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Demi
Sat, May-06-06, 04:00
The Times
London, UK
6 May, 2006


A Yale University doctor has devised a diet that tricks the brain. Is it science or snake oil, asks Vivienne Parry

It’s not often that a doctor who’s the author of a diet book admits that “it’s a gimmick”. But this is no ordinary diet doc. Come to that, this is no ordinary diet either; it’s based on an intriguing and little-known neurological phenomenon: sensory specific satiety. If you’ve not heard of it before, you certainly will when the Flavour Point diet hits town this month. It’s the brain child of Dr David Katz, a public health doctor from the Yale Prevention Centre in Conneticut.

I’ve never been on a diet; I regard fad diet doctors, particularly American bestselling ones, as creatures beyond contempt and those who drape their money-making activities in a robe of science as the worst sort of charlatans. So Dr Katz, a slight (and skinny) figure, was unknowingly walking into a minefield in agreeing to be interviewed by me.

His diet exploits an evolutionary device hard-wired into human brains. We are programmed to eat more if there is a variety of tastes available and to eat less if only one taste is on offer. It’s a device that drives us to seek alternative food sources, thereby making it more likely that we will get the range of nutrients we need to stay healthy.

This is because the brain is in charge of eating behaviour. The taste of our food registers in the appetite centre of the brain, lodged inside the hypothalamus which, depending on the flavours it receives, sends out signals via hormones to eat more or less. If we are eating just one food, the hypothalamus makes the taste of that food (and tastes similar to it) less pleasant and makes us feel full, thus encouraging us to stop eating and to forage for something different. If confronted with lots of tastes, the human appetite centre remains stimulated and encourages us to eat lots while the food is available.

This is called sensory specific satiety and it is the most important factor controlling how much food we eat at a meal. It’s the reason we can eat a Christmas dinner until we’re stuffed but can still say: “What’s for afters?” Our taste buds may have begun to pall on the savoury turkey and vegetables; our brain makes it taste less pleasant after the second helping. But the prospect of sweet Christmas pudding is very different and our brain allows our appetite to be stimulated once again.

We can graze endlessly at a buffet for the same reason; so many tastes leave our appetite continually restimulated. And modern food production methods are building on the principle of sensory specific satiety to encourage many of us to overeat. Many foods today contain so many ingredients and products that the brain’s appetite centre becomes confused. A savoury snack such as a sausage roll may sound simple but it is bursting with hidden flavours such as sugar and flavour enhancers.

This complexity of taste means that appetite is continually being restimulated — the brain encourages the body to have more and more of it in an attempt to maximise the nutrients seemingly on offer. The very feature designed to protect our health now threatens it.

All this informs the Flavour Point diet. Dr Katz has created a meal plan that revolves around giving people similar flavours throughout the day. So there are onion days, tomato days, sesame days and so on (see box below). Sometimes the similar flavours will be hidden, but they will have an effect on the brain and our appetite all the same. If we follow strictly, we won’t feel hungry. Or so the claim goes.

Dr Katz is is a proper academic, with a fine reputation among his peers and many publications to his name. The Yale Prevention Centre, which concentrates on studying the causes of chronic diseases, particularly diabetes, is funded by the Centres for Disease Control and Prevention and the US National Institute of Medical Health. So far, so good.

Dr Katz says he is appalled at some of the fad diet books (big tick) and was one of the most outspoken critics of the Atkins diet. “It was silly and bad nutrition. Dieting isn’t about weight loss by any means. If it were, we’d just hand cocaine to everyone.” (Cocaine is one of the most potent appetite-suppressants known.) He wanted to find a diet that was good nutrition, that didn’t ignore basic nutritional advice and that people could use easily.

In 1991 he stumbled across sensory specific satiety and was intrigued. “It’s rare that you come across something genuinely novel in medicine, but this was,” he says. The whole principle of sensory specific satiety was discovered only 30 years ago. The pioneer in the field was the American nutritionist Barbara Rolls and her husband Edmund.

In one breakthrough experiment, they gave 24 women test meals, all tasting the same and seemingly being the same, but concealing a wide variety of calories. Some were packed, others were virtually calorie-free. An hour after the meal, all the women were offered cheese and crackers (a different taste from the previous offering) and all of them ate the same amount, regardless of how high their calorie intake had been in the previous meal. Given a new taste, even the brains of those who had consumed most calories were not registering as “full”.

This is a sensory specific satiety effect. In another experiment, 32 people were fed meals that varied in taste and texture. The participants found sweet foods less pleasurable when they had recently eaten sweet foods and salty foods less pleasurable if they had recently had salty ones. It’s fairly obvious, but their research highlighted the effect for science.

Edmund Rolls, now a professor of experimental psychology at Oxford, explains the power of sensory specific satiety. “Even the smell of one food for about the time that you would normally chew it will diminish its pleasantness,” he says. Should any of you become a little overexcited at the prospect of the ultimate “sniff but don’t eat” diet, your body soon twigs that you haven’t actually eaten anything. But it is clear that this effect can be exploited and Dr Katz has done this. The central message of his diet is that by limiting flavours, your body thinks it has had enough long before it would do so if you were taking in many flavours at a time. It cuts out processed foods, which Dr Katz says are engineered to exploit the appetite stimulus that multiple flavours provide. The sort of straw- berry milkshake sold in fast food stores has recently been revealed to contain up to 59 ingredients. If you made it at home, it would contain three or four at most.

“When you taste so many flavours at once, whether from eating too many different foods or too many flavours processed into one food, you overeat before feeling full,” says Dr Katz.

It is the Flavour Point diet’s one-a-day flavour themes that he admits is the gimmick. But the idea of restricting flavours and sticking to simple foods is not. And because of the diet’s reliance on simple food, it has the benefit of sticking to the natural ingredients that are good for you anyway.
All of the recipes based around a day’s theme are calorie-counted. Most come out at about 1,500 calories a day and are low in fat, high in fibre, pay attention to glycaemic load and so on. Anyone would lose weight on such a regimen, so what makes this different? Such a low-calorie diet should also make you feel hungry and the point here is that the 20 guinea pigs Dr Katz used for his diet didn’t feel peckish.

In fact, some of the women in his study complained that they had to eat too much. And they all lost weight at the rate of about 1lb (450g) a week.

So will this diet work in the long term? I was delighted to hear Dr Katz say that he didn’t know. Honesty in a diet doc — hallelujah! But he insisted this wasn’t a fad, that it exploited a genuine phenomenon and it was food that could be eaten by the whole family.

Orange diary: a menu from the Flavour Point diet

BREAKFAST
A small bowl of wholegrain cereal with skimmed milk and a glass of 100 per cent orange juice

MID-MORNING SNACK
A small bowl of fat-free natural yoghurt with a sliced orange

LUNCH
A spinach and orange-lentil salad with feta cheese and pecans

MID-AFTERNOON SNACK
Orange and banana smoothie

DINNER
Orange cod served with green beans with orange peel, bulgar wheat and a tossed garden salad



http://www.timesonline.co.uk/newspaper/0,,175-2165257,00.html

Abd
Sat, May-06-06, 14:57
This whole article is so mind-boggling in its -- missing of the point. It makes ignorance into a virtue. Being honest about being ignorant is better than pretense, sure, but somehow what we have here is an "expert" who is being treated as an expert *and* who admits his ignorance of what has to be the most basic thing: will this diet work, long term.... And there are lots of reasons to think it won't, and no attention whatever is being paid to these reasons. For starters, yes, we are programmed to seek variety. Therefore the solution is a monotonous diet? Uh, isn't that bucking our programming?

The idea of eating one food at a time has been around for a long time. I used to do it 30-40 years ago. Yes, I was skinny as a rail. Did I continue it? No. Why not? Didn't it work? Sure it worked. And it goes against every instinct. Not sustainable. What worked, I discovered only recently, was to go back to what my instincts *were* telling me. Fat = good. Butter, yum! Cream, yum! Fatty beef, yum!

Now, "instinct" is a tricky thing. Conditioning can look like instinct. Addictions, especially, can look like instinct....


Dr Katz says he is appalled at some of the fad diet books (big tick) and was one of the most outspoken critics of the Atkins diet. “It was silly and bad nutrition. Dieting isn’t about weight loss by any means. If it were, we’d just hand cocaine to everyone.” (Cocaine is one of the most potent appetite-suppressants known.) He wanted to find a diet that was good nutrition, that didn’t ignore basic nutritional advice and that people could use easily.

What is "basic nutritional advice?" Is it based in science? Atkins was. It was immediately rejected by many, including, apparently, Dr Katz, not because the science was bad -- it wasn't -- but because it was "silly," and "bad nutrition." Why? Are carbohydrates necessary for human nutrition? Is saturated fat, like butterfat, unhealthy? Did Dr Katz have any science to back up his position, other than the obviously flawed Keyes studies?

I googled "David Katz Atkins" and found out more about him. He has given interviews which basically consist of the party line, the unproven ideology that so widely penetrates the nutrition establishment. I found this on WebMD:

"Anthropologists tell us that our ancestral intake of fat was approximately 25% of total calories, and that almost all of the fat they ate was mono- or polyunsaturated. Further, the meat consumed by our ancestors was an excellent source of health-promoting omega-3 fatty acids. In my view, if one combines the best of modern science with insights about ancestral dietary pattern, it points to a diet that provides maximal cardiac benefit. Such a diet helps to lower cholesterol while maintaining high levels of HDL."

I wonder. Who is "us"? The diets of ancient peoples varied drastically with where they lived. In the far north, diets with effectively zero carbohydrate content existed. In other areas, fruit was common and formed a large portion of the diet, and in some places, especially in more modern times, we see grains. Katz is vastly oversimplifying the situation in order to make a point, in order to extract a conclusion that allows him to believe that he has been giving basically the correct advice for years, it only needs to be tweaked. Good fats. Okay, low sugar.

"A well-balanced vegetarian diet is known to be very heart healthy, and such a diet modified to include fish is perhaps the most heart-healthy diet of all."

Perhaps. Reasonable thesis. What are the facts? Has meat been shown to increase cardio-vascular disease rates? What does the Framingham study show? Butter? Milk? And, all too often ignored, how do diet changes affect overall disease rates? Do they improve life expectancy? If so, which diets do this, either in controlled studies or by a true consensus of the knowledgeable, but not confirmed by controlled studies (because it can be quite difficult).

If Katz were truly humble about his ignorance, he'd stop giving advice rooted in it. He'd be much more careful. His apparent unquestioned acceptance of the fat-bad, vegetarian-good, "well-balanced" -- with no science behind the balance -- theory is part of the problem, not part of the solution.

We know very little for sure about nutrition. Some of us have a *lot* of anecdotal evidence, though, and Atkins was one such. And he developed theories from that evidence. It wasn't his position or mission to prove those theories -- it is expensive and can take a long time -- but he did, toward the end of his life, start to fund the research. And, of course, he was attacked for *that*. The research must have been biased since it was funded by Atkins.... (the same people, before he funded the research, complained that he *hadn't*, with all his diet-book money, funded research....)

"However, lifelong health benefits cannot be derived from a diet you are not comfortable staying on for a lifetime."

Of course, this "new" diet is directly contrary to what he said in the interview.

I could go on with the nonsense in that interview, including his highly misleading description of Atkins. Actually, this one is too rich:

"Moderator: What is your take on carbohydrates in the diet? What choices should we be making for heart health?

"Katz: An excellent question, too, especially because weight control is very important to heart health. Everyone has heard about the Atkins diet, including reports of rapid weight loss. However I must point out that cancer, cholera, tuberculosis, and AIDS also produce rapid weight loss. That does not mean they are good for you. In fact these conditions not only cause weight to plummet, they lower cholesterol as well. This serves to highlight the importance of thinking about overall health when making dietary choices for weight control."

Beautiful. He's right of course. An example of how truth can be used to mislead. He manages to equate Atkins with cancer, cholera, tuberculosis, and AIDS, without saying anything that one could pin down as false. It is the *implications* that are false, and he isn't responsible for them, is he?

The implication he makes is essentially that Atkins makes you sick, and, with this sickness, you lose weight. If that isn't what he means, what does he mean? What he said was theoretically true: one must consider overall health. But in context, the implication is that Atkins did not consider this, that Atkins only considered immediate and rapid weight loss. Which is, frankly, a lie, which Katz just promoted without taking responsibility for it. Innuendo, I think is the word for it.

"Popular diets like Atkins drastically oversimplify what the term carbohydrate means."

First of all, Atkins really isn't a diet, it is a way of understanding nutrition. Atkins does not tell you to eat, for life, X amount of carbohydrate. Atkins did, for sure, recommend that we try VLC, under 20 grams per day, to see what happens. Most of us reading this have tried it. Did it make us sick?

Depends on what you mean. Many of us experienced transient discomfort, of various kinds. Which happens with most any change of diet. Discomfort is not necessarily a sickness.... And some of us experienced no discomfort at all. I'm one of these. But we experienced something else. Using ketones for energy feels quite different from using glucose. Humans were designed to be able to do both, but which route is healthiest?

I don't think anyone knows for sure, but it seems that there is a general cultural preference for fat. Cultures that don't get much of it tend to seek it. When we were in Morocco, some people we visited gave us a traditional food to take back to the U.S. At the airport, we realized that this was not going to make it through customs, and our guide, quite eagerly, consumed the package. It was about two pounds of lamb fat, for the most part. He wolfed it down....

Katz, in considering low-carb as if it were a disease, or disease-causing, apparently considers ketosis a pathologic process. But it certainly is not. It is a *different* process, one which we were designed to use. After all, when we eat a lot of carbs, what do with do with them? Convert them to fat. Why? To punish us for gluttony? No, we store it for later use, in times of restriction. In order to use the fat, we convert it to ketones and burn it. Ketosis is *quite* physiologic. But Katz's prejudice against it is quite common.

"I quite agree the typical U.S. diet contains far too much processed starch and refined sugar. The way to fix this, however, is to eat more whole grains, fruits, and vegetables -- not to replace processed sugar with saturated and trans fat."

I'm quite sure that if an overweight person replaced the sugar and processed carbs in his diet with saturated fat, he would *most likely* have an improved diet. Might not be enough, to be sure. But he does not need the sugar and carbs, and he *does* need fat. Lumping together saturated fat -- a natural and normal food for humans -- with trans fats -- mostly artificial and probably *horrible* for health -- is exactly the mistake that Keyes made, for Keyes studied total fat, which, in the U.S., included a *lot* of trans fats.

"In general the best evidence we have supports a diet that is based largely on sources of complex carbohydrates with the right balance of fat and moderate, overall protein."

There is strong evidence that digestible carbohydrates are not at all necessary for human nutrition (consider the ancient Eskimo diet). If you are going to eat carbs, yes, it is almost certain that complex carbs are vastly superior to sugar or its functional equivalent, highly-processed starch (which turns to glucose before it even reaches the stomach).

But I'm really interested in this "best evidence." Where is it?

And is this "best evidence" adequate to support the conclusion he gives so freely? Who is "we"?

For years, nutritionists have claimed that "we" know this and "we" know that, and "we" are all agreed about it, when there were plenty of scientists and, yes, experts on nutrition, who disagreed. You can create the illusion of a consensus, a false consensus, simply by ignoring all the contrary opinion and evidence, which is exactly what happened when the whole Sat Fat dogma was established.

Abd
Sat, May-06-06, 15:22
More from Katz, CBS news, 2004:
“Mark my words. Within a couple of years, people who go on low-carb diets, even the Atkins induction phase, probably won't lose any weight -- because you’re not cutting calories.”

Okay, Mr. Katz, we've marked your words. From today's postings here on low-carber.org, some conclusions based in real science:

"A diet based on restricting carbohydrates leads to spontaneous caloric reduction and subsequent improvement in emerging markers of CVD in overweight/obese men who are otherwise healthy."

Atkins said this, and we have been saying it for years, based on our own experience as well as on, in Atkin's case, extensive clinical experience. To us, this is not at all suprising. But it *ought* to shake up Katz a little. After all, he had entirely missed the point, he had *assumed* that a low-carb, high-fat diet would not lower caloric intake. *Many* "experts" like him had dismissed Atkins as working by lowering caloric intake. Even he had written such, yet he assumed that it did this by making the diet monotonous. Bad. But then he comes along and proposes a diet that he thinks will work in the same way. Only he *really* makes it monotonous.

Can we spell h y p o c r i s y?

Of course, he was wrong. The Atkins diet is not monotonous. You can actually eat anything on an Atkins diet. In moderation. And realizing -- and observing -- the consequences. If you haven't been eating sugar for months, and you eat something very high in sugar, you *will* notice the effects. Coffee has less of an effect on me. And, within the foods that don't spike the glucose levels, there is tremendous variety. Nearly every vegetable, all kinds of meats and fish, cream, and more. Even with high-carb foods, like potatos, Atkins was known to eat an occasional baked potato. We can do that on maintenance. With butter and sour cream, of course....

His diet won't work, except for a few who somehow manage to stick to it (and they may get sick for other reasons. there are sound nutritional reasons to seek variety). His diet won't work for the same reasons that he thought that Atkins won't work, for long term weight control. But, of course, Atkins was Not Invented Here. And Atkins was a big, bad Popular Diet Doctor. I agree, bad company.... but there is a good apple in every barrel.

Caloric intake reduction is certain a factor in how Atkins works. But there is also the asserted "metabolic advantage," so caloric intake along may not be the whole story. I've written extensively here about what "caloric intake" actually means and how misleading it can be, because what we call "caloric intake," what is on the labels, is actually recalculated based on supposed metabolic factors, the calorie of diet is not the calorie of physics, in spite of a lot of opiniing by experts who seemed to have missed this entirely. If anyone is interested in this, google "Atwater specific factor." There is an assumption made, in food labelling, that specific foods are all digested by everyone with the same efficiency, and thermodynamic calories are multipled by the "Atwater factor" to calculate a presumed food calorie. It's *complicated*, folks, and people like Katz gloss over the complication completely, perhaps unconsciously because they don't understand it. It may be that *nobody* understands it!

What is the variation among people in calorie conversion efficiency? (probably substantial, I'd guess.) How does the efficiency vary depending on nutritional context? (I.e., does the body being in ketosis make a difference -- again, probably.) Has the research been done?

Probably not. There's no money in it. Figure out a way to turn it into a drug, there will be *lots* of money. The cholesterol hypothesis has been absolutely fabulous for the drug industry, since it is something you can measure and you can target it and you can show results (even if they are small). Never mind that it has never been shown that lowering cholesterol with statins has any beneficial effect at all on life expectancy. Who wants to know about that? Don't bother us, we are busy lowering cholesterol.

Remarkable, that Katz notes that overall health is important, but he does not see, really, the implications of this!

Dodger
Sat, May-06-06, 16:47
The whole principle of sensory specific satiety was discovered only 30 years ago. The pioneer in the field was the American nutritionist Barbara RollsI looked up Mrs. Rolls. She had her own diet plan, the "Volumetrics" eating plan. For some reason, her plan (http://www.npr.org/templates/story/story.php?storyId=4618562)doesn't seem to use the research that Katz was so excited about. Her plan is an eat lots of low calorie/high volume foods and trick your stomach into feeling full.

LC FP
Sun, May-07-06, 15:37
Abd

You can create the illusion of a consensus, a false consensus, simply by ignoring all the contrary opinion and evidence, which is exactly what happened when the whole Sat Fat dogma was established

Funny that the Mozaffarian study on saturated fat protecting against CAD in women was quoted in exactly two (scroll to the bottom) subsequent articles, one a reference from Westman, Yancy and Vernon, already true believers, and the other an editorial that tries mightily to find the fatal flaw.

http://www.ajcn.org/cgi/content/full/80/5/1175

Most of the pseudoresearch published in AJCN and Pubmed articles are referenced scores of times, provided that they regurgitate the prevailing wisdom.