"The edibility...,": Ohlson et al. 1955:173. Footnote. Ibid.

Ohlson initial y tested: Cederquist et al. 1952 ("subjects reported lack...").

"Without exception...": Ibid.

Over a ten-year period: Ohlson et al. 1955 ("dry, uninteresting...," "sufficient to provide...," "uniformly," "did not appear...," "they also appeared...," 185).

"can only mean that replenishment...": Ibid.:177.

Young tested diet on women: Young 1952 ("unanimous in saying...," "despite an unusual y," "reported that their skins...," "No excessive fatigue..."); Young et al. 1953. Male students: Young et al. 1957 ("in every case").

Bruch noted: Bruch 1957:353,37176.

Leith reported: Leith 1961.

"To be honest...": Interview, Per Bjorntorp. "There's no point...": Interview, George Bray.

"excessive fatigue...": Cederquist et al. 1952.

"The absence of complaints...": Wilder 1933 Bistrian and Blackburn reported: Palgi et al. 1985. "People loved it": Interview, George Blackburn. For confirmation of the absence of hunger, see Wadden et al. 1985. Footnote. Dietz 1989.

1000 calories: Rabast et al. 1978; Rabast et al. 1979. 1,200 calories: Krehl et al. 1967. 1,320 calories: Gordon et al. 1963. 2,200 calories: Palmgren and Sjoval 1957. More than 2,700 calories: Milch et al. 1957. "encouraged to eat...": LaRosa et al. 1980.

Comparisons with low-calorie diets: Hanssen 1936; Palmgren and Sjoval 1957; Silverstone and Lockead 1963; Pena et al. 1979 ("eat as much...").337 Kemp's three papers: Kemp 1963 ("One is that other...," "a working hypothesis...," "possible for the first time..."); Kemp 1966; Kemp 1972.

Beginning in 1956: Kemp 1972.

Atkins diet: Atkins 1972. The five adult studies: Brehm et al. 2003; Foster et al. 2003; Samaha et al. 2003; Yancy et al. 2004; Gardner et al. 2007 [the Stanford study]. The adolescent study: Sondike et al. 2003.

In two of these studies-Foster et al. 2003, and Gardner et al. 2007-the investigators also included a comparison of weight maintenance at the end of a year. In the former, those randomized to the Atkins diet maintained a greater weight loss than those a.s.signed to the low-calorie, low-fat diet (4.4 6.7 vs.

2.5 6.3 percent of initial body weight), but the difference was not "statistical y significant." In the latter, those randomized to the Atkins diet maintained, on average, a 10.4-pound weight loss, compared with 5.7 pounds for a "lifestyle" program that included both a low-fat, low-calorie diet and exercise. The difference between these numbers and the larger numbers that Kemp reported could be due to the fact that these modern studies were more rigorous in fol owing up on patients and measuring weight. It could be because the modern studies provided no counseling after the first two months of the trial, whereas Kemp categorized patients as having "defaulted" if they did not continue to appear at his monthly counseling sessions. Perhaps for this reason, the carbohydrate restriction after the first couple of months in the modern trials was at best modest. In Gardner et al. 2007-see p. 973 (table 2)-the subjects randomized to the Atkins diet consumed, on average, 30 percent of their calories from carbohydrates at six months, and 35 percent at twelve.

This problem was particularly significant in the one trial I omitted: Dansinger et al. 2005:46 (table 2). Here the subjects randomized to the Atkins diet consumed an average of 137 grams of carbohydrates per day (32 percent of calories) after only two months of the trial, and 190 grams (over 40 percent) at six months and a year-the equivalent of four to five large baked potatoes every day-effectively identical to subjects randomized to low-fat, low-calorie diets. Thus, the similarity in weight loss on the different diets in this particular trial may simply reflect the similarity in carbohydrate consumption.

"first published synthesis...": Bravata et al. 2003.

"Calories are al alike...": Quoted in Berland 1983:7. "the effect of specific...": Rubner 1982:36.

Bistrian and Blackburn instructed: Palgi et al. 1985. "thousands of patients...": Interview, Bruce Bistrian.

Paradox relating to hunger: Leith 1961 ("nagging discomfort"); Pena et al. 1979; Hanssen 1936; Krehl et al. 1967 ("more than amply satisfied"). "Isn't the proof...": Interview, Bruce Bistrian.

Sims's overfeeding experiments: Goldman et al. 1976:167.

Bloom's articles on starvation therapy: Azar and Bloom 1963 ("At a cel ular level..."); Bloom and Azar 1963.

"little hunger": Bloom 1958. "In total starvation...": Keys, Brozek, et al. 1950:829. "The most astonishing aspect...": Drenick et al. 1964. "The gratifying weight loss...": Anon. 1964c.

"mighty stimulant...": Pennington 1954. "Many individuals spontaneously...": Dwyer 1985:185.

"The fact remains...": Anon. 1973.

"If you put a restaurant-size...": Mayer 1975a:3031. Fal back for the NIH recommendation: Ernst and Levy 1984:73334; interview, Wil iam Harlan.

"Yudkin showed that...": Interview, George Bray. Two papers: Yudkin and Carey 1960 [six subjects]; Stock and Yudkin 1970 [eleven subjects].

Yudkin explained: Yudkin 1958 ("The irrefutable, unarguable...," 59; "much of the extra fat today...," 141; fat calories wil come down, 149).

Experimental evidence: Yudkin and Carey 1960.

Subjects losing weight consuming considerable calories: Milch et al. 1957; Werner 1955; Ril iet 1954 ("numerous and encouraging").

"al -you-can-eat diet[s]...": Brody 1981c. "The best definition": Keys, Brozek et al. 1950:32.

"persistent clamor of hunger": Keys, Brozek, et al. 1950:835. "nonappetizing nature": Cahil 1975:5859.

"token" amounts: Keys, Brozek, et al. 1950:74.

"their appet.i.te-depressing...": Spark 1973. "Substances cal ed ketones...": Brody 1996.

The existing research refutes ketone hypothesis: Drenick et al. 1964 ("It is not clear..." "...did not reappear"); Sidbury and Schwartz 1975. See also Kinsel 1969.

"these foods digest...": Brody 2002. Even those investigators: Werner 1955; Kinsel et al. 1964 ("There is a good reason...").

Yudkin had struggled: Yudkin and Carey 1960 ("for reasons..." "It would seem...").

"It is better...": Bernard 1957:37. "inevitability": Yudkin and Carey 1960. "Claims that weight loss...": White and Selvey 1974:48.

Physicians who took Pennington seriously: Thorpe 1957; Tal er 1961.

Pennington set out: Pennington 1954 ("voluminous...," "meager...," "These tended..."). See also Pennington 1951b.

Something Benedict suggested: Benedict 1925:57. And Du Bois believed: Du Bois 1936:25455. "index of calorie nutrition...": Pennington 1953b.

"static phase": Rony 1940:47. "His caloric intake...": Pennington 1952.

Diet-induced decrease: Benedict et al. 1919:69495; Strang and Evans 1929; Brown and Ohlson 1946. Lusk suggested: Lusk 1928:173. "their tissues are not...": Pennington 1952.

A conundrum: Pennington 1953d. Stetten reported: Salcedo and Stetten 1943.

Applying the same law of energy conservation: Pennington 1952.

"the size of the adipose deposits...": Ibid.

"provides for a more effective...": Ibid.

"It dawned on me..." and "like clockwork": Pennington 1954.

Defect explains sedentary behavior: Pennington 1951a.

Pennington explained this wasn't the case: Ibid.

Consider the kind: The example of Keys's conscientious objectors is my own, based on Pennington 1951a.

Maintain weight at seventeen hundred calories: Keys 1949.

"What happens when..." and "The first noticeable effect...": Pennington 1951a.

"A more rational form...": Pennington 1953d. directs "measures primarily toward...": Pennington 1951a.

Healthy equilibrium reestablished: Pennington 1953b ("Mobilization of increased..."); Adolph 1947; Richter 1976;353 If fat can be mobilized: Pennington 1953c ("sufficient effectiveness," "no calorie restriction...," "Weight would be lost...," "The result would...").

Energy expenditure would increase: Pennington 1953a. Du Bois's observation: McClel an et al. 1931.

Four thousand calories a day: Evans in Newburgh 1931a; Werner 1955. Might eat three thousand calories: Pennington 1953b.

Pyruvic acid: Pennington 1955. His contemporaries dismiss him: see Yudkin 1959.

CHAPTER TWENTY-ONE:.

THE CARBOHYDRATE HYPOTHESIS, I: FAT METABOLISM.

Epigraph. "Looking at obesity...": Bruch 1957:14748.

Astwood discovered: Anon. 1976 ("a bril iant series..."); Ca.s.sidy 1976 ("a record perhaps...").

"The Heritage of Corpulence:" Astwood 1962.

"regulation of ingestive behaviors...": Greenwood 1985:20.

"The vast majority...": Ibid.

"Something has happened...": Interview, George Cahil .

Bergmann's lipophilia hypothesis: Bergmann and Stroebe 1927 ("It seems just as il ogical...," 59394). I'm grateful to Richard Frank and Haidi Kuhn Segal for the translation. See also Bauer 1941; Rony 1940:15975.

"A second operation...": Bauer 1941.

Case reported in 1913: Rony 1940 ("Adiposity of the lower body," 17071).

"noted Vienna authority...": Anon. 1930b. Bauer's expertise: Anon. 1979. See also Bauer 1945. My primary source for Bauer's observations on obesity is Bauer 1941. "The genes responsible...": Bauer 1940.

"A local factor must exist...": Bauer 1941:975.

"Like a malignant tumor...": Quoted in ibid.:978.

"obese boys in whom...": Ibid.:980.

Grafe's textbook: Grafe 1933. "more or less ful y accepted": Rony 1940:17374. "...this conception deserves...": Wilder and Wilbur 1938:31011.

1955 German textbook chapter: Bahner 1955:102326. References from German literature: Rony 1940; Rynearson and Gastineau 1949. Footnote.

Interview, Theodore Van Ital ie.

Bauer's articles in English: Silver and Bauer 1931; Bauer 1940; Bauer 1941. Newburgh's seminal paper: Newburgh 1942.

"indubitable" and "is also probably present...": Cahil 1978.

"significantly more weight": Lee and Schaffer 1934. For a similar experiment, see Marx et al. 1942.

"These mice wil make fat...": Mayer 1968:48. Benedict reported this: discussed in Alonso and Maren 1955, which reported confirmation of the observation in a different strain of mice.

Greenwood's Zucker rat studies: Greenwood et al. 1981.

Hypothalamic tumor in 1840: Brobeck 1946. Nicolaidis recounted: Interview, Stylianos Nicolaidis.

Hypothalamic research in its early years: See Brobeck et al. 1943; Magoun and Fisher 1980. Hetherington and Ranson resolved controversy: Hetherington and Ranson 1939.

Brobeck's research: Brobeck et al. 1943 ("the laws of thermodynamics...," 836).

Ranson interpreted: Hetherington and Ranson 1942 ("the tremendously decreased..."). "related to the feeding habits": Brobeck et al. 1943:842. Footnote.

Ibid.

Ranson argued: Hetherington and Ranson 1942:615.

"concertmaster...": Anon. 1940.

Ranson studied fluid balance and diabetes insipidus: Fisher et al. 1938:12.

Hypothalamic lesions cause diabetes insipidus: Ibid.

"cla.s.sic type of experimental obesities": Mayer 1953a. Teitelbaum's experience: Teitelbaum 1955; interview, Philip Teitelbaum ("Of course they overate...").

Lesioning the lateral hypothalamus: Anand and Brobeck 1951. Ransom's lab had reported: Magoun and Fisher 1980.

Hetherington did research for U.S. Air Force: Interview, John Brobeck. Later editions of Ranson's textbook: See Ranson and Clark 1964:311.

Hypothalamus as regulator of eating behavior: See, for instance, Sutin 1976; Schachter and Rodin 1974:7583. Psychologists would "discard": Sclafani 1981b:409.

Brooks reported: Brooks 1946.