Posts Tagged ‘Scientific Controversies’

More on salt, actually salts

Saturday, June 30th, 2012

What should we make with our CSA-supplied spinach today?

We're in the prime of our CSA delivery season; fresh vegetables started three weeks ago and fruits this week. Many of our meals consist of spinach, lettuce, beets, rhubarb, apricots & cherries, with milk and/or cheese or yogurt. We rarely, if ever, shop for any "prepared foods," always check labels for sodium content, and only eat out, other than our weekly Thai food splurge, for birthdays and other occasions. I'm firmly convinced that less sodium (often termed "table salt," but most typically found in processed foods and restaurant dishes) is better for us.

So when I started reading an article in the ACP Journal Club section of the January 2012 issues of the Annals of Internal Medicine that was titled "Review: Interventions to reduce dietary salt do not reduce mortality or morbidity," I was skeptical. The original article, published in England, was a meta-analysis, a statistical look at a group of research studies. In this case seven randomized controlled trials were lumped together, and according to the Journal Club, the conclusion was as in the article's title.

But the US and Canadian reviewers disagreed. In people with normal, borderline, or elevated blood pressure, 6 of the 7 studies showed variable results and the pooled data did not reveal statistically significant decreases in death rates or medical complications. I went to the original article and the authors actually say, "Despite collating more event data than previous systemic reviews...there is still insufficient power to exclude clinically important effects of reduced dietary salt..."

That translates, to me, as "we don't know yet what happens when millions of people lower their salt intake." The reviewers, being ultra cautious, say, "...we are unaware of compelling evidence showing that consuming less sodium in the general population is harmful."

A free-lance science writer wrote an article in Scientific American in 2011 with the title, "It's Time to End the War on Salt." She argues that the data linking increased salt intake and various diseases is not solid.

Should I believe those statistics?

Yet there are lots of studies showing a strong link between salt intake and blood pressure and others claiming a similar correlation between dietary sodium and cardiovascular disease.

One country that decided to act on these supposed connections was Finland. In the late 1970s a national-level campaign was started to include mass media education, monitoring of urinary sodium excretion and food-industry cooperation using salt substitutes. The average sodium intake was cut by nearly 30% and over the next ~24 years stoke and heart attack deaths went down by 60%. Was this cause and effect? I'm not sure, since other factors may have played a role and the initial average salt intake was quite high.

But a December, 2011, New York Times article, with the striking title, "Sodium-Saturated Diet Is a Threat for All" led me to find another kind of salt that plays a role. I found the July, 2011, Archives of Internal Medicine research report, "Sodium and Potassium Intake and Mortality Among US Adults" and realized I was on the right track with our diet.

It's not just too much sodium chloride, the kind of salt some use at their dining room tables, manufacturers add to processed foods and restaurants to their recipes to add flavor and preserve food. It's also how much potassium you eat (in fruits, juices, vegetables, fish, nuts and meat), that makes a difference. In this case, within reason and assuming you have normal kidney function, more is better.

I'm going downstairs and eat some fruit and perhaps a baked potato and yogurt, all high in potassium and relatively low in calories.

Influenza H5N1 HPAI research: lots of viewpoints

Friday, March 16th, 2012

When experts disagree, who should we believe?

Shortly after I wrote my post on the dangers of H5N1 HPAI, my weekly copy of JAMA, AKA the Journal of the American Medical Association, arrived containing a commentary titled "International Debate Erupts over Research on Potentially Dangerous Flu Strains." The pros and cons of release of the two groups' research were discussed and the rationale for publishing the methods and details was explained.

One expert in the field had a balanced view. He felt release of the details of the recent research on H5N1 HPAI might be extremely useful to  those who evaluate which strains of influenza are about to pose a real threat to humans and could potentially cause epidemics. Doing so might provide lead time for other scientists who work on vaccines to prevent wider spread of the particular strain of flu.

But in a January, 2012 online discussion of the controversy the head of a university Center for Biosecurity felt the lives of hundreds of millions of people could be at risk if such an engineered virus strain were to be released, even accidentally. He feels that continued research would require the level of biosecurity utilized with other dire agents such as smallpox.

The first infectious disease specialist countered with the concept that H5N1 HPAI wasn't an especially likely pick for those interested in bioterroism. It's certainly not a selective weapon and its use would require considerable expertise.

The second expert noted there had been no data that such a strain of flu would ever develop naturally, outside the lab, and we had to return to the concept of weighing potential harm versus good.

Now the original researchers have stated that the new viral subtype isn't as deadly as feared; it hasn't killed the ferrets being used as laboratory substitutes for humans and has proven to be controllable with vaccines and antiviral medications. Because of ethical limitations it hasn't been tried on human subjects and they don't know whether it even could be spread among humans.

And which of these is the worst?

I think we're treading very close to the edge here. I don't look forward to widespread beneficial effects of complete publication of the ongoing lab research results. And I do fear the possibility of groups who don't care if they kill off a third of everyone, including their own followers. Accidental release of a lab-engineered organism into the human population could also happen, even if unlikely.

Another online article said the work on the mutant form of H5N1 had been performed in BS-3 labs, used for studying agents that can cause serious or lethal disease, but do not ordinarily spread among humans and have existing preventives or treatments.

A GAO 2009 report counted 400 accidents at BS-3 labs in the previous decade. Scientists argued that the H5N1 HPAI studies must be moved to BS-4 labs with one professor stating, "An escape would still produce the worst pandemic in history." Yet between 1978 and 1999, over 1,200 people acquired deadly microbes from BS-4 laboratories, the biosafety-4 level facilities that normally deal with infectious agents that have no known preventive measures or treatment.

Scandia National Laboratory's International Biological Threat Reduction program directed by Ren Salerno has a worldwide ongoing effort to prevent laboratory accidents, but there are varying standards for biosafety and at least 18 BS-4 labs outside of the US as of 2011.

So I'm still worried.

 

Dangerous research on influenza H5N1, the "bird flu"

Tuesday, March 13th, 2012

This "chicken" is safe to handle

I just looked at the World Health Organization's (WHO) most recent statistics on human cases of avian influenza H5N1, the dreaded bird flu. These cover the period from 2003 through March 10, 2012 and report 596 total cases and 350 deaths. The counties with the great numbers of cases are Indonesia, Egypt and Vietnam and I didn't see any reports of bird flu infections in the Western Hemisphere...yet.

That's a relatively tiny number of cases, but an incredibly high percentage of deaths, nearly 60% of those infected. But influenza epidemics and pandemics have been a common occurrence in the last century. So what's the difference between our seasonal flu, the pandemics and this new flu?

The Food and Agriculture Organization of WHO has published the first three chapters (of nine) of an online primer on avian influenza. It seemed a good place for me to start.

The first issue is how easily a new flu virus passes from animals  to humans (the usual hosts are birds, typically ducks and, secondarily, chickens, especially if flocks are raised in proximity to each other and the ducks are "free range") and then from one person to another. The second is how deadly the particular influenza virus is.

Up until now those infected with the relatively new H5N1 subtype, sometimes called H5N1 HPAI, have had direct or at least indirect contact with infected birds. The HPAI is the acronym for "Highly Pathogenic Avian Influenza," but in this case highly pathogenic, which translates into very likely to cause disease, mostly refers to birds. Unlike seasonal flu, there's been (thus far) absolutely no documented human-to-human spread of the virus.

The 1918 Spanish flu infected 1/3 of everyone alive and killed at least 20 million. My math says that's roughly 4%, but 3% is the usual quoted figure. Seasonal flu kills less than 0.1% of those infected. So this flu, if it does reach a human, is terrible.

These experiment may prove deadly

Recently there has been an enormous flap about the work done in two laboratories. I had heard about the issue, but hadn't read the details until my monthly copy of On Wisconsin arrived and I realized one of the labs was in Madison. CNN has an online review of the problem. The researchers wondered why this deadly flu variety hasn't spread from person to person, so they created a mutated form that could be easily transmitted from one mammal to another using ferrets as their test animal.

Then the excrement collided with the rotating blades. Detailed papers were about to be published in prominent, widely read journals, Nature and Science. The National Science Advisory Board for Biosecurity temporarily stopped the process, saying the papers should be published without methods or details to stop terrorists from making their own highly lethal and easily spread virus strains.

Think about it; if this virus subtype gets released it could potentially infect a third or perhaps all of all of us now alive and kill 60% of those whom it strikes. We have a world population of roughly 7 billion now, so that's somewhere between 1.4 and 4.2 billion deaths.

Yet many in the scientist community seems to think all the details of the research should be given to those responsible groups that need help with H5N1 HPAI.

I'm worried.

The PANDAS controversies

Thursday, December 22nd, 2011

We're not talking about this kind of Panda

The more I read about the relatively new syndrome PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus, the more I realize how complex the issues are that surround it. We appear to be entering a new field of medicine, one that holds enormous potential for unlocking the root causes of baffling problems in neurology and psychiatry

The story starts in the mid 1990s when Dr. Susan Swedo, now Chief of the National Institute of Mental Health's (NIMH)  Pediatrics & Developmental Neuroscience Branch , reported that childhood obsessive-compulsive disorder (OCD) may sometimes be triggered by a strep infection.  OCD may involve compulsive handwashing, twenty or thirty times a day; it can manifest itself as a need to have things "just so" in order to relieve anxiety, repeating and checking behavior, counting and arranging objects or clothing, hoarding, praying, reading a section of a story over and over again.

Some of these youngsters also have tics, involuntary movement disorders. Another subset just has tics, but no OCD.

A moving portrait of a child who fits this profile was published in the Los Angeles Times early this month. The boy involved wa a normal eleven-year-old sixth grader until he developed a strep throat. Then his behavior altered to the point where daily life seemed totally changed; he became obsessed with being clean  and afraid of germs to the point where he was unable to go back to school.

Increasingly these diseases and perhaps others are being linked by some eminent researchers to strep infections. A senior immunologist at the University of Oklahoma College of Medicine thinks the mechanism of PANDAS involves antibodies, released in response to a strep infection, that can bind to brain cells and cause the release of dopamine, a brain chemical which in excess, may be linked to OCD and tics. The diagnosis, at the moment, is strictly clinical; there is no lab test to confirm that a child has PANDAS.

One form of OCD involves repetitive handwashing

Many youngsters with OCD and/or tics don't appear to have this strep-related syndrome and some equally prominent academic physicians feel kids can have a mental health/neurological disorder first and just have it exacerbated by strep throat or other infections. Others want to treat the most severely affected of these children with antibiotics even if they don't have an active strep infection.

The NIMH makes the point that these children, as opposed to others with OCD and/or tics, have an abrupt worsening of their symptoms when they have a strep infection. They then will have a slowly improving course after a few weeks or months.

The guidelines are admittedly vague; NIMH says PANDAS can be "identified after two or three episodes of OCD or tics that occur in conjunction with strep infection."

A senior Harvard professor of psychiatry who is the head of the International OCD Foundation's scientific advisory board has been quoted as saying the portion of OCD linked to PANDAS is "exceedingly common."

Is this the tip of an iceberg of neuropsychiatric problems linked to infections? Only time and lots of research will tell.


Now we have PANDAS in the United States...unfortunately

Wednesday, December 14th, 2011

Those nodes are swollen

Until today I thought Pandas were black and white bears found in zoos or in small numbers in parts of China. Then I read a Wall Street Journal article titled "Does Strep Throat Trigger Serious Ills?" The concept being discussed was that of PANDAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus. I subsequently found a National Institutue of Mental Health (NIMH), article online about this unfamiliar, relatively new and bizarre condition in which children get neurological problems caused or flared by a streptococcal infection.

Let's begin this two-post discussion with an overview of strep throat, a bacterial infection most commonly seen in children between the ages of 5 and 15. Younger kids can certainly get this disease as can adults, but the typical kid in school has strep throat several times a year. It's important to realize that most (75-80%) sore throats in children aren't bacterial in origin, but if they are caused by streptococcal infection they can lead to severe consequences.

Among those are rheumatic fever with its attendant heart valve consequences and, less frequently, a significant kidney sequela, post-streptococcal glomerulonephritis (inflammation of the tiny filtering blood vessels in the kidneys). Both of these are seen worldwide with considerable frequency, but are much less common in the United States than in years past.

Why is that? Well, most of us who have healthcare (and I know that's far from all of us), would take our children to the pediatrician/family practice physician promptly if they had sudden onset of fever with a severe sore and red throat,  swollen lymph nodes in the neck and trouble swallowing (or even some of those). The doc would do a rapid strep test using a swab similar to that done for a throat culture and if that were positive prescribe antibiotics. If it was negative (it can be in about 5% of cases of strep throat, AKA strep pharyngitis), but the presentation and/or exam was suspicious, the physician would do a throat culture.

Those complications I mentioned are relatively rare. When they do occur they're due to an autoimmune reaction; that means the antibodies we produce to help fight the streptococcus can also, in some instances, attack our own tissues.. The theory behind that is called "molecular mimicry," a fancy way to say our heart valve, kidney, joint or brain tissue may have proteins that somehow resemble those of the bacterial cell wall.

after this you get a lollipop

There a PubMed Health review on treating strep throat, at least that caused by the bad kind of streptococcal bacteria. Their scientific name is group A beta-hemolytic strep sometimes termed GABHS. PubMed, by the way, comes from the National Institutes of Health's (NIH) National Library of Medicine and prints very solid material that I think you can rely on.

They looked at a series of articles on how best to treat strep throat, 17 trials with over 5,300 subjects, and concluded that good old-fashioned penicillin should be the first choice. It's cheap and no antibiotic resistance in GABHS has ever been documented. So unless you or your child have had an allergic reaction to penicillin, that's the drug your doc will likely use.

We'll get back to PANDAS next post.

It goes far beyond football, boxing and hockey

Wednesday, December 7th, 2011

The brain is vulnerable to trauma

I feel like I've opened the proverbial can of worms, finding, in this case, a topic that keeps expanding. I started with reading an article in The New York Times about the death of a professional hockey player, but I quickly delved into the medical literature.

I've spent much of the day reading article after article on traumatic brain injury  (TBI), which can be mild or severe, and another entity called chronic traumatic encephalopathy or CTE, one that's frequently been in the news over the last two years. Let's start with TBI. I'll be writing about teens and younger kids. I'll deal with CTE in another post focused on adults.

A Center for Disease Control and Prevention (CDC)  report in the most recent edition of the Journal of the American Medical Association reviewed nonfatal TBI related to either sports or recreational activities in kids age 19  or younger. The numbers involved were staggering, nearly 175,000 per year being seen in Emergency Departments (EDs).

A large majority of those sports and recreation-related TBI ED visits were by boys and the annual total of those ED trips increased markedly during that nine-year time frame. They were injured biking, playing football, soccer, basketball or while engaging in miscellaneous playground activities. They went to the ED in smaller numbers for injuries suffered in many other activities, including horseback riding, ice skating, ATV riding, tobogganing and even golfing (here the injuries included those related to golf carts). Surprisingly, skateboarding accounted for only a fourth of the ED visits for biking and football accidents and TBI was less frequently seen.

A helmet is a good start

As my wife and I drive around town, we often see college students riding their bikes at night while helmet-less and light-less. I fear for their brains.

There's another, less well-accepted entity, so-called "Second Impact Syndrome." I read an article about this in a February 2009 article by two authors on the faculty of the University of California, Irvine School of Medicine. In this scenario athletes who've had a TBI then have a second brain injury when they go back to playing their sport far too quickly. The initial injury may have been relatively mild; the recurrent trauma may kill them in a matter of minutes.

Another review of this  syndrome said 94 catastrophic head injuries had been reported in American high school and college football players in a 13-year time frame, 92 in high schoolers.  Seven of ten had a prior concussion in the same football season; over a third played with continuing symptoms.

This speaks to the crucial question of when an athlete (or a bike or horseback rider) who has suffered TBI should return to their sport/activity. Last night I called a younger friend who had been bucked off his spooked mare and suffered a concussion eight days ago. He was still having headaches and agreed with me that it was far too soon to get back on his horse.

A new CDC program called Heads Up offers TBI guidelines for coaches, parents and physicians.

 

 

 

More on the heatwave and its consequences.

Thursday, September 1st, 2011

Here's one way to cool off

This morning I read in the New York Times Breaking News that comes to my Kindle that NYC has recently seen an unprecedented number of heat-related deaths. The age range of the victims varied considerably; youngsters, a 45-year-old  woman and some elderly folk all were struck down. Today I'd like to concentrate on older adults.

You may or may not believe in global warming (I certainly do) and, if you do, whether humans are making a significant contribution to it. But in the meantime we seem to be experiencing a hot patch and we have to cope with that.

I got up fairly early, took Yoda, my Tibetan terrier, to Whole Foods to buy a sack of his dog food and then took him for a walk. All in 72 to 75 degrees on a day that will later see a 95+ degree peak temperature. And this is in Colorado at 5,200 feet elevation. I checked out temp predictions for Denver and for the mountains; the former will be just under 100 degrees later on today whereas those areas at considerably higher elevation will stay in the 70s.

But agewise, I'm also in my 70s, as of April, and therefore read with interest the National Institute on Aging's paper titled "NIH tips for older adults to combat heat-related illnesses." The basic concepts are threefold: we lose some of our ability to adapt to heat as we get older; we are in a group that frequently has underlying diseases/conditions that fare poorly in hot weather; the meds our physicians use to treat those diseases sometimes limit our ability cope with the  heat.

I'll add a link to the article below, but will paraphrase some of their points and add my own spin.

Firstly some of the physiologic changes we experience as we age limit our ability to respond to elevated temperatures. Those include our cooling via sweating or , in some cases, our limited mobility and, in other cases, our mental responses or lack thereof. Additionally, our ability to vasodilate small blood vessels may be compromised.

Then we're experiencing, as a nation, an epidemic of obesity and concurrently those who exceed their weight goal by a large amount experience more heat-connected problems. I searched medical websites for the rationale and, if I were a teenager, would have said, "Duh!" The layer of adipose tissue the obese accumulate is the equivalent of wearing an insulted suit, something you wouldn't want to do in the heat of a summer day.

And then there are all those medications we take as we age. One article I found said older people take 2 to 6 prescribed drugs while also taking a number of OTC medications. Those drugs can directly alter our response to heat while potentially causing increased body temperature in a number of other ways, e.g., hypersensitivity reactions or the pharmacological action of the drug itself.

That helps

So if you're an older adult, avoid the heat of the day, get enough fluids and, if necessary, contact the Low Income Home Energy Assistance Program (through HHS) for help with home cooling.

http://www.nia.nih.gov/NewsAndEvents/PressReleases/PR20110718hyperthermia.htm

Can there be long Life without Life?

Tuesday, August 30th, 2011

A "fountain with Youth" that's real

I was reading two articles, in our local paper last weekend when I realized I was channeling Yogi Berra and his famous quote, "It's déjà vu all over again. What's happened is a return to Herodotes, the Greek historian (5th century BCE) who told of a fountain in Ethiopia responsible for extraordinary lifespan and to Ponce de Leon, the Spanish explorer who traveled on Columbus' second voyage (1493) and described the Fountain of Youth, supposedly found in Florida.

Now we have a huge contingent of baby boomers (estimates in the 70 million range) who are about to reach 65 and don't want to grow or look older. The market for anti-aging remedies is currently about $80 billion a year and is expected to top $110 billion in the next four or five years. We live in a society that worships youth and many of our compatriots are being sold magic potions that some claim will prevent aging or at least most of its signs.

One of the articles had an amazing photo of Dr. Jeffrey S.Life, age 72, a body builder and author of a book titled The Life Plan: How Any Man Can Achieve Lasting Health, Great Sex and a Stronger, Leaner Body. You can buy this $26 book for $14.94 on Amazon, but I think I'll skip it.

Dr. Life's program includes diet, exercise and a healthy lifestyle; it also features, for at least some of his patients, injections of human growth hormone (at roughly $15,000 a year) plus testosterone.

The data on these hormone replacement regimens is, to say the least, not as rock solid as Dr. Life's toned torso. The NIH has a division called the National Institute On Aging (see link below), and the Geriatrician who heads this organization is solidly against widespread use of hormone replacement therapies.

http://www.nia.nih.gov/

What makes sense to me is exercising regularly, staying lean (or getting there) and stopping smoking. I noted that Dr Life's mentor died at age 69, a long ways short of my physician Dad's 94-year lifespan. Dad ran most days until his late 70s, stayed trim and quit smoking as a young doc when he realized he had three cigarettes going in three ashtrays in his three-room office.

lots of these out there

I think many baby boomers and others would like to find a magic bullet, a tonic or elixer that would allow them to eat what they want, do what they want and live to 100.

Until you show me a long-term, controlled study that points that way, I think we're as shy of the Fountain of Youth as we were in the days of Ponce de Leon or Herodotes.

Eat less and spend your money on a health club membership or a pair of running shoes instead.

Will this work and is it safe?

Tuesday, July 5th, 2011

The ultrasound said 9 pounds

I'm still digesting Taubes's work with mixed feelings, but his concept that insulin is central in the obesity epidemic took on a new meaning today. I was reading the "Health & Wellness" section of The Wall Street Journal and came across an article titled "Programming a Fetus for a Healthier Life." I was intrigued and read further, finding the U.K. government is backing a research effort in the realm of "fetal programming," changing the uterine environment during pregnancy in an attempt to better a child's health for the better in later years.

This is new turf for me and normally not an area I would have written about; in this case, however, the experiment, thus far only in its early stages, hopes to prevent obesity.

The underlying concept is the work of Dr. David J. P. Barker, who published a theory in 1997 termed the "thrifty phenotype," saying that in poor nutritional conditions, a pregnant woman can modify the development of her unborn child such that it will be prepared to survive in a resource-limited environment. The extension of this says reduced fetal growth is associated with a number of later-life chronic conditions.

Barker is now both Professor of Epidemiology at an English university and Professor in the Department of Cardiovascular Medicine at the Oregon Health and Science University. In 1995 his theory was renamed as the Barker hypothesis by the British Medical Journal. Now it's being applied in a very different setting.

a model of human insulin

The study is attempting to enroll obese pregnant women, 400 of them, in a trial of an oral agent called Metformin, normally utilized to treat type-2 diabetes, to lower their blood sugars, which tend to run higher than normal. The thought is that glucose is passed on to babies in utero and they then end up larger than normal birth weights and elevated insulin levels, setting the stage for lifelong obesity.

Dr. Jane Norman, a maternal-fetal health specialist at the University of Edinburgh is a lead investigator. A prominent US specialist, on the board of the 2,000-member Maternal-Fetal Medicine Society and not involved in the study, says he'd have no qualms about his patients joining the Metformin-taking moms-to-be.

I searched the literature and found the following

"Does metformin cause birth defects? Is it safe to take it during the first trimester?

Most studies suggest that metformin is not associated with an increased risk of birth defects. Some early trials suggested that the use of metformin during the first trimester was associated with an increased risk of birth defects. However, it is not clear whether these were caused by metformin or poor control of the mothers’ diabetes. More recent trials studying the safety of metformin during pregnancy, mostly when used to treat insulin resistance in women with PCOS (polycystic ovary syndrome), did not show an increased rate of birth defects or complications at birth."

So the concept appears to be a reasonable test of whether the uterine environment can be safely altered with a drug to prevent obesity.

Wow!

Reading Taubes: part one

Saturday, July 2nd, 2011

Avoid white bread

A while back one of my blog readers asked if I had ever read Taubes. I wasn't sure if that was a book title, a diet plan or an author, so I Googled the word and eventually purchased two books written by a veteran science writer, Gary Taubes.

Taubes studied applied physics at Harvard and areospace engineering at Stanford, then wrote articles for Discover and Science plus four books. He looks for scientific controversises and wades into them. In July 2002 he published an article in the New York Times Magazine titled "What if it's All Been a Big Fat Lie,"

The article takes us back to the Adkins diet craze. Dr. Atkins, trained in cardiology, was significantly overweight and used a JAMA study as a basis for his own personal diet plan. He then published two books urging dieters to severely limit carbohydrate consumption. At one point it was estimated that one out of eleven North American adults were on his diet. His company made over $100 million, but filed for Chapter 11 bankruptcy in 2005, two years after he died.

Taubes explores some of the same turf, saying it's refined carbohydrates that make us fat. His initial plunge into the field was the NYT piece, followed by a 2007 book, Good Calories, Bad Calories and now a 2011 book, Why We get Fat: and What to do About It.

Taubes has hefty credentials as a science writer; he is the only print journalist to have received the Science in Society Journalism Award three times. Currently he's a Robert Woods Johnson Foundation investigator in Health Policy Research at UC Berkeley's School of Public Health. But his initial article ignited a firestorm. In the piece Taubes mentions that the common veiwpoint links the kickoff of the obesity epidemic  (in the early 1980s), to cheap fatty foods, large portion servings (at commercial establishments presumably), an increase in food advertisements and a sedentary lifestyle.

He would beg to differ, invoking what he terms "Endocrinology 101," an explanation that says human evolution was not designed for a high-sugar, high-starch diet. Until a comparatively recent era (roughly 10,000 years ago) we were not agriculturists, but hunter-gatherers. So Taubes thinks the problem is our increased consumption of sugar, high fructose corn syrup, white bread, pasta &  white rice.

Others think he picks and chooses his facts. I don't think he's wrong in his basic premise, but he also disagrees with the ideas of "calories in; calories out," avoiding saturated fats and exercising being important in weight control (He seems to think people who exercise then hurry off to eat more).

more than one way to "thin a cat"

I'm down thirty pounds since early in 2009, have easily kept the weight off by exercising six days a week, avoiding sugar & HFCS foods and eating lots  more veggies and fruits while cutting back on portion size of meat dishes.

I'll read more on Taubes and his detractors and let you know what I agree with and what I don't.