Prologue: A Brief History of BantingFarinaceous and vegetable foods are fattening, and saccharine matters are especially so….In sugar-growing countries the negroes and cattle employed on the plantations grow remarkably stout while the cane is being gathered and the sugar extracted. During this harvest the saccharine juices are freely consumed; but when the season is over, the superabundant adipose tissue is gradually lost.–Thomas Hawkes Tanner, The Practice of Medicine, 1869William Banting was a fat man. In 1862, at age sixty-six, the five-foot-five Banting, or “Mr. Banting of corpulence notoriety,” as the British Medical Journal would later call him, weighed in at over two hundred pounds. “Although no very great size or weight,” Banting wrote, “still I could not stoop to tie my shoe, so to speak, nor attend to the little offices humanity requires without considerable pain and difficulty, which only the corpulent can understand.” Banting was recently retired from his job as an upscale London undertaker; he had no family history of obesity, nor did he consider himself either lazy, inactive, or given to excessive indulgence at the table. Nonetheless, corpulence had crept up on him in his thirties, as with many of us today, despite his best efforts. He took up daily rowing and gained muscular vigor, a prodigious appetite, and yet more weight. He cut back on calories, which failed to induce weight loss but did leave him exhausted and beset by boils. He tried walking, riding horseback, and manual labor. His weight increased. He consulted the best doctors of his day. He tried purgatives and diuretics. His weight increased.Luckily for Banting, he eventually consulted an aural surgeon named William Harvey, who had recently been to Paris, where he had heard the great physiologist Claude Bernard lecture on diabetes. The liver secretes glucose, the substance of both sugar and starch, Bernard had reported, and it was this glucose that accumulates excessively in the bloodstream of diabetics. Harvey then formulated a dietary regimen based on Bernard’s revelations. It was well known, Harvey later explained, that a diet of only meat and dairy would check the secretion of sugar in the urine of a diabetic. This in turn suggested that complete abstinence from sugars and starches might do the same. “Knowing too that a saccharine and farinaceous diet is used to fatten certain animals,” Harvey wrote, “and that in diabetes the whole of the fat of the body rapidly disappears, it occurred to me that excessive obesity might be allied to diabetes as to its cause, although widely diverse in its development; and that if a purely animal diet were useful in the latter disease, a combination of animal food with such vegetable diet as contained neither sugar nor starch, might serve to arrest the undue formation of fat.”Harvey prescribed the regimen to Banting, who began dieting in August 1862. He ate three meals a day of meat, fish, or game, usually five or six ounces at a meal, with an ounce or two of stale toast or cooked fruit on the side. He had his evening tea with a few more ounces of fruit or toast. He scrupulously avoided any other food that might contain either sugar or starch, in particular bread, milk, beer, sweets, and potatoes. Despite a considerable allowance of alcohol in Banting’s regimen–four or five glasses of wine each day, a cordial every morning, and an evening tumbler of gin, whisky, or brandy–Banting dropped thirty-five pounds by the following May and fifty pounds by early 1864. “I have not felt better in health than now for the last twenty-six years,” he wrote. “My other bodily ailments have become mere matters of history.”We know this because Banting published a sixteen-page pamphlet describing his dietary experience in 1863–Letter on Corpulence, Addressed to the Public–promptly launching the first popular diet craze, known farther and wider than Banting could have imagined as Bantingism. His Letter on Corpulence was widely translated and sold particularly well in the United States, Germany, Austria, and France, where according to the British Medical Journal, “the emperor of the French is trying the Banting system and is said to have already profited greatly thereby.” Within a year, “Banting” had entered the English language as a verb meaning “to diet.” “If he is gouty, obese, and nervous, we strongly recommend him to ‘bant,’ ” suggested the Pall Mall Gazette in June 1865.The medical community of Banting’s day didn’t quite know what to make of him or his diet. Correspondents to the British Medical Journal seemed occasionally open-minded, albeit suitably skeptical; a formal paper was presented on the efficacy and safety of Banting’s diet at the 1864 meeting of the British Medical Association. Others did what members of established societies often do when confronted with a radical new concept: they attacked both the message and the messenger. The editors of The Lancet, which is to the BMJ what Newsweek is to Time, were particularly ruthless. First, they insisted that Banting’s diet was old news, which it was, although Banting never claimed otherwise. The medical literature, wrote The Lancet, “is tolerably complete, and supplies abundant evidence that all which Mr. Banting advises has been written over and over again.” Banting responded that this might well have been so, but it was news to him and other corpulent individuals.In fact, Banting properly acknowledged his medical adviser Harvey, and in later editions of his pamphlet he apologized for not being familiar with the three Frenchmen who probably should have gotten credit: Claude Bernard, Jean Anthelme Brillat-Savarin, and Jean-François Dancel. (Banting neglected to mention his countrymen Alfred William Moore and John Harvey, who published treatises on similar meaty, starch-free diets in 1860 and 1861 respectively.)Brillat-Savarin had been a lawyer and gourmand who wrote what may be the single most famous book ever written about food, The Physiology of Taste, first published in 1825.* In it, Brillat-Savarin claimed that he could easily identify the cause of obesity after thirty years of talking with one “fat” or “particularly fat” individual after another who proclaimed the joys of bread, rice, and potatoes. He added that the effects of this intake were exacerbated when sugar was consumed as well. His recommended reducing diet, not surprisingly, was “more or less rigid abstinence from everything that is starchy or floury.”Dancel was a physician and former military surgeon who publicly presented his ideas on obesity in 1844 to the French Academy of Sciences and then published a popular treatise, Obesity, or Excessive Corpulence, The Various Causes and the Rational Means of Cure. Dancel’s thinking was based in part on the research of the German chemist Justus von Liebig, who, at the time, was defending his belief that fat is formed in animals primarily from the ingestion of fats, starches, and sugars, and that protein is used exclusively for the restoration or creation of muscular tissue. “All food which is not flesh–all food rich in carbon and hydrogen–must have a tendency to produce fat,” wrote Dancel. “Upon these principles only can any rational treatment for the cure of obesity satisfactorily rest.” Dancel also noted that carnivores are never fat, whereas herbivores, living exclusively on plants, often are: “The hippopotamus, for example,” wrote Dancel, “so uncouth in form from its immense amount of fat, feeds wholly upon vegetable matter–rice, millet, sugar-cane, &c.”The second primary grievance that The Lancet’s editors had with Banting, which has been echoed by critics of such diets ever since, was that his diet could be dangerous, and particularly so for the credibility of those physicians who did not embrace his ideas. “We advise Mr. Banting, and everyone of his kind, not to meddle with medical literature again, but be content to mind his own business,” The Lancet said. When Bantingism showed little sign of fading from the scene, however, The Lancet’s editors adopted a more scientific approach. They suggested that a “fair trial” be given to Banting’s diet and to the supposition that “the sugary and starchy elements of food be really the chief cause of undue corpulence.”Banting’s diet plays a pivotal role in the science of obesity–and, in fact, chronic disease–for two reasons. First, if the diet worked, if it actually helped people lose weight safely and keep it off, then that is worth knowing. More important, knowing whether “the sugary and starchy elements of food” are “really the chief cause of undue corpulence” is as vital to the public health as knowing, for example, that cigarettes cause lung cancer, or that HIV causes AIDS. If we choose to quit smoking to avoid the former, or to use condoms or abstinence to avoid the latter, that is our choice. The scientific obligation is first to establish the cause of the disease beyond reasonable doubt. It is easy to insist, as public-health authorities inevitably have, that calories count and obesity must be caused by overeating or sedentary behavior, but it tells us remarkably little about the underlying process of weight regulation and obesity. “To attribute obesity to ‘overeating,’ ” as the Harvard nutritionist Jean Mayer suggested back in 1968, “is as meaningful as to account for alcoholism by ascribing it to ‘overdrinking.’ ”After the publication of Banting’s “Letter on Corpulence,” his diet spawned a century’s worth of variations. By the turn of the twentieth century, when the renowned physician Sir William Osler discussed the treatment of obesity in his textbook The Principles and Practice of Medicine, he listed Banting’s method and versions by the German clinicians Max Joseph Oertel and Wilhelm Ebstein. Oertel, director of a Munich sanitorium, prescribed a diet that featured lean beef, veal, or mutton, and eggs; overall, his regimen was more restrictive of fats than Banting’s and a little more lenient with vegetables and bread. When the 244-pound Prince Otto von Bismarck lost sixty pounds in under a year, it was with Oertel’s regimen. Ebstein, a professor of medicine at the University of Göttingen and author of the 1882 monograph Obesity and Its Treatment, insisted that fatty foods were crucial because they increased satiety and so decreased fat accumulation. Ebstein’s diet allowed no sugar, no sweets, no potatoes, limited bread, and a few green vegetables, but “of meat every kind may be eaten, and fat meat especially.” As for Osler himself, he advised obese women to “avoid taking too much food, and particularly to reduce the starches and sugars.”The two constants over the years were the ideas that starches and sugars–i.e., carbohydrates–must be minimized to reduce weight, and that meat, fish, or fowl would constitute the bulk of the diet. When seven prominent British clinicians, led by Raymond Greene (brother of the novelist Graham Greene), published a textbook entitled The Practice of Endocrinology** in 1951, their prescribed diet for obesity was almost identical to that recommended by Banting, and that which would be prescribed by such iconoclasts as Herman Taller and Robert Atkins in the United States ten and twenty years later.Foods to be avoided:1. Bread, and everything else made with flour . . .2. Cereals, including breakfast cereals and milk puddings3. Potatoes and all other white root vegetables4. Foods containing much sugar5. All sweets . . .You can eat as much as you like of the following foods:1. Meat, fish, birds2. All green vegetables3. Eggs, dried or fresh4. Cheese5. Fruit, if unsweetened or sweetened with saccharin, except bananas and grapes“The great progress in dietary control of obesity,” wrote Hilde Bruch, considered the foremost authority on childhood obesity, in 1957, “was the recognition that meat . . . was not fat producing; but that it was the innocent foodstuffs, such as bread and sweets, which lead to obesity.”The scientific rationale behind this supposed cause and effect was based on observation, experimental evidence, and maybe the collected epiphanies and anecdotes of those who had successfully managed to bant. “The overappropriation of nourishment seen in obesity is derived in part from the fat ingested with the food, but more particularly from the carbohydrates,” noted James French in 1907 in his Textbook of the Practice of Medicine. Copious opinions were offered, but no specific hypotheses. In his 1940 monograph Obesity and Leanness, Hugo Rony, director of the Endocrinology Clinic at the Northwestern University Medical School in Chicago, reported that he had carefully questioned fifty of his obese patients, and forty-one professed a “more or less marked preference for starchy and sweet foods; only 1 patient claimed preference for fatty foods.” Rony had one unusual patient, “an extremely obese laundress,” who had no taste for sweets, but “a craving for laundry starch which she used to eat by the handful, as much as a pound a day. . . .” So maybe carbohydrates are fattening because that’s what those with a tendency to gain weight eat to excess.To others, carbohydrates carry some inherent quality that makes them uniquely fattening. Maybe they induce a continued sensation of hunger, or even a specific hunger for more carbohydrates. Maybe they induce less satiation per calorie consumed. Maybe they somehow cause the human body to preferentially store away calories as fat. “In Great Britain obesity is probably more common among poor women than among the rich,” Sir Stanley Davidson and Reginald Passmore wrote in the early 1960s in their classic textbook Human Nutrition and Dietetics, “perhaps because foods rich in fat and protein, which satisfy appetite more readily than carbohydrates, are more expensive than the starchy foods which provide the bulk of cheap meals.”This belief in the fattening powers of carbohydrates can be found in literature as well. In Tolstoy’s Anna Karenina, for instance, written in the mid-1870s, Anna’s lover, Count Vronsky, abstains from starches and sweets in preparation for what turns out to be the climactic horse race. “On the day of the races at Krasnoe Selo,” writes Tolstoy, “Vronsky had come earlier than usual to eat beefsteak in the officers’ mess of the regiment. He had no need to be in strict training, as he had very quickly been brought down to the required weight of one hundred and sixty pounds, but still he had to avoid gaining weight, and he avoided starchy foods and desserts.” In Giuseppe di Lampedusa’s The Leopard, published in 1958, the protagonist, Prince Fabrizio, expresses his distaste for the plump young ladies of Palermo, while blaming their condition on, among other factors, “the dearth of proteins and the overabundance of starch in the food.”This was what Dr. Spock taught our parents and our grandparents in the first five decades, six editions, and almost 50 million copies of Baby and Child Care, the bible of child-rearing in the latter half of the twentieth century. “Rich desserts,” Spock wrote, and “the amount of plain, starchy foods (cereals, breads, potatoes) taken is what determines, in the case of most people, how much [weight] they gain or lose.” It’s what my Brooklyn-born mother taught me forty-odd years ago. If we eat too much bread or too much spaghetti, we will get fat. The same, of course, is true of sweets. For over a century, this was the common wisdom. “All popular ‘slimming regimes’ involve a restriction in dietary carbohydrate,” wrote Davidson and Passmore in Human Nutrition and Dietetics, offering this advice: “The intake of foods rich in carbohydrate should be drastically reduced since over-indulgence in such foods is the most common cause of obesity.” “The first thing most Americans do when they decide to shed unwanted pounds is to cut out bread, pass up the potatoes and rice, and cross spaghetti dinners off the menu entirely,” wrote the New York Times personal-health reporter, Jane Brody, in her 1985 best-selling Good Food Book.* When the first American edition of The Physiology of Taste was published in 1865, it was entitled The Handbook of Dining, or Corpulence and Leanness Scientifically Considered, perhaps to capitalize on the Banting craze.** Endocrinology is the study of the glands that secrete hormones and the hormones themselves.