I had done Atkins in the mid-90s and lost 60 pounds. I felt great but thought the weight loss was due to not eating white sugar. I went off of the diet and slowly gained everything back. In 1999 I had half of my thyroid removed, which didn't help. Then in 2008 I found a wonderful doctor who helped me with my thyroid issues and finally diagnosed my food allergies. She told me to start by removing all wheat and rice. I immediately felt better. My joints stopped hurting and I started losing weight, all without exercising. A couple of weeks in I ate some pizza, and all my symptoms came back, which confirmed my allergies.

Over the next 3 years I lost 74 pounds and experimented with food elimination to figure out what I'm allergic to. I'm allergic to all grains (glutens are the worst), beans (soy reacts just like gluten), and carrageenan.

The longer I don't eat those foods, the better I feel. But the reaction is worse now if I do eat my allergens.

I've had a problem the past year and have gained 13 pounds (I'm at 195 currently - Jan 2012). If I stay low-carb I feel great and don't crave carbs. But if I eat sugar or chips, I start craving carbs. I don't feel good when I eat them, and they're not satisfying, but it's like "lizard brain' turns on and I eat them without thinking. I've had a problem eating carbs since I started my current job. It's stressful, I only get 5.5 or 6 hours sleep per night, and I think I'm stress eating. I'm not one to go through an entire bag of chips or an entire box of chocolates, but I will eat 1-2oz of chips a night or 2 pieces of candy a night (if it's there). The calories add up and it makes me crave even more carbs.

This past month I've been slowly eliminating carbs again. There's nothing I can do about getting more sleep, but I'm documenting everything I eat (including calories). I've been reminding myself that I simply cannot eat sugar/carbs. My body doesn't do well when I eat them.

What was the biggest challenge to adopting a carbohydrate-restricted or paleo diet?
Eating away from home. Dinner isn't so bad because I can get a steak almost anywhere. Lunch is a problem. Most lunches consist of sandwiches or pizza.

What advice (if any) would you give to someone interested in trying a carbohydrate-restricted or paleo diet? Were there any obstacles that you overcame that could help future dieters?
Cut out sugar completely. Find out if you have food allergies by trying food elimination (stop eating a food for 15-30 days and see how you feel, then eat it and see if any symptoms you had return). Plan your meals in advance, especially if you'll be out of the house. In-n-Out and Carl's Jr are the only fast food places that don't put wheat in their french fries, and they both have low-carb burgers wrapped in lettuce (only eat there in a pinch). Combat your carb cravings with high-fat meals. Don't try to eat low-fat low-carb -- there's a reason it's referred to as Faileo. You need saturated fat, it's good for you, and it makes you feel full.


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Tried a paleo or carb-restricted diet? Join the registry and contribute to a better understanding of this way of eating!

In February 2011 I discovered author and medical research journalist Gary Taubes through an interview article in the Reader's Digest. The magazine is often my bedtime reading, and I nearly skipped the article (whatever, more diet advice saying to eat less and exercise more). But I did read it, and when the full impact of what he was saying hit me, I exclaimed out loud, "Oh my God! This explains EVERYTHING!" It explained why my years of low calorie dieting and faithful exercise had never been able to keep my weight down. It gave me hope for the first time that I could help my overweight son lose weight while eating food he loves, like burgers (no bun) and steaks and sausage.

I went out the next day and bought Gary Taubes book called Why We Get Fat, and What To Do About It. I recommend you do the same, and read it cover to cover. My husband, my son and I all started the diet immediately, while I read this fascinating and eye-opening book. I also spent a lot of time doing research on the internet, learning what works and doesn’t work for other people doing this diet. 

The #1 thing that helped us all succeed on this diet was that everyone in the family was on board. We didn’t have to keep bread or cereal in the house for someone who wasn’t doing the diet, and if the stuff is gone, it makes it easier not to cave in to temptation, especially in the early days. Speaking of which, this questionnaire asked whether the cravings went away, and he didn’t have the option of giving the answer that applied to us – for all of us, the carb cravings disappeared after one week. We all ate pasta and bread often, it was our favorite food. The cravings for that food went away, it was very weird. When those cravings for pasta or bread or cereal come back now, it’s an excellent signal that I ate too many carbs, and to think about how that might have happened so I can avoid doing it again. 

My teenage son lost 30 pounds, and has kept it off for six months now. 

My husband was only about 10 pounds overweight, but high cholesterol runs in his family, and his numbers were terrible. After four months on our low carb/high fat diet, his triglycerides went from 128 to 64, and all his other numbers also improved. Right now he actually weighs less than he did thirty years ago. His sister also did the diet, and after three months her cholesterol numbers improved so much that her doctor took her off Lipitor.

Reading about low carb diets on the internet can be bewildering. Some claim you can eat potatoes and all the fruit you want; others claim you should also eat low fat (please don’t do that, it is unnecessary and you’re doomed to a much harder time of it). There are many different diet camps including paleo and primal and archevore. The bottom line is that we are all different, and you’re going to need to experiment to find out how many carbs you can eat and keep losing weight, or maintain the weight you have. 

I have a few simple points that I have culled from reading and researching for the past year, and I think anyone who starts from here is going to have the fastest success with this way of eating.

1. No sugar, no fructose corn syrup. Avoid artificial sweeteners. Check out Stevia (with NO additives, just pure Stevia) and check out xylitol, and use in moderation. Not cups of it, just teaspoons of it.

2. No grains of any kind, in any form. That includes corn and oatmeal, as well as wheat, rye and barley. Later on, some people can add back oatmeal.

3. No vegetable oils. Cook with butter, ghee, coconut oil and animal fat. (Research the effects of too much omega 6 in our diet.)

4. Eat low carb, moderate protein, high fat. Eat butter, virgin coconut oil, organic lard (do not use any that is hydrogenated or partially hydrogenated). Do not be afraid of fat, it will make you full longer, and your heart and arteries will love it. I promise.

5. Eat when you are hungry, and stop when you are full. Do not eat again until you are hungry again. If you do this right, you will find you go much longer between meals. Don’t worry about calories, let your body tell you when you aren't hungry.

6. Try not to snack. If you need to snack, a handful of raw nuts (walnuts, almonds, pecans, macadamia nuts) is great.

7. Drink lots and lots of water. 

8. Get most of your carbs from vegetables and berries, not from things like "low carb tortilla shells". Read the labels on everything, including salad dressings. 

9. If you're a chocoholic like me, buy 85% dark chocolate bars, and have a couple of squares every day as a treat. If you start craving more chocolate, add more fat to your diet, and you may find that those cravings disappear.

10. Don't get discouraged if you mess up. Just start again the next day.

I am SO grateful to Gary Taubes for his life-changing work... and also to the Reader's Digest for printing the article with his interview. It kind of cracks me up, I’ve been reading Reader’s Digest since I was 8 years old, and I never dreamed it would one day change my life. Gary’s work took it from there. 

I wish the best to anyone reading this, and I hope you great success if you are starting on your new life, too.

What was the biggest challenge to adopting a carbohydrate-restricted or paleo diet?
Social pressures, like turning down desserts at social gatherings, and people saying, "Oh, you're still doing that diet?" in a less-than-encouraging tone. Also the loss of convenience, it sure was easy to pour cereal in a bowl. Planning ahead and having easy food choices available helps a lot. 

What advice (if any) would you give to someone interested in trying a carbohydrate-restricted or paleo diet? Were there any obstacles that you overcame that could help future dieters?
I have a whole lot of advice! Here goes: I don't believe that the "induction" phase is necessary, where you cut your carbs really low at the beginning and then increase them. I advise you to start at about 15 carbs per meal, and work up or down from there. For one thing, starting with moderately low carbs instead of almost no carbs will help decrease the negative effects during transition. 

Don't be afraid to eat fat, in fact, the higher the percentage of fat in your diet (as long as you're keeping your carbs low!), the more successful you will probably be. Eat when you are hungry, and stop when you are not hungry. You won't feel stuffed like you do when you eat bread. Avoid vegetable oils like they are poison - read up about excess omega 6 in our diets. Going low carb automatically helps decrease omega 6, but read about it anyway. Besides other health problems, too much omega 6 seems to be able to sabotage weight loss. Cook with butter, ghee, coconut oil, animal fat. Read every label. While you're figuring out what you can eat, Google "how many carbs are in ______". Number one rule of thumb starting out: if it tastes sweet, even if you didn't expect it to taste sweet, immediately stop eating it and get something else. 

Avoid artificial sweeteners. Splenda is not your friend. Learn to substitute the pleasure of eating fat for the pleasure of eating sweet, which will happen if you stick with it. Stevia without additives is a decent sweetener, but use it in moderation, like a packet in your coffee or tea. Xylitol seems to be another good possibility, but it causes some people stomach upset. Buy one of those vacuum food savers, buy lots of meat in bulk when it's on sale, then seal and freeze them. In those sealed packages, a thick steak will thaw in a bowl of water in about an hour. If you goof up and eat too many carbs and gain a few pounds in a couple of days, don't panic, it's just water weight. Eat low carb again and it will come off. One response that helps when people offer you dessert is to say, "No thank you, I have cut sugar out of my diet." Be prepared: when you have weight loss success eating FAT, you're going to get excited and try to tell people about it. Most of them will not be interested. Be true to yourself, do not cave to social pressures and eat the bread, or share the dessert. Instead, enjoy your meat slathered in butter while they eat their salads with no dressing.


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Tried a paleo or low carb diet and want to contribute to a better understanding of this way of eating? Join the registry today!

As of last week, we are proud to announce that the Ancestral Weight Loss Registry has over 1000 members! People from all 50 states, and 32 countries have registered and shared their stories in vivid detail.  You can view the map of our members on our results page, or below:

New Data Published
We have published new data as well, on the side effects, reported benefits, and reasons for adopting paleo or carbohydrate-restricted nutrition. It can be viewed here.

Since we launched the registry on January 1st of 2012, we have had an incredibly positive response, with coverage from Gary Taubes, Robb Wolf, and many bloggers around the world. Compared to the the National Weight Control Registry, which has between 6,000 and 10,ooo members (depending on which source you read) after 20 years of existence, we are on pace to reach these numbers in 1.5-3 years. 

Just the beginning.
I would like to personally thank all 1000+ people that have taken the time to register thus far. Your efforts are contributing to a better understanding of paleo and carbohydrate-restricted eating, as well as shining a spotlight on the clinical trials which support this way of eating.

With your help in spreading the word on facebook and twitter, writing blog posts and encouraging others to join, we can achieve massive numbers in no time!

Thank you again.

Sincerely,

Larry

In 2004, PBS did a special entitled "Diet Wars," interviewing experts from all over the dietary advice spectrum, such as Dean Ornish and Gary Taubes. Below are selected exerts from one of the interviews. At first glance it may sound like Gary Taubes, but in fact it is Dr. Walter Willet, the chair of the department of nutrition in the School of Public Health at Harvard Medical School. 

Worth noting: early in the interview, Dr. Willet explains that  "farmers have known for thousands of years that you can make animals fat by feeding them grains, as long as you don't let them run around too much, and it turns out that applies to humans." Yet at the end of the interview, Dr. Willet states that at the base of the Harvard Food Pyramid (PDF) are exercise and whole grains. They have since updated their recommendations to the plate. It seems difficult to reconcile this advice. 

This low-fat dogma was incorporated into the USDA food guide pyramid in 1992?

Well, there's a little bit of complexity. It's interesting. In the '70s and early '80s, while heart disease rates were going bad, we were not talking about low-fat diets. We were talking about replacing saturated fat with a healthy fat, polyunsaturated fat. But somewhere in the mid-1980s, we lost that message. It's perhaps partly because some nutritionists felt it was too complicated to talk about different types of fat, and developed the notion we should just reduce all types of fat across the board. That was really the beginning of the low-fat, high-carbohydrate crusade.

How is the simplification -- eat less fat -- manifest in this food guide pyramid?

Well, the food guide pyramid that was developed in 1991 really is based on the idea that all fat is bad. Therefore [if] fat is bad, and you have to eat something, carbohydrate must be wonderful. So the base of the pyramid is really emphasizing large amounts of starch in the diet. We're told we can eat up to 11 servings a day, and if that wasn't enough starch, the pyramid puts potatoes along with the vegetables, so you can have up to 13 servings a day. That's a huge amount of starch.

Where's fat?

Fat's up at the top of the pyramid, and where it says explicitly "fats and oils, use sparingly." It doesn't make any distinction about the type of fat, and it tells us to eat basically as little as possible.

From a public health standpoint, how would you characterize this pyramid?

Well, this pyramid is really not compatible with good scientific evidence, and it was really out of date from the day it was printed in 1991, because we knew, and we've known for 30 or 40 years that the type of fat is very important. That was totally neglected.

[What were the] unintended consequences? The food industry started using vegetable oils, but baking was difficult so they made a technical modification.

In some ways, we do have to credit the food industry with being responsive to what nutritionists were saying. They did believe or accepted the evidence that vegetable fats, vegetable oils, would be better than animal fats, and that really led to the development and promotion of the margarine industry and Crisco, baking fats that were made from vegetable oils. But they were made by a process called partial hydrogenation, which converts a liquid oil, say like soybean oil or corn oil, to something like margarine or vegetable shortening. As it turns out that was a very disastrous mistake, because in the process of partial hydrogenation, a totally new type of fat is formed called trans fat. The evidence has now become very clear that trans fat is far worse than saturated fat.

So when people were told to switch from butter to margarine?

Unfortunately, as a physician back in the 1980s, I was telling people that they should replace butter with margarine because it was cholesterol free, and professional organizations like the American Heart Association were telling us as physicians that we should be promoting this. In reality, there was never any evidence that these margarines, that were high in trans fat, were any better than butter, and as it turned out, they were actually far worse than butter.

People read on the label "cholesterol free."

Right. This is a good example where just focusing too much on one particular piece of the diet, one particular substance or nutrient, can really mislead us. It is true that these vegetable shortenings and margarines were cholesterol-free, and that was pushed. ... Even though these products were cholesterol-free, the trans fats in them raised our blood cholesterol much more than actual cholesterol in the margarines would have done.

"All fat is bad" led to many low-fat products, some of which had beneficial value. Talk about one example.

This campaign to reduce fat in the diet has had some pretty disastrous consequences. ... One of the most unfortunate unintended consequences of the fat-free crusade was the idea that if it wasn't fat, it wouldn't make you fat. I even had colleagues who were telling the public that you can't get fat eating carbohydrates. Actually, farmers have known for thousands of years that you can make animals fat by feeding them grains, as long as you don't let them run around too much, and it turns out that applies to humans [my emphasis]. We can very easily get fat from eating too many carbohydrates, and the public was really directed to only focus on fat calories, when we really have to keep an eye on calories no matter where they're coming from.

With more fat-free products than ever, Americans got fatter.

Right. The reality is that during this campaign for fat-free and reduced-fat products, actual fat consumption did go down, but Americans got much fatter during this period of time. Now of course lots of things were going on at the same period in time, but I think it's highly likely this focus only on fat calories to the neglect of carbohydrate calories has contributed to this epidemic of obesity.

Is it fair to blame the food pyramid when people don't follow it anyway?

The food guide pyramid has actually had a substantial impact on the diets of Americans. If we look back compared to 20 years ago, the percentage of calories from fat in the American diet is quite a bit lower compared to earlier days. Second, there're some important indirect impacts of the food guide pyramid, in that many tens of billions of dollars of federal food policies have to be compliant with the food guide pyramid. So many programs -- for example, what's fed to young children, to pregnant mothers, to low-income families -- have to be consistent with low-fat diets. So the impact really has been, overall, substantial.

Behind the food pyramid were a collection of constituencies. Were people receptive when you raised these criticisms in the '90s?

There was not much receptivity in the 1990s, when we raised these criticisms of the food guide pyramid. It was almost an accepted religious belief that fat was bad and carbohydrates were good. Then there were lots of economic interests behind the food pyramid as well. Clearly the dairy industry is extremely well represented in the food pyramid. The beef industry is there, and it's very convenient that beef is combined along with fish and poultry and nuts and legumes. So each one of those industries can say: It's healthy to have three servings a day of our product.

What makes it so difficult to study the relation between diet and health?

The relation between diet and health is unusually complicated to study, and that's probably why we don't have all the final answers even yet. In a trial of a drug, for example, you can randomly assign people, one group to a placebo and another [group] to the new drug, and see what happens to them. But obviously you can't do that with nutrients or a whole diet very easily.

Second, we have to follow people for many years to learn all the consequences of diet, and perhaps even almost a lifetime, because some of the effects of diet may be operating during childhood and not be manifested until adult life. So there's no one simple kind of study that will give us all the truth about how diet influences our health, and we need to combine the results of many different studies to have the best and most complete picture.

One [kind] of study, for example, involves feeding small groups of people very controlled diets for short periods of time, and seeing what happens, for example, to their blood cholesterol levels. But blood cholesterol levels are only part of the picture, so we are also conducting very large studies where we enroll tens of thousands of people and follow them for many years, all the way along, finding out what they're eating, and then what happens to them in terms of their risk of heart attacks, cancers, and other conditions. And of course in those studies we need to control for many factors, like whether they smoke, how much exercise they have, their family history of various diseases. It's really only when we put those kinds of studies together with the more detailed metabolic, biochemical studies that we can have the best information about the effects of diet.

So you find out what they eat, rule out the bad things they do, and look for associations?

Right. What we do is find out what people eat through very detailed, structured questionnaires, observe what happens to them in terms of disease rates -- heart attacks and cancers, for example -- and then put these together, controlling for other aspects of lifestyle like diet and activity.

What did you notice that seemed to clash with the low-fat dogma?

When we began our studies back in the late 1970s, we expected that we would find a relationship between, say, fat intake and breast cancer, because that was almost an accepted relationship. But as the data started coming in over the years, we just did not find any higher risk of breast cancer among women who consume more fat in the diet. And the same was true for colon cancer and for heart attacks and risk of type 2 diabetes. In fact, the percentage of calories from fat in a diet has not been related to any important health outcome.

Amount of fat has no relationship to coronary heart disease?

The amount of fat had no relationship to risk of coronary heart disease, but the type of fat was extremely important.

So the advice we were getting was not just misleading but dangerous?

Right. The evidence that we accrued really suggested not only that the type of advice that people were getting was not useful, but it actually could be dangerous, because some people were eliminating the very healthy types of fat that actually reduce heart disease rates.

Certain fatty acids can dramatically reduce the incidence of cardiac arrhythmia?

One of the important findings, not just from our studies but several trials conducted by other people in Europe and also some careful animal studies, have very clearly indicated that some types of fatty acids in the diet, in particular the omega-3 fatty acids, can actually reduce the heart arrhythmias that really cause people to drop dead in the street. We call that sudden death. And that's very important because some people were eliminating those critically important fatty acids from their diet because they were told that all fat is bad. ...

Traditionally people think of carbohydrates as made up of simple sugars and complex starches. What's wrong about that?

Right. The thinking in nutrition about carbohydrates really had broken them down into two classes: sugars and so-called complex carbohydrates, which are mostly starches. ... The idea has been pushed that all forms of so-called complex carbohydrates are really the poster child of nutrients, and we should be eating them in large amounts. That's what the pyramid tells us to do. But in fact, these kinds of starches -- white bread, white rice, potatoes -- are starches that are very rapidly converted to glucose, really pure sugar, and almost instantly absorbed into the bloodstream. And these are the kinds of carbohydrates that we really should be minimizing in our diets.

A sugar rush from a potato?

Actually, careful studies have shown, demonstrated that you get a bigger rise in blood sugar after eating potatoes, a baked potato, say, than you do from eating pure table sugar.

Really!

Really.

That seems pretty extreme. Why is that?

... There are several problems with these rapid rises in blood glucose after you ingest large amounts of a rapidly digested form of carbohydrate. First of all, when the blood sugar goes skyrocketing up, the body wants to bring it back down. So our pancreas pumps out a big blast of insulin, and as a result, the blood sugar comes crashing down rapidly. In fact, in many people, after three and four hours, it overshoots and actually become a little hypoglycemic, and that rapid crashing down of blood glucose and insulin stimulates hunger. That would be no problem, except that it's often all too easy to go in the refrigerator or find a snack, and if we do that frequently throughout the day, that can add up to too many calories over weeks and months and years, and contribute to obesity.

Second, these high rises in blood glucose and insulin have a bad metabolic effect on the blood cholesterol fractions. Specifically the HDL, the good cholesterol, is driven down, and triglycerides, another type of fat in the blood that leads to heart attacks, goes up.

Third, after many years of demand for high amounts of insulin, the pancreas tends to give out. And at that point in time, we've got type 2 diabetes.

[What is the role of insulin?]

The role of insulin is to transport glucose from the blood into the cells, like into muscle or into fat cells.

What can go wrong with this system?

Well, the problem really comes about when we develop insulin resistance. And that means that the cells, like the muscle cells, become more resistant to the action of insulin transporting the glucose inside the cell. And we can become insulin-resistant in several different ways. There's some genetic component, and as it turns our, for example, many Asians tend to have more insulin resistance. Also if we have overweight or low levels of physical activity, we'll be more insulin resistant.

Many people argue the virtues of Asian diets, with a lot of white rice.

Right. The Asian diet as it's traditionally been used raises some very interesting issues in nutrition, in fact, some of the most important findings during the last several years. What we've come to realize is that if we have a higher degree of insulin resistance, then we much less well tolerate a high-carbohydrate diet.

Interestingly, in traditional Asian societies, people were very lean, very active, and therefore had low insulin resistance. They could eat large amounts of rice, even white rice, in the diet and have low heart attack rates and have low rates of type 2 diabetes. But if you take that same person, and they [now] may be living in Beijing and driving a car and watching a television, and they put on a few pounds, they're going to have much more insulin resistance. So if you take that same diet, high in carbohydrate and white rice, they will have a much worse metabolic response and much higher rates of type 2 diabetes.

If you're American and overweight, won't you be put on a low-fat diet?

If you're overweight and living in the United States, and you go to a hospital and see a dietician, almost for sure, you're going to be put on a low-fat, high-carbohydrate diet.

What's your view of that?

The problem is that that's really the wrong diet for an overweight person. Because the person is overweight, in general they're going to have quite a bit more insulin resistance and much less well able to tolerate low-fat, high-carbohydrate diet.

But fats have twice the amount of calories per gram as carbohydrates. Doesn't it make sense to push the low-calorie diet and therefore a diet low in fat?

There's been a very simplistic idea: Just because fats have more calories per ounce than carbohydrates, we should be eliminating fats or reducing fats to control our total caloric intake, in other words, to help control our weight. What's really important though is how satisfying a diet is, because we have very complex mechanisms that control our total intake of calories, and it's become pretty apparent that if we have a high-carbohydrate diet, particularly high refined carbohydrate, it makes it much more difficult to control our total caloric intake. That's probably because when we eat refined carbohydrates, we get these swings in blood glucose and insulin that lead to hunger between meals; whereas if we have a diet that's somewhat higher in fat, we tend to be more satisfied over the long run.

Is this what Dr. Atkins was saying 30 years ago?

Dr. Atkins was saying as much as 30 years ago, that if we reduce our carbohydrate intake to quite low levels, that will make it easier to control our caloric intake and thus promote weight loss. As it turns out, there is a strong element of truth in that. A number of studies in the last year have looked in a very careful way, comparing low-fat, high-carbohydrate diets with reduced-carbohydrate diets, and in general people have done better on the reduced-carbohydrate diets in terms of their weight.

Even though each ounce of fat has twice as many calories, you eat fewer calories because they're more satisfying?

Yeah. Well, first of all, this idea of how many calories per gram of fat versus how many calories per gram of carbohydrate is a little simplistic, because we almost never eat foods that are pure fat and pure carbohydrate. They come in foods as mixes, and often with a lot of fiber and a lot of water, and all of those things make a difference as well. But what is really important in the long run is how satisfying a food will be. And as it turns out, that many high-fat foods -- sometimes like meat, but even think of a handful of nuts -- are often very satisfying even though the physical amount is not very great.

One of the interesting observations in the recent studies that have compared high-fat diets with high-carbohydrate diets is that there are a lot of differences between people; that it's not that everybody loses a certain amount of weight on a reduced carbohydrate diet. Some people lose a lot of weight. Other people hardly lose any, so one of the things we have to come to understand better is the reasons why there's such a difference in response to these diets.

Talk about your food pyramid.

We've tried to put together an alternative food guide pyramid that would be based on the best available science. And of course it is a little bit challenging to boil down a tremendous amount of complex science to a simple graphic, and you really have to focus on the things that are well established and important.

Right at the bottom, we put weight control and regular physical activity, because overweight is the number one nutrition problem in the United States. Almost everyone is going to need to exercise on a regular basis if they want to control their weight over the long run. And this also is a message that all forms of calories are important.

On the next level, we put healthy forms of carbohydrate, meaning whole-grain carbohydrates and healthy forms of fat, meaning from vegetable oils, in the recognition that in most people's diet, most calories are going to be coming from some source of carbohydrate and fat. And what's really important is that those both be healthy sources.

Some of those fats have come right from the top of the other pyramid.

Right. What we've done is, we've brought some of those fats from the top of the pyramid down to the base, because healthy fats are an important part of a healthy diet.

The rest of the pyramid?

Our alternative pyramid, like the USDA pyramid, does emphasize plenty of fruits and vegetables, but we've taken potatoes out of the vegetable group. We've put legumes and nuts as a layer. If you want to be a vegetarian, those are good protein sources. But moderate amounts of poultry, fish, and nuts can also make a diet be a non-vegetarian diet and still very healthy. And up at the top we've put red meat and dairy products, dairy fat, because those are high in saturated fat. ... At the top of the pyramid, we've put foods like white bread, white rice, white pasta, and sweets as those that should be used sparingly. And that was really the base of the USDA pyramid.

Some nutritionists have criticized your pyramid as "floating on a lake of olive oil."

The formal studies that had compared a more moderate fat intake as we've suggested, with low-fat diets, have actually consistently shown that people did as well or better controlling their weight on a moderate-fat diet compared to a high-carbohydrate, low-fat diet.

Even good fats are more fattening than good carbs. So they think you're contributing to the obesity epidemic, or there's a risk of that. A tablespoon of olive oil is 14 grams of fat.

There are all kinds of beliefs about the amount of fat in a diet, tremendously strong opinions. What we really need is sound data, and the studies that have been done show that people actually end up controlling their weight at least as well, and usually better, on moderate-fat diets compared to low-fat, high-carbohydrate diets.

Is it okay to get more than 30 percent of your calories from fat?

The evidence is quite clear that it's perfectly fine to get more than 30 percent of your calories from fat, and probably, in fact, it's even better to be getting more than 30 percent of calories from fat, if it's the healthy form of fat. ...

When you look at the causes of obesity, what do you find?

The causes of obesity and the obesity epidemic in the United States are extremely complex. In fact, obesity is sort of a tip of the iceberg of tremendous social change that's been going on during the last few decades. First of all, our activity patterns have changed greatly. We have children and adults now watching on the average, about four hours of television per day, and in study after study, we've seen just the number of hours of television watching being the strongest predictor of obesity. When I was young and came home after school, we'd all go out and play, and our mothers would have to drag us in for dinner. That doesn't happen very often anymore. Often the mothers are not there. Kids are inside. The television is used as baby sitters. We've also made it dangerous and uninviting to walk to places, to walk to stores, to ride bikes in urban areas, and that's removed an important amount of physical activity from our lives as well.

So the physical activities pattern's changed, but the food environment has also changed. We have food available fast and very low-cost and very convenient, almost everywhere. The food industry has invested many tens of billions of dollars in making their products more attractive, more sweet, more salty, more sexy, more seductive in every way that they can, and we're vulnerable to that promotion, and we are eating more. So you put these two factors together -- reduction in activity, heavy promotion of food -- and you've got, not surprisingly, an epidemic of obesity.

Which we're exporting to the rest of the world.

Unfortunately, what we've created is now being exported to the rest of the world. And in almost every country, in Europe as well as Africa, Latin America and Asia, rates of obesity are climbing rapidly.

When you think about solutions, how can we proceed?

The causes of obesity are very complex, and therefore any response is going to have to be complicated and multi-faceted as well. There is no single solution to this, but we have to do many things to really solve this problem.

We've actually looked at this in a very detailed manner over the past two years in the New England states, and identified eight different areas that we have to really modify. For example, schools have to change what's served, what's promoted in schools. The healthcare providers -- physicians, nurses -- have to be providing much better and effective advice to their patients about controlling their weight. Work sites have to change. The whole food environment and what we promote to children has to be somehow modified, and we do have to protect children from these aggressive advertisements. We have to change the physical environment to make it more conducive, more attractive to bicycle to work, to destinations, not just drive places. Many other things need to be done if we're going to solve this problem, and it's time we really began.

The national obesity crisis, I mean, it's really severe. And to hear you talk about it, it sounds like it's hopeless to overcome it.

The crisis we're facing is severe, and it's getting worse. Interestingly, the full consequences won't be seen for another 30 or 40 years, because it takes that long a time for the risk of diabetes and the complication of diabetes to play out. But it's not hopeless, and I think that's the good news. There are places, if we look around the world, where people have been controlling their weight. For example, in Japan and in Sweden, women have really not been gaining weight as they've gone through midlife and gotten older, so we do need to learn more about how they're doing it.

Also in the U.S. there are many people who are controlling their weight successfully. Not everybody is going to be as successful, even if they do the same diet and do the same amount of physical activity, but many people are doing pretty well. And one piece of evidence we have is that upper-income groups actually only have about half the rate of obesity compared to lower-education groups. So it's not hopeless, but we are going to have to devote many more resources to doing this if, as a whole country, we're going to be successful. ...

The advice for so long was: Buy something that says "fat-free," or at least "low-fat" on it. All these [salad] dressings, fat free. But not necessarily a good idea?

In fact, a pretty bad idea, and that was really unfortunate that the crusade against fat really led the food industry to produce all these fat-free salad dressing products. The problem is that the fats that were in the salad dressings were the healthy fats, the ones you should be including in the diet. They were the unsaturated fats that reduce our blood cholesterol levels, and we've also seen that they reduce heart attack risk and type 2 diabetes, as well. So people were giving up these healthy fats, and what we've seen is actually an increase in risk of heart disease among people avoiding full-fat salad dressings.

Of course one of the important roles of a full-fat salad dressing is that it makes salads taste good, and we want people to be eating those vegetables. So it's not that we're telling people to gulp down bottles of salad dressing. We want them to use it on a salad and enjoy it. ...

[At] the base of your pyramid, after exercise: whole grains. Right?

Right. On the base of our pyramid, side-by-side, we put healthy fats and whole grains. And that's because we do see positive benefits in study after study, that there's lower risks of type 2 diabetes and heart disease, and probably better weight control as well, with some whole grains in the product. And that's because these carbohydrates are generally absorbed more slowly, they give less of a spike in blood glucose, and they come with a whole package of minerals, vitamins, and fiber that all have positive health benefits. ...

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