The Great Neurotic Art

One of the many endearing peculiarities of academic life at Harvard is that even routine departmental meetings sometimes turn out to be catered. Email announcements specify not just time, place and purpose, but also the name of the catering firm. I mention this only because I’ve just arrived there, and the first such meeting gave me immediate occasion to observe my new colleagues refecting themselves en masse. The victuals were, as is usual, high-end sandwiches and wraps, and, at the end of the meeting, it seemed that most of my colleagues, and some of the staff, had left the bread, and even the excellent chipotle tortilla wrappers, on their plates. I needn’t have asked, but I did anyway: some of them told me they were ‘doing Atkins’ and others that they were ‘doing South Beach’. Dietary virtue, it was apparent, lay incongruously between the buns.

Even asking the question elicited a torrent of second-hand expert commentary – on glycemic indices, net carbs, insulin-resistance and the effect of a high-protein diet on HDL and LDL-cholesterol. So this is one way, and perhaps one of the very few ways, in which Harvard resembles anywhere else in the world. Since the first appearance of Dr Atkins’ Diet Revolution in 1972, more than 16 million copies of its various revisions, editions and literary tie-ins have been sold worldwide; in the UK alone, two million copies of his New Diet Revolution. Thirty million Americans and three million Brits are said to have given the Atkins diet a go. Whether Atkins ‘works’ or not, low-carb regimes are prominent topics in the financial pages: the US market in 2004 for low-carb foods, books and paraphernalia was estimated at $30 billion; hundreds of millions have already been invested based on guesses about the future of Atkins-like diets, and several months ago the Economist reported that there was significant money being made selling Atkins-approved dog food.

Dietetics has always been a perspicuous site for getting a grip on the textures of everyday life and the ways in which technical expertise bears on it. Eating is something that everybody does, several times a day if they’re lucky. For those fortunate enough to decide what they want to eat, expertise can insinuate itself into the exercise of dietary choice. In the tradition of Galenic medicine that reigned from antiquity through much of the 19th century, food and drink comprised one of the ‘six things non-natural’; that is, those things subject to volitional control which were capable of causing alterations in the inherent constituents, faculties and activities of the healthy organism. You are presumed to be able to decide how, and how much, you have sex and consume food, and to be able to decide to control your emotions. Much of the fabric of material and mental life was made up of the volitional control of the non-naturals, and the etymology of dietetics is a reminder of that fact: where diet now signifies just food and drink, in antiquity it was understood as an ordered form of life. Dietetics – also known as regimen or hygiene – was that part of traditional medicine licensing the physician to advise patients about the siting of their houses (Galenic feng shui), their sex lives (moderate, lawful, and not solitary), how long and in which position they should sleep (seven hours if you’re sanguine or choleric, starting out on your right side, and keeping your mouth slightly open), and how to make the heart merry (contemplation, music and a sweet pomander), as well as what, when, how and how much they should eat.

Eating is an instrumental act, and is so understood. You eat to fuel the body, and, in that sense, a Big Mac and super-sized French fries, unlike any cigarette, serve their purpose in supplying the body’s momentary energetic needs. But eating is, of course, much more than its energetic function. Food is polysaturated with culture. Indeed, one could put it much more strongly: the practices attending the production, preparation and ingestion of food make up much of the substance of moral and social order. Foods are clean and unclean as well as nutritious and non-nutritious. They define racial, regional, religious, national, class and cultural identity: consider the haggis, the hot dog and chicken soup.

Most fundamentally, eating is a moment of ontological transformation: it is when what is not-you – not rational and not animate, at the time you consume it – starts to become you, the rational being which ultimately decides what stuff to consume. Flesh becomes reason at one remove, and every supper is, in that sense, eucharistic. We are, literally and fundamentally, what we eat. The material transformation is simultaneous with the possibility of social and moral transformation or the advertisement of the social and moral states to which you are laying claim. A temperate person is someone who eats temperately; a posh and powerful person is someone who gets an 8 o’clock table at the Ivy; respect for life is shown by vegetarianism; red-blooded machismo by the consumption of red meat; your friends eat with you at home; you have coffee with your colleagues; the High eat later than the Low, thus making a standard display of delayed gratification and acquiring the associated status of those who can wait an hour longer than others for their food. Self-nourishing and self-fashioning both happen at the table.

The relationship between the powerful moral and ontological capacities of diet and the authority of dietary expertise isn’t new, but its texture has changed markedly in recent times. For very many years, expert counsel was massively stable. Health, like virtue, followed the golden mean. Dietary temperance, or moderation, was a way to health, but it was also a virtue, just as gluttony was a vice. Balance was also a key article of expert advice: just as health was a balance of humours, so diet had to be balanced to suit your individual complexion. Obsessive monitoring of aliment and its physiological and mental effects on one’s body isn’t a new, uniquely Californian thing. The early moderns were masters of the Great Neurotic Art.

At the same time, it was widely, if not universally, acknowledged between traditional physicians and their patients that appetite was a pretty good guide to the healthfulness of foods. If you liked it, it probably liked you: the Renaissance and early modern maxim was ‘you should eat what you are.’ If you had a hot and moist complexion, then the foods that suited you best also tended to the hot and moist. (This was one reason cannibalism proved so interesting to dietary writers, since, in theory, no meat better suited to the human constitution could exist. Pork was a distant second.) That is, there were cosmological grounds for concluding that a little of what you fancy does you good.

The appetites might, indeed, be a reliable guide to wholesome food, but they needed to be mastered. You should, in general, eat less, and always leave the table with your appetite unsatisfied. Until at least the late 19th century, it was gluttony, not obesity, which was generally considered to be both a moral problem and a major cause of chronic ill health, but the key to avoiding vicious and inconvenient excess was the rational control of the appetites. Your job – the task of the higher and authentic you – was to keep the ‘belly gods’ in check.

Like all cultural expressions of the late modern condition, Robert Atkins and his low-carb kin both share in tradition and depart from it in telling ways. Consider how the LoCarbistas stand with respect to the appetites and the will. Virtually all the most popular diet writers of the last three decades thumb their noses at the very idea of restraint: Eat More, Weigh Less is now the signature sentiment, as well as the title of yet another popular book. Atkins’s own language reads like a studied inversion of traditional cautions about ‘luxury’, ‘gluttony’, ‘vice’ and their consequences: ‘Our physical urges are hard to combat,’ he says. That much is nothing new: Jesus and St Anthony knew it very well. But Atkins’s conclusion is staunchly democratic: ‘Fighting the scale armed only with willpower and determination works, at best, for only five low-fat dieters out of a hundred.’ If, however, we use the best nutritional science, we can ‘bypass our need to rely on willpower’, and then the weak-willed can enjoy as much success as the elite few traditionally have. No need now to leave the table with an appetite: ‘“This is not dieting,” you will feel, "this is a banquet.”’ You will eat ‘like a prince or princess’, or, raising the social stakes, ‘like a king or queen’. On the cover of the British edition of the New Diet Revolution, Nigella Lawson endorses Atkins as ‘the perfect diet for those who love food’. As an Atkins dieter, you will ‘eat as much as you want, as often as you want’; you will eat – and Dr Atkins repeats this word incessantly – ‘luxuriously’: ‘heavy cream, butter, mayonnaise, cheeses, meats, fowl’. The discipline of dietary moderation – indeed, the virtue of temperance – is no longer the way to health. And, despite What Would Jesus Eat? The Ultimate Program for Eating Well, Feeling Great and Living Longer and The Maker’s Diet: The 40-Day Health Experience that Will Change Your Life for Ever, and dozens of other faith-based fat-loss initiatives, among the bestsellers there is no question that an ample dietetics might be sinful.

Weight-loss the low-carb way is said to be wholly compatible with lusty connoisseurship. The Atkins-approved recipes included in the New Diet Revolution are guaranteed to ‘light a warm culinary fire in the pit of your stomach’. Atkins himself ascribed the ‘international success’ of his original book to his effectiveness ‘in communicating my own excitement over food’: ‘All my life I have been a cross between a gourmet and a gourmand.’ And, while the recipes in the 1972 book had a whiff of 1950s US suburbia about them – Devilled Eggs Curry, Tangy Meat Balls (with Krazy Mixed-Up Salt), Hamburger Fondue – the New Diet Revolution of 1992 enters a more advanced realm of connoisseurship:

Well, I couldn’t allow this book to achieve any less in the food line, so I had to find a chef to match the royal pleasures. Vacationing in Barbados, fortune smiled on me. I sampled the cuisine of Graham Newbould [who for six years] had been one of the chefs for Prince Charles and Princess Diana, and I soon understood why. Once you sample the recipes, so will you.

In the New Diet Revolution, ‘Chef Newbould’s recipes are distinguished, appropriately enough, by a crown’: Parfait of Chicken Livers with Braised Sultanas, Warm Avocados and Lobster Glazed with Béarnaise Sauce, Medallions of Lamb with Green Lentils and Bacon. No Krazy Mixed-Up Salt here. In the US edition of Dr Arthur Agatston’s immensely popular South Beach plan, in which ‘good carbs’ are permitted in moderation, photographs of Miami celebrity chefs adorn their contributions to the slimming high life. Not only is there no need to go hungry, but even on the transitional Phase 2 of the South Beach regime you can tuck into Elizabeth Barlow’s Veal Moutarde 4-Pax (from the Blue Door at Delano, ‘one of Miami Beach’s hottest destination resorts’) or a beet, red pepper, pecan and Kalamata olive salad (from Scott Fredel and J.D. Harris’s Rumi Supper Club, ‘a destination where fine dining turns to dancing as the evening draws late’). ‘The point of this diet,’ Agatston writes, ‘is to eat well. Food is one of life’s dependable pleasures.’ And when you reach the shining plateau of Phase 3, there are times when ‘you should go ahead and enjoy.’ Be a devil.

By 2003, the recipes in Atkins for Life had escaped to a new, marginally less self-conscious and more relaxed level of fine-foodism, presumably ascribable to the ageing doctor’s surrender of control over ‘the mouthwatering low-carbohydrate recipes and ingenious meal plans’ to a professional food editor. Combine the less restrictive position on the inherent evil of all carbs with the cheffy professionalism of the current Atkins recipes – Spinach Phyllo Triangles (with spelt or wholewheat phyllo dough) or Broccoli, Rabe and Sausage over Penne (low-carb soy pasta) – and, spelt phyllo and soy pasta apart, you can almost see Jamie Oliver . . . No, I suppose not. In any case, Dr Atkins had now become a corporate institution. He was no longer a well man. He had a heart attack in 2002, which, his office stipulated, was the result of an infection he had suffered from ‘for a few years’, and was ‘in no way related to diet’. He died aged 72 in April 2003, after falling and hitting his head on a New York pavement, and disputes still rage about his weight at the time of his death. The New York chief medical examiner’s report on his death recorded his weight as 258 pounds (18 stone 4 lbs), which, for a six-foot man, qualifies, on Atkins’s own criteria, as clinically obese. When the Wall Street Journal published these details, Atkins’s widow lashed out at ‘unscrupulous individuals’ who ‘will continue to twist and pervert the truth in an attempt to destroy the reputation and great work of my late husband’.

An early Atkins convert rejoiced that he was now able to eat ‘all I wanted to’; ‘I enjoyed good food.’ Barry Sears, the proprietor of the smash Zone diet, is far from alone in assuring potential converts that ‘weight loss has little to do with willpower.’ In the early 1980s, Judy Mazel’s Beverly Hills diet announced that ‘you too can learn to eat what you like, what you crave, what you want – without getting fat.’ It’s not really a discipline; it’s ‘fun’. One of Dr Agatston’s patients, celebrating the agreeableness as well as the success of his South Beach regimen, revelled in expert-approved indulgence: ‘My big thing is that I hate feeling hungry. I just don’t like the sensation . . . On this diet . . . the rule is that if you feel hungry, you eat.’

One of the last bestselling American diet books to adopt a minatory tone towards self-control was Dr Irwin Stillman’s 1967 Quick Weight Loss Diet. The key was radical calorie restriction, designed to achieve the fast results which would alone encourage further discipline. The means to secure these results was a large dose of willpower, sustained in moments of temptation by incantations of the health risks run by the overweight. ‘You must develop a firm almost fanatical desire to lose dangerous excess weight . . . Eat scared!’ the doctor wrote, using the fear of sudden death to good effect. Stillman’s stoic self-control strongly linked his views to ancient tradition: when ‘you’ are instructed to control ‘your appetites’, the controlling ‘you’ – as opposed to the appetitive ‘you’ – clearly bears a relationship to the rational, authentically human, quasi-divine ‘you’ of the great dietetic and moral tradition. But, since the late 1960s, that tone has rarely, if ever, been represented on the bestseller charts. So one thing we are witnessing in recent diet books should come as no surprise given current cultural commentary: the submergence of notions of individual volition, partly in ideas of external or genetic determination, but also through the straightforward rejection of the notion that self-control is either instrumentally necessary or morally desirable. If, for instance, there is ‘a gene for’ obesity, or if, as Atkins maintained, obesity is due to a ‘very specific metabolic defect’, then the exercise of willpower, especially orientated towards eating less, is either circumscribed or pointless. Dietetics is a good place to look if you want to document recent changes in conceptions of the self.

The metabolic science that justifies the low-carb programme inscribes characteristic views of the will and the self. Some of the appetites in the motivational menagerie of the late modern self are natural, healthy and not to be resisted, but others are unnatural, brought into being by the artifices of the civilising process. In common with many popular and academic dietary writers, Atkins posits a primitive dietetics as a justification for new departures and a resource for condemning a pathological present: ‘We tend to take it for granted that the way we eat now is the way we always ate. Nothing could be further from the truth. For most of man’s fifty million years on earth, we have lived off the flesh and fat of other animals . . . Man was a hunter and our eating habits were largely carnivorous.’ Hunting, and eating the fruits of the hunt, was natural and healthful. So Atkins articulates a secular version of the biblical story about agriculture, and consuming the crops raised in the sweat of our brows, as punishments for original sin.

But cravings for carbohydrates, specifically refined carbohydrates, are the most unnatural, pathological and pathogenic of current human appetites. In this connection, a little of what you fancy does you good, on condition that it is the right fancy. The way we eat now, especially in America, is not only wrong in itself, it produces the appetites which it then so abundantly and lucratively supplies: Atkins for Life cleverly uses the acronym SAD to designate the Standard American Diet. Refined carbohydrates – sugar and sugary soft drinks, sweets, biscuits, cakes, white flour, white rice – have been brought into being by recent human artifice: ‘This is not real food; it’s invented, fake food.’ None of it existed in the state of nature and not much of it in the more natural cultures of the past. Refined sugar, ‘the killer carbohydrate’, has been ‘important in our diet for less than a hundred years’, and ‘the biggest dietary change in fifty million years’ has been ‘the increase from four to 175 pounds of sugar per person per year’. Nor did such foods come into prevalence because of natural human appetites. The appetites themselves were called forth by the instruments of corporate capitalism. ‘We’re stuck with it . . . because it’s incredibly profitable’; ‘Sugar is the American food industry’s friend.’ And though Atkins Nutritionals Inc. is now itself an ‘incredibly profitable’ business, an (admittedly depoliticised) critique of late capitalism has to be part of Atkins’s appeal. While he was not willing to say so in his own name, Atkins did not resist citing ‘cynics and economists’ who pointed to ‘the influence of the giant food companies’, which were ‘deeply committed to selling junk carbohydrates’ and were ‘the chief funders of nutritional research’ opposing the low-carb regime.

In this respect, the Atkins diet is a curious cousin to the organic and Slow Food movements, and, indeed, to aspects of vegetarianism. Obesity, and such related conditions as type-2 diabetes, are, in the Atkins cosmology, diseases of the special civilisation that makes and markets refined carbohydrates. The result of all this making and marketing is addiction. The appetites are perverted; a monstrously hybrid self is produced, whose appetites are parsed between the natural and the unnatural, the ones to be gratified and the ones to be disciplined and eliminated. And the unnaturalness of that self is an internalising of the bad order of society – what the Yale psychologist and obesity expert Kelly Brownell has catchily called ‘a toxic environment’. A bad society makes bad food and bad food makes badly motivated and badly functioning people. This sensibility is important enough to have made it into The Simpsons. In ‘Sweets and Sour Marge’, when it is determined that Springfield is the fattest town in America, Marge goes on a crusade against the sugar companies, which have turned the citizens into obese zombies. She wins a class-action toxic tort suit against ‘Big Sugar’ but ‘Marge’s Law’ is soon subverted. When Homer himself becomes a sugar bootlegger, Marge realises she can’t win against the dark forces of carb-addiction and gives up.

The metabolic science that is said to underpin the addiction story, and that justifies Atkins’s regime, is by now reasonably familiar. When you eat carbohydrates, and especially refined carbohydrates, your blood glucose rises, in response to which the pancreas releases insulin to process the glucose, transporting it to the cells of the liver and muscles and converting some of the glucose into glycogen to be stored there for future use. Excess glucose is converted to triglycerides, the major component of the fatty tissues which overweight people are trying to get rid of. A meal high in carbs calls forth a rush of insulin which can overshoot the required amount, lowering blood glucose too much, and so making you hungry again. In many cases, people get, as it were, immune to insulin, eliciting even more insulin production. They are then suffering, Atkins says, from ‘insulin resistance’ and consequent ‘hyperinsulinism’. In that condition, the body becomes less efficient in converting glucose into glycogen and, instead, stores it as fat. Carbs, not fat, are what make you fat. Carbs also make you permanently, and unnaturally, hungry, a slave to your appetites, because all that insulin coursing around your system makes you eat even more. And that is why obesity is not your fault: ‘You see that what you thought was compulsivity, a behavioural problem, is really a glucose-triggered mechanism, a metabolic problem. So don’t feel so guilty.’ Metabolic science establishes how your appetites – in this case, your cravings for carbs – have been perverted. This is what Atkins called a late modern ‘horror story’, a tale of alien possession ‘which might be headlined: Innocent Possessor of Human Body Turned on by Its Own Hormones!’ But this possession is something ‘we did to ourselves’, something a pathological part of you did to the normal part of you.

Accordingly, the remedy for insulin-resistant obesity is clear: remove the predisposing cause; make an act of will and cut out the carbs. If you do that, the body will have no choice but to turn to other sources of energy, namely stored fat. That is when your body enters a metabolic state called ketosis. When stockpiled fat is used for energy, it breaks down into a series of compounds, including two-carbon ketones. Ketosis has been identified by some experts as a pathological metabolic state: many doctors warn against the risks of calcium loss and consequent osteoporosis, of kidney irritation, of abnormally acidifying the blood – a pathological condition known as ketoacidosis – and of the social consequences of seriously bad breath. But Atkins will have none of that. ‘Ketosis is one of life’s charmed gifts. It’s as delightful as sex and sunshine, and it has fewer drawbacks than either of them.’ Ketosis is the natural metabolic condition of our ancestors, and the ketogenic diet ‘is the safest, healthiest, most luxurious way to start the slim, second half of your life’. It is a self-changing metabolic epiphany. The outcome of a ketogenic diet is a radical remaking of the self, now truly born again: ‘Fourteen days of healthy, hearty, hunger-free eating will rapidly begin to take your excess pounds away and will show you the first outlines of a new you. It will be a you that is slimmer, more energetic, less driven by cravings . . . Welcome to a whole new world!’

A ketogenic diet quickly works its wonders on the appetite. Entering on the diet, you cannot perhaps even conceive what it would be like to deny yourself soft drinks, sweets, ice cream, pasta and white bread, so strong are the cravings: ‘you’re in a metabolic trap’ created by hyperinsulinism. But within days, possibly as little as a week on Atkins’s rigorous ‘induction phase’, you will find those cravings diminish and, ultimately, disappear. Now, there is no longer any need for willpower: you have remade yourself. Similarly, the South Beach Diet, which does not put you in ketosis, still assures you that during the first several weeks you’ll ‘have changed yourself internally’. You’ll need willpower – though not much – for those weeks, and then second nature takes command. Now you can safely satisfy your cravings, since those very cravings have been transformed. So have you, and that is why one of Agatston’s success stories testifies that ‘I’m pretty born again about this diet.’ Dietary success takes the form of a late modern salvation story.

The soteriological dimension of Atkins’s low-carb regime has survived despite substantial modifications of both its science and its practical advice over the past thirty years. The original purity of his denunciation of carbohydrates has been transformed into a far more eclectic and nuanced position, possibly in response to changes in market conditions and to the exigencies of building a sustainable mass movement and a durable corporate business plan. Atkins for Life of 2003 differs markedly from Dr Atkins’ Diet Revolution of 1972. There are now distinctions between ‘good carbs’ and ‘bad carbs’. The title of Chapter 3 is reassuring: ‘Yes, You Can Eat Carbs!’ You can have a certain amount of the complex and unrefined ones, and that is where the spelt phyllo dough and the soy pasta come in. There is also now a distinction between ‘good fats’ and ‘bad fats’. While fat is still not satanic, you should try to limit intake of saturated fats, and, especially, of the ‘trans fats’ in such manufactured products as the hydrogenated vegetable oils used in commercial baked goods. Where Atkins once celebrated his departure from orthodox dietary expertise, the latest version brings him uncomfortably close to his putative rivals, certainly to Dr Agatston but also to several pillars of the nutritional establishment. Redemption is now trade-marked: the Atkins Nutritional Approach™ helps you attain your personal Atkins Carbohydrate Equilibrium™, using the Atkins Glycemic Ranking™. The road to dietary salvation has been smoothly paved with corporate dollars, but the goal is no less redemptive, transformative and self-changing than it ever was.

Atkins, Agatston and other low-carb writers seek to resolve the apparent tension between, on the one hand, the idea of addiction as corroding the will and sapping resolve, and, on the other, the coherence of making an appeal to fat people’s wills. Carbohydrate addiction, it is said, is strong enough to pervert the will, strong enough eventually to kill you, but not so strong as to prevent the will from taking steps – those luxurious steps, after all – to reform itself. Within days, low-carb habit becomes second nature, its transformative power signalled by the rapidity with which pathological carb-cravings vanish. The rational you that attends to Dr Atkins’s message can quickly overcome the irrational, carb-addicted you, and what emerges is at once metabolically healthy and morally purified. The Atkins diet is a latter-day theatre of agency: its ketogenic luxury is a marked departure from the ancient dietetic tradition’s counsel of self-discipline, while the hybrid self with which it works belongs squarely within that tradition, and, indeed, within perduring traditions of practical and reflective moral reasoning. In the Pensées, Pascal repeated the ancient trope that ‘custom is a second nature that destroys the first.’ But then he asked, like the good postmodernist he wasn’t: ‘What is nature? Why is custom not natural? I am very much afraid that nature itself is only a first custom, just as custom is a second nature.’ Dietetic regimes like Dr Atkins’s have been vehicles for transforming these sentiments into social institutions, in the course of which they have helped make new bodies, new selves and, in the great American way, enough piles of money for all the popular diet writers to live for ever in Fat City.