비만의 역사 (1)

by Jason Fung, 한국어 정리 Dr. Hayun Lee

우리는 비만 문제에서 칼로리는 진짜 문제가 안된다는 사실을 알고 있기 때문에, 비만의 원인이무엇인지에 초점을 맞추고 시작합니다. 칼로리가 비만과 관련이 없다는 이유는 수년간 이 문제를심층적으로 다룬 칼로리 시리즈(calorie series)에서 알 수 있습니다. 칼로리에 대한 전체적인 강박관념은 이미 50년전에 끝났습니다. 실제 원인을 이해해야 체중감량과 증가 문제를 해결할 수 있습니다.그러면 
비만의 진짜 원인은 무엇일까요?
과거에는 사람들이 비만에 대해 어떤 생각을 했는지 살펴봅니다.
Since we know that calories are not the real problem, we can start to focus on what is really the cause of obesity (the aetiology of obesity).  You can review the calorie series here for an indepth discussion of why calories are not relevant.  The entire obsession with calories was a 50 year dead end.  We can only start to address the problem of weight loss and gain by understanding the real causes. So what is the real cause of obesity?  Let’s go back in time and see what people thought about obesity in the past.

 

William Banting

 

William Banting(1796~1878)은 다이어트에 관한 첫 번째 저자입니다. 그는 10대와 20대에는 정상체중이었지만 30대, 40대, 50대를 거쳐 체중이 조금씩 늘었습니다. 매년 몇 파운드씩 체중이늘었습니다. 그가 62살 때는 202파운드(92kg)에 이르렀습니다. 지금 기준에 의하면 그리 나쁘지 않지만당시 기준으로 보면 땅딸막한 원숭이 같았습니다. 그래서, 그는 의사 조언에 따라 덜 먹으려고노력했습니다. 피곤하고, 배는 고팠지만 체중이 줄지 않아서 그는 더 많은 운동을 했습니다. 템즈강에서노를 저어서 육체적으로 아주 건강하게 되었습니다. 하지만 여전히 체중을 줄일 수 없었습니다.마지막으로, 프랑스 외과의사의 조언에 따라 새로운 다이어트를 시작했습니다. 그는 칼로리가 아닌,정제된 탄수화물인 설탕과 전분을 줄였습니다. 빵, 우유, 맥주, 과자와 감자를 먹지 않았습니다. 가난한친구들에게 자기 탄수화물을 주었습니다. 체중을 대폭 줄이고 기분이 좋아서 "일반인에 대한 비만 해결에관한 편지(Letter on Corpulence Addressed to the Public)“라는 책을 썼습니다. 이 책이 바로 최초의현대적 다이어트 책이었습니다. Banting은 개인적 경험을 근거로 체중증가의 원인은 칼로리가 아니고정제된 탄수화물이라고 생각했습니다. 비만의 원인이 설탕과 전분이라는 Banting의 생각은 그 후 100년동안 지속되었습니다. 
"의학의 원칙과 연습(The Principles and Practice of Medicine)”을 쓴 영향력 있는 캐나다 의사William Osler는, 1900년대 초 대부분의 의사들은 정제된 탄수화물이 비만의 원인이라고 생각했다고말했습니다. 그의 유명한 저서는 식이요법에 의한 비만 치료는 주로 고기와 달걀을 많이 먹고 정제된탄수화물을 줄이는 것이라고 말했습니다. 1882년 Osler는 자서전 "비만과 치료(Obesity and its Treatment)"에서 지방이 많은 음식은 포만감(충만 느낌)을 증가시켜서 비만 축소에 중요하다고생각했습니다. 지방(fat)을 죄악시하는 현대적 생각과 정반대입니다. 이것은 비만 전염병으로 완벽하게맞는 말입니다. 
William Banting 1796-1878 is considered to have written the first diet book.  He started off as a normal weight fellow in his teens and 20’s.  However, as he went through his 30’s, 40’s and 50’s he started to gain some weight. Not much, but a few pounds per year. Before long, he was age 62 and weighed 202 pounds.  Not bad by modern standards, but a real chunky monkey by the standards of that time. So, on the advice of his physicians, he tried to eat less.  But then, he felt tired, hungry and he wasn’t really losing any weight. Then, he tried to exercise more.  He rowed the Thames and became quite physically fit. However, he was still not able to keep the weight off. Finally, on the advice of a French surgeon, he started a new diet. He would severely restrict not calories, but sugars and starches – what we now call refined carbohydrates. He avoided all breads, milk, beer, sweets and potatoes. Poor fellow loved his carbs, too. He lost so much weight and felt so well that he decided to publish his findings in “Letter on Corpulence Addressed to the Public“.  This pamphlet was really the first modern diet book.  Based on personal experience, Banting felt that it was not calories that caused weight gain, but refined carbohydrates. Many of his ideas that sugars and starches caused obesity persisted through the next 100 years of so. Sir William Osler – the influential Canadian physician who wrote “The Principles and Practice of Medicine” – illustrates that most doctors of the early 1900’s considered that refined carbohydrates were the chief cause of obesity.  In his famous textbook, he described treatment of obesity with diets predominantly featuring meat and eggs and low in refined carbohydrates. In his 1882 monograph “Obesity and its Treatment” Dr. Osler felt that fatty foods were crucial to reducingobesity because they increased satiety (feeling of fullness). Contrast this to the modern demonization of dietary fats.  This coincides neatly with the obesity epidemic. 

 

아마도 훌륭한 Osler 박사는 뭔가를 알고 있었던 것 같습니다. 1950년대까지 Osler박사의 조언은 거의표준이었습니다. 당시에 비만의 원인이 무엇이냐고 할아버지나 할머니에 물어봤다면 아무도 칼로리 하고대답하지 않았을 겁니다. 에너지 단위로서의 칼로리는 당시에는 크게 알려지지 않았습니다. 대신 달콤한전분 음식이 비만의 원인이라고 말했을 것입니다. 1950년대 육아의 바이블이었던 “스팍 박사의 아기와육아(Dr. Spock’s Baby and Child Care)”는 체중증가와 감소는 대부분 섭취되는 디저트와 플레인,전분 음식의 양에 따라 결정된다고 설명하고 있습니다. 
Passmore박사는 1963년 영국영양저널(British Journal of Nutrition)에 "탄수화물이 살찌게 하는 것을모든 여자는 알고 있다(Every woman know that carbohydrate is fattening)"를 썼습니다. 모든.여자. 알고 있다. 그것은 비밀이 아니었습니다. 모두가 알고 있었습니다. 이러한 생각들은 테스트 기간을견디었습니다. 상식과 경험적 관찰에 따라 사실로 확인되었습니다. 위대한 Nassim Taleb가 말하듯이이런 생각은 "잘-깨지지 않는(Anti-Fragile)" 것이었습니다. 그리고 당시에 비만은 큰 문제가아니었습니다. 이것이 바로 비만에 대한 그들의 생각이었습니다: 1950년대부터 상황이 바뀌기시작했습니다. 심장질환이 늘고 있다는 인식이 있었습니다. 실제 심장질환 증가했는지 여부는 논쟁의여지가 있습니다. Gary Taubes는 그의 획기적인 책 "왜 우리가 비만이 되나(Why We Get Fat)"에서심장질환 증가는 사실이 아니라고 주장했습니다. 그럼에도 불구하고, 모든 사람들이 심장질환이라는 '큰전염병'의 원인을 찾기 시작했습니다. 이들의 시선은 곧 지방으로 집중되었습니다. "다이어트-심장가설(Diet-Heart Hypothesis)" 은 1960년대에 힘을 얻기 시작했습니다. 영향력 있는 영양‘전문가’ Ancel Keys가 이러한 생각의 대중화에 도구적 역할을 하였습니다. 큰 열정과 흔들리는 과학이,지방(인간이 사람이 된 이후부터 사람들이 먹어온 음식)을 악마로 만들기 시작하였습니다. 당시에는몰랐지만 문제가 있었습니다. 단백질 섭취는 식단에서 일정하게 유지됩니다. 단백질바/쉐이크 등이아니면 칼로리의 20 ~ 30% 이상으로 단백질 섭취를 늘리기는 사실상 어렵습니다. 그래서 탄수화물섭취를 줄이면 반대로 지방 섭취를 늘려야 합니다. 다음은 그 결과 입니다.

저지방(Low Fat) = 고탄수화물(High Carb) 및 
저탄수화물(Low carb) = 고지방(High Fat)

당시에 지방 섭취는 악이었기 때문에, '건강한 심장(Heart Healthy)’은 고탄수화물 식단을 추천했습니다.서반구에서 탄수화물은 정제되었기 때문에, 점점 더 많은 저지방 빵과 파스타를 먹게 되었습니다. 결국,콜리플라워 및 케일에 대한 햄버거를 포기하지 않았고, 빵과 큰 파스타도 포기하지 않았습니다. 1950년대와 1960년대의 과학적 토론(가끔은 아주 신랄한)은 격렬했습니다. 
Maybe the good Dr. Osler was onto something after all. By the 1950’s it was fairly standard advice.  If you were to ask your grandparents ‘back in the day’ what caused obesity, they would not talk about calories.  Calories as a unit of energy was largely unknown at that time.  They would say instead, that sweets and starchy foods caused obesity. Dr. Spock’s Baby and Child Care – a bible of child rearing of the 1950s – describes the gaining or losing of weight as mostly dependent upon the amount of desserts and plain, starchy foods consumed. Dr. Passmore in the British Journal of Nutrition in 1963 wrote the “Every woman know that carbohydrate is fattening”.  Every.  Woman.  Knows. This was no secret.  Everybody knew it. These ideas had withstood the test of time.  Common sense and empiric observation served to confirm the truth of the matter.  The ideas were “Anti-Fragile” as the great Nassim Taleb puts it.  And obesity wasn’t such a great problem back then.  This is what they thought:
Things started to change in the 1950s.  There was a perceived increase in the incidence of heart disease.  Whether this is actually true or not is debatable.  Gary Taubes argues that this was not true in his groundbreaking book “Why We Get Fat“.  Nevertheless, people started to search for the reason behind this ‘great epidemic’ of heart disease.  Their gaze soon fell upon dietary fat. The “Diet-Heart Hypothesis” started to gain traction in the 1960s.  Ancel Keys, a very influential nutition ‘expert’ played an instumental role in popularizing these ideas.  With great enthusiasm and shaky science, the demonization of dietary fat (a food that humans had been eating since, well, we became humans) started. There was a problem, though we didn’t see it at the time. Dietary protein tends to remain fairly constant in human diets.  It is actually quite difficult to increase dietary protein to more than 20-30% of calories without resorting to protein bars/shakes etc.  So, if one were to restrict dietary carbohydrates, then one must increase dietary fats and vice versa.  This is the result: Low Fat = High Carb and Low carb = High Fat

Since dietary fat was now the villain of the hour, the ‘Heart Healthy’ recommended diet became a high carbohydrate one. Since carbohydrates in the Western hemisphere tended to be refined, we ate more and more low fat bread and pasta. After all, we weren’t giving up hamburgers for cauliflower and kale, but for bread and big plates of pasta. Through the 1950’s and 1960’s scientific debate (occasionally very acrimonious) raged back and forth. 

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일부는 지방 섭취가 악이라고 했고, John Yudkin 등의 정제된 탄수화물이 문제라고 믿었습니다. 그의 책, "순수, 흰색과 치명적 - 설탕이 어떻게 우리를 죽이나(Pure, White and Deadly – How Sugar is Killing Us”는 섬뜩한 선견지명이며, 책 제목에 대한 최고 상을 받을 만합니다. 신랄한 비평은 때로는극단적이 되었습니다. 하버드대학의 Jean Mayer는 저탄수화물 식단을 "어떤 의미에서는 대량 학살이다"라고 비유했습니다.
Some believed that dietary fat was the villain where others, such as John Yudkin believed that refined carbohydrates were the problem.  His book, “Pure, White and Deadly – How Sugar is Killing Us” is eerily prescient, and should certainly win the award for Best Book Title – Ever. The vitriol sometimes reached extreme levels.  Jean Mayer, PhD of Harvard once likened the carbohydrate reduced diet “in a sense, equivalent to mass murder”.  

그냥 조금 극단적인 ... 미국심장협회(American Heart Association)는 이들 식단이 또한 위험한유행이었다고 느꼈습니다. 음 ... 친구 ... 실제로? 200년된 유행? 
오랜 기간을 버티었다고 생각? 인간이 몇 십 억년 동안 먹어온 지방? 우리를 죽이고 있는 것이무엇입니까? 지방 섭취가 우리를 죽인다면 백만 년 전에 이미 우리를 죽였을 것 아닌가요? 물론 당시의저지방 다이어트는 인간에 대한 테스트가 완전하지 않았었습니다. 

역사상 누구도 건강을 위해서 지방 섭취를 줄여야 한다고 결정하지 않았습니다. 

그 효과를 아무도 몰랐습니다. 물론 당시는 모유보다 영양가 있는 것을 만들 수 있다고 믿던시기였습니다. 어찌되었든 2천년 동안의 진화 보다 스마트 하게 되었습니까? 그래서 크림, 버터, 올리브오일과 같은 천연 지방 대신 마가린 같은 완전히 인공적인 것을 먹었습니까? 물론 트랜스지방이 우리를죽인다는 것이 밝혀졌지만 그건 또 다른 시점이었습니다. 우리는 지방에서 정제된 탄수화물로이동했습니다. 그래서 누가 이겼습니까? 우리는 이미 답을 알고 있고 그것을 나쁜 것으로 여기고있습니다.
Just a little extreme….The American Heart Association felt that these diets were also dangerous fads. Umm…dude….really? A 200 year old fad? Ideas that had withstood the test of time?  Dietary fats that humans had been eating for, like, a bazillion years?  That’s what was killing us?  Didn’t it occur these geniuses that if dietary fat was going to kill us, it would have already done so in the preceding, oh, 1 million years?
The low-fat diet, of course, up until that point in time was completely untested in humans.  Nobody in history had ever decided to lower the fat content of their diet for health reasons.  We had no idea what effect it would have. Of course, this was around the time that we also believed that we could make a more nutritious substance for babies than breast milk.  
That we were somehow smarter than 20 million years of evolution.  So, instead of eating natural fats such as cream, butter, and olive oil we turned to purely artificial oils like margarine.  Of course, these turned out to kill us with trans-fats but that is a story for another time.  We moved away from fat and towards refined carbs. So who won?  You already know the answer, and we are all the worse off for it.

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