The scientific obligation, as I said in the prologue, is to establish the cause of obesity, diabetes, and the chronic diseases of civilization beyond reasonable doubt. By doing so, we can take the necessary steps to prevent these disorders, rather than trying to cure them or ameliorate them after the fact. If there are competing hypotheses, it does us little good to test one alone. It does little good to continue basing public-health recommendations and dietary advice on association studies (the Framingham Heart Study and the Nurses Health Study are prominent examples) that are incapable of reliably establishing cause and effect. What’s needed now are randomized trials that test the carbohydrate hypothesis as well as the conventional wisdom. Such trials would be expensive. Like the Diabetes Prevention Program and Look AHEAD, they’ll cost tens or hundreds of millions of dollars. And even if such trials are funded, it might be another decade or two before we have reliable answers. But it’s hard to imagine that this controversy will go away if we don’t do them, that we won’t be arguing about the detrimental role of fats and carbohydrates in the diet twenty years from now. The public will certainly not be served by attempts of interest groups and industry to make this controversy go away. If the tide of obesity and diabetes continues to rise around the world, it’s hard to imagine that the cost of such trials, even a dozen or a hundred of them, won’t ultimately be trivial compared with the societal cost.

Notes

Notes

PROLOGUE: A BRIEF HISTORY OF BANTING

Epigraph. “Farinaceous…”: Tanner 1869b:219.

“…corpulence notoriety”: Anon. 1864b. “…size or weight”: Banting 1864:14.

“Knowing too that…”: Harvey 1872:69–70.

Banting began dieting: Banting 1864:18–19. “I have not felt better…”: Banting 1869.

United States, Germany: Banting 1869. “the emperor of the French…”: Anon. 1864c. “If he is gouty…”: Quoted in “banting” entry, OED 1989.

A paper was presented: Anon. 1864f. See also Anon. 1864d; Anon. 1864a. “is tolerably complete…”: Anon. 1864g. Banting responded: Banting 1869.

Banting acknowledged: Banting 1869. Alfred William Moore: Anon. 1864g. John Harvey: Harvey 1864.

Brillat-Savarin: Brillat-Savarin 1986 (“fat…,” 237–39; “…rigid abstinence…,” 251).

Dancel: Dancel 1864 (“All food…,” 59; “The hippopotamus…,” 54).

“We advise Mr. Banting…”: Anon. 1864g.

“fair trial” and “…starchy elements…”: Anon. 1864e.

“To attribute obesity…”: Mayer 1968:6.

Sir William Osler: Osler 1901:439–40. Oertel prescribed a diet: Oertel 1895. See also French 1907:951. Bismarck lost sixty pounds: Schwartz 1986:103–4. Ebstein insisted: Ebstein 1884 (“of meat every kind…,” 33).

“Foods to be avoided…”: Greene 1951:348.

“The great progress…”: Bruch 1957:352.

“The overappropriation…”: French 1907:14. Rony reported: Rony 1940 (“…marked preference…,” 59; “an extremely obese laundress…,” 62).

“In Great Britain obesity…”: Davidson and Passmore 1963:382.

“On the day of the races…”: Tolstoy 2000:200. “the dearth of proteins…”: Lampedusa 1988:255.

What Dr. Spock taught: Spock 1946:361; Spock 1957:436; Spock 1968:449; Spock 1976:493; Spock 1985:536; Spock and Rothenberg 1992:380. 50 million copies: Pace 1998. “All popular ‘slimming regimes’…”: Davidson and Passmore 1963:389. “The first thing…”: Brody 1985:18.