Why I’m letting the latest big debate in nutrition wash over me

For quite a long time, there has been quite a debate going on in some nutritional circles about what causes obesity and how we should tackle it. One faction has argued that dietary fat is the main offender, and the solution is a diet that is low in fat (and calories). Another faction (of which I’d say I am a member) typically argues that carbohydrate is more of an issue, specifically forms of carbohydrate that provoke much in the way of secretion of insulin – a hormone that stimulates the deposition of fat in the fat cells.

In quite recent times, the debate appears to have shifted somewhat, in the blogosphere at least. The ‘low-carbers’ now find themselves more in a debate with those who popularise and believe in the notion that obesity has something to do with ‘food reward’. I might mangle this, but food reward is essentially the pleasure one derives from eating certain foods. The more rewarding a food, the more we tend to eat of it. In general terms, chocolate biscuits are a high reward food while raw almonds, say, are low.

One part of food reward theory states that different people derive different levels of reward from a specific food and that, overall, obese individuals derive greater reward from food and are basically driven to eat more than lean individuals. The food reward concept has been popularised by several people, of whom Stephan Guyenet over at the Whole Health Source blog is one of the most prominent. As an aside, I have a lot of time for Stephan and have learned a lot from reading his blog.

To be honest, I’ve engaged hardly at all with the ‘low-carb’ v ‘food reward’ debate. I actually think there’s a lot to the food reward concept, but one of my main interests in practice is helping people takes step to improve their health and, for me, low-carb principles are generally highly useful and effective here.

So, if I see someone who wants to lose weight, and I see their diet is rammed full of carbohydrate, I’ll usually talk about the impact of this sort of food on insulin and the effect of insulin on fat storage. Now someone has a tangible explanation for their weight issue that goes way beyond the ‘you’re a bit greedy and need to exert more self-control’ line. Plus, the solution is self evident. And most importantly of all, the vast majority of people in this situation who scale back their carbs will enjoy satisfying weight loss, enjoy what they’re eating, and not be preoccupied with hunger.

Imagine, though, if I bought wholeheartedly into food reward theory. What are my and my patients’ options now? Do I basically tell overweight individuals that they’re eating food that’s ‘too rewarding’, and what they need to do is eat a bland diet or something similar? I’ve never done this, but I’m not sure how well it would land, generally speaking. I don’t know, but I’ve got a feeling many would not find this much of an inspirational message.

The impact of competing dietary theories on the ground came home to me this week when I received an email from a 48-year-old lady. She has had evidence of diabetes in pregnancy, and her mother was diagnosed with type 2 diabetes later in life. Ordinarily, this is just the sort of person I would recommend eat a low-carb or ‘primal’ diet. She had, in fact, taken it upon herself to do this, and was enjoying very good blood sugar control. She’d also successfully lost weight with this approach.

She’d recently read about food reward theory (and, I assume, the notion that carbs aren’t so bad, after all). She put more carb back into her diet in the form of yams (a root vegetable). Guess what? Her blood sugar levels spiked as a result. Her email asked for my opinion and advice.

I told her that for someone with her history, I’d generally advise against much in the way of starchy carbs. It makes no different to me, quite frankly, whether yams for her are a low or high reward food – when she eats them, her blood sugar levels go out of whack. This is really all that’s important. Dozens of researchers and bloggers can (and do) theorise all we like about what causes obesity and what to do about it, but at the end of the day the only thing that truly matters for this lady is that she does not tolerate carbs at all well, and that eating less of them allows her to control her weight and her tendency to diabetes.

In many ways, this lady is a perfect embodiment of why I feel a bit detached from the ‘low-carb’ v ‘food reward’ debate. With people like this her (and many, many like her I might add), I believe no debate is necessary.

32 Responses to Why I’m letting the latest big debate in nutrition wash over me

  1. Kirsty 23 September 2011 at 12:51 am #

    Great article. I’ve been really confused by the food reward “debate”. It seems to me to boil down to some people enjoy food more than others. I especially don’t get why it’s food reward vs low carb. The food reward theory has nothing to do with how your body creates, burns or stores fat. I find it a profoundly uninteresting discussion.

  2. Dana 23 September 2011 at 1:26 am #

    I think food reward only matters when the food that’s rewarding is a food that borks up blood sugar and drives fat storage. Something Guyenet and his followers seem to have missed is that a ribeye steak is high reward, and yet if that’s all you ate every single day, you probably wouldn’t get fat.

  3. kem 23 September 2011 at 2:14 am #

    For some people, debate (for anything!) is necesssary.


  4. Lori 23 September 2011 at 3:17 am #

    A diet that tastes good is easier to stick to as well. To me, [fill in fatty meat] topped with [fill in fatty topping] trumps bland potatoes, rice and pasta for taste every time.

    I read Guyanet’s post on food reward, and have to say I didn’t understand much of it. But aren’t the traditional Mediterranean diets (the real ones with fatty meats, sauces, cheese, butter, lard, olives, etc.) a paradox? And a typical American Midwestern diet of overcooked meat, boiled veg, potatoes and no seasoning (think mouth-numbing bland), eaten by a mostly overweight population, isn’t this another paradox?

  5. Amy Dungan 23 September 2011 at 4:26 am #

    Excellent post Dr. Briffa. I feel the same way. Ultimately, it’s about helping others find the answers to improving their health and losing weight.

  6. Judith Fage 23 September 2011 at 9:25 am #

    Well, I think there is an element of commonsense that has to be exercised here. I am someone who has always done well on a low carb diet, and my ideal meal is a stir-fry with meat or fish,and a variety of good low carb vegetables. But like most people I do have some ‘reward foods’ which have to be limited. Cheese is one – I remember agreeing totally with someone on Desert Island Discs who asked for a whole Manchego cheese as their luxury! I could probably eat it all in one go! Kettles lightly salted crisps are another. And wine! But like many people I try to resolve this by moderation (eg crisps only when offered by hosts!)and by replacing with other better reward foods. If I were diabetic I might have to be more absolute, but if you have a basically satisfying diet with plenty of protein and good oils, it’s much easier to control the less beneficial reward foods.

  7. Jessica 23 September 2011 at 9:50 am #

    I think the ‘food reward’ theory oversimplifies the truth.
    Whenever I’ve taken sugar and refined carbs out of my diet I’ve invariably found that after a few days, other food (meat, vegetables, etc) taste amazing, with more depth and complexity of taste than they ever had before. It’s like in the Wizard of Oz, when Dorothy’s world goes from black-and-white to colour, or like the difference between eating with a bad head-cold and without. A friend of mine who practises Chinese medicine tells me that an excess of sweetness is said to deaden the taste buds. (And they didn’t even have refined sugar in ancient China!) When I’ve been sugar-free for a while, even naturally sweet foods like carrots or apples taste unpleasantly sweet to me.
    Conversely, when I’ve fallen off the wagon and started eating sugar again, sweet foods don’t taste good to me – just very, very sweet. It’s only after I’ve become re-addicted to them that they taste good (and the ‘good’ stuff tastes boring again).
    Andy Warhol said the main course was just something he had to get through in order to reach the dessert. That’s how a lot of us feel, I suspect, when we habitually overeat sugar and ‘white’ foods.
    There’s also the psychological factor of childhood conditioning – ‘Eat up your vegetables and you can have your lovely pudding’!

  8. John Walker 23 September 2011 at 10:00 am #

    The low carbers just don’t seem unable to win. I don’t discuss it with anyone any more, as I am usually the source of amusement when I try to explain the effects of insulin. True, I am not a Doctor, but even I can understand it, and explain it. But it’s a losing battle. For enjoyment, (and the lovely Cornish scenery) I watch Doc Martin on the TV. But even here they don’t miss a chance to push the ‘message’ that fat makes you fat; protein gives you acidic blood! I don’t know about the latter point, as I can’t find much about it to educate myself. In any case, mistrust most established theories now that I am losing weight on low carb.

  9. John Walker 23 September 2011 at 10:04 am #

    Correction.. “Unable to win”
    “I mistrust”. Sorry folks!

  10. Anne Robertson 23 September 2011 at 10:53 am #

    I put on weight by eating seriously unrewarding food which I was told was good for me (potatoes, pasta, etc.) and lost it again when eating what I really enjoy. If I ate the food Stephan Guyenet eats, I’d be fat again. I think he’s making a mountain out of a molehill and upsetting a lot of people on the way. Even Kurt Harris has gone weird, eating Rice Krispies for breakfast!

  11. George 23 September 2011 at 10:55 am #

    10 years ago (2002) I tried to stop my growing middle age spread. Obviously it was “the saturated fat”! 6 years of BORING porridge,fruit,wholemeal bread,dry chicken breasts,lettuce,etc. NO yummy bacon,cheese,cream, butter or eggs!! (I used to dream of eating butter!)

    6 years later (2007), 40 pounds HEAVIER, I had FAILED miserably (despite daily 3 mile runs! and the London marathon in 2004)I was getting FAT!!

    Well for the last 3 years I have maintained a fantastic 50 pound loss with YUMMY AND DELICIOUS AND REWARDING fatty meat,oily fish,eggs,cream, cheese, butter, salads and vegetables. My food is rewarding and delicious! I look forward to my meals. I stay lean and trim. I have a 6 pack!! (I’m 60!)

    Food reward theory??? Not for me!

    Guyanet:0 Briffa:1

  12. Catherine 23 September 2011 at 11:07 am #

    I think its interesting that you have raised this issue John. I agree with you that a lot of people in practice seem to do well on a low carb diet and indeed many of the studies you have written about point to this. On the other hand I do think that the food reward hypothesis also has much to offer in practice. For example in working with some people who are considerably overweight there does seem to be an addiction to food. Certainly I think the prospect of a bland diet does not go down that well but I wonder about the benefits of a bland diet for a week or so to treat the food addiction and get people to be more satified with simple primal food. I also note of myself when I have experimented with a bland diet that natural, simple foods become much more enjoyable. I also notice that if for example I eat a flavoursome curry that I am far more likely to eat a greater quantity of potatoes or rice and indeed am more likely to eat a greater quantity of food overall. My point is that I feel both have validity in practice.

  13. Barry Murray 23 September 2011 at 12:31 pm #

    I’m totally with you on this one. In fact, to extend it even further, I would almost let all weight loss theories wash over. The simple fact is that no one dress size fits all. Therefore, “low carb”, “zone”, “food reward”, “intermittment fasting”, “Paleo” etc etc… all have their merits but don’t necessarily work for everyone. The clever thing to do is to apply the principles of all these “diets”, find out what works for you, tweak and adapt.

    In relation to the Food Reward/Set-Point theory thing. Guyenet is definitely on to something. Much the same way fatigue is governed the brain (Central Govenor Theory)and not by energy levels or fitness, the same is potentially true for weight and fat metabolism. Regardless of how evidence based and research proven this Food Reward mechanism becomes, the practical issue will always dictate its affect. That is, who the hell wants to live life without seasoning their food, spices in their curries, herbs with their fish, dressing on salads, butter on their potatoes, marinating their meats.. the list goes on ! Surely there has to be other, sustainable and enjoyable ways of eating food where people can manage their weight ??? Thankfully, there is, and your little example here proves this.

    Right, I’m off to cook my bacon and eggs with some butter, herbs and seasoning 😉

  14. Catherine 23 September 2011 at 1:46 pm #

    However, one problem I do see with this whole debate is that the model of balancing blood sugar that we have used for so many years works well as we can link the symptoms with the pattern of eating and once people understand and experience the link between this way of eating they are careful to control the carbohydrate or the glycaemic load and it becomes a lifestyle. However in explaining how this model works we talk about the impact of insulin. Now if we view insulin as an anti-obesity hormone as Stephane Guyenet says it becomes impossible to reconcile with this model and rather opposes the blood sugar model which as you say works well in practice. I think there is something about linking a way of eating with immediate symptoms rather than long term weight loss. At the same time with the advent of manufactured low carb foods there is maybe the potential to eat low carb whilst maintaining a food addiction.

  15. George 23 September 2011 at 2:59 pm #

    For optimum health at a particular latitude; an individuals carb intake should be proportional to an individuals Vit D level?

    So if you artificially supplement up your D, for best health you then need to eat ‘lower latitude'(ie. higher carb)

  16. andy 23 September 2011 at 3:23 pm #

    What scientist and most ppl consider low fat diet (calories from fat under 30-35%) is not really low fat, and therefore it does not produce desired benefits or advantage against higher fat intake. However, low fat diet should be only considered when fat intake is reduced to under 10%, like is reocommended by Dr. N.Barnard, Dr. McDougall and Dr. Esselstyn and some others. Dr. barnard and Dr. Mcdougall manage to reverse diabetes on by reducing fat intake to under 10%.

  17. TokyoMum 23 September 2011 at 6:25 pm #

    Rewarding in what context? I think what Stephen is tryin to say is eating a bowl of pasta is more rewarding than a bowl of plain boiled potatoes. But that bowl of potatoes is much healthier for potatoes are rich in minerals and nutrients, altho low in reward, while pasta has no nutritional value, but higher in reward so you can eat lots of it. He didn’t say it like that, just my interpretation. Of course, he also recognises that a low carb diet is better for glucose control IF you have a metabolic issue. For those who are healthy and have no metabolic syndrom, eating safe starches is fine, that is why Kurt Harris eats unsweetened puffed rice krispies with half and half, and Paul Jaminet of the Perfect Health Diet recommends rice and root veggies as part of a healthy diet. The key is safe carbohydrates or starches. So no pasta, or wheat or gluten. I am glad I can eat risotto and roast potatoes again as I don’t have metabolic problems. So I hope folks without the same issues have no fear and enjoy eating their potatoes again.

  18. Lucy 23 September 2011 at 7:36 pm #

    I’m a vegetarian and although I eat some dairy I will never eat meat or fish. What can I do to stay low-carb? I really need lentils, beans etc in my diet. Help!??

  19. Galina L. 23 September 2011 at 10:43 pm #

    I can testify that bland diet doesn’t make people thin. Bland diet is the standard treatment in Russia for people with allergies, gastrointestinal issues, kidney issues. I spend most of my childhood on it due to eczima. The rules of the diet – food should be cooked by boiling or steaming, not pan-fried or smoked, low in salt and without spices except small amount of garlic, onion and herbs, tomatoes and vinegar are very limited, no chocolate, oranges, strawberries,pineapples. By the way, it works for allergies but doesn’t cause a weight-loss. I never been a fat child or a teen, but slightly on a chubby side all my life. Probably, after such diet background, I consider salty foods to be very rewording, even though food with too much flavor tastes often too strong for me. I can binge-eat on things like prosciutto and content of salad and olive bars and try to avoid it.
    Nowadays at 50 I manage my health and weight on a LC diet. Somehow LC eliminates hunger for all sort of foods and is a real help for allergies, pre-menopausal issues, migraines,mood-swings, seasonal colds and much else.
    I think ,after Steven’s attempt to promote FR theory ,few fatties tried to experiment with it, gained some weight, shrugged, and returned to their low-carb life. FR could be used as an addition to LC, but not as the main strategy to put somebody’s health in order.

  20. Gabriella 24 September 2011 at 12:47 am #

    I enjoyed reading Dr. Briffa’s blog and all of your comments. Thank you, Dr. Briffa!
    Because of a relative ill with ALS (AKA, Lou Gehrig’s Disease), I have become interested and done a lot of reading about the influence of toxic metals and substances we are exposed to in the environment and eat in our foods. A recent hair analysis for that ill relative found that she is carrying a truly enormous load of aluminum in her system, a level which would explain ALS.
    I recently read a very interesting article on the subject. Here is the link: http://www.westonaprice.org/environmental-toxins/mad-as-a-hatter
    While I totally agree with a low-carb diet and Dr. Briffa’s comments and ideas, I have discovered there is a whole ugly world of toxins out there that have a direct and nasty impact on your health even with the best of diet. In summary, I believe that good diets should go hands-in-hands with detox protocols.
    Your comments, please?
    Thank you all, Gabriella

  21. amanda 24 September 2011 at 7:19 pm #

    I found the whole series by S. Guyenet on food reward very interesting and read each section carefully. If I remember rightly, he specifically says that people with diabetes will need to watch their carbs. I don’t understand what your problem is here!
    As far as I understood the argument, whichever foods provoke the food-reward reaction differ from person to person, but, generally speaking, they will tend to be highly flavoured foods and energy-dense foods. What’s more, it is more ikely to be store-bought foods which cause this reaction.
    My take-home message was that it would be advisable to avoid processed foods as these can lead to the kind of binge-eating attacks that almost inevitably lead to people getting fat.
    I don’t understand why you find these arguments so offensive and wrong!

  22. Ivan 24 September 2011 at 10:17 pm #

    Why oh why oh why!!! Maybe it’s just me but I thought the food reward rather simple. Stupid me. I thought the idea was (GASP) that over-flavoured food often eaten by people who have no palette (typically processed stuff) fools your body into eating too much – something to do with sweet/fat/etc being associated with high nutrition. BTW Boring high-carb food like pasta, etc., can also be high reward, as I understand it – and that is my experience – it is unsatisfying.
    Bascally, my understanding of the food reward idea for ordinary folks is this – rediscover/stop ruining your palette and you will actually taste your food.
    You will eat less but enough for a healthy weight – there is a natural point when the more you eat the less you taste the food, probably because your body is satisfied with the nutrirional intake – so why on earth eat more?
    Guess what? If you get hungry later, you can eat something else to an ammount you ENJOY. ‘Bland’ was an unfortunate term to use as people mistakenly think that means unpalatble. But it is the other way around to me. If you have to strongly flavour something, do you actually like it? Why are you eating it? Why not eat the flavouring – try it and see what your body really thinks.
    My take on it is this: (for example) I LIKE gin, and I know which gins I like. As I like it, I don’t need to flavour it. Why would I add nasty tonic? If there is a lemon in the house, I’ll have a sltiher of peel sometimes. When I am in that sort of mood.
    I like good quality eggs – a plain omelette is nice, with a little chutney on the side sometimes. I like cheese – I eat it by itself. Sometimes I combine cheese and eggs – but generally I’m not that hungry – if I am it’s likely I’ll be bothered enough to make a quiche. Smoked salmon – a little squeeze of lemon juice. Parma ham – fine by itself. I like a hot chilli now and again – but red kidney beans – does anyone really like eating them? Maybe that’s why people need such strong flavours (they don’t like what they are eating?)
    Funnily enough, I enjoy my food, and have never been overweight – apart from when I stopped smoking once and ate loads of salty and sweet rubbish. Cognac and stout are also very nice all by themselves – although they are probably high reward foods. I suppose that’s that 80/20 rule.
    Liver – onions go very well – and bacon too – why not? A few spuds too. Sometimes I like a heavier pinch of salt, sometimes I don’t.
    The nutshell is: Taste the food first, flavour it second. Keep it simple.
    And if you want ice cream – have proper, good quality, simple vanilla ice cream – and have it with something like rhubarb crumble – works for me.

  23. Richard 25 September 2011 at 4:42 am #

    I suspect there is less to this debate that people make out. No one is disputing that low-carb (at least empirically) is an effective treatment for metabolically deranged individuals. Physicists use the term hysteresis (http://en.wikipedia.org/wiki/Hysteresis) to describe systems where there is a path dependency and I think we are seeing something similar in the distinction between cause and treatment. I think the real issue here is that paleo/ancestral research has nothing directly to say about treatment, since there is no significant data on civilisations that transitioned from an obese state to a lean one. At best we can study the opposite and hope to gain some insight by reversing the behaviours that lead to the transition.

    Dr Guyenet is primarily interested in cause (why we get fat) and the food reward theory seems an interesting area of research (I don’t pretend to understand it and suspect there’s a lot of work to be done before we start seeing authors popularising this work). I suspect Taubes is much more relevant on the treatment (and what to do about it), though a lot of his most powerful prose comes from case studies of societies that have gotten fat.

    I have a lot of respect for Taubes, before I read his books I would not have been interested in reading a “diet” book and now it is my obsession. His books have undoubtedly improved the lives of many and if a bit of rhetoric and oversimplification is required to do that, so be it.

  24. Lance Strish 25 September 2011 at 2:06 pm #

    Guyenet has said on record low-carb may even be backward:
    “I hope you can see by now that the carbohydrate hypothesis of obesity is not only incorrect on a number of levels, but may even be backward. The reason why obesity and metabolism researchers don’t take Taubes’s idea seriously is that it is contradicted by a large body of evidence from multiple fields. I understand that people like ideas that “challenge conventional wisdom” as the GCBC book cover states, but the fact is that obesity is a complex problem and it will not be shoehorned into simplistic hypotheses.”

    What do you make of this ‘physiological insulin resistance’ (going too low carb, eating high fat foods)

  25. Clair 25 September 2011 at 4:53 pm #

    I wonder if the supporters of “reward theory” have ever had a weight problem themselves. As someone who has lost 60 lbs on low carb and found maintenance easy, I find these new arguments totally academic and detached from reality.

  26. John Briffa 25 September 2011 at 6:01 pm #


    I don’t understand why you find these arguments so offensive and wrong!

    I don’t find these arguments at all offensive or wrong. My issue is that they are, for a lot of people, academic (and I use that term in the broadest sense).

  27. Bill 26 September 2011 at 8:54 pm #

    I am not bothered about the pedantics about diet. I know that for me, my diet works.
    I’ve followed John Briffa’s advice and other LCHF proponents and filtered out what works for me.
    I’m probably closest to Kurt Harris of archevore.com with my regime.

    I eat twice a day with an occasional 24 hour fast. My food is spicy, e.g. turmeric, ginger, and chillies, flavoursome and nutritious. Lots of fat from butter, evoo and full fat yoghurt.

    I’ve been totally grains free for 4+ years. Not one cheat.
    I’m 57 and surrounded by friends, family and people in general, who are relatively “unhealthy”. Especially those past 55.
    Up to date, I have yet to persuade any of them to follow my dietary way. I hear so many times that heart disease, athersclerosis, bowel disease, arthiritis and weight gain runs in the family.
    I’ve loaned out books including Waist Disposal to more than a dozen people with serious health issues.
    Not one has been able to go grain free or will contemplate it. They tell me I’ve been lucky, even my 3 brothers who are prime examples of “wheat belly”.
    A 63 year old female relative had a 90% blocked carotid artery. Blackouts, sight problems etc. Successfully operated on. Formerly slim, she is piling on weight, probably from the arsenal of drugs she takes for her “condition”. Her Vitamin D levels were very low, after I pestered her to get tested. Still not supplementing. Her father died from a heart attack with blocked arteries, her brother at 61 had stents fitted to his heart.
    Yet none will give up bread and grains for a month to see if it helps even or supplement with vitamin D.

    What is it with people? There seems to be a helpless fatalism with the vast majority. Doctor’s orders and drugs prevail….

    It’s so frustrating, knowing that dietary change could, I strongly believe probably would, make a great positive difference to most people.

    Here’s personally hoping for my n=2+ instead of the lonely, so far very healthy n=1.
    It’s almost making me ill!

  28. Sue Collison 27 September 2011 at 3:38 pm #

    I’m with John Walker on this. I’m afraid I’ve given up talking to people about the harmful effects of starch in our diets and find it most irritating to have the low fat theory perpetuated in t.v. programmes – it is disheartening but I suppose we should still keep trying.
    Bill, my sympathies are with you also.

  29. Jayson 8 November 2011 at 1:19 am #


    If you seriously believe breads & grains cause heart disease, bowel disease, atherosclerosis, and NOT the high fats you eat, you need to do a lot more research.

    Relying on a book that’s basically the same as the Atkins low carb high fat diet book, can only mean you have no idea how to look after your own health without the latest diet book tucked under your armpit.

    My god, just reading the comments made, I can only come to the conclusion that you, and the majority of the commentors here, are so gullible you’ll believe any latest diet/fad that hits the bookstands as being gospel. I’m sure when the next high fat low carb/no carb diet book is published, you’ll all rush out and buy it too.

    Guess what people. Nutritional grains, brown rice, legumes etc, have been around for a long long time. They also contribute to a persons good health and well being quite nicely when eaten in moderation.

    The only time they’d be a problem to health, is when a person has an intolerance/allergy to them, suffers from celiac sprue, or as in most cases, stuffs their mouths with too much of them.

    Controlling your weight does not mean having to cut whole grains and carbs. That’s the easy way out with short term gains, and I might add, a great boon to all the diet book authors out there.

    Fact.. Even though some of you swear you’ll only eat fatty meats and fatty foods and no carbs, a sickly eating regime at best, it won’t be long before you return to eating grains and carbs.

    Good lord. Common sense and controlling portion size is all that’s needed for weight control. If you people have not figured that out by now, You’re shelves will eventually be filled with every diet book that’s been published, and you’ll still be at square one.


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