las

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, July 2, 2012

What we really learn from Ebbeling et.al.

I think Carson Chow's observation that the TEE's measured in the supposedly weight stable phase of this diet, that varied from an average of 140 to >500 cal/day more than the average intake pretty much negates drawing any sort of meaningful conclusions from the  Ebbeling et.al. study.  It really is a waste of time and mental energy to discuss a highly suspect 300 cal/day difference in TEE measured by state of the art methods, but highly susceptible to error as it was not measured directly.

But what can we learn from this study?  Well, as with the Biggest Loser study we learn that:

  • Obese people, on average, eat more than the average American eats even today, and even more than the average American ate in the 70's -- if baseline TEE is anywhere near accurate they were consuming around 3200 cal/day.  
  • When you take people eating 3200 cal/day and restrict calories to 60% of weight maintaining levels (avg around 1900 cal/day) they lose weight and fat.  Period.  They lose weight because they are in calorie deficit.  Period.
  • Calorie counting didn't fail for weight loss.  (Somebody alert Gatewing!)
  • When you lose weight, your metabolic rate tends to go down
  • After losing an average of 30 lbs, intake to stabilize a roughly 200 lb weight averaged around 2600 cals/day (SD almost 700), still quite high.  
  • Even when you pay people and provide and prepare all of their food for free for almost 8 months, some have difficulty with complying.
  • There is a phenomenal amount of individual variability in EE, both resting and total.   Measured across two weeks, one person had a TEE  almost 800 cal/day above their baseline while another had a TEE almost 1200 cal/day below baseline.  That's huge.  I imagine that the individual whose REE declined by almost 500 cal/day will be having a tougher time maintaining his/her weight loss than those lucky few who saw increases. 
  • All subjects lost weight consuming over 200g carb/day
  • Subjects maintained weight eating almost 400g carb per day average on the LF diet.  No insidious weight gain ensued.  
Now for the bottom line take home message.   Unless the researchers are lying to us by omission., within the macronutrient ranges investigated in this study:

The quantity of calories mattered,
The quality of those calories did not matter

Think about this one long and hard Gatewing and Gary Taubes and anyone still suffering from CDS (calorie denial syndrome), and perhaps go watch and rewatch the BBC program on YouTube I linked to HERE -- and pay especial attention to the metabolic chamber study with the twins.  

Because in the Ebbeling et.al. study, the weight stable caloric intake of the participants was first estimated using weight loss phase intake and rate of weight loss.  Their intake was ramped up accordingly and then the subjects stepped on precise and accurate simple direct measuring device ... a scale ...  every day  ... for around 4 weeks, and intake was altered in response to gains or losses until their weight remained stable.  The researchers allowed for varying timeframes to stabilize weight.  Although they don't expand on the criteria they used to determine this (e.g. X days to within +/- Y kg change), but before going into the test phase these subjects were in caloric balance and weight stable by simple, direct measures.   If they were not, there really wasn't any point in doing this study, so I tend to think the researchers took care in this phase.  

Then they kept calories constant for a further 12 weeks, varying the macronutrient ratio.  Heck, they even varied protein in a way that should have favored the LC diet by thermogenic quotients.  But they kept calories constant and at the end of each 4 weeks on each diet, the average weight of the group stayed as near as dead-nosed constant at around 200 lbs ...  plus, we're not talking about people who don't have more fat to liberate here either.   Their fasting leptin and cortisol levels bounced around, they stayed weight stable.  Their insulin sensitivity bounced around (levels are not reported but no doubt those bounced around too), and they stayed weight stable.   Their inflammation markers bounced around, and they stayed weight stable.   The authors make mention that calories were held constant regardless of weight fluctuations in the test phase.  

So this is why I say either this study has demonstrated for once and for all that there is NO metabolic advantage to a LC diet, and weight loss/gain is ALL about the calories ... or the researchers are dishonest and withheld information that the subjects weights bounced around enough to influence the outcomes.  I don't think this is likely given that the average weight of the group stayed so consistent, and if they did this is unacceptable deception on the parts of the researchers.  I'm going to presume we're dealing with honest, well-meaning scientists here.  Eades, Fat Head and now Peter D, and all the rest certainly didn't question them as they tweeted and blogged exuberantly over some supposed  300 cal/day metabolic advantage.

They determined weight maintenance calories the old fashioned way -- 21 little "n=1" experiments if you will -- measured and adjusted intake until the number on the scale stayed constant within some acceptable variation.   Simple.  Nothing fancy.  No smoke and mirrors or statistical gymnastics.  And then, they varied the macros and controlled for calories.  And the average weight of these 21 people stayed virtually the same for the next three months.   Simple.  Nothing fancy.  No smoke and mirrors or statistical gymnastics.

CICO has been upheld.  The EL of ELMM worked as it has every time it's "practiced".  Amen and goodnight :D    

31 comments:

RRX said...

Word the eff up. This is damn near exactly how I found out my average TDEE (got REE measured to see what my average EE is for interest sake). And when I cut kcals accordingly, HOT DAMN the weight/fat came off!!! Holy crap! Can it be?! Can going from no/low carb eating to 200-400g carbs in my diet whilest NOT overeating actually allow me to lose and/or maintain weight?? It sure did for me. And has been a hell of a lot easier to do psychologically and socially than all the years I was low/no carb'ing. It's one thing, to me, to not know about the ward and these studies. It's another to know about them and to still refuse to 1) incorporate that into your understanding of what is actually causing your mass on the scale and 2) to refuse to give a legit honest go of trying to cut kcals.

That is if you're even interested to. If someone went from 300 lbs to 180 never counting a kcal because they...counted something else like a carb (in the end, we're still counting something!!!) and are completely happy and content with their body at that point and find eating low/no carb an easy affair, then I say hell yeah don't worry about kcals. You got that weight off and no understanding of the actual mechanisms involved is going to change that. Enjoy the loss! If not, though, and that person still has excess fat that they want to lose but zero carbs isn't giving losses anymore...then ELMM may be what they have to consider.

And I think studies like this show that they very well will get the job done, whether you just eat less of the low/no carb food or less of low fat foods. Whatever the macro-profile, just ELMM in that case (like I said, if you even want to lose beyond where cutting carbs got you).

Unknown said...

I don't want to count calories = I resent having to make sacrifices in order to lose weight

Kindke said...

All lean people in the world count calories. Did you know?

ProudDaddy said...
This comment has been removed by the author.
rodeo said...

Not all lean people are counting calories but 99,99% of them are not eating low carb.

Unknown said...

I tried being a hunter-gather, the cops called it shoplifting, getting to be a police state around here.

RRX said...

The last time I checked, hunter-gatherers also didn't wear glasses. I'm sure as hell not going to throw mine aside because of that. Neither am I going to refuse to count calories to lose weight just because hunter-gatherers didn't and not-overweight folks don't either (count calories to lose weight, that is). I guess I'm just more interested in results and getting the job done. I was overweight. I didn't want to be. Method 1 allowed me to lose some weight. Method 2 allowed me to lose the rest of the weight. In either case, conscious choices had to be made. In either case, my overweight state was NOT a never-overweight person's state. That they don't count calories never even factored into my consideration on the matter. I'm living my life and the hand I was dealt. I'm not wasting my time lamenting someone else's better hand.

Mike said...

"Kinda assumed that hunter-gatherers didn't have calorie tables"

True, but they didn't have refrigerators, either. If you dislike the notion of counting calories and want to restore your energy balance naturally, then try the following:

Unplug your fridge and throw out all your dried and canned foods. Every time you get hungry, you have to walk to the local supermarket. You can only buy foods that don't have an ingredient list and you can only buy as much as you can carry. Any leftovers must be left outside overnight. If anything is still there and edible in the morning you can eat it but if not, you have to start all over again.

bentleyj74 said...

Lol @ Mike. You mean he can just buy them and not dig them up or kill them and what not?

It's hyperbole of course but yes, we obviously have access to foods that way exceed our intake needs. Interesting thing is that this frees us up to go do other stuff besides seek food almost all hours of almost all days. What's going on with those hours?

ProudDaddy said...

I make a facetious post about hunter-gatherers not having calorie tables in response to somebody saying that everbody in the world counts calories, and all sorts of stuff about hunter-gatherers starts to get thrown around. So, I've deleted my post, and I'll leave it to the rest of you to figure out what your points are. I give up.

Craig in CT said...

@RRX

I'm curious as to how much you lost via low carb, and how much via EL(MM?). Any idea what kind of % body fat you achieved?

RRX said...

Greetings Craig,

In 2001, 300 lbs to 220 lbs eating low carb. During that time I also took up weight lifting, bike riding, walking, etc. that I was not doing before.
Maintained that until 2003 when I told myself to cut more carbs out and dropped down to ~180 lbs. I also took up tennis during that time.
I maintained that until the end of 2010. After reading enough ward studies and already eating low/no carb for so long, I decided to give the whole calorie thing a try. I threw out all concerns for macros at that point.
165 lbs by March 2011. I maintained that for the rest of the year.
(From January) By April 2012, I hit 150 lbs. When I got my REE measured then, they put me on their impedance tester scale and told me I was at 10% body fat. Those things have a lovely margin of error, though. The only reason I loosely accept that number is because from that time until today my abdominal complex is clear for all to see.
I have been at that weight since, not concerning myself with target macronutrient levels. The only physical activity that has changed in this time has been that I haven't played tennis in 2 years.

RRX said...

I've had comments go awry before. No worries. It did make me laugh to think of future readers getting confused.

Christopher said...

Ah, it's a hard life... :)

http://livinlavidalowcarb.com/blog/63-new-paleo-low-carb-health-blogs-for-july-2012/14628

Mike said...

The time spent earning the money to buy groceries is what you do instead of hunting and gathering. You see, I try to make sure my recommendations fit a modern lifestyle while respecting our Paleo DNA. ;)

The point about food availability is obvious. While some won the genetic lottery and can handle it without overconsuming, many can't. Paleo/Low Carb makes weight loss spontaneous for many people. For a lucky few, it'll take them right down to their "ideal". The rest of us need to put more effort into it.

Almost all of the Paleo/Low Carb gurus are dogmatically opposed to calorie counting because they're afraid it will lead to neurotic eating habits. So instead, the frustrated dieter becomes increasingly obsessed with doing the diet more perfectly. Grass fed only, lower carbs, only organic vegetables grown within a 10 mile radius picked fresh the same day, avoid fruit because of the fructose, maybe it's the BPA in our plastics, blah, blah, blah. I'm sorry but to me, having a routine that establishes proper portion sizes before I sit down to eat a meal takes at most 2 minutes out of my day and I don't have to worry about whether or not I achieved some magical balance of macro or micronutrients.

I plateaued on low carb on 3 different occasions and it wasn't until I combined it with calorie counting that I could finally break through the wall. Portion control enables me to manage my weight and paying attention to food quality enables me to stay satiated while doing it.

Tonus said...

A good satirist never tips his hand. :)

Evelyn aka CarbSane said...

Hey RRX, nice to "see" you! Sounds like things are going great for you. Good to hear!

Simon Carter said...

Hi RRX, your story is remarkable and thanks for sharing it. I have a few questions. What physical activities, workouts etc do you do? How often do you eat? How is your 150 lbs body different from your 300 lbs body, by that I mean do you move more and just do more things easily. Personally I find actual stories more useful to me than all the mental masturbating about the latest rat study.

Evelyn aka CarbSane said...

I wonder how many people noticed this, but Jimmy recently lost 20 lbs in his latest extreme eating scheme: "Nutritional ketosis". He's also developed a "mysterious" urinary tract infection that produced a sustained fever. EVERY time Jimmy goes on one of these extreme diets he gets sick. Really sick. Too wiped out to blog and bottles of cough syrup sick. This time it wasn't respiratory but fevers are not usually an issue for a run of the mill UTI.

pbo said...

Mike, you could not be more right! I have pretty much the same experience. At the end of the day if you are not losing any more weight, and you want to lose more, then count your calories, and then adjust accordingly. It's not that crazy and not that big of deal to accept that calories matter. I guess people want a simple answer or slogan for their diet. Carbs are evil, or eat as much as you want, but dont eat these foods. At some point you have to come to the conclusion that you have to just eat less. Once you accept that you can plan it out.

Nigel Kinbrum said...

PD, you obviously forgot to use the [Facetious] & [/F] tags!
Well, really! ;-D

Thomas said...

You hit the holy grail, although it's a little disappointing finding out that this HG holds no magic. For the obese, just changing the diet to something "healthy" often works to get the weight loss going due to a natural reduction in intake. LC, LF, Keto, whatever. This is where most people tend to get stuck in their well guarded belief systems, because is works to a degree and is often the first (and maybe only) thing they try. But after the inevitable plateau, when calories and expenditure meet again, portion control is a must. This may come in the form of just eating less (difficult to judge IMO) counting points (WW) or counting calories or whatever other portion control system is out there. In the end, for those trying to get super lean, counting calories is almost a must, unless they are on some kind of per-packaged food regiment. All along, though, it was about CICO. Sucks, but true.

Eric said...

I posted on the other thread as well, but for those following here take a close look at the study outcomes slide, specifically notes b and c. Yep, there was no significance to any of the energy balance numbers.

Oops, I guess that conclusion might be jumping to conclusions not supported by the outcome of the study.

RRX said...

Greetings Sane,

Things are going well overall, especially in this whole eating realm. Thanks. It looks like I will have some free time after working hours over the summer. So, I'm able to do some reading on here. I'm glad you're still tackling these issues!

Craig in CT said...

Thanks much for the details. Your story is impressive.

I lost ~40 lbs (200 -> 160) following a low carb plan. Been struggling to shave off the last 15 or 20 lbs ever since. You've inspired me to give calorie counting a serious try. (It's odd that I've never been able to bring myself to the point of measuring/weighing foods and adding up calories. Normally I'm very detailed oriented, keep a food journal, track workouts, etc. But I've always balked at actually running the numbers on calories).

I know you don't worry about macronutrient composition. But have you found certain food types that make it easier to cut calories, e.,g., are more satiating, less likely to trigger binges, etc.

RRX said...

Greetings Simon,

You made me literally Lol with that final sentence. I could write a book to answer your questions (Wait. Why haven't I?! Isn't that people do when they've done this?? At least get a show, yeah?). I'll try to answer in parts as I have the chance to respond and make sure I'm as concise as possible.

Back in the Fall of 2010 when I decided to go ahead and test all this calorie stuff on myself, I chose to hold my physical activity levels constant so as to minimize variability that could muck up my self-study. Because of work in the lab, getting professional development stuff done, and planning my wedding that is this October, I fell into the same routine as far as workouts and general physical activity. It's been the same since then. I walk 2 miles M-F in the course of getting to work. Other walking may occur outside of that but is totally random. I use my bike every now and again to ride within a 2 mile radius at most, usually within 1 mile. My gym time is one day of powerlifting on the weekend, a squat or deadlift that I work up to a single rep for the heaviest weight I can do. I go 3 other days throughout the week depending upon feeling and work schedule. At those times I do misc. weight lifting stuff that's not different than most people other than I guess I'm systematic about it. I last played tennis (which was my other regular activity) in the Fall of 2009, sadly. I just played again yesterday. It was great, but the whole reason I hadn't played in so long is that I can't find other people to coordinate a match with. So, I don't know when/if I'll play again. So, that's been my physical activity since Fall 2010.

I'll continue my responses later.

Happy 4th!

RRX said...

Greetings Simon,

A quick rundown of my activities prior to 2010 follows. The only reason I have such details is because I keep a log since day 1. I have forgotten and rediscovered many things over the years because of those logs. I absolutely recommend people keeping some form of a log throughout their efforts.

When I started my change in 2001, I followed a fairly set activity schedule through the rest of the year. I lifted weights ~3 days a week for ~30-45 minutes (which, knowing what I do now, was nothing more than calisthenics really). I jogged/walked about 30 minutes 2-3 days a week (alternate days from weight lifting). The only other thing I did activity-wise was walk around. Whenever I would go to see a friend, I would make us step outside and walk the neighborhood instead of sitting around their places. It was always a leisure stroll for the purpose of just moving. It was never to be an explicit workout.

I stopped doing any kind of workouts during 2002. I started that year at 220 and ended it at 240 lbs. At the start of 2003, I started back on the same exercise routine and "tightened up the carbs". By the end of 2003, I was 186 lbs. I generally stopped all attempts at running by the end of the year and started using my bike to get around whenever I could. Again, it was for transport and never for explicit exercise. My weight fluctuated between 185 and 175 throughout 2004. I was focused on just maintaining during that time and enjoying the weight loss. Sadly, I had a bicycle crash just before Christmas 2004 and broke my left collarbone.

The broken collarbone for the start of 2005 meant that I was pretty limited on the physical activity outside of walking. When I eventually got back into the gym, it was slow going for a while with light weights as my whole left side adapted. During that time, though, because I was still low/no carb, my weight varied between 167 and 175 lbs. I think the drop that occurred fairly immediately after I broke my collarbone was more a drop in lean body mass. I literally stopped all stimulus to my muscle mass at that point and spent a lot of time sitting and laying around. I took my first tennis lesson in the summer of 2005. I feel in love and played it 1-3 times a week pretty continuously for the rest of the time I was in San Diego (moved to Boston in May 2008). I continued to use my bike whenever I could, to walk as a social activity rather than "hanging out" whenever I could, and my weight lifting bounced around 2-4 days a week of the same old stuff. That was my physical activity until August 2007.

RRX said...

At that time, I learned about and got into powerlifting. I mucked around with it on my own for a couple of months and then in December I sucked it up and found a local coach and team. I trained with them until I left San Diego in May 2008. I also did a meet that month before leaving. I trained with them 3 days a week learning misc things and spending most of the hour each time on learning how to squat, bench, and deadlift correctly.

I left San Diego then to move to Boston to get a Masters. My walking and biking activity in Boston was much the same as it was in San Diego. My gym time and tennis playing was spotty at best for the next year. I played tennis at most once or twice a month after I found some people to play with by the end of 2008. They all moved away by Fall 2009 though and I literally did not play again until this week (Yay! I love tennis). The only consistency to my gym time was one day for sure on the weekend, in which I did the squat or deadlift and then some kind of row movement for a couple of sets. In total, the most I was ever in there was for an hour. Every now and again I would get in for a 2nd day during the middle of the week. Because of the powerlifting approach to things, I ate the carbs to gain weight and help my strength gains in the powerlifting. I started eating up in the Fall of 2008 and got to 206 lbs. Because I intended to compete in another meet in April 2009 in the 181 weight class, I then cut the carbs again and made weigh-in by that time (I'll talk more about this experience when I have a chance).

After the meet, I got more consistent about going to the gym for sure 2 days a week to work on my deadlifting. As before, it was for 45-60 minutes. Because of my continued collarbone issues, a third day was hit or miss and I was never too motivated to bother with it because, well, because I would rather have a functioning left arm and trying to do much with it in the gym would literally put it in a sling for a couple of weeks after. I followed the same eat up and carb down pattern over the next year and my weight followed the same pattern. I did another meet in ~May 2010. In the few months after that I got impatient with my deadlifting progress. I ended up doing something stupid and pinched a nerve in my lower back. That literally put me in bed for a week and walking around like an old man for weeks after.

It was during that time that I was truly contemplating all of the studies I had been reading over the previous year about calories, macros, fasting, nutrient partitioning, etc. And that's when I decided to throw low/no carb out the window and test these ideas on myself directly. The result of that is what I have said previously. It also worked nicely to test then because the 2-3 days a week that I could go into the gym I could only do light stuff that was much like what I did back in 2001. It provided a great opportunity to compare results.

That's the overview of my structured physical activity since 2001. Hell, I would say I didn't have physical activity prior to that so there wouldn't even be much to say! Well, I guess before I got into high school I was your normal active walk/bike all over town and have misc adventures kind of kid. Once I got into high school, though, my activity levels plummeted.

Ciao for now. Enjoy the holiday!

RRX said...

Salutations Craig,

One of the nicest things that I have discovered from the calorie experiment is that I no longer struggle in the emotionally taxing way that cutting carbs did for me. That is, if I only had X deficit one week and I didn't see a change on the scale, I had an explanation. I had not expended the necessary energy yet. When I reached 3500 kcals, I saw the scale go down (weighing only at the same time of day of course so as to minimize the variation in scale weight based on food in gut, hydration levels, etc.). I had answers! I was literally one of those people that would eat sub-20 grams of carbs a day and when I wasn't losing anything and was so obviously still over-fat, I could not help but ask what was wrong. That is one of the insidious things about low-carbing without acknowledging calories, IMO. It messes with your head and drives some people (like Jimmy with his attempted fixes) to do crazy things. When it's straight forward with the numbers, there is no wondering. And that had and has made the whole weight and eating experience SO much easier and freeing psychologically in ways that I could never fully describe.

If you're already keeping a log and track somethings, then I see no reason not to track calories. That was along the lines of my thought back in 2010. I already keep training logs that some times note dietary stuff. Why not add this (I think) simple thing in there?

One of the things that I have monitored over that time is what foods make me feel full at the moment, what keeps me feeling full, what leaves me more ravenous, etc. The two major things I discovered for myself are that the carb/fat-mixed manufactured foods easily make me more psychologically hungry and volumentrics/fiber totally leaves me sated and full for hours after. The SAD kind of foods totally just make me desire them more, rather than satiating me. Consequently, I do limit those foods in the house. Fruits, veggies, and grains DO fill and sate me. The bonus is that I went years without eating those foods and now eating is a whole novel frontier for me to enjoy and seek out things I have never tried or been so long since last consuming. Those were the go-to foods to keep in my diet as I cut down to my present body comp.

RRX said...

Agreed, Mike. People get neurotic about something be it the carbs or the fat or what have you. What makes calories so special as the thing to count?? Lol.

George Henderson said...

Call me a chemist, but I'd expect that different fuels would burn with differing efficiency. I think the real question is, why should this "advantage" be more effective than other ways of cutting calories; eating less, or exercising?

The "stable weight" part is a chimera; the study wasn't designed to test for a difference between diets. Ludwig explains:

"The point is that 4 weeks isn't long enough to translate a 300 kcal/d difference into statistically significant weight change, especially when one considers that body weight normally fluctuates by a kilogram or two through the course of a week, based on differences in hydration status, the time of the last bowel movement, etc. We'd need 6 months to reliably see this effect. Nevertheless, there was a slight, and not statistically significant difference in the hypothesized direction, with body weight highest on the low fat diet (data included in the results section)."
The differences in CRP and cortisol were also slight, insignificant to barely significant. All diets did much better than baseline SAD.
(see tables here http://eatingacademy.com/books-and-articles/good-science-bad-interpretation)

The low-carb diet was 30% protein, the others were 20% protein.
So it is possible that the low-carb-higher protein diet would have resulted in more lean mass - and therefore in a reduction in fat, if not in weight.

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