sumo diet, body composition, and health. The world of professional sumo wrestling, according to Nishizawa, is divided into an “upper group,” constituting the best wrestlers in the country, and a “lower group.” The members of the upper group consumed on average some fifty-five hundred calories’ worth of chanko nabe (a pork stew) a day, out of which 780 grams were carbohydrates, 100 grams fat and 365 grams protein. This constituted more than twice the calories and carbohydrates of the typical Japanese diet of the era,^*90 slightly less than twice the fat, and four and a half times the amount of protein. The sumo diet was very high in carbohydrate by our standards—57 percent of the calories—and very low in fat—16 percent—considerably beneath what most public-health authorities in America consider a feasible low-fat target. The lower group of sumo weighed as much as their more accomplished colleagues, but were significantly fatter and less muscular. They consumed, on average, only 5,120 calories of chanko nabe a day, consisting of 1,000 grams of carbohydrates, 165 grams of protein, and only 50 grams of fat; these lesser sumo attained and maintained their corpulence on a diet of nearly 80 percent carbohydrate calories and 9 percent fat.

It seems that if we wanted to design a diet capable of inducing pathological obesity in young men in their prime, we might start with just such a very low-fat, high-carbohydrate diet. The diet would provide an enormous amount of calories, which might be the salient factor, but we would have to wonder what it is about this dietary composition that allows for such extraordinary overconsumption, not just for a few days, but for years or perhaps decades.

For the past quarter century, public-health authorities and obesity researchers have insisted that it is dietary fat, not carbohydrates, that fattens most effectively and causes obesity. This is why low-fat, low-calorie diets are recommended for weight loss as well as prevention of heart disease. This notion is based on four pieces of evidence, all of which are easily challenged.

The one that has been most influential is the association between heart disease, obesity, and diabetes. If heart disease is caused by high-fat diets, as is commonly believed, then so are obesity and diabetes, since these diseases appear together in both individuals and populations. But there is no evidence linking obesity to dietary-fat consumption, neither between populations nor in the same populations.^*91 And, of course, if dietary fat is not responsible for heart disease, then it’s unlikely that it plays a role in obesity and diabetes.

Second, laboratory rats will become obese on a high-fat diet. This is the evidence that convinced George Bray that excessive dietary fat would cause obesity in humans, too, and Bray has been among the most influential obesity authorities and the foremost proponent of this dietary-fat/obesity hypothesis. According to Bray, the rats used in his laboratory experiments would grow reliably obese on high-fat diets. “I could feed them any kind of composition of carbohydrates I want,” Bray said, “and in the presence of low fat, they don’t get fat. If I raised the fat content, particularly saturated fat, in susceptible [my italics] strains I would get obesity regularly.”