Insulin Wars VIII: Adam Kosloff of Low Carb Survivor's Guide

Let me start by saying I never heard of this guy.  But wonder, if LC is so great, why would one need a "Survivor's Guide"?  But I digress.

This is my latest installment in response to Jimmy's roundtable of "experts" on James Kreiger's series on insulin;  “Insulin…an Undeserved Bad Reputation”, Part 2,Part 3, Part 4, Part 5.

Kosloff starts out with a long "preamble" directed to James as if he were corresponding with him.  I am not privy to their interactions and will defer to James to discuss this part when he has the time to draft his own rebuttals.  I will comment on my observation that Kosloff seems to come at this from the viewpoint of having bought into the carbohydrate hypothesis hook line and sinker, and basically he disagrees with "calories count".

So, some point by point responses:

This theory, at its essence, as far I as understand it, says that eating too many carbohydrates (in particular sugar and refined starches) makes you fat and sick. Having evolved for millions of years as hunter-gatherers, human beings get hurt by the chronic abuse of these new and biologically unusual foods. Among the many bad things carbs do, they chronically warp the body’s metabolism by spiking blood sugar and driving the pancreas to secrete way more insulin than it should. Over a long period of time, chronically elevated insulin levels wreak havoc throughout the body. In terms of the fat tissue, specifically, the long-term super-supply of insulin ultimately deforms adipose tissue regulation, leading to problems like obesity and, perhaps, anorexia.

As much as I can appreciate paleolithic arguments, they still don't explain why we did fairly well for ten thousand years or so eating these "biologically unusual" foods before all of a sudden they started to chronically warp metabolism and all that.  Howzzat?   As I've mentioned before, kids of my generation weren't eating whole grains over white bread and unsweetened cereals and whatnot.  To be fair, we didn't eat as much and weren't exposed to sugar added to seemingly everything, but we certainly consumed enough to warp things.

The carb/insulin hypothesis is excruciatingly complicated. The “moving parts” involved no doubt number in the hundreds to thousands.  

So if your overall point is that the carb/insulin hypothesis is not a complete and total description of reality… it is a fantastic point, and I am actually on board with you!

Here I thought this was the energy balance that was excruciatingly complicated.  The carb hypothesis is supposed to be so simple.  We'll be treated to an even simpler version in a week or so.  I think James' point is more along the lines that the carb/insulin hypothesis oversimplifies things that basic realities (such as protein stimulating insulin, etc.) readily contradict.  We really don't need "completion" of the hypothesis, we need honesty.  And when one looks at the totality of the science, there's little if anything to support it.

Your aim, as far as I can tell, is to drive people to embrace (or, rather, re-embrace) the calories-in-calories-out paradigm....

This idea certainly makes sense upon first inspection. I used to believe it. Indeed, even most heroes in the low carb world — including Atkins and Yudkin ... have assumed that this idea is somehow fundamentally correct. That it requires no justification. That it is akin to a religious truth.

Well, I won't speak to James' motives, but my take from his series was that it was intended to set the record straight on several misguided "truths" about insulin that have been circulated unchallenged by Taubes and his ilk.   The second paragraph just oozes "I've seen the light, you're a boob" arrogance.  

The basic rejoinder is twofold:

1) Beating up on the carb/insulin hypothesis does nothing to prove that the Calories Count idea is correct.

True.  But James is not the one going on these days about null hypotheses, alternate hypotheses and all that.

2) The Bray assertion that Obesity is the result of a prolonged small positive energy surplus doesn’t follow from the laws of physics. Specifically, the 1st Law of Thermodynamics provides us with no causal information that’s of any use.

Yes it does.  We're not just blobs at equilibrium with our environments.  We need to put energy into our mouths or we WILL starve to death.  The energy we expend is finite.  If we're in any sort of state of chronic surplus, we gain weight.

Gary Taubes actually published a response to Bray’s argument. He wrote:

“[Bray’s] inference of causality is logically indefensible. Vertical growth, too, if accompanied by increasing body mass ... blah blah if not vertical growth why not horizontal and all that ...

 [the question] is why we rightfully focus on hormonal 

regulation when discussing growth abnormalities ... 

but insist on discussing abnormalities of fat accumulation –

obesity and anorexia – as though fundamentally caused by eating behaviour without attending to the hormonal regulation of fat tissue.”

So Kosloff believes anorexia is an abnormality of fat accumulation too.  *Sigh*  Even assuming hormonal regulation drives us to overeat (a recognition that 1st law does hold after all), how does Kosloff account for this sudden wave of hormonal dysregulation when these "biologically unusual" foods are consumed and have been by humans for 10K+ years?  

Robert McCleod, a whip smart Canadian blogger, also composed a rejoinder to the Bray thesis. I hope he doesn’t mind my quoting him at length, but he does an especially sharp job.

I've taken this apart HERE.   Summary:  First Law is perfectly applicable and heat evolution as macronutrients are metabolized can be handled quite well with TFLOT treating the body as a "black box" and accounting for all avenues by which energy enters and exits the body.  Since we don't even attempt to harness thermal energy to add to our total internal energy (e.g. to "fix" mass), entropy considerations boil down to nothing more than an exercise in distraction.  

So I throw down the gauntlet: what’s the rebuttal to this guy? How do you dismantle Robert McLeod’s debunking of Bray’s assertion?

Anyone who wants to save James some time can let Adam Kosloff know of the rebuttal here.  Really, it's not rocket science and don't let them make you feel so stupid compared to these geniuses that you let go of the common sense you were born with.  

Unfortunately, most people knee-deep in this debate — including you, me, Bray, and essentially every obesity expert — are not physicists. We lack a significant and deep understanding of the laws of thermodynamics and the math used to analyze these laws. I’d be willing to wager that Robert McCleod (among others) could take us all to school on the 1st Law of Thermodynamics.

Sounds like Kosloff is perfectly willing to let others baffle him into submission with bullshit.  It makes him feel better, apparently, to presume that everyone else is equally clueless.   Speak for yourself.  This so reminds me of Eades and Feinman bellyaching on Eades' blog over steam engines and how they don't really understand thermo, but I digress ...

I don’t mean to insult anyone. I actually majored in physics at Yale University, and the equation that McCleod asserts is “but a bare starting point for energy balance in a complex system like a living organism” reads like total gibberish to me.

You don't mean to insult?  But you do with your broad brush painting here.  Translation:  I'm clueless and I have an ivy league education, therefore anyone with the same or less has got to be clueless too.  To heck with anyone with even the innate intelligence (formally educated or not) to understand such things. 

Okay. Point made. So what flows from this? Well, first off, if the Bray position falls apart, then so does the idea that consuming excess calories causes obesity and creating a caloric deficit fixes it. Because those ideas flow directly from the calories-in-calories-out point of view.

When did the Bray position fall apart?  I must have missed that, and I think Hall & Chow might have something to say on that.  Not to mention Keith Frayn and any number of other researchers in this realm.

But what about all the biochemistry? What about carbs and insulin and all that jazz?

Well… as I mentioned at the start, you raise some fascinating points. Any truly comprehensive theory of obesity, weight loss, and chronic disease must successfully explain all real world data, not merely some.

I cannot begin to comment on all you wrote because of my lack of space, time, and, frankly, expertise. But let’s touch on a few points…

I think we can all agree that the body has various complicated pathways by which it can convert all three macronutrients — carbs, protein and fat — into stored fat. This makes sense. After all, if this wasn’t true — if only carbs alone could drive fat storage — then people on ultra low carb diets would waste away and become emaciated. 

If, indeed, Kosloff believes that we need to "convert" all three macros into "stored fat", he's further off the reservation than I initially thought.   In any case, as readers here know by now, our stored fat is comprised largely of fat molecules ingested as such and repackaged if you will.  Very little comes from converting carbs to fat (DNL) and even less from converting proteins to fat.  But he points out a key problem with the carb/insulin hypothesis that can not be "complexified" out.  IF it were only insulin causing unfettered trapping/storage, and if one were able through diet to get insulin low enough to matter, they would waste away.  And he goes on to discuss low carb to treat anorexia with initial losses and eventual weight gain:

This eventually gives way to increased body mass as the production of growth hormone eventually increases, and the nutrients needed to build tissue (fat and protein) are consumed. Over a long period of time… they will eventually reach a larger body mass compared to when they began the low carbohydrate program. The new weight, however, will be in all the right places.”

Who knew?  There's a hormone besides insulin that causes fat storage (and protein storage, which insulin does too)?  Did we not know of this hormone?   Did the anorexics have fat in all the wrong places before they starved themselves?  But this is a bit of a distraction so I won't comment further.

The reality is that the adipose tissue is a complex organ. It is a metabolically active organ, not an inert piggy bank to store excess calories, as Bray and you apparently insist.

That adipose tissue is metabolically active is not disputed. That it acts like some sort of isolated self-regulating tissue scavenging from and giving up stores at will in some sort of a vaccum is in dispute. Talk about your inappropriate application of a "closed system" if you will.   The bank analogy works just fine if one applies one thing savings accounts don't have (upper limits).  Speaking of the bank analogy, Taubes would have us believe that the fact that an account is interest bearing will cause the account to draw in more funds or pay interest when no deposit has been made.  

So many factors can impact our fat tissue — alter it, disregulate it, perhaps fix it again. Think about all the hormones, enzymes, genetic factors, medications, exotic agents from outside the body, etc etc, that might influence its character and constitution. And, almost certainly, the relevant influence of these agents changes over time, varies from person to person, and, in general, generates a dynamism so dizzying complicated that I doubt even today’s biggest supercomputer, cranking on all cylinders, could model it for long.

Couple of points on this:  1.  Nobody believing in energy balance denies that changing one factor can have a myriad of effects on the others, changing something on the "in" side can alter "out" term(s).  And 2.  Just because we can't model all the minutia to pinpoint accuracy does not negate the underlying principles of energy balance.  Most of that minutia is accounted for in relatively stable basal metabolism for a given individual and intake calories adjusted for what is bioavailable to humans.  

So is it all as simple as, in the words of George Cahill (as quoted by Taubes in GCBC): “carbohydrate is driving insulin is driving fat”?

Likely this is an oversimplification......

.....You can surely generate thousands of what appear to be attacks on the boiled down supposition that carbs -> insulin -> obesity. Basically you can say: your cause-and-effect chain is too darn simple!

The rebuttal is: sure, nuances abound. Granted! But the question is: how much does this oversimplification really matter?

The carb/insulin hypothesis appears to be a robust first approximation of reality. Much better, certainly, than the calories-in-calories-out hypothesis that most of the world insists is dogma.

Yeah, no double standard applied there, right? Here I thought the carb/insulin hypothesis was excruciatingly complicated, but now it's a robust first approximation of reality?  This, my friends, we can simplify so the *idiots* can understand it.  And yet energy balance theory is just SOOOO complicated that the math looks like gibberish to a Yale physics grad.  For this, a first approximation of reality that can be demonstrated daily (e.g. when intake/expenditure are controlled and manipulated, a person either maintains, gains or loses mass fairly predictably) can't possibly be made.  Uh huh.  Oh, but what do I know.  Kosloff uses a clever tactic of faux humility ("even I don't understand it") so any of us lesser beings can't possibly.  So glad he cleared that up for me!  Here I was belaboring under the notion that having actually understood chemical thermodynamics and several courses in biochemistry I might just get it.   < /sarcasm >

Furthermore, in practical terms, an Atkins or Protein Power type diet should be the diet of choice — or at least the starting point for the diet of choice — not the American Heart Association diet that revolves solely around calorie counting and ignores the different effects that different quality nutrients have on the fat tissue.

Why?  Has it been demonstrated to be more effective for a majority of people who've tried it?

Let me throw out a few more points:

1. You said the following: “In fact, if you truly wanted to keep insulin as low as possible, then you wouldn’t eat a high protein diet you would eat a low protein, low carbohydrate, high fat diet. However, I don’t see anybody recommending that.”

Many of the major LC plans recommend a low carb, moderate protein, high fat approach.

I believe James conceded this point in the comments when I pointed this out to him.  Still, Atkins is not the sort of "high fat" that many are advocating (Kwasniewsky etc.), and indeed there's no admonition to always choose the fattiest cuts of meats or slather leaner proteins with a ton of fatty sauces as so many do.

2. You wrote: “Your Body Can Synthesize and Store Fat Even When Insulin Is Low"

True. As discussed above. And your point is?

That insulin actually doesn't play that big a role in the storage (esterification) of fat.  The demonization of insulin as a "fattening" hormone comes from taking its roles out of context.

3. You wrote: “5000 calories of olive oil isn’t very palatable so of course I won’t get very far. I wouldn’t get very far consuming 5,000 calories of pure table sugar either.”

I wouldn’t be so sure about the sugar part. As Taubes discusses in GCBC, Japanese sumo wrestlers fatten up by eating 10,000+ calories a day on a very low fat, very high carb diet.

But they don't eat 5000 calories of table sugar so how is this relevant?  The wrestlers eat thousands of calories including several beers with meals followed by a nice long nap.  Although they're fat, perhaps becoming a totally blubbery sloth that consuming a high fat + carb diet would effect is not optimal.  In any case, they clearly OVEREAT.   Helllloooo energy surplus --> obesity!

4. You wrote the following: “MYTH: Since diabetics who inject insulin gain weight, this means that insulin is the reason for weight gain in non-diabetics.

FACT: Amylin is co-secreted with insulin in non-diabetics; amylin has appetite suppressant and lipolytic effects.”

So insulin is completely innocent? If you believe this is the case, then riddle me this. Explain the following evidence to me purely in terms of calories-in-calories-out.  [cites that familiar pic of an otherwise thin diabetic with fat balls on her thighs where she routinely injects insulin]  Did that woman gain that fat in her thighs because she over-ate? Or because she didn’t exercise enough?  The consumption of excess calories clearly did not cause her to develop huge lobes of fat at the precise location of her insulin injection spots. Those fat deposits were clearly caused by the insulin injections. She then “overate” enough food to supply the nutrients to nourish that new fat tissue. In at least this case, the “overeating” was clearly a consequence, not a cause, of the fat accumulation.

This is a very clear example of insulin acting as a lipogenic agent. In other words, INSULIN made that woman gain fat where she did.  Is insulin the ONLY lipogenic agent? No.  Is the science of fat regulation dazzlingly complex? Yes.  

Gosh, that slide and the one of the lipodystrophic woman are so absurd.  Was the diabetic fat over all?  No.  She didn't "overeat".  Nobody claims that hyper-physiological local concentrations (e.g. by injecting insulin) can locally influence fat deposition, etc.  This has nothing to do with the action of systemic endogenously produced insulin levels.  And nobody argues against the fact that our distribution of fat tissue is genetically and hormonally regulated.  We're talking TOTAL mass here, and possibly partitioning between lean and fat as well, though Kosloff doesn't mention that.    This doesn't even fit in with Kosloff's "first order approximation" schtick because this is not reality in any normal person (or diabetic who rotates their injection sites).

But insulin is INVOLVED. It is SIGNIFICANT. And it is significant not only when it comes to the cause/cure of obesity but also when it comes to the likely cause/cure of chronic diseases like Alzheimer’s, cancer, and so on.

As to the first part, nobody disputes insulin's involvement in fat metabolism and the Triglyceride/FA cycle in particular.  But its overall significance, especially in light of what most people relying on the whole of scientific literature available on the topic demonstrates its overall significance is much smaller than Taubes' insulin-centric myopic misrepresentation would lead one to believe.  As to the last part ... this has to do with the price of tea in China how??

In conclusion, to a first degree, two things almost certainly must be true about all of this:

1) Some form of the carb/insulin hypothesis of obesity and chronic disease should be our collective null hypothesis that we can shape and modify. I’m not saying we all hop on the carbs->insulin->obesity train and call it a day. But this hypothesis should be our home base.  Our starting point. The new paradigm for thinking about obesity and disease.

Does this guy have an original thought or does he just parrot Taubes?  Does he even know what he's saying?  Where's the evidence that this hypothesis even deserves consideration given that it is so easily demonstrated to be inconsistent with observations?   I do believe that insulin RESISTANCE deserves the attention of the medical establishment for a whole array of diseases.  Seems like it's involved in just about every malady.  Ironically, the result of IR is to BLUNT the action of insulin.  Therefore, I propose our new paradigm of thinking about disease be one that recognizes the "positive life force" properties of insulin and what we can eat and do to maximize our body's sensitivity to its action.

2) The Bray interpretation of the 1st Law of Thermodynamics — the so-called calories-in calories-out paradigm — has been decisively exposed as nonsense.  If confusion remains about this thermodynamics issue, we have a neat and easy way to resolve the debate once and for all. We simply need to ask physicists, engineers, and other experts trained in thermodynamics to weigh in (so to speak). So I invite you, James, and anyone else who has not been bored to tears reading this: let’s go ask the physicists. Ask them this simple question: does the Bray hypothesis — That obesity is the result of a prolonged small positive energy surplus with fat storage as the result. An energy deficit produces weight loss and tips the balance in the opposite direction from overeating — follow from the 1st law of thermodynamics or not? Or is the McCleod refutation correct?

Well hopefully biophysicists Hall and Chow qualify in Kosloff's book for starters.  Or perhaps Kosloff can peruse a course catalog at any larger engineering and science institution of higher learning and realize that thermo is not just for physicists to deal with.  He might be surprised to see that there are thermodynamics courses specific to fields like biology, polymer chemistry, metallurgy, EE, ChemE, etc. ad infinitum.  I'd dare say that even some genius Yale physics grad students couldn't hold a candle to some of the thermo in my background.