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Welcome all seeking refuge from low carb dogma!

“To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact”
~ Charles Darwin (it's evolutionary baybeee!)

Monday, September 5, 2011

Bloggo Science ~ A Hypothetical Post ~ III: Fasting Insulin & Weight Loss

I started this series a while back and had intended this post to come right on the heels of the other two.  The best laid plans ...

If you haven't read them already, I suggest reading the first two posts now before proceeding:  A Hypothetical Post, and II: Plots thicken.  As I've related elsewhere, recent events have me cleaning out the draft bin here on the blog.  Many of these draft bin posts have been collecting dust for quite some time and this one is no exception.  It was started after the whole tiff I apparently set off with Peter of Hyperlipid with a post entitled  Insulin Caused Cerebral Stress.  The title was not intended to mock anyone, it was to point out just how untenable TWICHOO is.   In light of recent events and discussions on the merits of TWICHOO and Food Reward, it may not be the wisest thing I've ever done to complete this series at this time, but I think this sheds light on two important components in this whole debate.  Credibility and debate tactics.  Because the punchline of this series is that the data and the analyses were not published on some science blogger version of The Onion.  They came from a post of Peter's in support, apparently, of his contention that fasting insulin is the determinant of weight loss.


I think the background of events are somewhat key here to understanding why this is not, as I'll surely be accused of, merely some ad hominem attack.  So, I'd ask new readers to please read the Cerebral Stress post before proceeding, along with the post of Peter's to which I was referring:  Potatoes and Weight Loss.  Now perhaps I interpreted Peter's opening words in that post incorrectly, but when a blogger opens with:
I tried and failed to produce a comprehensive post about weight loss on an all potato diet. It runs to too many pages. This is a brief simplification.  
... and ends with:
There are a whole stack of follow on posts to this one but let's see how this one holds up first...
It implies that they spent considerable time in their effort and really aren't done yet.  This is what prompted the "cerebral stress" in my post title.  It seemed to me that at the time Peter was a hold-out in the already  dwindling group of TWICHOO believers, and his recent post on the Taubes/Guyenet debate would indicate that he still is.  Weight loss should not be possible on diets of potatoes or Twinkies etc. according to all the various incarnations of TWICHOO.  His discussion of the potato diet, even though I believe parts inadvertently went counter to parts of TWICHOO, boiled down to this statement:
The ultimate determinant of weight loss is fasting insulin.
I challenged this in his comments linking to this Grey & Kipnis post of mine.  Peter's reply was "Nice study, I'll deconstruct it for you sometime after I've done as much reading as I need to."  Now perhaps Peter's intent was not to be condescending and he interpreted my ensuing blog post as some sort of a response, but it wasn't.  It was solely about how untenable the TWICHOO is -- in particular this notion of "starving cells" and hyperinsulinemia preventing weight loss by preventing lipolysis -- in the face of weight loss on very high carb diets.   Peter did not respond kindly to my post, publishing a pretty nasty one in retort:  Gourmand Rats.  Now I'd really like to know what I ever said to or about Peter to elicit this opening from him:
You know how it is when CarbSane quotes a paper which refutes the carbohydrate hypothesis of obesity. You really can't be *rsed to chase it but you also know that there will be a fundamentally flawed approach which needs looking at. CarbSane was my route in to Kathleen Axen's work with transfats, which I've probably not finished with yet, but which markedly ramped up my dislike of these industrial lipotoxins. I really enjoyed digging back through the Axen papers, though it took hours, and there's no way I would have hit on them without CarbSane's dire (and incorrect) opinion of LC eating based on the last of the triad. Cracking.
So it is with Grey and Kipnis' paper on the irrelevance of fasting insulin to weight loss. It leads back to a rat paper (aren't you surprised!).
Again, if anyone can see mockery in my post to elicit this bullshit (yes, she just cursed!) I'd like to know.  His articles on Axen were also brutal in their attacks on those researchers.  Peter let quite the little fun-fest at my expense go in his comments.  Ahh yes, but he's never moderated comments so all was fine and good.  I did respond to the factual misconceptions about my blog content and let the rest of the nonsense roll off my back, but I think Peter's letting that go and even joining in (no offense intended of course) was poor form.  This was also around the time that Internet Kindergarten Cop II decided to take up his cause of which blogs it was appropriate for me to comment on.   One of those being Peter's blog.  ZZZZZzzzzzzz.

Some time later, Peter did a post on diabetic nephropathy that discussed a rat study and contained the following laugh line:
Obviously this must be the satiating effect of protein, so often cited by idiots as the reason for weight loss of LC diets.
Now I do appreciate Peter's special brand of scarcastic wit, but this is not witty.  There are numerous studies in real humans (not to mention anecdotes) that demonstrate the satiating effects of protein.  So Peter was being unnecessarily nasty here, basically calling anyone who believes in a well-studied and documented phenomenon "idiots".  That's not witty, scarcastic or otherwise.  I responded to that part of his post in his comments:  "Perhaps for the edification of us idjuts in the audience you can explain how the mice lost weight, reversed diabetic nephropathy and even partially reversed the damaged morphology while more than tripling the neolithic agent of disease content of their diet."  Yeah ... I suppose I could have phrased that a little better, but hardly a disruptive comment.  Peter is famous for deconstructing the contents of rodent diets to explain away any outcome that might cause him to re-think his admitted insulin-centric bias and cocoa and heavy cream diet.  So it was interesting to me how the improvements were seen in a diet containing more than three times the veggie oil content of the "high fat" diet. 

Peter responded: "@CarbSane, No. The edification of idjuts is, in general, unrewarding." Ouch!  I won't do a blow by blow of all the comments there, you can see where LCKCII chimed in, but others addressed me and I did clarify in one response that I was referring to the veggie oil O6's.  Peter then posted the following:  "Hi Poisonguy and others so inclined, Could I politely ask that you do not engage CarbSane on my blog. As I say, the edification of idjuts is unrewarding and both you and I can see the gaping holes in this current dose of twaddle which she has posted. But please do not engage. Thanks Peter"    Apparently Dr. I-Don't-Moderate-Comments Dobromylskyj thought discussions between his readers on science rather than personalities were too much for him and his readers to deal with.  Oh well ...

Now, it's certainly his blog, but I received a number of emails and a few comments here wondering "whassup with that?" ... especially since he regularly hosts free-for-alls in his comments section.   I don't really know, nor was it worth my time to even speculate.  Some people apparently do not like to have their dearly held beliefs challenged on other blogs I suppose.  So that occurred towards the end of April of this year.  You see, I am the one who is always wrong in interpreting studies somehow.  Now I really don't think some sort of "my analysis is better than your analysis" blogger war is ever necessary.  But it has always been rather interesting to me when certain studies make a splash to see the monolithic toutings or debunkings about the blogosphere.  It's nice to see that this seems to be changing to where there are even conflicting analyses between bloggers of considerable like minds on most issues.  A blogosphere that fosters individual takes rather than group think is a far better one.

OK, so back to the subject of this post.

About a month later, Peter posted:  Fasting insulin and weight loss on a water fast.  He begins:
I think we have to be very careful with the term fasting insulin.
If we read, in a clinical paper, that fasting insulin level was X iu/ml it is perfectly reasonable to assume that this level simply reflects the carbohydrate content of the diet over the two or three days in the lead up to the blood draw.
I read that and thought to myself, how odd.  Because his first post that started this all was one in which he tried to explain weight loss on the potato diet by describing a mechanism by which that high carb diet lowered fasting insulin levels.  This is the inherent problem with this variation on TWICHOO.  The data don't fit the theory.  So I guess this is why Peter decided to play with the data a bit to make it fit.  Statements like the following are more the norm than the exception for Peter:
Obviously, if you perform a cross sectional observational study of fasting insulin vs bodyweight there will be a positive correlation between the two variables. It is a perfectly valid hypothesis to propose that obesity CAUSES hyperinsulinaemia. Equally, if you are as stuck in the rut of fasting insulin inhibiting inter-meal lipolysis as I am, it would be perfectly reasonable to hypothesise that people with the highest fasting insulin are the fattest because hyperinsulinaemia CAUSES obesity. Both are potentially valid explanations of the observation.
I would suggest that, this is the problem with many adherents to TWICHOO.  They are stuck in the rut of defending a hypothesis (or set of hypotheses really) that came about in a bass ackwards way.  That is the hypothesis was proposed and then Gary Taubes cherry picked amongst observations for only those that could support it.  Leaving aside that many of his own data don't support the hypothesis, the biggest problem with remains that there are so many other observations -- billions of them without conducting a single scientific study -- that should preclude the statement of such a hypothesis to begin with.

Peter frequently tells his readers that he is hopelessly biased.  If anyone challenges his beliefs he can't counter them with the facts because those are not on his side.   In order to consider both explanations where obesity and hyperinsulinemia are concerned (rare occurrences like hypothalamic lesions aside)  potentially valid, one must ignore all of the rigorous scientific studies/data/observations pointing the direction of causality from obesity to hyperinsulinemia in the "metabolically deranged".   Indeed where hyperinsulinemia causes obesity it is by instigating gluttony and sloth.  (Robert Lustig discusses obese kids who get that way through damage to the hypothalamus -- they overeat and are inactive.  This does not extend to the population at large, however.)

So in the post in question Peter sought to debunk CICO in an attempt to support his fasting insulin hypothesis version. Does this sound familiar?  We've only gotten the first almost 5000 word installment of Taubes defending his TWICHOO, in which he wants folks to believe that the real test of any hypothesis is to discredit all other hypotheses and lament that studies don't exist that have tested them.  Yes, as a Swedish diet doctor suggests, let's apply the "we have nothing better to replace it with" test on this hypothesis (oh ... and something about infant hygeine).  

Doh!  

When the science doesn't support your hypothesis, divert attention to other hypotheses and hope they're wrong.  This makes yours the correct one by the process of elimination. Yep ... that's how science should be done!!  Someone ought to write a book ...

And so Peter erects a mini-strawman with his CICO argument:
Who would lose weight fastest on a water fast?
Calories in, calories out... Obviously calories-in during starvation is solely supplied by lipolysis and protein breakdown, once glycogen is depleted. With a BMI of 50kg/m2 "calories-in" from fat breakdown are essentially unlimited, if they happen to be metabolically available. So weight loss should be determined by basal metabolic rate plus exercise/spontaneous movement. A fat person should have a slightly higher basal metabolic rate just to run the support tissue for moving their fat around, even if the fat itself has a relatively low metabolic rate. You must also remember that an overweight person is like me doing a squat with 60kg on my back every time they sit down and get back up again from a chair. So on both of these counts you would expect the fattest people to have highest "calories-out" and so lose weight more rapidly than less obese people.
They don't.
Now there's no reason to doubt that Peter's shooting straight here, right?  I mean Peter must have a pretty darned brilliant scientific mind for Gary Taubes to praise him so.  What with Gary's general views of scientists as idiots humans operating with suboptimal intelligence and all.  I guess he's a veterinarian not a scientist so he must be smarter and all.  Now I'm not sure exactly what Grey & Kipnis did wrong in conducting their study other than, perhaps, the fact that they had done some prior research on rats, but Peter cites "a rather better conducted study we can look at the effect of starvation on fasting insulin levels."  Now since the full text is free, I'm not sure why he would link to the PubMed abstract unless, of course, he was hoping readers wouldn't bother to look too closely at methods and the data he was about to cherry pick from.  Yep ... and he tells his readers he's about to do just that!!
I data trawled and carefully selected choice points from table 1, discarding the half which don't fit the line. I used the blokes only. All is forgiven Dr Keys. Plotting weight loss against starting weight gives a crude (negative) correlation for men. Let me be the first to admit that the relationship does not hold if you include the female subjects. Life would have been easier if we had been given individual starvation insulin levels, rather than having to take bodyweight as a rather crude surrogate. The three women outliers who ruin the plot are, interestingly, short stature.
Honestly folks.  I thought this was a joke and re-read the paragraph and the rest of the post a few times hoping it was.  That I was missing some tag-line to indicate this was intended for HyperlipidfriedOnion or something.  Only the post was not a joke and he continues on with a serious discussion.  The study was small, only eleven subjects.  How can one even use the term "outliers" to describe three of eleven data points?   I thought for sure one, just ONE, of his readers might call him on these shenanigans?  Nope.  Peter ignores half the data to make some sort of point about a study on only 11 subjects to begin with.  He offers up this plot at right for his readers to consider, seriously?

Now, here is all the data.  I suppose when you start by trying to make the results fit your hypothesis the 8 points that look to establish a negative correlation might jump out at you, and those 3 other inconvenient points would appear to be outliers.  But that's not how science is done.  Just because some data doesn't fit your hypothesis doesn't make it an outlier.  There are very stringent tests real scientists must apply in order to exclude data from their analyses.  I authored considerable amounts of the documentation submitted to the FDA for approval of a drug I worked on in my career with Big Pharma.  I can assure you leaving out even one of those points would not have flown with the FDA, however flawed their approval methods and procedures may be.  Peter's analysis goes something like this:  If CICO holds, the more obese a person, the more weight they should lose because the obese have higher metabolic rates.  Now, it is true that metabolic rate correlates with total body mass b/c it correlates (even better still) with lean body mass.  But the correlation is far from definitive, and it is not invariably true that a person weighing 200 lbs has a higher RMR than one weighing only 150 lbs.   No attempt was made (that wasn't the point of the study apparently) to measure REE or TDEE of the 11 subjects prior to the start of the study.  


Peter asks you to presume there is an absolute correlation and use bodyweight as a surrogate for energy expenditure when viewing the plot of just half the data, and conclude that CICO is somehow falsified by these results.  What's interesting is that if we pick the other half of the cherries, the relationship if flipped to one that would seemingly support CICO.  Peter would have us believe, then, that estrogen acts to enforce the laws of thermodynamics while testosterone acts to suspend them.  And here I thought everyone agreed that the laws of thermo were just some uninteresting tautology.  Yet Peter appears to be telling us the men in this study demonstrate otherwise.  


Divining yet more phantom data from the study -- that being the individual fasting insulin levels based on the correlation FI and obesity, Peter posits that the less obese subjects lose more weight during the fast because they have lower fasting insulin levels.  Okey dokey.  His cherry-picked data sure looks convincing!  Bravo!  Another fascinating blog post.  Back pats all around.  Just remember to ignore those ladies again.  Something about estrogen is mucking up his hypothesis.  

This is a horrible study to use to test either hypothesis.  Just as Shai is an even more horrible study with which to test CICO vs. TWICHOO.  The raw data are simply non-existent.  CICO cannot be tested without measuring energy expenditure.  Period.  And the role of fasting insulin levels cannot be tested without actually  having the individual fasting insulin levels to analyze.  Furthermore, and this is a limitation of G&K as well, any rigorous test would also involve not just weight loss but measurement of body composition to assess losses in fat mass and fat-free mass.   Instead Peter makes giant leaps of faith from rather gross correlations in a very heterogenous group.  We are to accept, for example, that 49 y.o. male F.N. at 132.6 kg has both a higher TDEE and higher fasting insulin levels than 19 y.o. male A.B. at 125.2 kg.  Odds are probably better than 50-50 that the opposite is actually the case there, at least where metabolic rate is concerned.


Come on Peter.  Surely you've seen enough data on fasting insulin levels to know that it is highly variable?   That even going through your cherry picking exercise defied all manner of credulity?   Let's look at the data from G&K, and not just for the one subject who lost a little weight in what was supposed to be the weight stable leg of the study, but for all the subjects.  Here's a plot of Weight Stable Caloric Intake v. Body Weight.  Yes, there's a reasonable correlation there ... all but for that "outlier" I suppose down there on the bottom right - and we're talking 1 out of 10 subjects that would throw a monkey wrench into any hypothesis.  Even among those following the expected correlation, you have subjects weighing 105, 108 and 110 kg with daily energy expenditures of 3400, 3800 and 3000 calories respectively.   This certainly doesn't surprise me and it sure 

shouldn't surprise anyone reading this.  In that less "better conducted" study, we also actually have access to individual fasting insulin levels we can pull off the plots.  I estimated roughly using the first reading for each subject and plotted FI values vs. starting weight.  Wow.  A loose positive correlation, sure.  Any indication that body weight is a good surrogate variable for fasting insulin level?  I would say not.  Here it seems 30% of the subjects fail to conform.



There's yet one last problem with this "better conducted" study that would need to be accounted for in any careful analysis.  That is, the length of the fast was not constant between subjects. Therefore, even if one is going to stretch the bounds of credulity to use initial mass as a surrogate for CO or FI, the weight loss should at least be adjusted for the length of time over which it is assessed.  And when you do that, the correlations Peter is celebrating fall apart even for his cherry picked sub group.  Plots of initial weight v. rate loss kg/day are shown at right for just the cherries.   The plots for women and all subjects are shown  below left and right respectively.  Hardly impressive to demonstrate anything whatsoever.


        
    
{the x-axes are all 0.4 - to - 0.7 kg/day weight loss rates}

But based on his analysis, here was Peter's conclusion:
On a water fast the higher your starting weight (surrogate for "fed" fasting insulin, remote surrogate for "starvation" fasting insulin), the less weight you lose over 5-6 weeks.  [Unless, of course, you're a woman, but what's 5 testosterone challenged subjects out of 11 anyway ...]
The bottom line here folks, is that this analysis of Peter's would be roundly (and rightly!) criticized, dare I say even laughed at, were the source not some well-established, respected blogger whom I'm told has some "clout" in the community of rebels-against-the-mainstream.  Surely his cherry picking of the data is FAR worse than that of Ancel Keys.  That it wasn't viewed critically by even one person commenting is indicative of the dogmatic group-think that has permeated this same community.  If Peter says it, or Gary does, or fill-in-favorite-LC-guru says it, too many accept it uncritically.  Where did all the healthy skepticism go?

Of course anything I write here at the Asylum is just twaddle to Peter.  Only you'll never catch me trying to pass off anything like this fine example to my readers.  And I would certainly hope that if I were to try, at least one of you would call me on it.  To summarize the transgressions:
  1. Cherry picks 6 data points out of only 11
  2. Use body weight as surrogate for TDEE because TDEE is not assessed
  3. Use body weight as surrogate for fasting insulin because individual values are not reported
  4. Fails to adjust total weight loss for differing durations.
Sloppy science ... although I hesitate to even call it science at all.  And all of those machinations and manipulations of the data brought us to what end?  As Peter writes:
Elevated insulin is associated with obesity BECAUSE it inhibits lipolysis.
He signs off with:
Maybe there are other explanations. I just can't see them. None as blind as...
Of course addressing what causes elevated fasting insulin and why it doesn't normalise on prolonged fasting is a whole new ball game. People should look in to it.
People, research scientists that is, have looked into this Peter.  Elevated insulin is associated with obesity because it is the body's way of trying to inhibit excessive lipolysis and delivery of excessive free fatty acids to the tissues.  This is not controversial.  So long as significant adiposity persists, the fatty acid trapping ability of the fat is impaired and NEFA are elevated to some degree.  Meanwhile, free fatty acids play a significant role in regulating basal insulin secretion in the short term, an they likely play a much larger role in an extended fast.  The stimulation of insulin by NEFA is, again, not unknown or controversial for those willing to see.   You just have to take the blinders off.  There is a reason why the obese require "10 times the insulin" that lean folks do.  It is because NEFA release is higher by virtue of the sheer amount of fat tissue, but excessive lipolysis/circulating NEFA is ultimately toxic to ectopic tissues.  Therefore we have a nice little feedback loop controlling insulin levels in the fasted (or basal or postabsorptive) state, and provided your pancreas is able to respond when called upon, everything's relatively OK.  Even the limited fat reserves of a very lean person would be deleterious if they were released en masse, and ultimately of what use would fat stores be if insulin levels dropped so as to release them all in short order? 

I repeat:  When too much energy in the form of fatty acids is released from fat cells, they stimulate insulin secretion to facilitate their reuptake into fat cells.  This is a well established metabolic feedback loop.  Not controversial.  Not needing to be addressed at some future date. 

Let's look at the average fasting insulin levels from the study.  Unfortunately the x-axis labels are on a plot below this one.  The hash marks correspond to -3 days, 0, 3, 10, 17, 24, 31 and 38 days where the fasting began at t = 0.  The -3 day level is on the usual diet of the subjects, approx 45 μU/ml.  After three days on a standard diet of approximately 300g carb/100g protein/85g fat totaling 2500 cals it dropped to about 37 μU/ml.  By the third day of total water fasting, the fasting insulin levels dropped by about half to 20 μU/ml.  In the 5 weeks that follow insulin levels creep down a bit before making a slight comeback in latter weeks.  But they don't drop anywhere near zero or even some sort of physiological baseline normal.   The NEFA levels increase to between 2X-to-3X baseline as the fasters are now burning only endogenous fuel.  

There is a lesson to be learned here for those with open eyes and minds.  The fasting insulin is still elevated vs. lean individuals, even 5 weeks out with no nutrient intake.  Why?  Because it is not life-sustaining to have unfettered access to stored fat.  It is stored in adipocytes for a reason.  The insulin-NEFA feedback loop is in play.  The obesity results in greater NEFA delivery due to the excessive amounts of fatty acids mobilized, baseline insulin is sustained (and seems to be making a comeback in later weeks) to prevent a catastrophe of bulk release.  The hyperinsulinemia of the obese is *protecting* the body from lipotoxicity.  It is in reaction to the accumulation of excessive fatty acids in tissues.   (And it's not measured or addressed in this study, but you know what else is going on here?  Re-uptake of some of the surplus fatty acids into adipose tissue.  In the sustained ketotic state.  Likely a small percent, but nonetheless even in scarce times, we overcompensate with our delivery system and mop up excesses as need be.)

That is, of course, the explanation supported by the science everywhere but in the Bizarro LC Bloggo world.  But let's all play nice and ignore such minor inconsequential transgressions ... right?  Us "real smart people" need to stick together to get "them" to do some real science for a change.  That is, of course:

assuming they're capable of doing good science after the past fifty years of doing otherwise

Sigh.

116 comments:

Amy said...

My morning blood sugar was higher on low-carb: 100 instead of 68. I kind of think that one of the reasons that low-carb worked for me was because it kept my insulin higher. After meals was 130 low-carb; with carbs and a ton of candy 115. I become extremely hungry when my insulin drops to 68. There is an older study out (I don't have time to find it right, now.) comparing Atkins, Ornish and Mediteranean that was done in Israel. There, again the morning blood sugar was higher in the Atkins group.

Perhaps, low-carb works for some of us because it keeps our blood sugar higher. I question if that is healthy in the long wrong. I still use low-carb at restaurants. It is away to keep my eating under control.

The other bad thing I do to keep my blood sugar higher, since I stopped low-carbing is to eat a spoonful of sugar, when I'm hungry. It curbs the hunger fairly quickly. If I don't eat a spoonful of sugar 2 or 3 times a day I tend to get too hungry and overeat. But, a spoonful of sugar works as well as low-carbing for appetite control.

Jim said...

When I address these topics with n=1 experiments, I find additional elements. When I tried to gain lean mass (positive energy balance) using only potatoes or rice (little fructose) in a rather high-carb diet, I got so much flatulence and anxiety that I presumed that 1) liver glycogen was not being efficiently replenished and 2) the small intestine was refusing to absorb glucose in excess of muscle glycogen requirements and simply passing it on to be fermented in the colon for a few extra fatty acids. Then I switched out the potatoes for raisins instead (1/2 fructose) and the picture changed: now I was absorbing all the carbs and heading toward metabolic syndrome as I read the symptoms; yet I should actually be needing to make less insulin under this scenario because of the fructose substitution for glucose. By adjusting the ratio of fructose to glucose, I can get rid of the trend toward metabolic syndrome and just gain the lean mass (and a little fat mass, too) so I think that there are two crucial elements to initiate metabolic syndrome: too much fructose overfilling liver glycogen and positive energy balance.

I'm not bariatric, so I can't do experiments on slimming down. But if I go to negative energy balance, I lose fat mass AND lean mass; if I go to positive energy balance, I gain fat mass AND lean mass. The only way to improve body composition is by oscillating slowly between negative and positive energy balance, which minimizes fat mass and maximizes lean mass, and which the natural world would have done for us by providing alternating periods of feast and famine.

So I think it is necessary to be able to eat at both negative energy balance and positive energy balance for health. Unlike Peter, when I go to negative energy balance (losing weight), low-carb is totally unsatisfactory because I am hungry and have a totally wretched mood; instead I need to eat low-fat with lots of starch. When I go to positive energy balance, low-carb is OK but I prefer some carbs because they makes me feel more energetic, just so long as I do not overfill liver glycogen and head toward metabolic syndrome.

Jim Jozwiak

Stephan Guyenet said...
This comment has been removed by the author.
Harry said...

Thank you for this post Evelyn.

It is sad to see people of Peter's intelligence resorting to such poor argumentation and science in order to preserve their faith in their theory.

I think the only valid response is to do as you do, and scrutinise the data over and over again until the message gets through (by increments) to the 'true believers' that their theory rests on sand.

Of course, it would be preferable that the millions (billions even) of free-living falsifications of TWICHOO (e.g. most of Asia) also did some work in the enlightenment process...but the blinkers are so strong on this issue!

Great work...it is much appreciated.

Cheers

Kurt G. Harris MD said...

I am going to put our personal differences aside and take a risk here by leaving a comment.

This is actually a very good explication of the true direction of causality regarding obesity and insulin.

And anticipating the "what about skinny diabetics" question, the folks who get Type II DM or metsyn and don't "look" fat of course ARE fat metabolically.

They have just stopped filling their adipocytes earlier than those with the more visually obvious obese phenotype.

Mirrorball said...

I quit reading Hyperlipid after I found this post:
http://high-fat-nutrition.blogspot.com/2007/12/fruit-and-vegetables-re-post.html

I can't think of a worse example of cherry picking. Someone cited that post to me once, trying to argue that vegetables and fruits cause oxidative stress. In response I searched PubMed and Google Scholar and there were TENS of studies showing a decrease in oxidative stress following a diet rich in fruits and vegetables. Peter simply chose the only ones that didn't. Amazing. I wonder how he can do that and keep a straight face.

M. said...

I would endorse Dr. Harris’s comment about putting personal differences aside. Sniping about a personal grievance that occurred months ago can be somewhat counterproductive, especially when the subject is science. It seems like a lot of wasted energy for someone who is mostly in agreement with you where the science is concerned…But I’m really drunk at the moment, so what do I know…

Evelyn aka CarbSane said...

Hi Kurt: You've always been welcome here and it is unfortunate in my mind that you chose to take your discourse here in the direction you did. I've been saying much of this same things for over a year now. Not much has changed except for the size of the mountain of peer review research behind the "counter theories" -- aka what Taubes refers to as all the bad science from the past 50 years that hasn't been done.

Hi M: I never knew I had personal differences with Peter. I knew that posting this at this juncture would probably raise a bit of a fuss, but it is more important than ever to air this sort of thing.

Why? The purpose of this post (and the two set up posts) were to get folks to think critically about the information they read on the internet, even from their favorite trusted sources -- this post of Peter's just provided an almost caricature example of what I'm talking about.

If you're talking about Kurt, you'll have to ask him what I ever did. He has claimed that I mocked him, mocked Peter, mocked Stephan and that started it? My version of events is rather different and I'd welcome anyone to point me to where I'm wrong in that regard.

@Stephan: Shortly after the diabetic post, Peter was playing around with moderating comments. I've also noticed for some time how the blogger software and spam filter seem to act up more on his blog than just about anywhere else ;-) I was willing to give him the benefit of the doubt that he's busy with the move, etc. in letting Woo use his comments to continue her rants against you. I guess I was wrong. Yep ... classy.

@MBall: When I first "found" the LC Internet Peter's blog was widely cited. I remember reading phrases like "I like this study because it agrees with me" interspersed in posts that were authoritative. At that time, every study that was pro-LC was touted universally, every study that was the slightest anti-LC was universally "debunked" and the researchers maligned. I see the differing responses to the Fatty Diets study as a step in the right direction in the blogosphere. This is a "good thing" <- in my best Martha voice.

Aravind said...

Nice post. I am very disappointed with Peter's apparent censorship of Stephan. I had asked him a question politely suggesting that he was conflating causation vs remediation of metabolic derangement (amongst other things) and didn't really get a direct answer to my points. Oh well.

We need Emily Deans to comment about the psychology of this since the foundation of what LC-ers have been clinging to for years now is being shaken. The emotional reaction of denial is understandable. I think the next phase is anger, but it's been years since my Psych 101 class.

Kurt G. Harris MD said...

Hi Evelyn

Why not just accept the compliment? If you want to re-hash our differing perceptions of the past it's your blog, but I'm not inclined to participate.

I would have never commented here regarding your concerns about arrythmias in the first place if I had found your ideas of no merit. I am not implying anything has changed here, nor have I changed in my level of (scientific) agreement with you.

I've been a skeptic of the GCBC version of the CH since well before I heard you on Jimmy Moore. And I remain a skeptic.

@Stephan

At least there is a relief valve for woo now ; )

Larry Eshelman said...

Evelyn,

I recently re-read the exchange you had with Kurt back in February. I found your initial responses to Kurt respectful. However, early on in the debate, one of the other commenters was disrespectful and condescending. The commenter said to Kurt: "Have you even read the above quoted research [quoted by CarbSane]? I realize it's challenging to read and understand (because it's very technical and littered with acronyms), but it really is an eyeopener." I believe that this comment helped set the tone of the subsequent debate.

--Larry

Evelyn aka CarbSane said...

@Harry: Thanks for the support. As mentioned above, I think it's important to bring this sort of thing up for discussion. There are also a cadre of "authoritative" bloggers out there who make big claims they fail to supply any evidence for. It wouldn't be worth addressing were it not for all the desperate people taking this or that supplement or eating this or that way on their advice and getting more and more frustrated when the expected result does not ensue.

Evelyn aka CarbSane said...

@Larry: I use a very light hand moderating here and I'm pretty impressed overall with the tone of discussions here. So I'm not going to go back through that whole exchange again, but in the end I cannot be responsible for comments by others. Also, although I was aware of who KGH, I had not read a whole lot of his work and it did not seem clear at the time that he had read a lot of mine. I think it's also presumptive of someone -- anyone -- to think readers of someone else's blog are familiar with their work, credentials, etc. Especially in an atmosphere where "mainstream" doctors are so often ridiculed for lack of intelligence. Kurt seemed to take offense when I suggested he read certain references as if I'm supposed to know what all he's read. Maybe it was all sorts of misunderstandings here ... but where Kurt took it to another level was to trash me elsewhere and post nasties after any comment I left on blogs he reads. WTF is/was up with that? He also did a lot of speaking for Peter and Stephan supposedly in the name of keeping me from confusing my readers with misinformation. This was poor form. Whatever. It's water under the bridge but since it was raised again over at Paleo Hacks etc. it's apparently not for some.

Hi Aravind: I suspect Peter has been playing "hide the comment" on his blog for entertainment for quite some time.

Evelyn aka CarbSane said...

Hit post accidentally. Continuing to Aravind: Every blogger or forum moderator is free to conduct their content accordingly. I'm actually quite amazed that I can leave moderation off here and pretty much just have to delete the occasional Razzy-matazzies ;-) What I do object to, however, is when bloggers claim to not moderate but they do. Jimmy Moore has been a huge offender in this regard for most of 2011. It gives readers a skewed impression of the general sentiment.

M. said...

Hi Evelyn, I was talking more about Kurt than Peter. Just as an outside observer, it has seemed that Kurt has made some efforts to make peace and move on.

Diana said...

Dr. Harris,

I don't want to stir up trouble (really!) but Dr. Harris, do you realize what an amazingly defensive character you are?

You wrote, "I am going to put our personal differences aside and take a risk here by leaving a comment."

When Evelyn graciously acknowledged this superfluous preamble by writing that there were no personal differences, only intellectual ones, you accuse HER of bringing up personal issues and of ungraciousness in "not just accepting the compliment."

Hunh?

She merely acknowledged something you said and you slammed her for it. Think about it. Do you have control freak issues? Do you have to dominate every aspect of the conversation, including responses to what you said?

Actually, you needn't have even said anything about putting aside "personal differences" - which are irrelevant. Just address the substance of the issue.

Speaking of substance....

"I've been a skeptic of the GCBC version of the CH since well before I heard you on Jimmy Moore. And I remain a skeptic."

Hunh? that is not my impression of your views at all. In fact I remember distinctly the excruciating exchange on another Carbsane post (with Christian chiming in) where you beat the Taubes' tautology gong as loudly and as hard as you could. Taubes' tautology gong is really another way of denying that a calorie is a calorie, and that negative energy balance produces weight loss.

Is this your way of throwing in the towel and admitting that Taubes is full of it? That CICO, when practiced rationally, works?

Because if it isn't, I'm going to call you a flat-out bald-faced liar, because didn't you write, "I became a medical heretic upon reading Gary Taubes book "Good Calories, Bad Calories" two years ago. I changed my eating habits the day I first heard Taubes interviewed on the radio. Since then I have tried to play John the Baptist to his Jesus (hopefully keeping my head) while expanding on his ideas."

OK, Johnny, now you are a Taubes Skeptic? When did that happen?

Oh by the way, Evelyn, terrific post.

Beth@WeightMaven said...

Yeesh Diana. See Kurt's podcast with Jimmy Moore, which aired before Evelyn's and was taped in late 2010. I have the transcript here: http://weightmaven.org/2011/01/23/gary-taubes-why-we-get-fat/

"If I’ve deviated from being a complete Taubesian, it’s on insulin. … I started out thinking, after reading Good Calories, Bad Calories, and, like a lot of people still think, that the connection was carbohydrates chronically high, you need high insulin to handle the carbs, and [that] the high blood sugar is causing half of the bad things and other half is being caused by the insulin itself. That is backwards in my view.

The reason people have chronically high insulin is because their insulin sensitivity is abnormal. [Abnormal insulin sensitivity] is caused by an abnormal inflammatory state, which may be related to consumption of specific types of carbohydrates, but in my view, no longer do I think of that as being related to the macronutrient ratio of carbs."

As a front-seat spectator to most if not all of Evelyn's back and forth with Kurt, it is clear to me that she contributed considerably to the tone and/or outcome(s) of their discussion.

I've made this comment to Evelyn before and think she has a bit of a blind spot about it, which is a shame if you ask me.

O Primitivo said...

Cahill GF Jr. Fuel metabolism in starvation. Annu Rev Nutr. 2006;26:1-22. Review. http://www.annualreviews.org/doi/pdf/10.1146/annurev.nutr.26.061505.111258

Kurt G. Harris MD said...

@Beth

Thanks for posting that transcript snippet.

There is plenty of evidence for my rejection of the CH portion of GCBC on my blog that antedates this, even if there is no post "calling out" anyone on it.



@Diana

"Because if it isn't, I'm going to call you a flat-out bald-faced liar"

Somehow I get the impression you had decided to call me that even before I posted here ; )

""I became a medical heretic upon reading Gary Taubes book "Good Calories, Bad Calories" two years ago. I changed my eating habits the day I first heard Taubes interviewed on the radio."

I totally stand by that statement I made more than two years ago. I started replacing bread and pasta with animal products four years ago and I eat that way to this day, even as I now see starchy plant organs as perfectly healthy food and have added them to my diet, just like many in the whole foods/paleo influenced "movement".

That statement had little to do with theories of insulin and everything to do with the vindication of animal products (fats) as innocent in causing disease.

With a few exceptions, everyone listed on my blogroll accepts ideas from GCBC like the nutritional transition and deconstruction of the diet/heart hypothesis, while rejecting the GCBC version of the carbohydrate hypothesis.

I simply can't see how the only options are total fealty to the writings of GT or total repudiation.

It's just a book, after all.

Kurt G. Harris MD said...

@DIana

You said, quoting me:

""I've been a skeptic of the GCBC version of the CH since well before I heard you on Jimmy Moore. And I remain a skeptic."

Then you said:

" Taubes' tautology gong is really another way of denying that a calorie is a calorie, and that negative energy balance produces weight loss."

I disagree with your claim that saying energy balance is a rhetorical tautology is equivalent to claiming a negative energy balance does not produce weight loss. In fact, if one were to deny the truth that there must be a deficit to lose fat, one could not claim it to be rhetorically tautological, as one would be claiming it is false instead. There could not be any rhetorical tautology if were not true in the first place.

I've never claimed that CI=CO is not "true", ever. And I don't now. And for the life of me I can't see how saying that CI=CO is not that helpful is the same as saying it is not true. I said early on on my own blog that my caloric intake decreased about 20% on LC, and it has stayed low even on my current moderate carb real foods diet. I have always attributed the success of LC to spontaneously lower caloric intake.

And I don't see what the status of the usefulness (not truth) of CICO has to do with whether eating starch can lead to hyperinsulinemia and fat gain. They seem quite independent to me, even if not everyone treats them so.

Fashiontribes Diet said...

I'm glad both Stephen & in this case, Kurt Harris weighed in. It seems a shame that the LC discussion - and to a huge extent Paleo - gets so sidetracked with either (a) personal and/or troll'ish attacks or (b) cherry picking, pseudo-science, and impenetrable writing - why use an action verb when there's a high-falutin' jargon'y nominalization waiting to be abused...or maybe it just seems that way for layperson-eedjuts like me.

Larry Eshelman said...

It seems to me that Evelyn and Kurt often end up talking past each other. Their CI=CO dispute is a good example

Evelyn uses CI=CO to counter those low carbers who claim that when they switched to a hi fat diet they actually ate more calories than when they were in weight maintenance, and yet lost weight. Furthermore, Evelyn is denying that there is some significant metabolic advantage with low carb diets and agrees with Kurt that low carb diets often work well for some people because these people are less hungry and spontaneously cut calories.

Kurt, on the other hand, dismisses CI=CO as a rhetorical tautology, because it doesn't contribute to our knowledge as to why some people eat too much and gain weight. Evelyn has sometimes indicated, in response
to Kurt, that she isn't interested in this question, but clearly she is, since she has offered several possible explanations: higher protein suppresses hunger, and low carb diets are often less rewarding.

I think Evelyn and Kurt both need to be more charitable in their interpretations of each other's statements. I make this suggestion from a self-interested point of view, since a constructive discussion between Evelyn and Kurt promises to be very enlightening.

--Larry

Swede said...

Low carb is like teenage rebellion. When you start reading and researching more about nutrition people invariably come across information about how low carb diets prevent fat gain and degenerative diseases by reducing insulin. It feels like you have some "inside information" about how all mainstream medical and nutrition advice is all wrong.

But then you grow up and move on with life. Low carb has always been marginal, and despite a brief surge in popularity during the early part of the 21st Century it will continue to be marginalized because its main advocates are people like Peter, Taubes, Eades and Jimmy Moore. They simply have no credibility and their viewpoint is so tinted by their low carb colored glasses that they have absolutely no idea how obviously their bias clouds everything they say/write.

I can see why guys like Lyle McDonald are thought of as assholes. They are so sick of having to answer questions about this kind of crap.

Look, as someone with a BS in chemistry and nutrition I am going to appeal to my own authority here. Carbsane does a much better job than most other bloggers of explaining studies and evaluating the strengths and weaknesses of their conclusions. Thank you for being reasonable and honest about what the science really says.

Kurt G. Harris MD said...

I confess that some of this might result from a lack of appreciation of audience.

In my case, I did not come from within the LC blogoshere and message boards.

So I confess to having been being somewhat incredulous that so many people really thought that you can literally eat as much you want and so would need to be reminded of thermodynamics.

Perhaps there still are many people that need to be reminded of this, I don't know as I still don't read LC discussion forums.

Swede said...

Forgot to add Fred Hahn to the above list of low carb advocates who are...well...definitely passionate about NOT eating their carbs (my rice and beans are cooking on the stove as I type this)

Evelyn aka CarbSane said...

Beth, please. What sort of "front seat" are you talking about??

Show me ONCE where I wronged Kurt.

I see this is all about timing and saving face. Sorry I didn't play by those rules.

Evelyn aka CarbSane said...

For the record ... I posted this before reading many other comments. Hold fire folks please :-)

Fashiontribes Diet said...

@Swede - LOL re the "teenage rebellion"aspect of LC; add to that spouting off about Ayn Rand. I kid...sort of! It does definitely remind me of teens & hormones - always a bad combination. I do agree with Evelyn though that underneath the LC hype & willful ignorance of the fact that calories do indeed count (doh!) there's some baby in that thar' bathwater. Now, if I could just wrap my brain around this NEFA-insulin stuff, maybe I'll actually understand the real deal about how weight loss works.

Beth@WeightMaven said...

Evelyn, I have no desire to go digging in your site (or the others where I believe this started and/or spilled over). But I thought your response to Kurt's initial comment here is a good example of what I'm talking about. And here's one that struck me recently as another.

On August 9th, you wrote a post welcoming people who visited to check out Stephan's account of the Taubes incident. I thought it was fab that you saw the traffic and wrote a post for those folks.

But I read this statement and thought there she goes again:

"If you're here from PaleoHacks, try to check your preconceptions at the door. I know that's tough to do, but if you can't, perhaps just move on and ignore rather than make asses of yourselves."

I don't think everyone in the world should be Dale Carnegie. But I think you should own that you're a pretty aggressive blogger yourself.

Lerner said...

Hi, Kurt. I'm curious: Are you claiming that the idea that "calories don't matter" isn't absolutely central to Taubes' entire view?

What you're saying here seems very sensible, such as LC = reduced calories. But I can't reconcile that with Taubes-as-Jesus. Once one has rejected the Ornish-style idea that SFA must be minimized (and AFAIK Taubes was far from being first to say that), I don't see anything of value that Taubes preaches.

I also can't believe that somebody would actually compare Taubes to Jesus, and place himself as the John the Baptist to Taubes. I've never seen anything like that. Did you really mean to be that fawning? Was it a joke?

I'll say that I don't know much about you. So these are actual questions, not back-handed insults. I think it would be interesting to hear if you've changed your views recently to diverge even more with Taubes. Maybe you wish you'd never written that Baptist thing?

Things are curiouser and curiouser.



P.S. To all: I just looked at http://hyperlipid.blogspot.com/ and the blog is there but no posts are accessible.

Christopher said...

@Beth - True, Evelyn may be an aggressive blogger. Agreed. But I think that's infinitely preferable to being a PASSIVE-aggressive blogger - i.e., one who moderates their comments to the point of creating a cheering section, takes submitted comments and edits them to change their essential meaning, and bans people from their site for daring to mention certain nonpersons (e.g., Evelyn). I happen to be speaking about Jimmy Moore, and, yes, every one of those things has happened to me and others I know. Evelyn is a welcome change to what is becoming increasingly the norm in the LC blogosphere. There must be a reason they're so defensive.

Lerner said...

oops, I see that hyperlipid is really at: http://high-fat-nutrition.blogspot.com/

@Swede: I see you use the word 'advocates' for LC writers. In the not too recent past, I've read or listened to a few - more than a little bit. But I mostly gave that up when it became apparent that they were indeed more interested in being advocates than in getting at the truth. The final straw was that no one would openly criticize the wacky idea that calories don't matter. I suspect that more and more are thinking the same.

Kurt G. Harris MD said...

@Lerner

This is what I love about having even things that are not on your blog anymore available on the internet.

Can I really be that fawning?

I don't know, have you stopped beating your wife yet ; )?

It's called hyperbole. A rhetorical technique that depends on context.

Read my blog and see decide for yourself if I really think anybody is Jesus, even the actual Jesus.

I've described my differences with GCBC succinctly but accurately.

You may think it's "fawning" but I would be much worse if I denied the effect the book had on me. It started me reading and learning about things that have changed my life. Melissa McEwen and quite a few others have said the same.

Regarding the Diet/Heart hypothesis, I've read them all, and none tells the story as completely as GCBC, IMO, regardless of when they were written.

I'm assuming from the incredulity in your question all these issues must have been old hat to you four years ago, in the fall of 2007.

If so, you could have written a book without the errors of the CH and covering these other topics as well.

Would have saved us all some effort.

Sue said...

Stephan your comment was apparently posted elsewhere so Peter copied and pasted in correct spot. So you can see it now.

Todd said...

Evelyn,

I’ve read your analysis of Grey & Kipnis and agree with most of it. But I don’t understand why you think it is incompatible with the carbohydrate/insulin theory of obesity (or as you call it, TWICHOO). In fact, I think much of what you say is compatible with it.

Forgive me if I oversimplify the argument in your above post:
1. Obesity leads to spilling of excess fat as NEFA
2. Excess NEFA leads to insulin resistance in the tissues, including the adipocytes
3. Elevated NEFA stimulates the pancreas to produce elevate insulin as a feedback response to minimize lipotoxicity, one manifestation of which is insulin resistance

In short, obesity causes hyperlipemia and compensatory hyperinsulinemia

But none of this is incompatible with the additional observation that consumption of a high carbohydrate diet tends to raise insulin levels more readily than low carbohydrate diets of equal calories, and is itself a path to hyperinsulinemia and obesity. One of the key findings of Grey & Kipnis (which you credit me for sending to you, but have so far declined to comment upon) was precisely to establish this point:

“The hyperinsulinemia characteristic of obesity has generally been regarded as a compensatory adaptation to the peripheral insulin antagonism that has been demonstrated in obesity….The results of our studies suggest an additional explanation for the hyperinsulinemia of obesity….In the markedly obese person, not only is the total caloric intake typically increased, but the absolute amount of CHO ingested is also appreciably greater than normal…In view of these considerations, it seems reasonable to suggest that the hyperinsulinemia of obesity is also a result of dietary factors rather than exclusively a secondary adaptation to insulin resistance. In this context, the insulin antagonism that develops with obesity might actually represent an adaptive mechanism to protect the obese person from hypoglycemic episodes resulting from the excessive intake of carbohydrate.”

The fact that G&K’s obese subjects lost weight even with somewhat elevated insulin levels is most likely due to their insulin resistance, which would tends to override any apparent correlation between insulin and weight loss. As you suggest, that’s because an insulin level that would stop fat spilling in a more insulin sensitive individual, would not do so in a more insulin resistant individual. That only points to the complexity of the system. It does not establish that insulin and carbohydrate levels are unimportant in determining fat gain or loss, only that there are strong compensatory factors in the receptors.

G&K themselves note that, while the insulin levels of their obese individuals remained elevated even after dietary intervention, three to four weeks is insufficient to effect a significant reduction in insulin levels. However,

“When insulin secretion has been studied in obese subjects before and after more prolonged periods of caloric restriction (two to three months) or after normal weight has been attained, normal basal plasma insulin levels and insulin secretory responses to glucose have been observed…Consequently, it cannot be ascertained whether restoration of normal insulin secretion was a consequence of CHO restriction or the disappearance of insulin resistance.”

Exactly my point. It doesn’t have to be “either/or”, it can be “both/and”. The debate about whether

I. A high carbohydrate diet drives hyperinsulinemia drives insulin resistance drives obesity

or rather

II. Positive caloric balance drive obesity drives insulin resistance drives hyperinsulinemia drives an appetite for carbohydrates

seems so much like the debate about whether the chicken came before the egg. As with much in biology, causation occurs in circles. Why can't both I and II be true?

Other than the pleasure of slaying dragons, why is it so important to “defeat” the carbohydrate/insulin hypothesis, rather than to fill it out by highlighting the complementary half of the circle of obesity?

Todd

Melchior Meijer said...

GCBC is working like a huge catalyst. Isn't Gary the raison d'être of this blog? What would we have learned about say the role of chronically elevated NEFA in the pathogenesis of betacell dysfunction if Evelyn wouldn't have read GCBC and subsequently went ballistic (metaphorically speaking)?

It would be really nice if Kurt and Evelyn could just shake hands, step back and discuss science. I don't believe Evelyn's 'saving face' argument at all. At the moment, most people interested in the biological 'truth' - even doctors - are confused and navigating from argument to argument. Someone who is blinded by low carb dogmatism wouldn't come here and try to start a serious conversation.

I think it's perfectly legitimate to think that CICO is irrelevant to the problem - because it doesn't answer the 'why' - and still participate on this blog.

Is it a crime (or at least a sign of complete idiocy) to believe that obesity is primarily biologically driven (even if carbs drive insulin drives fat accumulation happens to be too simple)?

Evelyn aka CarbSane said...

Hi Melchior,

In chemistry, a catalyst facilitates a reaction essentially increasing reaction rate. After months and months of plodding along with this, perhaps one could now view GCBC as being a catalyst that eventually produced some increase in the knowledge base.

However I see the obesity sections in that book, particularly the misrepresentation of insulin resistance, to be more of a scavenger than a catalyst. Scavengers remove components from the system. Applied to the analogy of advancing our knowledge, GCBC has wasted more time and energy to the understanding of obesity and fat metabolism. Requiring way more reactants to achieve the product. Having to unlearn deeply ingrained misinformation -- NOT errors, but MISINFORMATION (sorry to shout but it has to be emphasized) -- has wasted a lot of everyone's time. He is wrong. He continues to repeat and disseminate incorrect information. Wonder if Kurt Harris told him so at any time during their recent two hour conversation or whether he encouraged him to address Stephan's post on TWICHOO rather than trying to dismantle FR.

MM said...

Stephan's comment just got "misplaced" on Peter's blog? Is anyone really buying that? I wonder if that will be Jimmy's new excuse too.

Lerner said...

Kurt said, "This is what I love about having even things [i.e., the "Baptist" statement] that are not on your blog anymore available on the internet."

Kurt, I'm going to do you a big favor. Then you'll owe me one. (That's the hypothesis propounded by one Vito Corleone.)

Apparently, you've forgotten that your Baptist statement is still right there on your profile. Yep, that's where I saw it yesterday. So there is no context to it other than what is right there for anyone to see by itself. Now, one quick edit and you can set yourself free of it. No need even for any river dunking :)


Oh yeah, about that favor... Just click here:

http://healthcorrelator.blogspot.com/2011/08/refined-carbohydrate-rich-foods.html

You'll see a comment I made about how Taubes has it all wrong on glycemic effect of foods (that e.g. typical whole wheat bread is much lower GI than white, and many others). Then one day do a blogpost on that, if you haven't already. You'd actually be doing the world a favor, especially PTs who actually need to keep BG low.

That error, about how refining is the element that makes foods have a low GI, is everywhere. Even Ornish has got it wrong. Unlike the case where people say 'glycosylation' instead of 'glycation', this error has consequences.

Evelyn aka CarbSane said...

One other thing for those who care to read Kurt's comments here. He was clearly still in the carbs -> hyperglycemia -> disease camp at the time. Perhaps not all carbs, but every time I suggested that getting the NEFA controlled will bring glycemic control (provided the pancreas hasn't been damaged too much), he would go off on that and accuse me of bashing dietary fat. If we were on any sort of similar page I'd have been damned to see that from his comments. He also seemed to argue VLC vs. SAD and nothing in between.

A number of people listened to his interview and were left wondering what his position was, why the change, etc. One issue I have with Don Matesz is that he's done a 180, given the reasons why from a personal standpoint, but failed to explain why what he believed and the science that was based on were now wrong. It seems most of his readers thought he believed TWICHOO. Now, apparently he doesn't. A lot of people are wondering why that is.

In one of the interviews he talks about how he went to Taubes' original sources. Perhaps it embarrassed him that he didn't do that for the obesity section and some bunny-eared cartoon chick actually did. Don't know.

Kurt G. Harris MD said...

@Evelyn

"Wonder if Kurt Harris told him so at any time during their recent two hour conversation or whether he encouraged him to address Stephan's post on TWICHOO rather than trying to dismantle FR."

You don't have to wonder as that is exactly what I did.

M. said...

Evelyn, this is a comment that Kurt made on Free The Animal blog in December, several months before your argument:

Like many, I did indeed start by believing that macronutrient ratios (high fractions of starch) could per se cause metabolic derangement.

However I no longer believe this as it quickly became apparent to me that the anthropological and ethological records simply do not support this assumption, nor does it fit with what we know about insulin function, pathological insulin resistance and what we are learning about leptin.


(If I remember correctly, he was mainly skeptical of the "NEFAs are dangerous" theory you were pursuing, and it might not have been too realistic on your part to believe that you could convince someone overnight.)

Again, just as an outside observer, it seems like a big waste of energy to argue about “he said/she said” from months ago when there is not really much substantive difference in what is being said now. It would seem that the energy could be better spent on someone you are actually arguing with now.

Larry Eshelman said...

Evelyn,

I agree completely with M, and in fact had just looked up the quote that M found.

You are hypersensitive to carb bashers and Kurt is hypersensitive to saturated fat bashers, and you both read each other's comments through these respective filters.

I'm not saying that you and Kurt completely agree on everything, but that you both tend to caricature the other's position.

--Larry

Kurt G. Harris MD said...

@Evelyn

"One other thing for those who care to read Kurt's comments here. He was clearly still in the carbs -> hyperglycemia -> disease camp at the time."

not carbs per se, but hyperglycemia yes. Otherwise not true.


"If we were on any sort of similar page I'd have been damned to see that from his comments."

I am shaking my head here. You literally cannot tell when people stipulate agreement you are so focused on the argument.

"He also seemed to argue VLC vs. SAD and nothing in between"

This is totally false. I never once advocated VLC as optimal and said I agreed it was not optimal several times. I only made the mistake (to you) of disagreeing that it would cause diabetes by failing to suppress NEFA pp. That remains your speculation.

"In one of the interviews he talks about how he went to Taubes' original sources. Perhaps it embarrassed him that he didn't do that for the obesity section and some bunny-eared cartoon chick actually did. Don't know."

Jesus, Evelyn, do you think you are the first person to find errors in GCBC?

I have news for you. You are not. McDonald, Kinbrum, Ned Kock, Krieger. I read them long before I ever heard of you.

I am not embarrassed that I did not fact check the entire book any more than I suppose you are that you have not fact-checked the sections that don't have directly to do with why you are fat because they don't interest you.

Your grudge seems permanent to me Evelyn. Go ahead and pigeon hole me the way it suits you. It seems as if having demons to help you with your anti-Taubes campaign is more important to you than just discussing science after all.

At least it seems more important to you than discussing what we agree on, which is what I have tried to do by posting here.

I'm sorry I tried. At least some of your readers know where I stand.

"one issue I have with Don Matesz........."

You seem to have issues with almost everyone.

Evelyn aka CarbSane said...

@Kurt: I wonder if he'll take your advice. Doubtful. His problem runs to the very core of his credibility as a science journalist. That is, he seems to not have read many of his references (makes you wonder what he did for 15000 hours), and grossly misrepresented a lot of them to boot. These are not minor errors or where the hypothesis "needs complicating", they undermine it entirely. Which I note he's pretty much reduced to a Toothpick lecture these days. If he wants science to move in a productive direction, he should start by not demeaning their work in such a broad manner. Especially when his own research skills leave so much to be desired. If he wants to help people, he would set the record straight in print and not keep digging his heels in further in defense of the indefensible.

In the end it's awfully ironic to me how often folks say I'd get listened to more and be taken more seriously if I were only nicer in my delivery. Yet somehow Taubes is all upset that scientists don't listen to him or take him seriously. Wonder if that has anything to do with him telling them they're all idiots who have no clue how to do their jobs.

@MM: I'm not buying it. ;)

@O Primitivo: Looks like a good read for later in the week!

Kurt G. Harris MD said...

@M

Thanks but you are wasting your time. I am merely a cartoon villain in Evelyn's universe of good and evil. Stephan himself used to give credence to GCBC and I suppose at one point even Evelyn did herself.

But I did not "convert" early and publicly enough to be pure. I am tainted by having argued with her over NEFA and it's role in arrythmias and sudden death.

Kurt G. Harris MD said...

@M

"If I remember correctly, he was mainly skeptical of the "NEFAs are dangerous" theory you were pursuing, and it might not have been too realistic on your part to believe that you could convince someone overnight."

I am not skeptical that inappropriately elevated NEFA is dangerous. I am skeptical at concluding that failure to suppress NEFA postprandially after a VLC fatty meal (the randle cycle) is dangerous. Stephan voiced the exact same skepticism on this blog in comments.

Kurt G. Harris MD said...

@M

You've pointed out something critical. Evelyn seems to assume you need detailed biochemistry to reject the CH, so anyone doing so must have read her blog but just not be giving her proper credit.

You don't and I didn't. There are these other fields of study - called evolution and paleoanthropology and ethology - and they are what first led me to reject it, as it is not plausible just based on knowledge of these fields, which I am guessing neither Evelyn nor GT have done all that much reading in.

Kurt G. Harris MD said...

@Lerner

"you've forgotten that your Baptist statement is still right there on your profile."

my profile (about me) reads thus and has not been changed in many months:


"Kurt Harris MD

I graduated from the University of Iowa with a Bachelor of Science in Zoology in 1983 and received my MD from University of Iowa College of Medicine in 1987. After residency training in radiology, and fellowship training in neuroradiology, I spent several years in academic positions at Iowa before entering private practice. I am currently a practicing board-certified radiologist and a senior member of the American Society of Neuroradiology.

I have had a lifelong interest in science and medicine as culture, and believe all claims to scientific authority should be subject to thoughtful skepticism.

After hearing Gary Taubes on the radio, I had an epiphany and ever since I've been exploring the field of nutrition through the lenses of medicine and evolutionary biology.

For more information, the Archevore mission and tips on posting go here."

Are you looking at my Archevore blog or what?

Larry Eshelman said...

Evelyn,

I believe that it is clear to most readers that Kurt has been making an effort to make peace, but for some reason you fail to see this.

Again, I second M's advice to concentrate on the real differences of opinion that you have with Kurt, rather than whether Kurt has sufficiently distanced himself from Gary Taubes.

--Larry

Kurt G. Harris MD said...

@Lerner

OK, Duh! now I get it. The google profile written in June 2009!

Thanks for bringing that to my attention. I didn't know anyone still read those. Haven't seen that since I wrote it.

I appreciate your comment on Ned's blog. I've always thought GI was a red herring.

Evelyn aka CarbSane said...

@Swede: Welcome! Spot on analysis.

One thing that will forever bother me as well is this notion that we've been listening to authorities -- replacing fat with carbs, eating low fat. It's not the case. I don't recall the government telling anyone to drink 20 oz sodas, Starbucks specialty coffees every day, etc.

Duffy Pratt said...

In my observation, fat people generally drink diet soda. Buy the portion sizes have gone up quite a bit. Remember the wonderful 6.5 oz Cokes in the little green bottles? Then the standard became 12 oz cans or glass bottles. Then 16 oz plastic.

I think the question of how people have listened to authorities is fairly complicated. It's possible that people have paid some attention, and yet have gotten further and further away from what the authorities intended. A trip to the supermarket will show that low fat has at least become a very popular marketing tool. I know lots of people who buy into it, when it suits them. They will opt for the low fat variety of, say, salad dressing even though it tastes worse and is more fattening. That's no more surprising to me than the hordes of people who are getting supersized Big Mac meals with a Diet Coke.

Todd said...

Evelyn,

I’ve read your analysis of Grey & Kipnis and agree with most of it. But I don’t understand why you think it is incompatible with the carbohydrate/insulin theory of obesity (or as you call it, TWICHOO). In fact, I think much of what you say is compatible with it.

 Forgive me if I oversimplify the argument in your above post:

1. Obesity leads to spilling of excess fat as NEFA.
2. Excess NEFA leads to insulin resistance in the tissues, including the adipocytes.
3. Elevated NEFA stimulates the pancreas to produce elevate insulin as a feedback response to minimize lipotoxicity, one manifestation of which is insulin resistance.

In short, obesity causes hyperlipemia and compensatory hyperinsulinemia.

But none of this is incompatible with the additional observation that consumption of a high carbohydrate diet tends to raise insulin levels more readily than low carbohydrate diets of equal calories, and is itself a path to hyperinsulinemia and obesity. One of the key findings of Grey & Kipnis (which you credit me for sending to you, but have so far declined to comment upon) was precisely to establish this point:

“The hyperinsulinemia characteristic of obesity has generally been regarded as a compensatory adaptation to the peripheral insulin antagonism that has been demonstrated in obesity...The results of our studies suggest an additional explanation for the hyperinsulinemia of obesity...In the markedly obese person, not only is the total caloric intake typically increased, but the absolute amount of CHO ingested is also appreciably greater than normal...In view of these considerations, it seems reasonable to suggest that the hyperinsulinemia of obesity is also a result of dietary factors rather than exclusively a secondary adaptation to insulin resistance. In this context, the insulin antagonism that develops with obesity might actually represent an adaptive mechanism to protect the obese person from hypoglycemic episodes resulting from the excessive intake of carbohydrate.”


The fact that G&K’s obese subjects lost weight even with somewhat elevated insulin levels is most likely due to their insulin resistance, which would tend to mask any otherwise evident correlation between insulin and weight loss. As you suggest, that’s because an insulin level that would stop fat spilling in a more insulin sensitive individual, would not do so in a more insulin resistant individual. That only points to the complexity of the system. It does not establish that insulin and carbohydrate levels are impotent in determining fat gain or loss, only that there are strong compensatory regulatory factors in the insulin receptors and glucose transporters.

(to be continued)

Todd

Todd said...

continued from above:

G&K themselves note that, while the insulin levels of their obese individuals remained elevated even after dietary intervention, three to four weeks is simply insufficient to effect a significant reduction in insulin levels. However, they state:

“When insulin secretion has been studied in obese subjects before and after more prolonged periods of caloric restriction (two to three months) or after normal weight has been attained, normal basal plasma insulin levels and insulin secretory responses to glucose have been observed…Consequently, it cannot be ascertained whether restoration of normal insulin secretion was a consequence of CHO restriction or the disappearance of insulin resistance.”

Exactly my point. It doesn’t have to be “either/or”, it can be “both/and”. The debate about whether

I. A high carbohydrate diet drives hyperinsulinemia drives insulin resistance drives obesity

or rather

II. Positive caloric balance drive obesity drives insulin resistance drives hyperinsulinemia drives an appetite for carbohydrates

seems so much like the debate about whether the chicken came before the egg. As with much in biology, causation occurs in circles. Why can't both I and II be true? Other than the pleasure of slaying dragons, why is it so important to “defeat” the carbohydrate/insulin hypothesis, rather than to fill it out by highlighting the complementary half of the circle of obesity? I think what you are doing on your blog is better seen as a valuable and insightful corrective to an otherwise incomplete theory, rather than as a revolution that topples it.

Todd

Evelyn aka CarbSane said...

I'm the first that I'm aware of, Kurt, which is why it got under Taubes' skin, to look at the 2003 Reshef paper and point out that it was among the references in GCBC. There may well have been others (if I read correctly, LynMarie Daye may have done so), but I guess I'm just lucky that Fred Hahn happened to see it. I'm not aware of anyone else getting a copy of Newsholme & Start or Frayn's book, or following up on the research of the latter to the present day -- all misrepresented and/or ignored in GCBC. I have seen many critiques of GCBC but this part of mine is/was different.

Who cares anyway, it just seems you're feeling left out getting credit you think you're due or something. Maybe you should have blogged more about it? I don't know, I don't get you. If it was all so important to you, why did you spend so much time here bashing me rather than just writing at your own blog?

You disagreed on far more than that NEFA and diabetes issue, which BTW, I never presented as fact and remains a viable concern. According to me if folks listened to me they'd all end up blind amputees in dialysis wards because I was scaring them off their VLC/VHF diets into eating NADs and the SAD. You kept equating NEFA with dietary fat... repeatedly. And when I pointed that out, you got all upset that you knew they weren't the same.

Here all I said was that you were welcome here and you feel the need to knock me that I didn't bow down and kiss your feet for the compliment. As Diana points out, a true compliment would not have been preceded by the disclaimer of sorts.

All I did was lament that you took your discourse in the direction you had previously.

Evelyn aka CarbSane said...

Larry & M: I appreciate your takes, but Kurt is obviously not about making amends. If I had gone on his blog, questioned his intelligence and ability to read, posted nasties on other blogs about him, followed him there and posted after my comments how I should go away and stop trolling, tell bloggers their blogs had been infected by a virus, etc., I doubt highly you would see his behavior here in this thread as "making peace".

It is ironic that this discussion should come up again in a thread about Peter's presentation of science. He and Peter had quite a few laughs at my expense while he was telling me that I should bow to Peter's supposedly superior qualifications for reading and analyzing papers. He argued in circles as well back then, and is now denying it. One minute I'm just a good source for reading material but can't read for shit myself.

@M, re: timing. My interview with Jimmy was not the first time I "made my argument". That was taped on 11/9/10. Look in the archives, I've been blogging about this stuff for well over a year now. I'm not a reader of FTA and apparently neither are a lot of my readers. It seems Kurt thinks folks should know his stance on everything just because he has a popular blog. Not everyone reads every popular blog or every post on them either or the comments sections, etc.

This stuff about timing is very curious to me. It's like Kurt thinks I'm stealing his ideas or something? I'm not the one who brought this up. Weird.

Tonus said...

re: Listening to authorities: Part of it may be that people only take the advice that they find convenient, then claim that they're following all of it. There's also the likelihood that some of the advice is being misinterpreted or misunderstood. And with the focus on red meat and saturated fat, carbs and sugar may be getting a pass.

How many people will order a diet soda with an otherwise calorie-heavy meal? I recall that research showed that people will eat larger amounts of foods that are marketed as being healthier, such as potato chips labeled as having no trans fat, or sugar-laden granola bars that "help keep your cholesterol low."

Indeed, what is the primary attraction that many LCers talk about? That you can eat eggs and bacon and steak and butter and many other very delicious foods... and you don't even have to mind your portions, because you can't overeat on LC! (Unless your metabolism is broken, of course)

People follow advice that promises the greatest gains with the least amount of work. Thus, most dietary advice tries very hard to present itself in this manner.

Evelyn aka CarbSane said...

Whoa up there Kurt. I'm not the one bemoaning not getting credit of some sort, or playing the who said it first game here. You were the one who questioned my credentials and ability to understand the science, remember?

M. said...

“Here all I said was that you were welcome here and you feel the need to knock me that I didn't bow down and kiss your feet for the compliment…All I did was lament that you took your discourse in the direction you had previously.”

The only “knock” I saw was this -
“If you want to re-hash our differing perceptions of the past it's your blog, but I'm not inclined to participate.”

He pretty much stopped addressing you and started addressing the comments of others.

Then for some reason you came back with the “he said/she said” stuff and claiming that he was still a VLC supporter at the time.

If you really enjoy holding a grudge that much, then more power to you, I guess. It would just seem better to devote that energy to something new.

I really don’t understand all the talk about timing and when your interview was taped and “credit”. The point of FTA quote was just to show that Kurt really wasn’t stuck in the VLC camp like you claimed. If you were not clear about that, then maybe you were not clear about other things.

But it was in the past. Let it go (if you can).

Larry Eshelman said...

Evelyn,

I haven't followed Kurt's comments about you on other blogs, and so can't comment on them. You may have a legitimate complaint. I don't know.

But it seems to me that the issue about timing has nothing to do with Kurt wanting to claim credit or who said it first. The issure arose with regard to what Kurt's position was when he first commented on your blog: at that time he had already publicly stated his disagreement with the carb/insulin hypothesis.

Also, I don't think anyone is claiming that you should have been familiar with his views at that time. To me, at least, the point is that Kurt's position wasn't that different from yours, but you BOTH assumed the opposite. You assumed that Kurt accepted the carb/insulin hypothesis, and Kurt assumed that you were a dietary lipophobe. This resulting in escalating hostilities.

It still seems to me that Kurt was (at least initially) trying to make peace. For Kurt to make a favorable comment about a post that was critical of Peter (rather than remain silent) was quite significant in my opinion.

--Larry

Stephan Guyenet said...

Hi folks,

Peter says my comment on his recent post went to another post, and he re-posted it for me. I don't know whether or not that's true. I wasn't reading any other posts, so I don't know how it could have happened, but I do make absent-minded errors sometimes so who knows. I don't care to speculate about what happened. In any case, I'm not going to take the conversation with Peter any further.

I resonate with Swede's comment about LC being like teenage rebellion. Just look at the cover of GCBC: "challenging conventional wisdom". Makes me want to get a tattoo and eat some steak. I don't think low-carb as a fat loss strategy per se is teenage rebellion, but I do think the accoutrements of the movement (e.g. carb-insulin-fat, researchers are idiots) are like that.

These last few years have been full of scientific growing pains for me, as I have realized that some of the people I respected have built their houses on sand and are irremediably wedded to their ideas. I feel that I was quite misled at times, and I agree with Evelyn that much of it has been a huge waste of time and effort.

To Evelyn and Kurt: for what it's worth, I wish you two could get along. You are both people who seem to actually want to figure out what's going on, rather than clinging to some convenient dogma. I think your perspectives are basically compatible. It would be great to have you both on the same side. I know there have been insults exchanged, but why not forgive and move on?

Kurt G. Harris MD said...

@Evelyn

"All I did was lament that you took your discourse in the direction you had previously."

Yes, I alone took it there. You had no part in it whatsoever with your responses to me.

"This stuff about timing is very curious to me. It's like Kurt thinks I'm stealing his ideas or something? I'm not the one who brought this up. Weird."

When you claimed that at the time I first posted here I was "firmly in some camp", that is relevant to timing. Unless you think I switched back and forth like a P-N-P transistor and just happened to be pro CH when I came here :)

"@M, re: timing. My interview with Jimmy was not the first time I "made my argument". That was taped on 11/9/10."

It is the first time I HEARD of you, hence the earliest I could have got any information at all about CH from your blog. No one said you first existed on the Jimmy Moore show.

I don't know how many times I have to say that one can, and I did, reject the CH without your help and without the specific references you mention fact-checking. Many people rejected the GCBC CH, prior to the advent of your blog, whatever your specific contributions.

I first posted here at all because I agreed with you on CH and said so right here in the comments. I don't post on Vegan websites. I don't bother unless I think there is some common ground in the first place.

I haven't "knocked" you once. You've twice referred to our past exchanges - assigning me sole responsiblity of course - prior to me mentioning anything at all about them.

@Larry

"It still seems to me that Kurt was (at least initially) trying to make peace. For Kurt to make a favorable comment about a post that was critical of Peter (rather than remain silent) was quite significant in my opinion."

Thanks. Larry. Now I know at least one person has a clue what my comment here was about. Indeed it was not easy for me to praise a post critical of someone I still like and have got on very well with.

I'm sure I'm as tired of reading a thread about what I knew and when I knew it as everyone else is.

@Stephan

Thanks for your perspective and I share your sentiment.

But it's a waste of time trying to agree with someone who is absolutely determined not to in order to nurse a grievance.

Fashiontribes Diet said...

@stephan yes, "misled" is exactly the right term. I've been trying to put my finger on what it was about LC that's been getting under my skin. I guess you see the letters behind the names, the credentials, the endless scientific citations & then the sand-foundation realization sets in. And I guess the small tribe of truth-seekers is much like any disfunctional fam - prone to quarrels and bouts of only speaking to each other through go-betweens - but ultimately on the same side.

Diana said...

" "one issue I have with Don Matesz........."

You seem to have issues with almost everyone."

Classy dude. Real classy.

Against my better judgement (I am still a glutton, if only for punishment nowadays) I checked Johnny Baptist's latest blog.

In the entry, "How To Lose Weight," he does not mention calories once. So, it's completely useless. You can be fat eating Paleo. I've done it.

Johnny Baptist may understand fat metabolism but he doesn't understand how to advise a fat person how to lose weight (hint: swallow the bitter pill of CICO. Then proceed....)

Among the things I have eaten while losing 17 pounds and counting: cheese danish, chocolate danish, ice cream, white rice, French toast, blueberry pancakes made with evil white flour, mapel syrup, Twix bars, trail mix, bagels, English muffins...the neolithic agents of disease fattening lot.

Just not a lot of it.

And I've exercised a lot, come to think of it.

Lerner said...

Exercise? I was at the supermarket today and there was a really overweight person pushing a cart filled with food - snacking as they went. I rushed up to them and shouted, "Please! I implore you! Stop exercising so much. It's making you fat!"

Everyone around applauded. They, too, were fans of Gary Kardashian. Oops, I mean Gary Taubes. I get them confused.

eulerandothers said...

He pretty much stopped addressing you and started addressing the comments of others.

'Then for some reason you came back with the “he said/she said” stuff and claiming that he was still a VLC supporter at the time.

If you really enjoy holding a grudge that much, then more power to you, I guess. It would just seem better to devote that energy to something new.'

I don't think anyone ENJOYS holding a grudge. Some people just feel entitled to respond to whatever they think deserves a response - in this case, on her own blog.

Devote energy to something new? You are actually telling Carbsane, on her own blog, what she should be devoting her energy to?

Let's turn the tables here. Anyone who can direct YOU, with words like, 'maybe it would be better if you...' and tell you where you should be better spending your time... I'm guessing would be considered rude.

Melchior Meijer said...

Hi Evelyn,

Completely off topic, but don't know where to dump it.

Via Chris at Conditioning Research (thanks Chris!) I found this piece about the potential dangers of extreme endurance training with too little rest. I'm a totally addicted swim-bike-runner (but have decreased the volume after reading your radiologist friend ;-) ), so have a keen interest in findings that provide cognitive dissonance. Now, here's an internist who speculates that the excess cases of sudden cardiac death and silent cardiac damage in high dose endurance athletes might be due to magnesium depletion. The magnesium depletion in its turn, would be, according to this physician, caused by elevated NEFA!

Here's the link:

http://www.femsinspace.com/exercise.htm

Magnesium deficiency and thrombogenesis
Magnesium ion deficiency is a further possible complication of long exercise,[18-20] some deficiency may still be present 3 months later.[18] The mechanism is not clear, but may be partly due to removal of free magnesium ions from the circulation by chelation with catecholamine-induced free fatty acids.[19] Exposure to heat also contributes to magnesium ion deficiency.[20] This deficiency increases release of catecholamines,[21] increases the potential for coronary vasospasm,[22] potentiates the vasoconstrictor action of catecholamines,[22] and—in combination with catecholamine infusions or stress—sensitises animals to myocardial necrosis.[23] Magnesium ion deficiency may precipitate a hypercoagulable state,[23] which may be aggravated by residual increased catecholamines (conducive to platelet aggregation and thrombin generation),[24] the increase in catecholamine concentration may persist until the second day after a marathon.[25] It is noteworthy that in a group of 20 patients with vasospastic (variant) angina Goto et al [26] showed that almost half had magnesium ion deficiency that is often unrecognised.[19,21,26]

Evelyn aka CarbSane said...

Very interesting Melchior. I've been working (slowly) on a post on Mg, VitD and possible causal direction for the correlations there. Mg deficiency is associated with IR & diabetes. In one rat study, supplementation forestalled the development of diabetes in a genetic strain, but did not reverse diabetes once developed. Thanks!

Melchior Meijer said...

Great. Look forward to it. Another possibility is that low magnesium is just a marker of impaired NEFA clearance and that the impaired clearance is the root of the trouble, with or without magnesium depletion. Possibly both factors work synergistically.

Diana said...

@Lerner, 8:14,

Re: exercise, here's the irony. The one thing I agreed with Taubes on (still do, with caveats) is that exercise makes you hungry. Meaning: real exercise, really hard work, not just an hour of pumping iron at a gym (which is mostly not pumping but prepping and waiting). Etc.

But in looking back at my food and exercise journal since May, when I have lost 18 pounds due to rigidly applying CICO/ELMM (after years of "carb abuse" and with a "wrecked metabolism"), I note that exercise has played a part. I'm not at all sure how direct it is, but I can't discount it.

And, during a week of extreme exercise, I ate a lot and lost weight.

Evelyn posted a study about hedonic eating after exercise, and it revealed that the people who wanted to overeat did. Those who didn't, didn't.

Well, this n=1 wanted to overeat but didn't.

WWTS? (What would Taubes say?)

Tsimblist said...

@Melchior

I use an iPhone App called ithlete to help avoid overtraining. It measures heart rate variability and resting heart rate each morning. Then it gives a recommendation on whether more rest is needed.

Lerner said...

@Diana: It makes sense that expending energy makes one want to replenish. But Taubes takes things that are true and then drags them straight down the rabbit hole.

Regardless, people like you, who refashion themselves by the force of their own will, will do well and won't be affected by averages or theories anyway.

I could go on about these things forever :)

One thing I will say is that exercise sends a signal to the body: keep the muscle as I lose weight, I'm using the muscle.

Yes, there are studies.

Rob said...

Lerner - By exercise you mean resistance training correct? I think many people think cardio when the word exercise comes up which isn't essential to losing weight.

Most people who diet don't seem to be aware that that when you're losing fat you need to consume adequate protein and do some form of resistance training so your body uses mostly fat reserves for energy instead of muscle tissue. It's the use it or lose it principle.

Sue said...

Rob, I think resistance training plus cardio is beneficial for weight loss particularly if someone is not very active. Those that are active daily don't need to add cardio.

Sue said...

Just to clarify - I mean those that are active as a normal part of their day - some folks have a very sedentary day and would benefit doing cardio.

Rob said...

Sue - What I meant was no one NEEDS to do aerobic exercise when the goal is caloric reduction, the main focus should always be your intake since it's so much easier to say eat 400 calories less than to burn it with formal exercise.

But I agree with you that it can be beneficial for increasing fat loss for those who are especially inactive and overweight.

Although dieting and excessive activity can actually hurt fat loss.

http://www.bodyrecomposition.com/fat-loss/why-big-caloric-deficits-and-lots-of-activity-can-hurt-fat-loss.html

And to reiterate my previous post, strength training is necessary for muscle retention (which should be everyone's goal) when losing fat.

Sue said...

Thanks Rob. Agree with what you said.

Melchior Meijer said...

Hi Tsimblist,

That's cool! HRV monitoring is a phenomenally fascinating concept. I have been thinking about purchasing a HearthMath devise or StressEraser for years, but I guess I'm too old fashioned. I don't even own a simple heart rate monitor, which I heard is odd for someone who writes for the Dutch Runner's World ;-). I'm also happily running in cotton T shirts.

Do you think your HRV app is offering you a reliable window into your ANS-function? Have you noticed benefits in performance/wellbeing?

I'm a huge fan of Dr Malcolm Kendrick, who basically argues that HPA-axis dysfunction is the root cause of most 'diseases of civilization', especially metabolic syndrome and coronary heart disease.

Everything that disrupts the HPA-axis, from discrimination and social dislocation to spinal cord injury, is associated with CHD. And I think this association is causal.

Evelyn aka CarbSane said...

Hi Rob: You might be interested in the study I blogged on in this post: http://carbsanity.blogspot.com/2011/03/diet-cardio-resistance-training-insulin.html

Resistance seems to produce a bit more fat loss, both seem to maintain muscle vs. diet only that lost muscle.

For me these days, activity of some sort is no longer negotiable.

Tsimblist said...

Here is some evidence that aerobic is better than resistance training for fixing broken metabolisms.

http://ajpendo.physiology.org/content/early/2011/08/10/ajpendo.00291.2011.abstract

Tsimblist said...

@Melchior

I did a lot of research into HRV before investing in an iPod touch and the ithlete app. I discovered that some medical research studies were using HRV as one of the metrics of outcomes. Other studies showed relationships between HRV and various healthy vs. disease conditions.

My personal experience is that it is sensitive to health issues, but all it can do is indicate that something is wrong (or right). I have to review the past day and mentally nominate candidates for what is causing the change in HRV. Maybe I did workout too hard or didn't get enough sleep. It has even dinged me when I have pigged out on junk food.

Here is a screen shot of this morning's reading:
http://dl.dropbox.com/u/19811888/ithleteHRV20110909.PNG

It is somewhat unusual because my HRV index (and RHR) improved dramatically from the previous day, but the red light is a recommendation to take a rest day. The algorithm has a trap for "too much of a good thing." I had done a more intense run than usual yesterday, but it would still qualify as moderate intensity. The amber and red lines in graph (at 09-04) were probably the result of a long cycle ride on Saturday, 9/3.

Here is an Excel graph showing my data for the past year plus:
http://dl.dropbox.com/u/19811888/ithleteHRV20110909.JPG

My numbers were the best back in Oct/Nov 2010 around the time I finished my first half iron distance triathlon. Then they dramatically declined during the December holiday season. :-(

Currently I am not training for any event, but I am experimenting with higher workout intensities (although still moderate) to see what happens.

Jin said...

Hi CarbSane,

I think a nice addition to your blog would be an acronym guide, perhaps somewhere on the side bar?

Evelyn aka CarbSane said...

Hi Jin, Yep ... it's a label on the right there. If any are missing please ask in comments and I'll update. I actually intend to make it a top or side tab at some point. If only there were 48 hours in the day and I didn't get distracted so easily by other things. ;)

Lerner said...

Hi, Rob. I think you're right that exercise should be based on resistance training. Well, that's also a bias that I have - because I like it, even though I am not a born mesomorph by any means.

But as with everything, you can analyze it down to more detail. How best to retain muscle might depend on how much muscle there is to retain in the first place. Evelyn's study is with obese men. I'd expect the two training groups (resistance versus endurance) ended up having mostly the same outcome because they didn't have too much muscle to begin with. You have to always look at who the subjects are. That relates to your use-it-or-lose-it, because generally more muscle = more strength.

I also think that Tsimblist's comment on using endurance to better retrain metabolism has the ring of truth to it. Everything (unfortunately) goes in trends and the current trend is that everything has to be high intensity. If someone were overeating for years and years, and their body has sort of forgotten how to release fat or glycogen, then training by counting time and instead of reps seems best.

Everything (unfortunately) goes in trendy cycles. So the trend now is that all exercise must be high intensity. But people should find what suits them.

Jin said...

Sweet! I looked for it as a separate link or tab, and never saw it in the labels. And, doh! it's the first one, in caps, and with asterisks. :-)

Diana said...

@Lerner, "who refashion themselves by the force of their own will,"
Reinforced by fear, sheer unmitigated fear.

"people should find what suit them"
Amen to that. The best exercise is the kind that you do. We have to remove disincentives to exercise. I have found that a huge disincentive is, "I hate it." I hate gyms. So I didn't exercise. I love Central Park. It is my gym now.

Lerner said...

@Diana: I think I am not in the usual. I *love* exercise. If the news said that a gigantic meteor will strike the earth and end all life, I'd think that I'd better work out now because there's not much time left :)

Take a dog outside and immediately it wants to run. Go on a trail ride, and when the horse gets to an open field, it wants to break into a run. So we need to connect with that deep down part of ourselves that wants and needs the so-called "exercise". It's part of the lower brain.

As per diet: I assume that this story has been discussed here. but when I searched for 'Nevin' I didn't see it:

http://www.cnn.com/2011/HEALTH/07/29/nevin.weight.loss.irprt/

"Fearing scary diagnosis, man drops 175 pounds"

Motivation overcomes ALL theories.

Diana said...

@Lerner, motivation is absolutely the key. And you can't motivate anyone else, which is frustrating, but it's the case. I had a psych professor who asked us once in class whether it was possible to motivate another human being. We all said yes. He flat-out said "no." And proved it. Motivation is something that only comes from within. I am a lazy dog, but occasionally in my life I've accomplished things. I buckle down and ask myself, "do you want this badly enough?" And if the answer is "yes," I do it.

Forgive me but I think this is true of everyone.

However...and this is crucially important, which is perhaps one of the reasons why the "Calorie Dismissalists" get on my nerves so much, I could have been as motivated as anything, but if I didn't ACCEPT the reality of calories, I'd have gone out and done the same old shit I'd done a million times before.

I'd have done a Jimmy: cleaned my cupboards of all the "neolithic agents of disease". I'd have allowed not one grain of sugar to pass these lips. And so on. And ya know what? I'd be in the same goddamn situation as I'd been in a million times before, gaining and losing the same weight, wondering what I'd done wrong. Then I'd have gone crazy, as I did before, stressing about my cephalic responses and bullshit like that.

So what I'm saying is, motivation is key - but you also need information, and the ability to accept that truth:

If you eat more Paleo calories than you expend, you will be a Paleo Fatty.

Regarding exercise, I love it when I am actually exercising. I love to move, and to sweat, and to connect with, as you say, that lower brain part that wants to exercise. But I don't love the idea of doing it before. I have to say to myself, "OK, now get out there and exercise." This is another problem with our sedentary lifestyle. If you have no choice in the matter, these issues are irrelevant.

Lerner said...

Diana, you are just such a cool thing. And I do resent generally the fixation on "cool" that gave us rap and Paleo and all that. Hah, that gave us Taubesism, too - rebelling against the status quo.


Please challenge Gary Kardashian to arm-wrestling and whip his butt :) I get so tired of hearing how he looks so good. I think he looks like doughy/pasty.

I'll probably regret posting this but here I go...

Evelyn aka CarbSane said...

@Amy: I usually try to welcome all newcomers here but this slipped past me. So Welcome! Thanks for reading and commenting!

@Beth: I had composed a comment days ago but I guess forgot to hit the Post button. I don't know what it is you don't think I "own", but whatever you like or dislike about my style, I don't make a habit of going on others' blogs and criticizing them on a personal level. This is what Kurt did here. It wasn't enough for him to disagree with my ideas.

Evelyn aka CarbSane said...

@All:

I just now realize that the followup post to the NEFA exchange was not linked to: To my readers

It is more than a little ironic that Kurt resurfaced here in this post.

The way Kurt worded his "compliment" in light of events that transpired here, could easily be interpreted as backhanded, especially since there were some recent exchanges on Paleo Hacks. For the record there, I made the mistake of posting an "Answer" rather than a comment to Travis Culp's laughter. I also think my description there of Kurt "going all immature frat boy on me" (I didn't call him an immature frat boy, I was referring to his behavior)

Kurt said: "I am going to put our personal differences aside and take a risk here by leaving a comment. This is actually a very good explication of the true direction of causality regarding obesity and insulin."

My response: "Hi Kurt: You've always been welcome here and it is unfortunate in my mind that you chose to take your discourse here in the direction you did. I've been saying much of this same things for over a year now."

Kurt's use of the word "actually" seemed to imply "you said something right for a change". I said he's always welcome, that I find his past behavior here regrettable, and that what I wrote here in this post, in terms of the relation between hyperinsulinemia and obesity, is nothing new, I've been saying it for a very long time. I meant nothing more and nothing less by my comment.

Kurt got defensive at my response here. There's no he said/she said in this, it was all he said except for what transpired at PH. I think that was a mild description.

It is water under the bridge. I thought I was being gracious in telling Kurt that he was welcome here. I guess some will infer rudeness to everything I say.

I don't think Kurt realizes that not everybody about the net knows the positions of the great PaNu or Archevore. Also, not everyone listens to all of Jimmy's podcasts. It would have been nice if Kurt had linked to some posts of his, but I'm not seeing one clear post on his position. It seems somewhere between listening-to-Taubes-caused-an-epiphany to where he apparently agrees that the carb/obesity part of the book is wrong he could have composed a blog post explaining his shift in position. A comment on Nikoley's blog? Seems an odd way to "go public" about something like this.

I believe he's since linked elsewhere to this post explaining his position, but I'm not finding that to be very clear.

Is insulin involved? Yes. Do higher insulin levels, all other things being equal, shift the equilibrium towards storage and away from fat release? Definitely. Does any of this mean you cannot store fat without eating carbohydrate or that you cannot burn fat with insulin present? Of course not. You always have some level of insulin present if you are alive and healthy. What effect it has is contextual, as is the case with every hormone.

Insulin levels are an important factor in fat storage but they are not the only factor and IT IS NOT AN ON/OFF SWITCH. Insulin is ONE hormone that affects the storage/release equilibrium.


I do not know if Kurt still believes the above. If he does, this does not seem to be consistent with agreement on the causal relationship between obesity and insulin put forth in this post.

This will be my last comment on this. It is NOT an issue. I just posted this so that everyone has an idea of where I'm coming from. I'm human.

Diana said...

Lerner,

"you are just such a cool thing."

I will never let you forget that, Lerner. I may put it on a t-shirt. (My other motto t-shirt is, "Yes, they are real."

"Please challenge Gary Kardashian to arm-wrestling "

Is he one of the Kardashian sisters?

In fact, I shall issue a challenges in a few months. I shall take on some very big names in the Low Carb world in a very public way. But right now I am biding my time. Gotta get healthy (I have a nasty summer flu) and I gotta get strong.

"I don't think Kurt realizes that not everybody about the net knows the positions of the great PaNu or Archevore. Also, not everyone listens to all of Jimmy's podcasts."

Well, yeah! I was going to write something along these lines but I got the flu and tired and tired of the whole thing.

The only thing I know about the great Kurt Harris is that he has two blogs. I wasn't aware that one of them was defunct, so sue me. And it's on the defunct one that he gives the John the Baptist description. So it would seem logical that John the Baptist would take "Jesus" major doctrinal pronouncements seriously.

"That Sermon on the Mount stuff? Don't take it seriously. Other than that, spot on."

These denizens don't understand something: the rest of the world doesn't give a shit about their doctrinal disputes.

Also that Kurt Harris the guy who said that apples are "candy from a tree." My stomach turned, reading that. WHACKO ALERT!!

This is my last word on the subject too. I am no longer paying the slightest attention to anyone associated with the low carb or paleo or archevore or schmarchevore crowd. It's a dead loss.

Kurt G. Harris MD said...

@Evelyn

"I do not know if Kurt still believes the above. If he does, this does not seem to be consistent with agreement on the causal relationship between obesity and insulin put forth in this post. "

So you are saying that when I said I agreed with this post I must be lying, then?

I have never in any endeavor met someone so absolutely determined to not be agreed with. To interpret that (old) and general quote saying insulin is important but its action is contextual and not overdetermined as in any way supporting the CH is simply disingenuous.

Rejecting agreement just because it comes from someone you dislike advances your interest in science?

Are you really all about the scientific truth, or is is about just debunking, and the angry "takedown", and maintaining the "good guys versus the low-carb charlatans" narrative?

Despite our disagreements, I had always thought the former. I am left to wonder what other things you write that are ostensibly scientific opinions might also be overly colored by personal feelings. What a pity.

@Diana

I'm sorry to hear of your impending silence. I so enjoy reading your well-reasoned posts.

Diana said...

Kurt,

I said I would have nothing to do with Paleo/archevore/LC controversies, but it would be rude not to acknowledge the obviously sincere and gracious compliment such as the one you just paid me.

And I'm also absolutely certain sure that you'll reciprocate by happily acknowledging my success at losing 21 pounds (and counting) as a result of one thing, and one thing only: accepting the reality and importance of CICO, which effected a profound change in my attitudes, enabled me to control my eating habits without too much bother.

Once I flushed Low Carb dogmatism down the toilet, where it belongs, it was quite doable.

All this on a wrecked metabolism, while eating small amounts of "candy from trees" and "Neolithic agents of disease." I must be an n=1 marvel.

Kurt, I'm positive I can count on you, because you never disappoint.

Evelyn aka CarbSane said...

@Kurt: Hunh? I don't get you. I'm sure I'm not the only one here either.

Look, a lot of people read (or used to) your blog and it is/was rather highly linked to in discussions on LC forums and such. You have a lot of information there, that you are telling folks is outdated and not reflective of your current beliefs. You're striking out at folks for reading your own writings and getting the wrong impression or making certain presumptions about your positions based on having read what you wrote. Obviously you're under no obligation to do so, but don't you think a blog post clarifying your current positions on things might be helpful?

You are being very defensive here. No, I'm not calling you a liar. I'm trying to figure out exactly what it is you believe, other than that CICO is an uninteresting tautology that tells us nothing. And for some reason, many others are as well.

This is what I was saying about Don's turnaround. He has years of blog posts supporting a totally different diet than he now advocates. His "goodbye" post didn't address any new knowledge that brought about the turnaround. (From his interview with Jimmy with his wife helping him answer questions in the background, it seems more her influence than anything else.) You obviously seem to have changed your mind in the face of new/different evidence. Why not blog on that sometime?

Larry Eshelman said...

Evelyn,

I see that one good thing that has come out of this "discussion" is that Kurt has updated his website with a new version of his recommended diet.

Having said that, I think it is unfair to lump Kurt with Dot Matesz. With regard to diet, Kurt hasn't done a 180-degree turn around. The changes have been subtle -- a shift in emphasis over time.

I believe what is causing you confusion is Kurt's views on Gary Taubes. Kurt's interest in Taubes stems from Taubes' criticism of the diet-heart and lipid hypotheses, whereas your interest has almost exclusively been from the point of view of weight loss. Kurt has become increasingly critical of Taubes views on weight loss and the carb-insulin hypothesis. (Just as Stephan has become increasingly critical.)

Finally, I want to again point out that it is clear that Kurt has been making an effort to put personal differences aside. You can only fail to see this by ignoring the context -- Kurt praised a post that is highly critical of Peter (someone who he has considered a friend).

BTW: I thought your response to Kurt's praise of your "CICO vs. Regulation of Fat Tissues" post was a good start in clearing the air.

--Larry

M. said...

It looks like Kurt has revised his “How to Get Started” post to make it more explicit. I think his “Paleo 2.0” post and his “There are no Macro-nutrients” seemed to lay out his position before. I think you two just have different styles.

I do think a version of confirmation bias is pretty rampant in this area of the blogosphere where people just skim over the parts that might contest their world-view. I thought Stephan had been pretty clear for a while where he stood in regards to Taubes’ insulin hypothesis, but many people acted like this came out of the blue. Other people complained about other prominent bloggers just “blindly” supporting Stephan, but in reality they simply failed to notice that these bloggers had all reached their own conclusions long before Stephan made his Insulin Hypothesis post. Had they really paid attention to these bloggers then it would not have been a surprise.

I think many of the bloggers are constantly evolving, and the tact used by many of these has been more to point people in what seems to be the right direction rather than “going to war with the Insulin Hypothesis.” I think there are benefits to each approach. Maybe more of a mix would be better. I don’t know.

Evelyn aka CarbSane said...

Oh lord Larry, I just highlighted and deleted an entire response. Sigh. I do want to say I did not intend to lump Kurt in with Don. Actually I was saying the opposite. Don's 180 does not appear to have been inspired by new info and he's not offered any explanation why prior posts are "null and void". Kurt's apparent 180 on the obesity part of Taubes' writing seems to have been prompted by new/different info but he has not set the record straight on his blog so there's less confusion. I'll be checking out the newly published parts tonight.

Kurt G. Harris MD said...

@M

You said:

"I thought Stephan had been pretty clear for a while where he stood in regards to Taubes’ insulin hypothesis, but many people acted like this came out of the blue. Other people complained about other prominent bloggers just “blindly” supporting Stephan, but in reality they simply failed to notice that these bloggers had all reached their own conclusions long before Stephan made his Insulin Hypothesis post. Had they really paid attention to these bloggers then it would not have been a surprise.

Thanks for being so perceptive.

I have been a reader of Stephan's blog since 2008 and it was obvious to me, based only his posts and not counting additional personal communications, that he had evolved his views to be at odds with GT over the CH (carbohydrate/insulin hypothesis of obesity).

Stephan, to his credit, has I believe tried to avoid controversy and just stuck to what he felt like blogging about, and like me and many others in the ancestral/paleo realm he has simply not been focused like a laser on the issue of insulin and why we get fat.

When GT queried Stephan at AHS, I thought it was inevitable that Stephan would have to respond to this, as although FRH and CH are not really alternative hypotheses - they need to be judged independently -part of the FRH argument is that it accounts for empirical observations that the CH simply does not.

For reasons of my own, based more on ethnology and anthropology than biochemistry, and like the majority (not all) of the bloggers on my blog roll, I had already long ago decided that I agreed with Stephan and that the CH was not viable.

So I personally encouraged Stephan to repudiate the CH in an explicit and detailed fashion, as I felt that it was not as obvious (subsequent comments on Stephan's blog reflect this) to most of Stephan's readers as it was to me that they disagreed.

"Had they really paid attention to these bloggers then it would not have been a surprise."

That's worth repeating, but I think the reaction to Stephan's series debunking the CH proves that it was quite necessary.

Evelyn aka CarbSane said...

I found the LC Web in early 2009. I was looking from the weight loss perspective and so mostly just from LC. I can't tell you Kurt how many times folks linked to your PaNu blog, or Stephan's or Daily Lipid in support of various theories in discussions, and of course Hyperlipid. Early on it became clear to me that only Peter seemed to really buy fully into Taubes' theories. However Kurt I hope in retrospect you can see why the John the Baptist schtick and other posts may have given that impression of you as well.

I agree with M's observation that people read what they want into a lot of what they read, and surely nobody should have been surprised by anything Stephan has written in 2011. It's not any sort of change in his thinking. It just seems to me he's sharing that more directly these days and I'm happy to see that. Now if only we could get a carb/insulin hypothesis eulogy blog from an archevore ;-) C'mon Kurt ... go for it!

Evelyn aka CarbSane said...

I would add that I don't "get" Jimmy's podcast audience. Like I've related, and maybe it was the whole listening-to-so-many-at-once thing that drove it home, the vast majority of guests did not buy into the whole carb/insulin thing. Yet folks would hear what they wanted I suppose and discount the rest.

Kurt in one of your earliest comments you answered my question about Stephan's concerns over going below 20% carbs. I heard that in this interview, aired 6/24/10, likely recorded in March 2010.

Listen to the lead in folks! My how times have changed, but I don't think Stephan has changed much in his views. Did I hear the phrase "reward pathways" in there?? (right around the 9:30 mark)

Kurt G. Harris MD said...

@Evelyn

I've long since given up promising blog posts as real life always impinges on such plans.

But there is a post in forme fruste that was titled "Why I don't believe in the carbohydrate hypothesis" and might now be titled "No more black monoliths".

No promises. For one thing, it would be hard to add much to Stephan's series and your recent posts, and there is more to blogosphere life than debunking the CH, as dear to your heart as that might be....: )

One of the reasons I changed my blog name was to try not to be pigeon-holed into any one "movement", be it paleo, or LC or anti-LC dogma or whatever.

I do think this is an insidious threat to dietary science and indeed all science, even if it is just essentially scientific cultural criticism, which is what I do, and not Real Science (TM).

I have not disowned ancestral health even as I want to avoid the "paleo" moniker.

I think the misunderstanding is that there are folks like you who, according to your interests and history, equate Taubes 90% with the CH, and ancestral health oriented folks who equate him 90% with the slaying of the Diet/Heart hypothesis.

Regarding "John the Baptist", you might see how one could get excited enough by the vindication of animal fat to say something that a weight loss oriented person focusing primarily on G3P thinks is insane, and a person seeing attacks on GT thinking there might mistakenly see lipophobia afoot, as that is still part of the dietary zeitgiest and shows no signs of lying down dead anytime soon.

When you are a practicing MD you are confronted with the idiocy of the Diet/Heart hypothesis daily, but unless you do bariatrics, details of how we get fat doesn't much show on the radar.

I owned a clinic imaging coronary and carotid and renal arteries with CTA and MRI. A doctor like me dealing with vascular disease is going to see the lipids bit as pretty important, just as someone like you, frustrated with reading unscientific nonsense on Jimmy Moore's forum is going to be pretty focused on insulin's role in how we get fat.

I appreciate where you came from, and I think you are starting to appreciate where I came from.

From the ancestral health perspective, when the "minor" parts of GCBC - the ones that are major to those with an interest focused on fat loss -start to screw up our refinement of ideas about what constitutes an evolutionarily appropriate diet, then it becomes time to explicitly deal with the CH and repudiate it.

It seems to me that time is now.

There was really no conspiracy to protect the CH or even GT even if it looked that way, it just did not become a priority until now, when the reaction to Guyenet/Taubes at AHS made it clear that the CH dogma was more ascribed to than many of us thought.

The genesis of my "Paleo 2.0" manifesto was that I thought it was obvious it was time to separate both low carb dogma and the diet heart hypothesis from ancestral health.

And I wrote "No such thing as a macronutrient" as a repudiation of the CH. It still reads as such to me, even if the argument is more subtle and less biochemically based and direct than you would have written.

Kurt G. Harris MD said...

@Evelyn

Stephan had been developing his ideas about food reward for quite a while. You can see hints of it even earlier in his posts about diets of various groups eating horticultural whole foods - the simplicity of the diet is often commented upon, as well as the lack of disease on high starch.

If you are saying that Stephan has not believed the CH for a fair length of time, I agree. I can't speak for him, but he had blog posts that could reflect belief that LC was part of the evolutionary milieu maybe 4 years ago, but none I ever saw in the past 1 1/2 to 2 years.

Kurt G. Harris MD said...

@Diana

Though you were done? Oh well.

"And I'm also absolutely certain sure that you'll reciprocate by happily acknowledging my success at losing 21 pounds (and counting) as a result of one thing, and one thing only: accepting the reality and importance of CICO, which effected a profound change in my attitudes, enabled me to control my eating habits without too much bother. "

Well I cannot say I am happy as I am pretty much indifferent to the fate of people who insult me and have nothing else to offer.

But why would I not accept it? I've never in my life claimed it is impossible to gain or lose fat by force of will, or counting and measuring, or low fat diets or weight watchers or any particular method that works. I'm really puzzled why you would think otherwise. Is it just because I advocate a whole foods, low NAD low FR approach that also works well? Or that I would not choose to do so personally?

"Once I flushed Low Carb dogmatism down the toilet, where it belongs, it was quite doable."

I am sorry if this dogmatism - in whatever form, made things difficult for you. Did someone, maybe Atkins, tell you that you could eat unlimited calories on low carb? It sure as hell was not me. Any diet that makes you eat MORE and gain fat should be abandoned, is that not obvious to anyone?

"All this on a wrecked metabolism, while eating small amounts of "candy from trees" and "Neolithic agents of disease." I must be an n=1 marvel."

Who ever claimed that just because my approach works that yours must not? Do you think my approach is universally invalid because it did not work for you or anyone in particular? Does your counting calories experience prove anything at all about mine? Of course it doesn't.

I've never, ever, said counting calories cannot work, just that it is stupid to do if yo don't need to. Most people don't need to. Too bad that you do. I guess that is why you are so bitter?

"Kurt, I'm positive I can count on you, because you never disappoint."

I have no idea who you are, but I am glad you find my responses so gratifying.

M. said...

@Kurt

Yep, I think it was about time for someone in the Paleo/Ancestral blogosphere to repudiate the CH in an explicit and detailed fashion, and Stephan was probably the right guy to do it (though it would have been interesting to see the reaction to your "Why I don't believe in the carbohydrate hypothesis" post.)

Kurt G. Harris MD said...

@ M

If I had mastered all the details and knew how to make the argument as skillfully as Stephan, I would have done it first.

Hints had been dropped and subtle arguments made, but Stephan was the best one to do it from within ancestral health, and it is good that he did so.

Evelyn aka CarbSane said...

@Kurt: I think it would be fair to say that 90% of all people who read GCBC view it as a treatise on obesity and look at the sat fat/cholesterol/CVD part as merely assurances that sat fat is OK. You don't see "Gary Taubes tells us ..." cited repeatedly about the web ending in "saturated fat is good for you". You hear some version of "fat doesn't make you fat, carbs do", or "exercise just makes you hungry", or (used to) "you can't store fat in the absence of carbs". His GCBC inspired lectures have not been trying to convince doctors and researchers about the fats part. No, they are about the obesity part. I began blogging when WWGF was in the works and folks were anxiously awaiting it.

I think a pass for "errors" in GCBC could have been given were it not for the fact that Taubes has basically ratcheted it up a notch and dug in his heels with WWGF. The book and the promotional blog posts being out for an awfully long time now.

He is also the de facto leader of the "low fat made me fat" chant. Yeah ... that stoopid Jillian Michaels has no clue.

If you can convince GT to lecture at medical schools about the wrongheadedness of sat fat phobia that would be great. Good luck with that! With the exception of margarine, salad dressings and some low fat dairy, Americans didn't buy in. This notion that we're all eating low fat diets and that's what caused the obesity epidemic is such a farce.

Kurt G. Harris MD said...

@Evelyn

I was only trying to think about how readers can have different impressions of the book depending on where they approach it from, not really making a "moral equivalence" argument or one based on net impact.

Just trying to explain how you and I were talking past each other based on our differing histories.

Your perception is, of course, closer to the universal one than mine. For one thing, the weight loss universe is way bigger than the ancestral health sphere, even as ancestral health is growing faster.

I think, given Taubes' own lectures and especially publication of WWGF, that you and he would agree on that one point, that the fat/insulin bit is the "important" part of the book.

Which is why I was disappointed to see WWGF, rather than a book that might further refine what the putative NADs (whatever they are) might be, beyond just saying "easily digestible carbohydrates".

"I think a pass for "errors" in GCBC could have been given were it not for the fact that Taubes has basically ratcheted it up a notch and dug in his heels with WWGF."

I think we agree on that.

Evelyn aka CarbSane said...

I understood what you were getting at Kurt, was just, as you've now confirmed, pointing out the prevalence of those reading it for the obesity angle. I think Taubes is trying to shift things a bit with the sugar angle but I'm not sure he can now shift from his obesity schtick. In case you don't know, I only read the book in mid 2009 after losing the weight. I never feared saturated fat my entire life. But I did go through fat-phobic phases, always from a calorie standpoint. In this regard, I do thank Atkins for showing me that I could lose weight eating ad libitum and "fattening" foods at that.

I have done low fat diets, because let's face it, to deliberately cut calories it is far easier to substitute or eliminate fats. It works very well, just requires more conscious effort. For a short spell I ate those (cringing thinking about them) rubbery cheese foodish slices and "I can't believe it's not butter", but again, not out of phobia but for calorie savings. It didn't take long before I realized I much preferred 1 tsp of butter to 2T of wannabe butter-like substance.

I've got to also say that my chem background always had me wary of those transfats -- how do you make a PUFA solid at room temp? Hydrogenate, therefore make it a saturated fat. If my mother-in-law were still alive she could tell you how way back almost 20 years ago I tried to get her to ditch the margarine (on the advice of the docs due to her having a heart attack and my FIL's BP/angina issues) and use real butter. I never succeeded.

Maintenance is the problem with "dieting" and permanently reversing obesity, not the ELMM approach or whatever works to lose the weight.

While I have your ear ... what do you think of the walnut paradox? Of all nuts walnuts are probably some of the highest in O6 content and yet there are many indications that they are beneficial. It's things like that that make me wary of the whole PUFA thing. I think the problem with veggie oils is more their susceptibility to oxidation with heat, chemical extraction, hydrogenation and use in "junk food", than an inate problem. Do you see harm in truely cold pressed veggie oils used in salad dressings and the like?

Fred Hahn said...

"This notion that we're all eating low fat diets and that's what caused the obesity epidemic is such a farce."

Strawoman argument. Tsk, tsk.

But anyhoo:

http://www.proteinpower.com/drmike/wp-content/uploads/2009/04/macronutrient-intake.jpg

We are indeed eating less fat and more carbs especially refined carbs.

And Jillian Michaels IS fairly clueless.

Sanjeev said...

FRED:
> Strawoman argument. Tsk, tsk.
_____________________
The black hole calls the neutron star dense.

I'm shocked, SHOCKED I TELL YOU.

FRED:
> And Jillian Michaels IS fairly clueless.
____
Ad homimem

Kurt G. Harris MD said...

@Evelyn

"For a short spell I ate those (cringing thinking about them) rubbery cheese foodish slices and "I can't believe it's not butter", but again, not out of phobia but for calorie savings."

I have to pass on that I have a good friend whose mother-in-law insists on using that stuff - "I can't believe it's not butter", but just to irritate her, he insists on calling it:

"I can't believe you think that shit tastes like butter": )

Kurt G. Harris MD said...

“While I have your ear ... what do you think of the walnut paradox? Of all nuts walnuts are probably some of the highest in O6 content and yet there are many indications that they are beneficial. It's things like that that make me wary of the whole PUFA thing."

I've not seen anything but observational data on walnuts or any particular nuts being beneficial, and we're not likely ever to get any better proof than that anyway.

One big theme of mine is to be highly suspicious of any particular plant food that is claimed to be "magic" - in the "you must be sure to eat this to avoid fill-in -the blank" sense.

That said, if walnuts are good for you, it's likely due to polyphenol content and despite the PUFA. If it is the polyphenol or other hormesis inducing compound, then I would think a few walnuts could be good for you, but would be suspicious of eating many, as the hormesis is likely to go away and the PUFA excess would come to the fore with higher doses.

"I think the problem with veggie oils is more their susceptibility to oxidation with heat, chemical extraction, hydrogenation and use in "junk food", than an innate problem."

It's sort of hard to imagine getting very high PUFA intake without much of it being already fairly well oxidized, so that will be hard to sort out in a clinical sense.

It's hard to know if it is only PUFAs that are eaten outside the context of whole foods, or total PUFA per se that is harmful, as one cannot really get giant loads of total PUFA without eating industrial seed oils, unless you guzzle fish oil and eat nuts as your primary carb source.

The thing that makes me really suspicious of total PUFA, whether “pre-oxidized” or of pure virgin whole foods origin, is that of all the things we eat it seems to be the most outside our evolutionary history – several times if not an order of magnitude more than anything before the 20th century. Chris Masterjohn points out that the actual quantities we require of essential (PUFA) fatty acids are so small it really makes them micronutrients, and we eat them at well over 10% of total calories on the SAD.

The thing is, there is so little downside to their minimization. It’s not like bread or sugar. I’ve never heard of anyone craving soybean oil.

For obesity it may just be food reward effects, but I think there is enough evidence for effects on oxidative stress and pro-inflammatory eicosanoid effects, that even if there is no effect on obesity per se that avoidance of total PUFA as a putative NAD is prudent. It’s not at all hard to do.

Just eat nothing but real whole foods and avoid processed foods, industrial fried foods, and unnatural quantities of (mostly rancid or roasted) nuts and you’re there.

"Do you see harm in truly cold pressed veggie oils used in salad dressings and the like?"

No harm in real food oils like olive oil eaten at room temperature. They tend to have antioxidants built in as well as phytochemicals that provide some benefit via hormesis. Olive oil on salads – a bit of a politically correct fad (driven by mono content and little sat fat content) no problem, it tastes great. I never fry with it, though. When coconut and ghee and animal fats are so much better, that makes little sense.

The crux moves in health I see as 1) not eating too much, 2) avoiding NADs (whatever they prove to be, and yes, many are NADs because they DO make you eat too much) and 3) getting proper micronutrients. This is not a rank ordering as these can’t really be separated from each other.

Eating whole foods and excluding wheat products (kind of a special case) is probably 90% of the game. The weight loss thing, as I’ve said before here on your blog, may require steps far beyond this, depending on who you are. Yes, that includes counting, and measuring and force of will, if that’s what it takes.

Kurt G. Harris MD said...

I meant to say using lots of olive oil outside the context of flavoring salads was somewhat motivated by a degree political correctness - lipohobia about sat fats.

Kurt G. Harris MD said...

"I've got to also say that my chem background always had me wary of those transfats -- how do you make a PUFA solid at room temp? Hydrogenate, therefore make it a saturated fat."

If you saturate them completely, then they are are totally saturated and no problem. The problem is that in the linear trans configuration they behave - cooking and mouth feel wise- like they are saturated but they are not. Eliadic acid is a monounsaturate -the isomer of oleic.

So you have something that looks safe- like sat fat, but is not. They hydrogenate it with a catalyst to get it just solid enough and not too stiff for baking, which guarantees that it will be not completely saturated.

By the way, companies now remove the trans isomers and can label something as trans fat free as long as it has less than 0.5 g of TF per serving. So if the serving size is arbitrarily made small enough, there can be a fair amount of TF in it anyway and the label can say zero.

Just another reason to eat nothing that comes in a box - no processed "food".

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