Verdict: Guilty as Charged!

Hi all!  I thought for a bit on whether or not to respond to Larry Istrail's Response to Criticism from 'Carbsanity'.  There's not much of substance there to address ... but it is typical of the lack of real substance and mischaracterization that is so common amongst my detractors.  So, I thought I'd address it.

Is this registry a joke?  The verdict is in:  Guilty!  I'm sure that Istrail is serious, and many of those who are registering are serious, and that's not what the joke is.  The joke is that somehow anything meaningful to the purported goal of the study will come about.  Let's take a look.  I'll try to be consistent and put Istrail's words in purple.

From AWLR Home Page:  The Ancestral Weight Loss Registry is an international assembly of people who have tried a carbohydrate-restricted or paleo diet to lose weight or improve their health.
In response to which I wrote in my "cheeky" style:  And I'm an internationally known blogger.
Response:  She describes it as a "JOKE", condemning the fact that I describe it as an "international assembly"

Condemn?? Ha!  I was merely poking fun of the fact that in this age of zee interwebs there is no longer any clout to the term "international", although it is used in that manner, hence the little poke.  I'm going to add this to my list of studies demonstrating that carbohydrate restriction severely impairs humor recognition.   I'm thinking I don't want this guy for a doctor someday, his bedside manner may have him telling me I'm "condemned" to a life of disfigurement due to a pimple on my nose or something.

From AWLR Home Page:  Whether you lost 100 pounds or gained 20, we want to hear about it.

I wrote:  They want to hear if you've gained weight!  Yeah ... right ... LOL. 

AWLR Response:  She describes it as a "JOKE", condemning the fact ... that I am interested in hearing from those who have gained or maintained their weight while eating a carb-restricted diet as well

Note to Istrail: Start with renaming the registry something other than Weight Loss if you are truly interested in the stories of those who have not had positive experiences low carbing, or who have had success, but limited success and now weigh far more than they did prior to trying a low carb diet.   In all my years of weight struggles, I never met a more dogmatic group that is less friendly to even seeing merit in alternative approaches than the low carb internet community. If someone doesn't succeed they must be doing *something* wrong -- not eating enough fat, too much protein, a few grams of blueberries, whatever.  Don't listen to your body, end up in the emergency room b/c you passed out instead of having a few carbs, just eat meat and greens and you'll be OK, and my favorite, the nasty "good luck with that and all the weight you're going to gain"  if you dare entertain another approach.  Heck, even low carbers aren't safe unless they demonstrate their cred by eating at least 60% calories in fat daily, preferably far more.  Dukan dieters are driven off low carb boards by the up-the-fat crowd.  You can say you take all comers all you like, but those who gained or didn't lose or had bad side effects are long gone. 

AWLR Response:  This registry is then compared to the National Weight Control Registry (NWCR), describing how inferior our data is, praising the fact that the NWCR only accepts registrants who have lost weight and kept it off for at least a year.

Does the Insurgency need a new playbook already?  I mean really.  Did Istrail have no clue that Gary was going to hype his registry on his blog?  I didn't make the comparison ... that IS the joke here ... that there is any meaningful one.  But there can be no doubt that AWLR was supposed to be some sort of LC/paleo version of the NWCR.  Note that third letter in each acronym and it's even more ironic.  Here we have the NWControlR who accepts only those who have lost considerable weight and demonstrated an ability to keep it off for at least a year.  OTOH, we have the AWLossRegistry that accepts all comers, losers and gainers, maintainers and yo-yo's.

Repeating from the home page:  As thousands register from all over the world, we hope to uncover the most effective practices for losing weight on a diet high in vegetables, protein and fats.

So if this is not your diet, you need not apply.  Don't tell Gary's friends at JumpStartMD!  Their fat intake is comparable to WW at 18%.   What more is there to the most effective practices?  Just eat meat, eggs and leafy greens and STFU already, right?  This is the advice you get on low carb forums when you ask for help with plateaus or problems.  Or you need to take a whole alphabet soup of supplements ... and when all else fails, you've just got a damaged metabolism so just be happy you're not quite as fat as you used to be and STFU unless your doing your daily "healthy high fat, moderate protein, low carb" chants. 

Now, Larry didn't take kindly to my description of the quality of the data he's likely to collect.  He keeps focusing on self-selection and self-reporting.  Yes, there are inherent limits to this type of data as he admits:

Of course, people can "pad their stats", saying they've lost more weight than they actually did. They can lie, or they may enter false data. This is a simple fact that plagues all self-reported data.

I would simply hope that the same criticism be conjured up when describing the NWCR data. The fact that the NWCR require their registry members to mail in a packet of information and provide their home address does not necessarily improve the quality of self-selected, self-reported data. 

If Istrail truly believes that data collected in a survey where you have to provide a real name, physical mailing address, spend significant time to fill out the materials sent, sign that the information is truthful and supply supporting evidence is no different than an online survey that can't even limit entries to one per email, where not even a fake name is required, where followup is optional .... a huge *SIGH* is all I can say.  In a "gotcha" moment, Istrail links to one publication using NWCR data to show that my memory "may not be entirely correct".  He says: You can give a visual verification of your weight loss (before and after pictures), as you can with the AWLR, but it is not required. As Dr. Wing explains , "19% (145 subjects) were unable to provide any source of documentation" verifying their weight loss.   Awwww c'mon Larry, did you really think you'd get away with that cherry picking?   As I don't have my packet handy I can't say exactly how it was put, but NWCR is big on providing some kind of documentation.  It is understandable why some might not have that and return it anyway, I'm a bit surprised 19% were so bold as to do so, but that's 19%.  ALL of that 19% provided more verifiable information than AWLR can ever hope to obtain.  But let's look at the whole paragraph in the NWCR article, shall we?

Entry into the registry was based on self-reported height, weight, and weight change, which have been shown to be quite accurate in other studies (9, 10). To increase the veracity of self-reports in this study, subjects were asked to provide documentation of weight loss (either “before and after” photographs or names of individuals able to verify the weight loss).  Thirty-five percent (274) of the sample provided “before and after” photographs; 42% (332) provided names of doctors, weight-loss counselors, or other individuals able to verify that the weight loss had occurred; 4% (33) provided both photographs and names; and 19% (145) were unable to provide any source of documentation. Subjects unable to provide documentation did not differ significantly from others with respect to the primary variables under investigation; therefore, they were included in the sample.

So ... 81% of the registrants DID provide some verification of their self-reported data.   More importantly -- and conveniently not included by Istrail, the authors analyzed the data separately and determined that they were similar enough to be included in the analysis.  Ultimately you have to rely on honesty of the participants, but the same goes to self-report data from any study including those on his cherry-picked list.  Some low carbers don't have the best record of their online pictures matching their current state of affairs ... let's leave it at that and color me skeptical.  Can I nominate some cases in the public record for inclusion in the registry?

Back to the inclusion/exclusion criteria.  I have to give Larry an "A" for effort here ...

Me:  Let's see what we need to join NWCR. For one thing, you have to have lost a minimum of 30 lbs and KEPT IT OFF for at least a year. The criteria for joining the AWLR? Laughable -- we don't care how much you've lost or gained, we want to hear from you? This IS a joke ... right?

Larry:  No it isn't a joke. Only allowing people who have lost 30 pounds and kept it off for over a year is like Yelp.com only allowing you to review a restaurant if you are going to give it 5-stars. Excluding those who may have been less successful biases the data to immeasurable proportions. Those people who are most successful at losing weight and qualify for the NWCR may be systematically different in ways uncaptured by the registry questionnaire, further confounding the already weak data these questionnaires can provide. 

I've already addressed this, but it bears repeating.  Even Taubes says it's easy to lose 100 lbs by almost any means, the problem is being hungry all the time and thus gaining it all back.  Jimmy Moore lost 170 lbs once before.   Again, if this is an all inclusive registry -- RENAME IT NOW -- Somehow the word Loss in the name isn't going to be attracting gainers if that is truly your intent.  Larry asked for suggestions to improve his registry over on PaleoHacks ... I'd say changing the name would be a good start.  I wonder how many people who weigh more now after low carbing than before would want to admit that and join up.  I find this notion that the NWCR members may be systematically different (from who, in what way?, confounding?) odd.   How thick can this person be to not get the purpose of that registry?  I may well be jaded, but I don't get excited by success stories and before/afters any more because too many of them have regained and ridden off into the anonymous internet horizon never to be seen or heard from again.   Do you expect cautionary tales to come from the AWLR about how for some odd reason, many people tend to regain not just a bit more post low carb, but a lot?  How will including people who gain weight on low carb help us find more effective ways to lose weight by restricting carbs.  Oh ... yeah ... might bring the truth that calories count out, but somehow I doubt this is going to be stressed.  Surprise me.

Larry writes (bolding his):  What I do hope it can be is a lens by which the clinical data can be viewed.

Isn't that what GCBC, WWGF, and a gazillion blog posts by Taubes, Eades, Eenfeldt, Feinman, Moore, Dungan, Carpender, Naughton, Dolson, etc. etc. have provided?  That uber myopic lens.  He goes on to list various studies where LC produced more weight loss than LF.  Folks, this is SO tired at this point.   Long term fat loss comparisons are a wash at best.   Humans do not undergo genetic transformation when they check into a metabolic ward.  Ward studies have looked at all manner of macronutrient compositions and if anything higher carb/lower fat comes out a teensy bit ahead.  Look there is NO doubt that for many, particularly on their maiden voyage, LC leads to a significant spontaneous reduction in caloric intake usually above and beyond that prescribed by intake-restricting regimes.  But even here we can't get a coalition amongst the factions of the Insurgency.  For everyone who acknowledges this, and claims no hunger ... you have someone claiming they are apparently more hungry because they eat more now than before.  Otherwise why are they eating more? 

And now for the ultimate strawman:

While I agree with Carbsanity [sic, it's CarbSane or Evelyn thanks] that the strength of data created in the Ancestral Weight loss registry is weak, I don’t think Rose or Jackie or the hundreds of people throughout the world signing up to AWLR each day, many of which have tremendously inspiring stories of weight loss and improved health without calorie counting and devoid of hunger, would agree that carb-restricted eating is a “joke”.

I never said carb-restricted eating was a joke Larry.  To even suggest that makes you a joke.  If you can't be bothered to learn the most basic things about your critics, it would behoove you not to respond, because you only make a fool of yourself.  Also, call me jaded, but weight loss stories are rarely inspiring to me anymore.  And it's not one thing like anonymity or visual confirmation or whatever ... it is the whole matter of so many disappearing acts and lack of follow up.  It matters not the means by which these transformations occur any more, the maintainers clubhouse is always sparsely populated and you rarely get the straight scoop from those who have fallen off the face of the earth with nary a quick post to say they'll be away.    "Losers" who inspire me are those like Princess Dieter of Happy Weight After who are putting it "out there".  And I'm oddly inspired by the forthright approach to regain by Diet Girl.   I don't need to name names of low carbers who could learn a thing or two from these ladies.  If you think the web really needs another repository for success stories and pictures, more power to you, but the web is littered with pictures and stories of success from yesteryear, and there's no lack of representation in that virtual trash bin for the carbohydrate restriction approach.