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Nutrition Initiative to Fund Exacting Research in What Makes Us Fat

What better place to meet Peter Attia, president of San Diego’s recently unveiled Nutritional Science Initiative (NuSI), than at our “Meet the Xconomist” reception, where invited leaders of San Diego’s innovation community kibitzed while nibbling appetizers?

Before co-founding NuSi (pronounced Nu-see) with the science writer Gary Taubes, Attia worked at McKinsey & Co. as a healthcare and corporate risk consultant. He previously spent five years at the Johns Hopkins Hospital as a general surgery resident. With $5 million in seed funding from the John and Laura Arnold Foundation, Taubes and Attia say their initiative is intended to dramatically reduce the economic and social burden of obesity and obesity-related diseases by significantly improving nutrition science.

Taubes, a science and health journalist now researching health policy at U.C. Berkeley, has been arguing in his books and magazine articles that the type of calories consumed is far more critical in the progression to obesity than the total number of calories consumed. He contends that the conventional wisdom about nutrition is flawed—and so confused by misinformation—that the time has come to seek some unambiguous clarity about what makes us fat.

In our brief conversation, Attia said the state of nutrition science today is about where our understanding of gravity was when Isaac Newton watched an apple fall out of a tree. We can see that nutrition has an effect on obesity—just as people could see that gravity acts in some way on everything and everyone around us. But how, exactly, does it work?

“We’re never going to figure out what’s going on at this nth-degree level,” Attia said, “unless we can quantify it at the cellular level.” For example, he says one basic question that needs to be answered is what makes a fat cell store or release fat.

“We’re so obsessed with why people are becoming obese, why do people get diabetes, what causes insulin resistance, we are failing to go back to ask the most fundamental and basic questions,” Attia said.

One reason for this failure is because the science of nutrition is so hard. How is it, Attia asks, that two people could literally eat the same thing every day—and one turns into a blimp while the other remains rail-thin? It’s an important question to answer. Another big reason for the collective failure of nutrition science, he adds, is that there are huge market incentives to skip over the fundamental questions—and get to the stuff that sells.

In the statement announcing the creation of NuSi, Kevin Schulman, director of the Duke Clinical Research Institute and the Center for Clinical and Genetic Economics at Duke University, said, “The largest public health crisis in the United States is being addressed with the type of data that we reject in every other field of medicine: observational studies subject to selection bias and small scale, short-term clinical studies which can’t offer definitive results.”

So Taubes and Attia want to cut through the ball of confusion by funding scientifically rigorous research in nutrition and obesity, done by independent scientists with divergent backgrounds and beliefs.

Attia says the kind of research they want to do also will require some unusual scientific equipment.

“The type of facilities that are necessary to do the kind of science that we’re talking about requires something called a metabolic chamber,” Attia said. “It’s a pretty ominous sounding thing. It’s a room that has to be exactly 30,000 liters worth of air. It’s about a 13-foot by 13-foot room, and it has to have the most precise CO2 (carbon dioxide) and O2 (oxygen) measuring sensors imaginable.

“People have to live in these rooms, and you have to be able to measure within 1 percent their RQ—respiratory co-efficient. Only when you do that can you calculate a human being’s total energy expenditure in the face of changing macro-nutrients.”

Attia says such metabolic chambers are an absolute necessity in nutrition science, but the equipment is expensive and difficult to get.

“So here’s an idea,” Attia says. “How much does it cost to build eight of these things in one setting? That would allow you to run 24 patients simultaneously around the clock, and by the way, why don’t we make them like hotel rooms so that they’re actually pleasant to be in. A novel idea, right?

“That’s the kind of stuff that NuSi wants to do,” Attia says.