sugar levels, the cellular uptake of vitamin C will drop accordingly. Glucose also impairs the reabsorption of vitamin C by the kidney, and so, the higher the blood sugar, the more vitamin C will be lost in the urine. Infusing insulin into experimental subjects has been shown to cause a “marked fall” in vitamin-C levels in the circulation.
In other words, there is significant reason to believe that the key factor determining the level of vitamin C in our cells and tissues is not how much or little we happen to be consuming in our diet, but whether the starches and refined carbohydrates in our diet serve to flush vitamin C out of our system, while simultaneously inhibiting the use of what vitamin C we do have. We might get scurvy because we don’t faithfully eat our fruits and vegetables, but it’s not the absence of fruits and vegetables that causes the scurvy; it’s the presence of the refined carbohydrates.*96 This hypothesis has not been proven, but, as Will and Byers suggested, it is both biologically plausible and empirically evident.
When we discuss the long-term effects of diets that might reverse or prevent obesity, we must not let our preconceptions about the nature of a healthy diet bias the science and the interpretation of the evidence itself.
UNCONVENTIONAL DIETS
Here was a treatment, that, in its encouragement to eat plentifully, to the full satisfaction of the appetite, seemed to oppose not only the prevailing theory of obesity but, in addition, principles basic to the biological sciences and other sciences as well. It produced a sense of puzzlement that was a mighty stimulant to thought on the matter.
ALFRED PENNINGTON,
Does it help people lose weight? Of course it does. If you cannot eat bread, bagels, cake, cookies, ice cream, candy, crackers, muffins, sugary soft drinks, pasta, rice, most fruits and many vegetables, you will almost certainly consume fewer calories. Any diet will result in weight loss if it eliminates calories that previously were overconsumed.
JANE BRODY, talking about a high-fat, high-protein diet, unrestricted in calories, in the
A. J. LIEBLING, THE CELEBRATED AUTHOR of
1. The reporter, who writes what he sees.
2. The interpretive reporter, who writes what he sees and what he construes to be its meaning.
3. The expert, who writes what he construes to be the meaning of what he hasn’t seen.
“To combat an old human prejudice in favor of eyewitness testimony,” Liebling wrote, “the expert must intimate that he has access to some occult source or science not available to either reporter or reader. He is the Priest of Eleusis, the man with the big picture…. All is manifest to him, sincehis conclusions are not limited by his powers of observation.”
Leibling was talking about journalism, but a similar ranking holds true in medicine. In fact, the medical experts have the further advantage that they can disseminate their opinions with considerably greater influence. They can make their case with the imprimatur of the institutions that employ them—the American Medical Association, for instance, or Harvard University. They can easily attract the media’s attention. Physicians’ case reports and the patients’ anecdotal experience have a fundamental role in medicine, but if these conflict with what the experts believe to be true, the experts’ opinions win out.
This conflict between expertise and observational evidence has had a significant influence in the science of obesity. Reliable eyewitness testimony has come only from those who have weight problems themselves, or the clinicians who regularly treat obese patients, and neither group has ever garnered much credibility in the field. (The very assumption that obesity is a psychological disorder implies that the obese cannot be trusted as reliable witnesses to their own condition.) But it is these individuals who have the firsthand experience. When Hilde Bruch reported in 1957 that a fine-boned girl in her teens, “literally disappearing in mountains of fat,” lost nearly fifty pounds over a single summer eating “three large portions of meat” a day, it was easier for the experts to ignore the testimony as a freakish phenomenon than to contemplate how such a thing was possible. But the process of discovery in science, as the philosopher of science Thomas Kuhn has put it, only begins with the awareness that nature has violated our expectations. Often it is the unconventional events—the anomalous data, as these are called in science—that reveal the true nature of the universe.
In 1920, while Vilhjalmur Stefansson was just beginning his campaign to convince nutritionists that an all-meat diet was a uniquely healthy diet, it was already making the transition into a reducing diet courtesy of a New York internist named Blake Donaldson. Donaldson, as he wrote in his 1962 memoirs, began treating obese patients in 1919, when he worked with the cardiologist Robert Halsey, one of four founding officers of the American Heart Association. After a year of futility in trying to reduce these patients (“fat cardiacs,” he called them) with semi- starvation diets, he spoke with the resident anthropologists at the American Museum of Natural History, who told him that prehistoric humans lived almost exclusively on “the fattest meat they could kill,” perhaps supplemented by roots and berries. This led Donaldson to conclude that fatty meat should be “the essential part of any reducing routine,” and this is what he began prescribing to his obese patients. Through the 1920s, Donaldson honed his diet by trial and error, eventually settling on a half-pound of fatty meat—three parts fat to one part lean by calories, the same proportion used in Stefansson’s Bellevue experiment—for each of three meals a day. After cooking, this works out to six ounces of lean meat with two ounces of attached fat at each meal. Donaldson’s diet prohibited all sugar, flour, alcohol, and starches, with the exception of a “hotel portion” once a day of raw fruit or a potato, which substituted for the roots and berries that primitive man might have been eating as well. Donaldson also prescribed a half-hour walk before breakfast.
Over the course of four decades, as Donaldson told it, he treated seventeen thousand patients for their weight problems. Most of them lost two to three pounds a week on his diet, without experiencing hunger. Donaldson claimed that the only patients who didn’t lose weight on the diet were those who cheated, a common assumption that physicians also make about calorie-restricted diets. These patients had a “bread addiction,” Donaldson wrote, in that they could no more tolerate living without their starches, flour, and sugar than could a smoker without cigarettes. As a result, he spent considerable effort trying to persuade his patients to break their habit. “Remember that grapefruit and all other raw fruit is starch. You can’t have any,” he would tell them. “No breadstuff means any kind of bread…. They must go out of your life, now and forever.” (His advice to diabetics was equally frank: “You are out of your mind when you take insulin in order to eat Danish pastry.”)
Had Donaldson published details of his diet and its efficacy through the 1920s and 1930s, as Frank Evans did about his very low-calorie diet, he might have convinced mainstream investigators at least to consider the possibility that it is the quality of the nutrients in a diet and not the quantity of calories that causes obesity. As it is, he discussed his approach only at in-house conferences at New York Hospital. Among those who heard of his
