Saturday, April 09, 2011

Saturday Stories


Stupidly busy week this week.

Can't say I read much of anything. Last weekend though, I read an article I found interesting.

So you think I'm an angry blogger? Imagine how angry I'd write if I were an anonymous blogger. Or instead read CarbSane's recent take on Gary Taubes' theories.

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23 comments:

  1. Anonymous11:16 am

    Profame yes. The truth, that too. Taubes is one hell of a pitchman. Just another snake-oil salesman. Will we ever learn?

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  2. Profane, yes. Crazy antagonistic towards Taubes, yes. The truth, not necessarily. CarbSane has a tendency to do largely what she accuses Taubes of doing, handpicking studies (usually genetically modified rat studies) and saying they disprove Taubes' theories.

    For example, the Grey Kipnis study was about hyperinsulinemia, not necessarily weight loss and they concluded that "Thus the hyperinsulinemia characteristic of obesity may be the result of dietary factors rather than exclusively a consequence of the insulin antagonism associated with obesity". In other words, those subjects that went on a low carbohydrate diet, lowered their basal plasma insulin levels (a good thing) and even after going back to eating carbohydrates, had a decreased (ie. improved) insulin response to an oral glucose test (the ones that stayed high carb had an increased (ie. worse) response).

    She concludes "Diets work, when they do, when there is a sustained caloric deficit". She jumps to that conclusion which I can't find anywhere in the actual paper.

    Taubes suggest that calories-in calories-out is not the best way to look at weight loss because he believes that they are not independent variables and eating more and excercising less is not a cause of obesity but a symptom of an underlying hormonal issue. The GnK paper she sites does nothing to refute that.

    A good, and unemotional, discussion of that same study appears here:

    http://high-fat-nutrition.blogspot.com/2011/03/fasting-insulin-and-weight-loss.html

    He also discusses the Kraus study:

    http://www.ajcn.org/content/83/5/1025.long

    which showed when they tried to keep weight stable there was 'accidental' weight loss amongst the low carb groups (with the group that ate saturated fat losing not the most weight but the most fat).

    This accidental weight loss can be the result of a few things. Either the subjects refused food within the diet or they ate the required number of calories and lost weight or for some reason they started expending more calories (either through basal metabolic rate or exercise) and losing weight. Either way, it seems to indicate that lowering the number of carbohydrates in your diet will result in a spontaneous lowering of calories-in or a spontaneous increase in expenditure.

    So profane yes. Truth.. no. Taubes a snake-oil sales man. Well, he wants to sell books but I don't see him out there selling anything else.

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  3. Anonymous4:39 pm

    It seems that blog commenting is usually more rude and angry than actual correspondence between people - by email, text, on the phone or in person. I think there is something about the forum itself that causes some people to take their gloves off and be really disrespectful. Carbsane is especially vitriolic, and is obviously obsessed with discrediting Gary Taubes to such a degree that I wonder what she would do with her life if Taubes stopped writing about health issues. Since you don't stake out a particular position and chip away at everything that disagrees with that position, I think you probably attract less vitriol as a result - which probably comes as a surprise to you!

    Jennifer D.

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  4. Anonymous6:32 pm

    Please. You don't see him selling anything else? He's selling Gary Taubes. He's a writer. His income has increased multifold since he started this. I'd bet the sum total of his lifetime writing gains rior to these books didn't equal one year's income since. It's not the book Gary's selling.

    Not to forget, he wrote the same book the second time. Hey, why fiddle with success, especially when you're a second-rate hack.

    UP UNTIL someone has pushed themselves into the danger zone by years and years of overeating, and screwed up their pancreas permanently, yes, it's calories in=calories out.

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  5. Geez, you know, you are right. If Taubes wanted to be credible, he should have done the 5 years of research it went into Good Calories Bad Calories and given away his book and refused any national media attention. Anybody who wants to be paid for doing that kind of work must be suspicious.

    In fact, I'm sure the author of this blog gets paid for his work as a doctor so obviously he is not to be believed.

    Give me a break. That 'he did it for the money' is a ridiculous argument used to avoid trying to point out where he made errors in his interpretation of the science.

    If he really was a snake oil salesman, he would be far better off writing some book with less research and then selling a line of frozen foods or supplements.

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  6. @All regarding the profanity, I had hoped using the tags and such conveyed the sarcasm with which I employed the language. It's not my usual style at all!

    @LCL: Where did I cherry pick? I look at ALL the data and its meaning which is exactly what Taubes fails to do repeatedly. In Shai, he ignores 1/3rd of the data. Data that would counter his analysis. In G&K it demonstrated that improved or whatever insulin had NO bearing on weight. Period. Peter/Hyperlipid reads this then still maintains that fasting insulin determines weight loss. Taubes ignores it entirely.

    If when you cut carbs you create a calorie deficit you lose weight. If not, you don't.

    Accidental weight loss is due to reducing intake. Why don't low carbers just rejoice in this rather than spinning untenable tales and gimmicks?

    Regarding his 5 years of research, he obviously didn't do a very thorough job. He never read Frayn's cited text, he didn't look at this study closely enough or he wouldn't have cited it, he stated the exact opposite of what Newsholme & Start said about G3P in their text he cited, the list could go on.

    @Jennifer, it's nice to see you've followed me here with your critique of my style. LOL.

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  7. The point is WHY do people on a low carb diet create a calorie deficit without consciously doing so in study after study? These studies would more correctly describe the diets as low carb/calorie unrestricted in many cases because they do not require the participants to limit their calories. The 'accidental' weight loss, by your own account is because people are eating too few calories? Why would obese people refuse calories if told to eat them?

    And whatever mechanism is causing them to spontaneously eat fewer calories then they need to burn may be a clue that the opposite mechanism (eating more carbs) is causing them to over eat and it is not just a character defect as the world at large seems to believe.

    If it isn't insulin levels being lower and, as a result, fat stores being more accessible, then what is it about removing carbs from the diet (especially sugar and refined carbs) that causes this phenomenon to happen?

    The point is that the calories-in/calories-out paradigm is problematic because it doesn't explain why does someone over eat and why do they move less. It also doesn't address how the body may compensate for fewer calories in with going to muscle for energy instead of fat or by slowing down metabolism.

    You say "In G&K it demonstrated that improved or whatever insulin had NO bearing on weight." That's not a conclusion they seemed to have reached but regardless, it did show that low carbohydrates DID have an effect on insulin levels (a conclusion which was the purpose of the study and one that you ignored). And if insulin levels have an effect on allowing people access to their fat stores and therefore allowing them to eat less without hunger (as is the phenomenon people seem to experience on a low carb diet) would that not have at least an indirect effect on weight loss? They are eating less but if they are not doing so consciously, WHY are they doing so?

    Your representation of the Shai study was that the mediterranean diet and low carb diet weight loss was the same after 2 years BUT the quote from the study:

    The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group

    4.7 > 4.4. Not statistically significant maybe but still a little more. Plus lipid profiles were better on the low carb for HDL, Triglycerides. The mediterranean diet was only better in lowering LDL.

    I also might mention that the low carb group NEVER got their carb % of energy below 40% which isn't really low carb (at 1600 calories, 40% is about 160 grams which is high for an Atkins or paleo diet).

    I'd also mention the low carb diet was described as a "low-carbohydrate, non–restricted-calorie diet" whereas all the other diets were calorie restricted. So again WHY did they restrict calories more than the mediterranean diet and low fat diets at 6 months and 1 year and almost as much as low fat at 2 years?

    THAT is what I mean about cherry picking? Taubes did ignore the Mediterranean diet, sure, but you ignored all those other things that came out of this study. If it is because of calorie restriction that all diets lost weight, there still is the question that given that the low carb diet was NOT calorie restricted, why did those dieters do so? If the low fat and mediterranean people were told NOT to restrict calories, would they have eaten as little as they did? We don't know. That variable was uncontrolled.

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  8. You're overthinking things, but the "why" is that protein is satiating. This has been shown over and over and over in clinical trials. The 15% protein proscription is insufficient on CRD's. I would estimate that on many of my VLC days I ate <5% carb / 45-55% protein / 45-55% fat was the norm and <1000 cal sometimes in the 7-800 range.

    It has nothing to do with insulin levels. Plain boiled potatoes are one of the highest glycemic yet satiating foods.

    There are many who do not lose weight or stall on low carb diets because they eat too many calories. Easy to do with high fat dairy and macadamia nuts galore.

    The point is that the calories-in/calories-out paradigm is problematic because it doesn't explain why does someone over eat and why do they move less. It also doesn't address how the body may compensate for fewer calories in with going to muscle for energy instead of fat or by slowing down metabolism.

    It explains that when we overeat we get fat. Period.

    our representation of the Shai study was that the mediterranean diet and low carb diet weight loss was the same after 2 years BUT the quote from the study:

    The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group

    4.7 > 4.4. Not statistically significant maybe but still a little more. Plus lipid profiles were better on the low carb for HDL, Triglycerides. The mediterranean diet was only better in lowering LDL.


    If you want to hang your hat on 0.3kg weight loss differential be my guest. The other differences were inconsequential as well.

    You say "In G&K it demonstrated that improved or whatever insulin had NO bearing on weight." That's not a conclusion they seemed to have reached but regardless, it did show that low carbohydrates DID have an effect on insulin levels (a conclusion which was the purpose of the study and one that you ignored).

    I won't be the first nor the last to look at the results of a study and focus on a different aspect of them. The changes in insulin levels were inconsequential vis a vis body weight. QED. So 75% carb diet given to obese women increased basal insulin. So? Did it make them gain? Lose? No. It had nothing to do with it (all the while the unemotional Peter somehow maintains it is determinative?).

    I'm not ignoring anything when I'm looking at "why diets work when they do" - that was the focus of this post and the others related to it. Not lipid markers. Not anything but whether it was calories or carbs/insulin levels that decide if a diet works.

    It's the calories. Not the carbs/insulin. I challenge a "friendly voice" to ask Gary this on his blog. He won't answer. If he does, it will be some sort of dismissive post that doesn't address the data.

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  9. Protein is more satiation but in the Shai study, all diets reduced the amount of protein, not increased it so that hardly explains the voluntary reduction in calorie intake. At all points in the study, the dieters were basically eating 20% calories from protein (between 19% for LF dieters and 21.8% for LC dieters).

    I don't believe Hyperlipid is saying the insulin works regardless of calorie intake (in fact he says he believes in calories in/out). He is rather suggesting a mechanism by which lower basal insulin rates lead to lower calorie consumption because the fat cells more easily give up their stored energy.

    Do you believe that insulin has no effect on the release of fatty acids from fat cells or the storage of fatty acids from fat cells? If so, I believe you are in the minority on that.

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  10. I should also mention, none of the data from these two studies that you are talking about show that insulin does not play a factor. GK restricted calories so yes, lowering calories to 1500 calories people lose weight. Shai restricted calories on the low fat and mediterranean diets but not on the low carb. So while all diets restricted calories, we still don't have an explanation as to why the low carbers voluntarily restricted calories (they ate LESS protein so it's hard to believe their diet was more satiating than before because of the protein).

    Personally, given the choice of counting calories (as I have done and starved) and restricting carbs and not having to count calories (as I have done and lost weight without starving), I'll pick the latter. The best explanation I have heard to date as to why I don't have to count calories is the insulin. Saying a diet high in fat, moderate in protein and low in carbs is more satiating still doesn't answer the question "Why is it more satiating?" Hyperlipid's explanation to date seems to be the best so far.

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  11. Do you believe that insulin has no effect on the release of fatty acids from fat cells or the storage of fatty acids from fat cells? If so, I believe you are in the minority on that.

    No, I believe that insulin is intricately involved. What I don't confuse is lipolysis with beta oxidation. If fatty acids are released and not oxidized, they either return to the fat or they get stored in the ectopic tissue.

    As for counting calories, I'm with you. In case you didn't notice, I rode the LC train (high protein) down 80+ lbs.

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  12. @LCL: Regarding Shai and the low carbers eating less protein it was like 10g (6 at study end). I tend to believe we are protein seeking creatures - we eat to meet those needs. Eating high protein foods, one gets there sooner.

    This is why, IMO, the CAF rats (http://carbsanity.blogspot.com/2011/02/why-we-get-fat-lessons-from-cafeteria.html) overate so much. When you look at the foods, they are calorie rich, protein poor.


    Insulin? Look at the insulin changes in the two studies in this post: http://carbsanity.blogspot.com/2011/03/fasting-insulin-weight-loss.html

    One of the studies in that post, the study that's the subject of this blog post:
    http://carbsanity.blogspot.com/2010/04/high-protein-diet-induces-sustained.html , fixed carbs at 50%. Foods were provided at weight maintaining caloric levels for 15% protein, 35% fat. Then subjects were switched to an isocaloric 30% protein, 20% fat diet - no change in weight. Then they were provided with extra food from the high protein diet and told to eat ad lib. The result? Over 12 weeks they dropped an average of 10.8 lbs because of a spontaneous reduction in intake of almost 450 cal/day.

    No cutting carbs. Just more protein by percentage of caloric content of food.



    The diets were all 50% carb

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  13. I glanced over the protein study and yes, it does suggest another mechanism that could be at play in a low carb diet, yet another hormonal one. Protein amplifying leptin signalling and therefore increasing satiety. I'm willing to buy that that can play out in a low carb diet as protein intake is increased somewhat (although not normally doubled). However without any change in carbohydrate intake in any of the diets followed, and no change in basal insulin level, means no basis for comparison as to whether it is ONLY protein uptick that causes the increased satiety or if lowering the carbs and fasting insulin levels has an effect as well.

    The Shai study did not increase protein as a percentage of calories so probably not the mechanism at work here.

    But since fasting insulin did not change, does that mean changing fasting insulin has no effect? Not really, just shows another possible mechanism at work. Even your buddy Frayn points out that insulin suppresses fat mobilization.

    BTW when you say:
    What I don't confuse is lipolysis with beta oxidation. If fatty acids are released and not oxidized, they either return to the fat or they get stored in the ectopic tissue.

    Does that not also mean that if fatty acids are not released (Frayn: Insulin suppresses fat mobilization ) they are not oxidized.

    Funny how you are unwilling to believe that one hormonal effect (lower insulin) has any effect on weight loss (through release of fatty acids that make our energy stores available to burn more easily) and willing to believe another hormonal effect (higher proportion of protein amplifying leptin reception thereby increasing satiety does).


    BTW, I'll let you have the last word on this (not that you'd give me the choice). I'll just add, thanks for adding in another mechanism by which low carb diets might work (protein=better leptin reception)but you have yet to debunk the insulin thing.

    And I will continue to ignore the genetically modified rat studies.

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  14. Insulin never TOTALLY suppresses mobilization. You have to look at 24 hours, not a few hours here and there. Most obese have elevated circulating free fatty acids and fatty acid delivery to their cells. Nothing's "locked away". Even your buddy Taubes knows fats are continually , being mobilized (and re-esterified)

    The burden of proof is on Taubes, although ample evidence debunking his theories has been provided.

    Listen to some of Jimmy's podcasts. Westman admits it's ultimately calories. Stephan Guyenet does. Just about everyone, even Taubes at times.

    The obese are overeating everything. By percentage of total calories, protein is increased on low carb. It really is that simple. But it only goes so far in the long run.

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  15. Had to post one more comment. CarbSane and I are debating about why low carb diets work not THAT they work. We are not debating whether or not they are safe, they are. There are also some beneficial outcomes to low carb diets such as:

    1) Improved HDL levels (higher)

    2) Improved triglyceride levels (lower)

    3) Improved LDL particle size if not count.

    4) Improved blood pressure.

    5) Improved blood sugar levels.

    6) Better insulin sensitivity.

    7) Weight loss while being satiating (whatever the reason).

    Do low carbs diet result in better improvements in these factors above low fat diets? The studies seem to show that.

    The thing I worry about in this debate about insulin/carbs vs calories-in/calories out as a weight loss factor is that the fact that low carbs diet are not unsafe as the conventional wisdom seems to indicate. In fact, there are many reasons to believe there are benefits beyond weight loss.

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  16. Well LCL, they work for most - better the more obese you are to begin with it seems - but not all. And they seem to have limits in being the SOLE dietary strategy to becoming truly lean. They're safe in the relatively short run. I don't think we know either way in the long run.

    As to your list:

    1-3 may only have meaning on a "normal" diet. For example, high trigs are accompanied by high NEFA in those at high CVD risk. Is lowering the trigs thus elevating the NEFA beneficial? I don't think we know the answer. Also there are cultures w/o CVD who have high trigs.

    4. Not in everyone, especially in maintenance the lower carb some go the more they see BP creep up.

    5. If you eat no carbs at all I suppose but many see fasting BG's (hepatic IR) creep up and become more and more intolerant of any carbs as time goes by.

    6. Just the opposite in the long term once maintenance has been achieved.

    7. Agreed, but back to my opening paragraph, this is not the case for all. Perhaps not even most as those for whom it doesn't work tend to move on silently.

    You ignore Shai yet again where diabetics were concerned and their improved health markers. If Taubes' were so good why did he refuse a cholesterol test (of his choosing) and the opportunity to explain the results?

    Oh ... so one can't discuss the science honestly lest we give ammo to those who insist it's a fad diet that will kill you?

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  17. I'm surprised you stooped to the cholesterol test thing. One person's cholesterol is meaningless and a redd herring whatever it is. I assume you are talking about his Dr. Oz appearance. One could equally argue that Dr. Oz's pre-cancerous pollup in his intestine was due to his diet as any cholesterol result being the result of Taubes' cholesterol test.

    Actually, given the level of Taubes obsession you seem to have, I'm not all that surprised at the stooping.

    And I'm not ignoring Shai, the numbers improved for the low carb group better than low fat and arguably as much or better than the meditteranean diet. Maybe not statistically significantly better but still better.

    Sorry, said you'd get the last word. I'll unsubscribe and be quiet now.

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  18. Lovely (and I'm truly not being sarcastic here), to see thoughtful disagreement that's not degenerating into ugliness. Thanks to you both.

    My two cents are that I agree with CarbSane regarding the why and protein.

    My only issue with low-carb, and it's certainly not true for everyone as evidenced by both of you, is that a very significant percentage of people who try to live low-carb quit because they don't enjoy their lives enough to continue living that way. That's regardless of whether or not they successfully lost weight on the regime.

    My practice is certainly inclusive of low-carb, but our default approach is decreased carbs (40% as an aim) along with the explicit inclusion of protein with every meal and snack, the de-boogeymanization of fats, along with frequent meals and snacks.

    Has worked well for many folks who've tried and failed to enjoy truly low-carb lifestyles, and as evidenced by serial fasting insulins, has in virtually all cases, eliminated hyperinsulinemia despite a still fairly ample supply of carbs.

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  19. I am curious Yoni how you react to someone such as myself who tried the 40% carb recommendation and found myself hungry and unable to lose weight. I had the recommendation to eat about that percentage from my nutritionist. I don't remember off hand the fat and protein recommendations although they were in line with what is traditionally recommended. I tried sticking to that for 3-4 months and was successful at following the recommendation. I was exercising intensely 3 times a week, eating between 2000 and 2300 calories (what my nutritionist recommended) and lost no weight.

    Once I changed to go into Atkins induction, the weight came off, the hunger went away and when I did calculate what I was eating, it turned out my calorie count was in the 1800-2000 calorie range without me having to consciously control my eating. The change in composition of my diet was not an increase in protein. When I did figure out what I was eating the change was almost solely from carbohydrates to fat.

    So I guess my question is, when you have someone such as myself who does not have success with the 40% carb recommendation, do you believe lowering that is an option if the patient finds themselves hungry and unable to lose weight?

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  20. LCL, there are more variables than simply macronutrients.

    We'd want to look at the timing of your meals and snacks, calorie content of each (with minimums being important to us), sports nutrition and whether you were fueling yourself properly, macronutrient distribution (meaning protein at every meal and snack), as well as quality of carbohydrates.

    If all of that looked stellar and you were still struggling with hunger we would in fact suggest an increase in protein, and that increase would certainly be easiest to achieve by means of a reduction in carbs.

    If that didn't help, that's when we'd consider pharmacology, and in some cases, surgery.

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  21. Frankly, I'd rather just eat fewer carbs and more fat and slightly more protein(maybe 20-40 grams more) and have success that way :-)

    As you've said many times, the diet you should eat should be something you can enjoy, not just live with. Eliminating grains, sugar and potatoes and limiting fruits to low sugar fruits such as berries is easier than you'd think and a lot less work than counting calories, has fewer detrimental side effects than medication and less invasive then surgery.

    I'm not saying low carb-high fat-moderate protein is for everyone, but it is an alternative that I believe a fair number of obese people could benefit from. And it seems the studies (Gardner's AtoZ study is one example) seem to show that to be true.

    And in case you were wondering my cholesterol was just checked and is fine , my blood pressure is good, and I'm down 30 pounds.

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  22. Probably the only thing we'd disagree on LCL (I don't worry for instance about LC being unhealthy, nor do I think it couldn't help lots of obese folks), is the ease/willingness with which people are able to permanently adopt the LC lifestyle.

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  23. I don't disagree that permanent adoption of a LCL can be difficult for some but much of the perceived difficulty is that the long term low carb lifestyle is Atkins induction.

    Pretty much all of the low carb choices (Atkins, paleo, etc) suggest adding back certain carbs (nuts, fruit, etc) to see how you react and to find the level of tolerance to carbohydrate intake. Probably the most balanced approach to LCL is the Primal Blueprint by Mark Sisson which has a lot of variety and healthy choices in it. He just doesn't recommend grains, sugar and limits tubers.

    I'm glad you said you don't have concerns about the safety of it. It's refreshing :-)

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