On Monday night Gary Taubes will board his second transatlantic flight in a weekâ€”from Zurich to Aspenâ€”then eventually back to Oakland, where he calls home. The crusading science journalist best known for his beef with Big Sugar is beat after four days of nutrition conference glad-handing. But thereâ€™s no rest for the down and out. Taubes is on a desperate money-raising mission for the Nutrition Science Initiativeâ€”his nonprofit dedicated to improving the quality of nutrition research.
NuSI (pronounced new-see) launched in September 2012 with much fanfare, including in the pages of WIRED. It quickly raised more than $40 million from big-name donors to facilitate expensive, high-risk studies intended to illuminate the root causes of obesity. Taubes and his co-founder, physician-researcher Peter Attia, contended that nutritional science was so inconsistent because it was so expensive to do right. With a goal of raising an additional $190 million, they wanted to fund science that would help cut the prevalence of obesity in the US by more than halfâ€”and diabetes by 75 percentâ€”by 2025.
Rehabilitating the entire field of nutrition research was always a long shot. But six years in, NuSI is nowhere near achieving its lofty ambitions. In fact, the once-flush organization is broke, president-less, and all but gone. Itâ€™s been three years since it last tweeted, two years since itâ€™s had a real office; today NuSI consists of two part-time employees and and an unpaid volunteer hanging around while Taubes tries to conjure a second act.
Because while heâ€™s almost out of money, Taubes is not yet out of ideas. This time, though, that might not be enough.
When Taubes and Attia first hatched their â€œManhattan Project for nutrition,â€� they planned to work on it nights and weekends, crowdsourcing funds from the low-carb corners of the internet. They didnâ€™t think it would be too difficult; between a 2002 New York Times cover story titled â€œWhat If It’s All Been a Big Fat Lie?â€� and his best-selling book Good Calories, Bad Calories, Taubes had become the countryâ€™s anti-sugar agitator-in-chief. Then, in 2011, Taubes received an email from a former natural gas trader named John Arnold who wanted to help.
In May 2012, just weeks after announcing his and his wifeâ€™s new charity aimed at reforming iffy areas of science, the John and Laura Arnold Foundation gave NuSI a $4.7 million seed grant to do nutrition research right. In 2013 they followed that up with an additional $35.5 million commitment over five years, making them NuSIâ€™s lead funder.
At the heart of their mission was the decades-old question of whether all calories are, in fact, created equal. The mainstream view is that itâ€™s simply an excess of calories that makes people fatâ€”no matter whether those calories come from a bagel or a steak or a bowl of broccoli. Taubes and Attia subscribe to a growing minority stance, dubbed the carbohydrate/insulin or C/I hypothesis, that contends obesity is caused by an excess of insulin driving energy into fat stores. In other words, sugar makes people fat.
Taubes and Attia thought those questions needed a more streamlined research approach to get real answers. So they formed NuSI to funnel money into a rigorous new set of studies, while leaving scientists with the experimental independence that would shield their results from bias.
With the Arnold money in hand, in 2012, Taubes and Attia started recruiting top researchers to conduct four initial studies. They purposefully brought on people who disagreed with them, like Kevin Hall, a senior investigator at the NIHâ€™s National Institute of Diabetes and Digestive and Kidney Diseases whose mathematical models predicted that a low-carb diet, low-insulin diet would have but a tiny impact on calorie-burning. He would head up one of NuSIâ€™s first studies, dubbed the Energy Balance Consortium.
The EBCâ€™s pilot project would lock 17 overweight men inside metabolic wards for two months, feeding them precisely formulated meals and pricking and prodding to see what happened to their bodies on a low-carb diet. If it made them burn calories faster, a follow-up study would do the same tests on a bigger group of people. If the effect was minimal, researchers would then test the effects of low-carb diets on hunger.
Hall was skeptical they would find anything to support the carbohydrate/insulin hypothesis. But he was assured by the terms of the contract; NuSI would have no control over the pilot studyâ€™s design, operation, or reporting. He could build the study he wanted.
At first, things went according to plan. The EBC researchers met with NuSI quarterly to finalize the studyâ€™s design and clinical procedures. NuSI signed a consulting agreement with Dr. Jeff Volekâ€”author of the book The Art and Science of Low Carbohydrate Livingâ€”to create the diets and menus.
By August of 2014 the EBC researchers had preliminary results on their 17 volunteers: The data showed â€œno significant differenceâ€� in energy expenditure. That didnâ€™t mean it was a failure; to the researchers, they had succeeded in verifying the methodology before using it in an even bigger, longer study. â€œWe had to work out these rather complex logistics of getting common food sources distributed among many institutions,â€� says Rudolph Leibel, one of the consortium scientists working on the pilot at Columbia. â€œIt looked like something the Allies would have organized for all the landings on D-Day.â€�
But when Hall presented the pilotâ€™s results in-person to representatives from NuSI at a meeting in Bethesda in September, they were not so rosy-eyed. NuSI wanted to see the data, and began providing extensive critiques once they had it.
Taubes in particular had issues with many of the studyâ€™s designs, which fed participants a â€œstandard American dietâ€� for four weeks before switching them to an extremely low-carb, or ketogenic, regimen with the same amount of calories. It was supposed to get them to a stable weight, or energy balance, to establish a baseline before going keto. But the subjects all lost weight even before they started cutting out carbs. Taubes contended that was because the standard diet didnâ€™t have enough refined sugary beverages to depict average American consumption.
â€œFrom my perspective, the pilot was a failure for several reasons,â€� says Taubes. â€œFirst, it failed to get people in energy balance in the run-in period and that was a necessary condition to interpret the findings.â€� In addition, he points out the design didnâ€™t include a group of non-dieters, and non-randomized trials do not allow for firm conclusions about causality, conditions that everyone in the group knew going in. All the pilot told them then, in his eyes, was that their method was flawed. “If this was an animal study, theyâ€™d have thrown them out,â€� says Taubes. â€œEuthanized them and started over.â€�
But NuSI had already spent $5 million of the Arnoldâ€™s money, and everyone was eager to get to the second phase of the study. As they worked out the details through 2015, the relationship between EBC and NuSI continued to fray. â€œThere was not a real team,â€� says Eric Ravussin, EBCâ€™s co-principal investigator and director of Penningtonâ€™s Nutrition Obesity Research Center. â€œAs scientists we were in agreement over the pilot results and the new protocols, but NuSI had some concerns. It eventually just became us versus them.â€�
According to Hall and Ravussin, NuSI began to push back, in a way that they felt jeopardized their ability to do good science. In April, the EBC researchers sent NuSI an email requesting to re-establish their academic freedom.
As 2015 turned into 2016, the relationship between the EBC researchers, NuSI, and the Arnold Foundation deteriorated even further. At the end of December, Attia quietly resigned from the organization. Sources close to him say he was unhappy being a full-time fundraiser; he wanted to get back to research.
NuSI scrambled to fill Attiaâ€™s position as president, first with Christopher Ochner, a psychiatrist at the Icahn School of Medicine at Mount Sinai and a few months later with Julie Eckstrand, NuSIâ€™s then-director of clinical operations, who has since left. At the beginning of 2016, NuSIâ€™s yearly contract with the Arnold Foundation was replaced by a series of three-month bridge contracts, with marching orders to downsize. Fifteen full-time employees and major contractors shrunk to a skeleton crew that could handle the three remaining studies. NuSI shuttered its San Diego headquarters and became a virtual organization.
Things came to a head at a meeting in January 2016. In front of John Arnold, NuSI directors Taubes and Mark Friedman openly quarreled with Hall and his colleagues about what was really necessary to run a good study. Hall had had enough. At the end of the meeting he stepped down from his role with the EBC, citing changing expectations about the structure and practice of the NuSI collaboration.
As the remaining researchers continued to clash with NuSI over the summer about the second phase, the pilot results were finally published in the American Journal of Clinical Nutrition in July. They received a lot of media attention, in no small part because Hall said the pilot, along with another study heâ€™d conducted previously, â€œbasically falsifyâ€� the theory that sugar makes people fat. By the end of the summer the Arnold Foundation had decided not to fund the second phase of the study.
After that, NuSI stopped getting checks from the Arnolds. But the foundation didnâ€™t stop funding research into the carbohydrate/insulin question. That fall they opened their search to the wider world, putting out a call for proposals for â€œrigorous research projects that will assess the role that sugar and/or macronutrients play in metabolic responses and fat accumulation.â€�
The Arnold Foundation declined to respond to specific questions about how it came to end its relationship with NuSI about $14 million short its commitment. A spokesperson emailed the following statement: â€œThis research was designed to answer scientific questions in the fields of nutrition and obesity. While the foundation no longer directly supports NuSI initiatives, we continue to fund work in the field of nutrition science and remain open to further investments in this area. The NuSI project was a worthwhile effort and remains an important health-related issue for Americans today.â€�
Itâ€™s still too soon to assess what NuSI has added to the nutrition science canon. Results from the two outstanding NuSI-backed studies are due later this year. The fourth and largest one, conducted at Stanford, randomized 600 overweight-to-obese subjects into low-fat versus low-carb diets for a year and looked at whether or not their weight loss could be explained by their metabolism or their DNA. Published this February in JAMA, the study found no differences between the two diets and no meaningful relationship between weight loss and insulin secretion. The most significant finding was that itâ€™s hard to stick to a diet for a whole year.
Obesity docs like Yoni Freedhoff, a professor of family medicine at the University of Ottawa, arenâ€™t surprised that NuSI hasnâ€™t sparked an epistemological revolution. â€œFrom the outset, their approach was simply that knowledge will be enough to drive behavior,â€� says Freedhoff, who has argued that efforts to prove one diet is better than another does a disservice to patients by implying thereâ€™s only one right way to lose weight. Heâ€™d love to see research dollars be spent instead on studying how to improve adherence to different eating strategies.
Taubes says the fundraising trip to Zurich went well, though he wonâ€™t share specifics. It could just be the jet lag, or it could be the mental burden of having to sing for his supper, but Taubes sounds tired. â€œI say this to my wife all the time: â€˜Maybe Iâ€™m a quack.â€™ All quacks are sure theyâ€™re right. Isnâ€™t that the defining characteristic of a quack? But the fact is that we funded four studies and the three randomized trials were highly successful operationally. One of these has been published in a top journal with interesting results and I remain hopeful that we will soon see if the last two studies will move some needles. Our convictions have gotten us this far, and despite some disappointments these questions still seem vitally important to test.â€�
Taubes is optimistic that NuSI is just evolving into something a bit more humble. Between its current coffers and the agreements heâ€™s working on, he thinks NuSI can stay afloat for several years, eventually supporting more outside research, though on a much more modest scale. Heâ€™s got ideas about instituting a scientific oversight committee to make sure everyone agrees on methods and statistical analyses from the outset.
But heâ€™s also starting to think about how to go back to the life he had before NuSI, the life of a journalist. Heâ€™s got more articles and more books he still wants to write, not exclusively about sugar. But itâ€™s tricky. â€œI know I clearly have conflicts other journalists just donâ€™t have and thatâ€™s a tightrope I havenâ€™t figured out how to walk yet,â€� Taubes says. â€œThis nutrition science crusadeâ€”right or wrongâ€”expands easily to fill all the time in my life that can be allotted to work. So Iâ€™m going to figure out how to partition time better in the future.â€�
In between flights and conference dinners heâ€™s been checking his email for notes on an upcoming article about a new kind of observational study that uses genetic variation to mimic a randomized control trial. While the story isnâ€™t strictly related to nutritional science, Taubes now has the kind of conflicts of interest that make publications wary. Heâ€™s working with a new editor and a new outlet after his old editor at Science wouldnâ€™t touch it. Taubes founded NuSI to support objective science; now, it’s his own objectivity he has to defend.
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