Calories (Again)

I don't know what it is about the CDS (Calorie Denial Syndrome) sufferers out there, but it seems that every couple of months or so we get a new wave of posts about calories from various corners of the Incestral Health Community.  For the most part, and as usual, these "complaints" are made against elaborately erected strawmen.  One must erect these to counter the obvious, you see.  But the CDS know better than the scientists and spin ever more convoluted explanations for why a calorie is not a calorie.  Of course it's not.  But newsflash!  Those who acknowledge the supremacy of calories in the overall picture recognize that nutritive intake is not solely for the purpose of energy production.  There.  Half your scarecrow strawmen now lie rotting in the field (or perhaps some David Duke inspired mental picture ... grin).

Diet Doctor - Andreas Eenfeldt

Rumor has it his parrot blog is high on someone's list of good sources for low carb information.  Even if I was still a low carber I wouldn't bother with it unless I just wanted to keep up with the latest hype like stuff from heroes like Robert Lustig.  Even Richard Feinman commenting there on Lustig's mangled biochem hasn't dissuaded him from his bromance with the fructophobe.  But Eenfeldt makes the cut here for his multiple posts of late equating calorie counting with eating disorders.  Look.  One can certainly develop an obsession with calories, you'd have to be a fool to deny that.   But arbophobia can do the same, as can each and every facet of some restrictive religiosity-based diet -- wait, "lifestyle".  I think that a case could be made that having a name for and identifying yourself -- often first and foremost -- by the foods you eat is disordered!  

But any approach that might be construed as calorie counting is disordered in his mind.  Of course a non-diabetic beanpole diet doc buying a ketone meter is perfectly normal, as is encouraging hundreds if not thousands of non-diabetics to gather up the various and sundry supplies and prick away?!  Yeah ... because Grok and Great Granny didn't know from calories, but they monitored their blood glucose by the moon and their ketones by the stars.  Sheesh!

Finally, lest we missed it elsewhere in the IHC, Eenfeldt links us to the latest to convince us that a calorie is not a calorie!

Robert "Pick-Your-Poison" Lustig

It's bad enough he documented his manglings of science in the virtually unreadable tome Fat Chance.  But proving the truly bipartisan whackery in the IHC, Lustig penned a piece for the Huffington Post:  Still Believe 'A Calorie Is a Calorie'?  We've discussed a lot of this before, but he put forth four "proofs" that a calorie is not a calorie and I'll address each briefly:
1. Fiber. You eat 160 calories in almonds, but you absorb only 130. The fiber in the almonds delays absorption of calories into the bloodstream, delivering those calories to the bacteria in your intestine, which chew them up. Because a calorie is not a calorie.
Depending on where you live, fiber may be included as a carb, counted for zero calories, or counted as "half carbs" essentially 2 cal/g on your nutrition labels   Everyone who is anyone in terms of nutrition science and related fields knows that fiber is processed differently.  How does this change things?  True, it puts a small unknown into one's efforts to strictly control calories in, because it is both unknown and variable as to how much energy is made available to you by the bacteria in your gut.  It is also not controversial that fiber can interfere (again unpredictably) with the absorption of caloric carbohydrates and fats.  From a nutrition POV, this is a bad thing to a certain degree -- unless foods are plentiful it would be disadvantageous to rely on foods your body has to work harder to extract calories from.  However when you think about it, vegetative calories are always associated with fiber in nature.  But in the end, whatever calories you absorb are calories.
2. Protein. When it comes to food, you have to put energy in to get energy out. You have to put twice as much energy in to metabolize protein as you do carbohydrate; this is called the thermic effect of food. So protein wastes more energy in its processing. Plus protein reduces hunger better than carbohydrate. Because a calorie is not a calorie.
    I'll give him props for not defaulting to the Feinman & Fine paper on this, but the thermogenic effect of food is part of the whole calorie equation. As usual, no mention is made of protein vs. fat or carb vs. fat which is about 7:1 and 3:1 respectively by Jecquier's factors (while protein to carb would be about 3:1 as well). Still, part of our basal metabolism is not "wasted" on generating heat, unless you consider living a wasted effort, and transient thermal effects have rarely translated into any substantial or even measurable differential in 24 hr metabolic rate in humans with the possible exception of very extreme diets.  Protein's effect on satiety/hunger/appetite is irrelevant.  If you are really hankering for a cookie or a Dorito, no amount of chicken breast or whey shakes are going to do it for you!  

    But I digress, because again, nobody is saying that all macronutrients are interchangeable on the basis of their caloric content.  Our protein needs and limits are individual and primary in nature.  Regardless of one's dietary choices, it would behoove everyone to meet their protein needs first and then "fill in" caloric needs for energy around that.
    3.  Fat. All fats release nine calories per gram when burned. But omega-3 fats are heart-healthy and will save your life, while trans fats clog your arteries, leading to a heart attack. Because a calorie is not a calorie.
Sigh.  This is his worst example but his artery clogging trans fats are telling.  Still, nobody is saying that the sources of all calories are equal.  That is not the same as saying a calorie is a calorie.  I would note that if he truly believed this and cared he wouldn't cop to takeout Chinese all the time :(  .  This is too vast a topic (fat types) to discuss here.  I declare red herring alert!  And lastly:
4. Sugar.   This is the "big kahuna" of the "big lie." Sugar is not one chemical. It's two. Glucose is the energy of life. Every cell in every organism on the planet can burn glucose for energy. Glucose is mildly sweet, but not very interesting (think molasses). Fructose is an entirely different animal. Fructose is very sweet, the molecule we seek. Both burn at four calories per gram. If fructose were just like glucose, then sugar or high-fructose corn syrup (HFCS) would be just like starch. But fructose is not glucose. Because a calorie is not a calorie.
Ahh the cause célèbre. Fructose is not glucose. So? I'm surprised he didn't drag out his fructose = alcohol crap.  I wonder if this man ever bothers to look at his examples -- molasses?  Its sugars are 53% sucrose and 24% free fructose and 23% free glucose.

I think to a large degree the caloric differences between fructose and glucose carb sources are due more to the vehicles than the carb themselves.  Which is again a far greater topic than I have  time to delve into today.         All of these arguments are intended to distract in my opinion.   Ultimately Lustig understands that he struggles with weight because he eats more calories than he expends.  The Occam's Razor in all of this is that we Americans demonstrably DO eat more than we used to.  The obesity problems that have resulted are no mystery.  I actually envy those who may be overweight due to drinking a few sodas per day as that seems like the easiest way to cut calories from your diet.  There are certainly some who drink several sodas per day, but Lustig himself is overweight yet claims to consume sugar only twice a year and is a poster-case for why it is calories that ultimately matter.  This does not mean it is simple to change one's calorie balance.  Actually it is simple, but not necessarily easy.   I know all too well.  But to continue to deny the role of calories in all of this is getting ridiculous.

Two more from the more paleo side of things soon ...

P.S.  To Razwell:  Your blog was removed by Blogger for violating rules.  You have repeatedly posted vulgar and threatening things, about myself and others, both here and in my email.   Please do yourself a favor and cease and desist with the harassment or one day you may discover that you've pissed off enough people to do something about your sorry ass for once and for all.    


Gabriella Kadar said…
Evelyne, from my own professional perspective, any 'food' that results in an overgrowth of bacteria which are adverse to good health is not good. If a food causes an overgrowth of dental plaque and caries it is not a good food to eat. That's first.

Other foods cause other problems but it starts in the mouth with me.

Fresh fruit doesn't create a problem. Dried fruits do especially when they are consumed in their dried, chewy form. Mind you there are people who 'mill' citrus fruit and this causes hypocalcification and eventually erosion of enamel and dentin. So depending not only on what fruit is consumed but how it is consumed also factors in.

Depending on form, grains are also problematic. Potatoes are not cariogenic. Mind you, pasta is not a problem but soft McDonald's type buns and whatnot are because they glom onto the teeth and contain sugar as well as wheat. Toasted oatmeal is a problem, cooked steelcut oats with high fat dairy less so.

I've noticed that eliminating foods which encourage bacterial growth in the mouth also results in better oral health. Since the entire gut biome is affected by diet, consuming less fermentable carbs can't be a bad thing.

I'm always reminded of the results from the study of 2,200 skeletons from the Samara River Valley project: these people did not consume grains (maybe only chenopodium seeds and water plant tubers) = zero dental caries.
Unknown said…
It could be this "mysterious never before seen in humans bacteria infecting SIBO patients and this is caused by GMOs somehow, oh and it makes you crave carbs."
Gabriella Kadar said…
I wouldn't say that at all, Charles. But I'll have a look at the link.
Gabriella Kadar said…
Charles, how DO you find this esoteric cr*p?
Unknown said…
I'm a very curious person who likes research.
Dustbunny said…
You are really stretching to find fault with Eenfeldt's four proofs that a calorie is not a calorie. There's basically nothing wrong with them.

"Still, nobody is saying that the sources of all calories are equal. That is not the same as saying a calorie is a calorie."
This may just be a case of semantics for you but the source of calories is exactly what is meant by a calorie is not a calorie.
CarbSane said…
Those are Lustig's. But OK, since the Diet Doc regurgitates his stuff, OK :-)
CarbSane said…
Gedgaudas is paleo royalty!
Gabriella Kadar said…
She may be royalty, but Charles efforts have probably increased views on that YouTube video to over 200.
snakeojakeo said…
macguyver hair. so i trust her.
Dustbunny said…
I stand corrected. Wrong guy, same point. ;)
blogblog said…
My mouth went from putrid to pristine in a few months once I eliminated sugars from my diet. My teeth and gums are now absolutely immaculate. I don't have any evidence of gum disease, no scale and my teeth are always squeaky clean. I rarely brush, never floss and don't use mouth wash.

My brother in law is 60. He has absolutely perfect teeth. He visits the dentist once every 10 years or so and has never needed any treatment - not even scaling. His secret - no sugars
CarbSane said…
Perhaps I needed to quote the lead in paragraph:

A calorie is a measurement of energy (a matter of physics), not a value judgment on where that energy goes (a matter of biochemistry). As my book Fat Chance explains, you get sick from inappropriate energy storage (in your liver and muscle), not defective energy balance (bigger love handles). Nonetheless, "a calorie is a calorie" continues to be promulgated by the food industry as their defense against their culpability for the current epidemic of obesity and chronic metabolic disease. But it is as dishonest as a three-dollar bill. Here are just four examples that refute this dogma

Inappropriate energy storage not defective energy balance. I also read Lustig in the context of everything he's said about ELMM, etc. which he says is basically impossible. His evolving message is getting dangerous IMO. While I believe the "dangers" of overweight and even obesity are overblown, it's surely not as simple as visceral fat = bad, subQ = no worries mate.
CarbSane said…
I'd lay bets he got that from Paleo Drama. That "esoteric crap" was from her PaleoFX presentation. The candida overgrowth scam has been around for ages and made a lot of hucksters a lot of money. It's one of Zoe Harcombe's big 3 that she "discovered" with her 20 years of obesity research and claims her diet is perfect for curing in 5 days.
Diana said…
Evelyn, Calorie denialism is a real problem, but let's be fair and admit that it's not just the Paleo/LCers who do this. There's a whole wing (mostly women) who have taken the research about metabolism to "prove" that if you eat less and lose weight you are somehow training your metabolism to become lower and less efficient. They claim that dieting causes the body to go into "starvation mode."

Unless you really are starving, this just ain't so. Eating less than your body requires isn't starvation. True, it's deprivation but in most cases in our society the body has more than enough energy to make up for it in the form of....fat.
Diana said…
Evelyn, OK, context is all and perhaps "defective" is the wrong word, "surplus" being much better but....isn't "defective energy balance (bigger love handles)" an indication that Lustig realizes that the concept of overeating isn't "inane"?
Diana said…
Gabriella, What about sourdough? "Since the entire gut biome is affected by diet, consuming less fermentable carbs can't be a bad thing."

And sauerkraut, etc., There's quite a vogue started by the Weston Pricers for fermenting, etc.

(Confession: I have a lovingly preserved sourdough starter, and I occasionally make my own sauerkraut.)
Unknown said…


Conclusions. Maintenance of a reduced or elevated body weight is associated with compensatory changes in energy expenditure, which oppose the maintenance of a body weight that is different from the usual weight. These compensatory changes may account for the poor long term efficacy of treatments for obesity.
"One of the most intriguing findings of Dr. Leibel's exceedingly technical research has been that normal people appear to have a very powerful weight "set point." When they eat more than needed to maintain their weight at that set point, their body becomes 15% more efficient in burning off the excess calories. When they eat less than they need for maintenance, which is what happens with intentional weight loss dieting, their bodies become 15% LESS efficient.

Here's Dr. Leibel again, explaining this:
When you do these studies you find that when you force an individual's weight up 10 percent, they require more energy to maintain that higher body than you would predict based on their requirements at usual body weight.

There is some degree of heterogeneity. It is not that great, although you do occasionally see people who have very little increase in energy expenditure when they gain weight [emphasis mine] . Why somebody who has this change in body weight doesn't increase is a very interesting question.

...When a person goes down 10 percent in body weight, lean or obese their reduction in energy expenditure is in the 15 percent range. If you take them down by 20 percent, it doesn't get any more. So it appears that whatever this defense mechanism is, if you want to look at it teleologically like that, it kicks in quite early: 10 percent is enough to bring it out. We don't know whether five percent is, because we've never tested that small an increase in weight.

A fraction is due to changes in resting energy expenditure. But the majority of the change occurs in the energy cost of physical activity.... We're trying to figure out the mechanism by which a change in body weight not only would cause an alteration in resting energy expenditure but also in the energy cost of physical activity. Is something happening in muscle or in the autonomic nervous supply to skeletal muscle, which influences blood flow?"
Is the Energy Homeostasis System Inherently Biased Toward Weight Gain?

Travis Culp said…
You know, I've been wondering if candida, SIBO, adrenal fatigue etc. are anywhere near as prevalent as claimed by so many of these people. I need to invent one of these that can only be treated by essential oils extracted from a rare species of snake.
Travis Culp said…
You know, I've been wondering if candida, SIBO, adrenal fatigue etc. are anywhere near as prevalent as claimed by so many of these people. I need to invent one of these that can only be treated by essential oils extracted from a rare species of snake.
Travis Culp said…
I've often wondered if candida, SIBO, adrenal fatigue etc. are anywhere near as prevalent as claimed by various hucksters. I must admit that I am tempted to invent one of these phantom conditions myself, which can only be treated by essential oils I've extracted from a now-extinct snake, the existence of which have been covered up by scientists getting big $$$ from Conventional Wisdom vaults.
Travis Culp said…
To be fair, obesity results not only in adipocyte hypertrophy, but also hyperplasia which can dramatically increase the number of adipocytes a person has for a long time. This occurs in any normal female undergoing puberty, but is quite pronounced in obesity.

Anyway, the idea is that Person A (Ms. Neverobese) will effortlessly maintain her weight compared to an identical height/weight/etc. Person B (Ms. Previouslyobese) who has far less leptin output due to (presumably) there being a threshold in adipocyte fullness that leads to leptin secretion.

As a result, the hypothalamus misreads the body's fat stores and thinks that Person B is actually at 10% bodyfat instead of 20% and goads her into eating more.

The solution would be some way to induce adipocyte apoptosis following weight loss so that Person B has the same number of adipocytes as Person A and thus an equal leptin output.

I think the hypothesis is plausible.
Unknown said…
Adipocyte Apoptosis, a Link between Obesity, Insulin Resistance, and Hepatic Steatosis

It's a mouse study
Unknown said…
Nutrition and Aging: Changes in the Regulation of Energy Metabolism With Aging
Unknown said…
Imo you have to look at the electroconductivity of the adipose remnant tissue, absent that you are a blind man swinging a tennis racket at bats in a cave.

Studies have shown that in the absence of post-prandial glycogenic absorbtion, the electromagnetic waves remain hyper-modular, that is the range of the wave can be predicted with statistical confidence. But upon the introduction of myoplasticular free-floating acidic buffering agents, the wave reverts to placidicy.

So what can we make of this?

We need more science.
Travis Culp said…
Surely you don't equate adipocyte hyperplasia with Krusian clusterfuckery...?
Gabriella Kadar said…
Diana, sourdough has already been fermented before it goes in the oven.
Grinch said…
Just like people need to stop saying "Calories don't matter", they also need to stop saying, "A calorie is a calorie" because its baloney. Nobody should treat all calories the same because when doing so while you might temporarily lose weight and have about a 95% chance of gaining it all back, you will also be starving all the time because you eat garbage foods and are malnourished.

Thinking in terms of only weight loss (a calorie is a calorie) is idiotic, people should think in terms of improved health. That means stop counting calories, start exercising more, and start eating better foods. If people are living healthy lifestyles, then they will lose weight. People don't stay obese while eating good foods and becoming physically active. There is no need to count calories.
blogblog said…
the original purpose of fermentation was to preserve food and improve it's nuritional value.

Eating foods (and probiotics) is a waste of time for several reasons: a) the fermentation bacteria are generally not species that benefit the gut b) the bacteria don't survive transit through the stomach and c) introduced bacteria can't compete with the existing gut bacteria.

The science is very clear that you cannot make major changes to the gut microbiota by eating fermented foods or taking probiotics. There is only one proven way to permanently modify the gut bacteria - fecal transplantation. Major dietary changes such as eliminating refined carbohydrates or eating more soluble fibre will eventually shift the gut microbiota to a healthy profile.
blogblog said…

actually gut dysbiosis is extremely common. Fructose malabsorption alone affects as many as 40% of people.

Google "fodmaps" for more information.
blogblog said…
"The solution would be some way to induce adipocyte apoptosis following weight loss so that Person B has the same number of adipocytes as Person A and thus an equal leptin output.

It ain't gonna happen. You will literally starve to death before your adipocytes die. Once you get fat you will never be lean again.
Unknown said…
I treat calories differently based on what kind of activity I am engaged in, if I am mostly running I eat more carbs, doing more weightlifting I eat more protein.

I also keep a rough tally of the total calories on any given day, I don't see the downside to doing that, only takes a few seconds per day.

If you don't keep track of your calories how will you know if you are consuming enough to fuel your physical activity?
Jane said…
'The solution would be some way to induce adipocyte apoptosis following weight loss...'

Yes, and leptin can do it.
'..Leptin, produced in adipose tissue, acts both centrally and peripherally to orchestrate complex metabolic and behavioral changes that increase loss of adipose tissue, including suppressing food intake and increasing
thermogenesis. In addition, recent evidence indicates that leptin acts centrally to trigger an apoptotic process resulting in adipocyte deletion. ..'

Therefore losing weight --> less leptin --> less adipocyte apoptosis. But one might expect that as leptin goes down, leptin sensitivity would go up. Apparently it doesn't, for most people who lose weight. The problem of leptin resistance remains, it seems. The evidence I have seen suggests it may be caused by damage to the hypothalamus. I don't see any reason why such damage cannot be repaired. I rather think my hypothalamus may have been somewhat damaged 30 years ago, and it certainly isn't now.
Travis Culp said…
This might lend credence to the hypothesis that our runaway obesity epidemic occurred as a result of constantly elevated levels of excitoxins such as free glutamate and aspartate damaging the hypothalamus. If I'm not mistaken, the median eminence of the hypothalamus is outside of the blood brain barrier and is the location where leptin uptake occurs. Damage to this area could starve the arcuate nucleus of leptin and cause a misreporting of fat stores.
Unknown said…
Travis, you've pretty much landed on the core issue of how important points of discussion have also become prevailing points of ridicule and mockery thanks to certain caricatures.
Unknown said…

Right and faecal transplantation is still going a bit too far, in my opinion, as it isn't always necessary for everyone and in some cases, actually not wise. It's better to explore other options, especially when the problem can be resolved at a more gradual pace with dietary changes.
Travis Culp said…
It's a sad state of affairs. I thought that he had disappeared into the ether, but he posted this a little while ago on PH: It's not his posts that worry me since I've seen many a raving lunatic on various street corners in my day, it's when people are happy to receive them and pretend that they actually mean something.
Unknown said…
When I read Lustig's paper I kept thinking I've read something about a place with a whole lot of sugar and a dropping diabetes rate. It's a place in the past but I found it in Stephan Guyenet's Whole Health Source:

I wonder how Dr. Lustig would explain that one? The fiber in sugar cane somehow counteracted all that sugar? 28% of calories from sugar cane is a lot to explain.

Anonymous said…
"It depends on what the meaning of the words 'is' is." –Bill Clinton
Jane said…
Yes it's interesting about excitotoxicity. You know the enzyme that detoxifies glutamate (glutamine synthetase) is a manganese enzyme. In the middle ages epileptics were treated with lupine, which is very high in manganese.

'The most frequently prescribed herb for "devil-sickness" in the vernacular medical books from Anglo-Saxon England, the lupine, is exceptionally high in manganese. ...manganese depletion has been linked with recurring seizures in both clinical and experimental studies...'

I expect you remember Stephan telling us that a high fat diet causes inflammation in the hypothalamus of rodents, and that obese humans have inflammation in the same place. I can't see any way a high fat diet could damage the hypothalamus unless it somehow lowers protective factors. In rodents at least, saturated fat inhibits manganese absorption.
Kindke said…
Jane what links do you have for this, re: leptin sensitivity doesnt go up with weight loss?
blogblog said…
Sugar isn't a major problem if you are physically active. Elite road cyclists practically live on sugary drinks and pasta yet they have only 5-10% body fat.
Jane said…
Sorry Kindke, I don't have any. I'm assuming it doesn't because weight loss so often stalls and reverses. I don't know of any other explanation for that.

Jane said…
I remember reading about elite cyclists doing that, and I thought maybe that's why they have to take performance enhancing drugs. Their mitochondria would be defective.
Anonymous said…
'There is only one proven way to permanently modify the gut bacteria - fecal transplantation. Major dietary changes such as eliminating refined carbohydrates or eating more soluble fibre will eventually shift the gut microbiota to a healthy profile.'

blogblog, could you point me to the abstract of the study that shows the 'one proven way to permanently modify the gut bacteria'? I'm interested. A collection of studies wouldn't be the answer - I've got that already. I'm looking for how the 'permanently modify' part is established.
marksuave25 said…
Evelyn, I believe that many of your readers get it. Calories will determine if you gain or lose weight. But. Your body will get to a point where you stall or feel cold all the time and your weight won't budge. Do you agree? I just went through this late last year. 1800 calories is a small amount of calories for an active young man. I lost weight fast at first, but I stalled, and was miserable, cold all the time, scars not healing quickly, etc, etc. I don't know if this is your message, so I will just ask you. So if I wanted to lose more fat, I should of cut my calories even more to let's say 1300 a day? That is what I interpret when I hear someone say "calorie is a calorie". I may be joining to subjects that aren't the same. That by saying a calorie is a calorie is not the same as saying, that to lose fat, one most simply cut their calories and keep cutting until they are at goal. What do you think? lasltt, you don't think that the food we eat hormonal effects that could lead to weight gain or weight lose?
Diana said…

I've known of more than one ballerina who drank lots of sugary soda. Research in the '80s showed that overfeeding glucose did not result in fat gain.


N of 1, one of those superskinny ballerinas was Patricia McBride, a Balanchine dancer of the 1970s, who would drink a full liter of cola after a 3-act ballet. She had fertility problems, and then suddenly got pregnant age 40. My guess is that she was too skinny to conceive and then when age set in, gained 5 pounds and became fertile. But maybe her mitochondria were involved somehow?

She gained 60 pounds during her pregnancy, which tells a lot, don't you think?

She's 70 now and still thin, but not dancer thin.
marksuave25 said…
There are always a few bad apples that ruin a civil conversation. Why do these idiots have to post vulgar stuff on here? Grow up!
Unknown said…
@Diana: what does "overfeeding glucose did not result in fat gain" mean? Was it eating a lot of glucose, but at a caloric balance, didn't result in fat gain? This is the case of an elite cyclist who is burning off 1000's of calories during training. A 100 mile ride will burn off about 4000 calories; I've done them and I am flat out starving for the next 3 days. Or was it truly overfeeding - eating more calories than you need - didn't result in fat gain? From Stephan's article:

"The overconsumption of energy from food is at the core of obesity and strongly contributes to cardiometabolic disease. Some of the harmful consequences of eating refined carbohydrate and sugar do not materialize when there is no calorie excess. This natural experiment is consistent with a large body of evidence from controlled feeding trials in humans and animals."

I think the Cuban natural experiment is a reasonable counter to the Lustig econometric work because it is also at a population level. It's not an n=1. A single Individual or even a small group of them (say, elite cyclists or dancers) are not representative of people in general. My mother-in-law is 84 years old, developed diabetes when she was 81, and ate/continues to eat a diet filled with refined crabs. And she is overweight, at times in her life obese. I would not suggest everyone look to her for a model of healthy nutrition despite her excellent health into her 80's. My dad developed hypertension in his 40's, had a quad bypass in his 60's and finally diabetes in his 70's. Never overweight by much. Certainly never obese. Active too. Their diets have been similar. n=1 is meaningless unless that 1 is very closely related to you!

I find the case of developing diabetes (or other cardiometabolic diseases as Stephan calls them) really interesting because we think that being overfed means being fat. But, as my family shows, you don't need to be very overfed to develop these diseases. I have hypertension like my dad. I am very active. I am 52 now but started on meds for hypertension when I was 42. I am slightly overweight, like my dad, never obese. So, I am very curious about how this happens. Which is why I follow this blog because Evelyn gets at the science out there, deep down molecular biology science. I just love it!
Diana said…
@blogblog: "The science is very clear that you cannot make major changes to the gut microbiota by eating fermented foods or taking probiotics."

Erm....I've always had a gut feeling that what you are saying is true. I eat the sourdough cos I like it, not because it's going to do me any good.

@Kade: I hope you are right. In any case, fecal transplantation ain't happening chez Diana!

I'm just hoping I share genes with my aunt who died age 104. She basically lived on hamburgers and grilled cheese sandwiches. White bread. Perhaps if she had cut out the white bread she'd have lived to....105?
Diana said…
PS to blogblog, I'm surprised you subscribe to the nutritional improvement theory. I would have thought you'd be skeptical of that. I am. I think the only reason primitive people fermented was to preserve foods. I don't think they knew or would have cared about the nutritional aspects. Nutrition didn't even start as a science until the 19th century, although it's true that some smart individuals noticed the link between diet and health.
Diana said…

See this:

"The data imply that: (1) The capacity for glycogen storage in man in larger than generally believed, and (2) Fat synthesis from CHO will not exceed fat oxidation after one high-carbohydrate meal, even if it is uncommonly large. When a single high-carbohydrate meal is consumed, dietary CHO merely has the effect of reducing the rate of fat oxidation. These findings challenge the common perception that conversion of CHO to fat is an important pathway for the retention of dietary energy and for the accumulation of body fat."

And other papers under the name J.P. Flatt

I suspect that his research was badly reported, and was partly responsible for the "carbs don't make you fat" bullshit of the 1980s.

Real people in the real world don't eat pure glucose. They ate - overate - carbs plus fats plus proteins. And got fat.

I would like to know how much fat and protein the Cubans ate.

I understand that McBride's n of 1 means nothing to me. I gave her as another example of what an active woman who lived on sugar looked like. I think her 60 pound weight gain was revealing that exercising furiously and living on sugar isn't the healthiest lifestyle because once one of the variables changes, the whole house of cards comes tumbling down.

In fact I expect that China is on the cusp of an obesity and diabetes epidemic, worse than ours.
Unknown said…
Fair point, Diana. No faecal transplants wanted.

There are other factors that help people achieve their longevity numbers and some of us are just more adapted to a wider range of food options and staples. Just so many factors. But good for those folks.
Unknown said…
I second Blogblog's comment.

Sugar ain't gonna' fatten as a primary element in the diet if the fat is low, and especially so if the person's constantly running about like a rabbit on crack. I can attest to that and I have known many who can say the same. Lean. High sugar. But what about the rest of one's health? Quality of hair? Teeth? Mood? Being sub-10% body fat doesn't equate to a magical gateway to health for the aforementioned points, and I accept that totally from first-hand experience.
Unknown said…

Do you also suspect a similar fate for the more healthier sub-populations of Japan (e.g. Okinawans)?
Unknown said…
A community-driven global reconstruction of human metabolism
Diana said…
Some of us can even eat a small amount of refined crabs and survive. Refined carbs, too.
Diana said…

Yes. I think Flatt (and others but mainly Flatt) inadvertently discovered the key to why these high carb low fat eating people maintain their low body weights. Carbs in and of themselves do not become metabolized as fat unless you really an awful lot of them.

But - and here's the kicker - as I understand Flatt, he's saying that carbohydrate intake also inhibits fat oxidation. So if you eat a lot of fat (and carbs), watch out. And we do.

This trail leads to the Bray overfeeding study, which Evelyn has dealt with a couple of times. To me, Bray simply reproduced in a metabolic ward in miniature, the conditions that created the OE. High fat, high carbs, high protein in a high calorie diet. Results: Fat gain AND lean body mass gain. In other words, modern Westerners: big fat muscular people.

I'm a little bit over my romance with the traditional Japanese diet by the way. As I've been reading about it, the true traditional Japanese (that is pre WWII) diet was a bit of rice and fish, which produced a population of small, skinny bowlegged people.

So sue me, I'm American, I like our height and muscularity. I think pre OE we looked quite good.

Anyway back to the subject at hand - I thought the Lustig study controlled for calorie intake.
Gabriella Kadar said…
Skeletal muscle mass is a factor I think in calorie expenditure. A person with little muscle mass will store calories in fat despite their total intake being relatively low. Muscle tissue burns up calories at a higher rate than fat.

So I don't think that physical activity is going to have a different effect on the usage of calories depending on the amount of muscle tissue to begin with. And good muscle development depends on more than diet.
Harry said…
One way or another, if you're not losing @ 1800 cal you're going to have to either reduce calorie intake further, increase energy expenditure, or both. But the 'one way or another' clause is a biggie.

The type of calories you consume will play a big role in your perception of duress on the diet (especially protein, which ceteris paribus, should reduce dieting duress to a greater extent than carbs and fats).

The metabolic adaptations that lead to poor mood, low libido, and low body temperature are more a function of prolonged energy deficit (particularly on the 'energy in' side of the equation)than of type of food eaten. Unfortunately, as you get lean, further excursions into greater leanness come with a price (e.g. most natural bodybuilders hit the stage only a couple of steps above catatonic depression!).

Taking a diet break might be a good idea to get those leptin, testosterone and thyroid levels back towards normal range.

Harry said…
One way or another, if you're not losing @ 1800 cal you're going to have to either reduce calorie intake further, increase energy expenditure, or both. But the 'one way or another' clause is a biggie.

The type of calories you consume will play a big role in your perception of duress on the diet (especially protein, which ceteris paribus, should reduce dieting duress to a greater extent than carbs and fats).

The metabolic adaptations that lead to poor mood, low libido, and low body temperature are more a function of prolonged energy deficit (particularly on the 'energy in' side of the equation)than of type of food eaten. Unfortunately, as you get lean, further excursions into greater leanness come with a price (e.g. most natural bodybuilders hit the stage only a couple of steps above catatonic depression!).

Taking a diet break might be a good idea to get those leptin, testosterone and thyroid levels back towards normal range.

blogblog said…
Fecal transplants are simple, quick, cheap, safe and extremely effective. They have been used for centuries in animal medicine. The only real downside is the "yuck" factor. Professor Thomas Borody from Sydney University has performed over 2000 fecal transplants without problems. The results can only be described as miraculous - C. difficile induced colitis can go into permanent remission within a matter of hours.

Diet can't replace the missing "good" bacteria. It can only temporarily reduce the overgrowth of pathogens. These pathogens can quickly revert to harmful levels by just eating a small amount of a problem food.

People in the past were probably far more obsessed with nutrition. Food was considered to be medicine. It was literally a matter of life and death.

Diana said…
Russians have longer intestines than Italians.

This is one of those claims that screams out for "cite your source!"

I don't know what to make of it - but the article is well worth reading & pondering.
Matt said…
I always thought the reason why you don't absorb all the calories from nuts is because you don't chew them to a pulp. Now if you make almond muffins or eat cashew nut butter that's a different story. But certainly your body isn't extracting all 160 calories from a handful of almonds when you can clearly see some bits of almonds in your stool.
Anonymous said…
'Treating Clostridium difficile infection with fecal microbiota transplantation.'

The PDF is free. An interesting read.

Search argument in NCBI is 'fecal transplantation' or 'fecal microbiota transplantation.' The research that surfaces seems to focus on Clostridium Difficile and other diarrheal or intestinal ailments. However, there's a lot more study of the gut micriobiota that doesn't involve FMT (fecal microbiota transplantation)..

C. Difficile can be life-threatening, but my guess is that giving the patient something orally (there seems to be one tested, popular medication) is easier, not because of the 'yuck factor' so much as the difficulty in scheduling a procedure that takes a lot longer than swallowing a pill, especially in the elderly. It looks to me like it would be similar to scheduling a colonoscopy, although nasogastric procedures and enemas are also mentioned. They would still have to be scheduled.

I had a relative who suffered C. Difficile in a nursing home setting, so I am somewhat familiar with how easy it is to catch and difficult to get rid of.

I still don't see that the effects of fecal transplants are permanent. 'Cure' is used in some instances, but that does not mean future occurrences are not possible. If it does mean that, that would be headline news. It would amount to some sort of immunization against C.D. and nursing homes would benefit greatly.

Quicker results, sometimes immediate, and more effective in the case of C. Difficile; FMT is still extremely valuable treatment - especially mentioned in the case of 'reccurrent' C. Difficile infections.
'Colonoscopic versus nasogastric fecal transplantation for the treatment of Clostridium difficile infection: a review and pooled analysis.'

Years ago, as a lab student, I was on the giving end of nasogastric procedure, not the receiving end, and even I was squeamish (the patient didn't like it either).

The least uncomfortable treatment may be the enema, and I still think many people would want to try pills first! Somewhere in the reading, there was mention of being able to self-administer that at home, so that might be an option - but with C. Difficile, there would still have to be a doctor involved somehow, or perhaps a visiting nurse.
'Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome.'
Unknown said…
Limits to sustainable human metabolic rate
Energy expenditure during overfeeding
The Role of Diet and Exercise for the Maintenance of Fat-Free Mass and
Resting Metabolic Rate During Weight Loss

Gabriella Kadar said…
Exactly. Even more applicable to walnuts. Never seen cashew pieces but walnuts? It was like a yule log.
marksuave25 said…
Thanks Harry. So one must quit the diet for a while to get it to work? I'll give it a try. I've been doingtthe weight lifting thing and am getting very strong and changing my body composition.
Unknown said…

High dietary intake of prebiotic inulin-type fructans in the prehistoric Chihuahuan Desert

In this semi-arid region limited rainfall and poor soil conditions prevented the adoption of agriculture and thus provides a unique glimpse into a pure hunter–forager economy spanning over 10 000 years. Ancient cooking features, stable carbon isotope analysis of human skeletons, and well-preserved coprolites and macrobotanical remains reveal a plant-based diet that included a dietary intake of about 135 g prebiotic inulin-type fructans per d by the average adult male hunter–forager. These data reveal that man is well adapted to daily intakes of prebiotics well above those currently consumed in the modern diet.

Detailed paleodietary studies(19 – 23) demonstrate that these prehistoric populations consumed a wide variety of plants, animals and other resources including prickly pear, agave, mesquite, sotol, acorns, walnut, berries, pecan, acacia, onion and other geophytes, rodents, turtle, fish, rabbits, hares, insects, birds, reptiles and deer. Analysis of well-preserved faunal and macrobotanical remains from excavated rock shelters and caves reveals a broad-spectrum diet of wild plants and predominately small animals for the entire 10 000-year record. Among the consumed plants, the desert succulents Agave lechuguilla (agave), Dasylirion sp. (sotol) and Opuntia sp. (prickly pear) were heavily utilised, along with Allium drummondii (onion), Yucca sp. (yucca) and Prosopis sp. (mesquite). No evidence of agriculture is present in the area, owing to limited rainfall, high evaporation rates and poor soil conditions.
Diana said…
"Taking a diet break might be a good idea to get those leptin, testosterone and thyroid levels back towards normal range. "

Ah, so that's what I've been doing for the past year? (I lost 20 pounds in 2011, have been maintaining more or less since early 2012.)

I vill lose those last 10 pounds! I vill! It vill be a triumph of ze vill!
Unknown said…

"Here is what my daily feast consists of. Every day I drink ½ gallon of certified organic, full-fat, grass-fed Raw Jersey milk and 16 oz of homemade Kombucha. I vary the arraignment some but here is the plan I roughly follow.

1st course: is usually between 4:30 and 5:00 am. I drop a handful of ice in a tall glass, pour in a pint of raw milk and then stir in a few spoonfuls of organic decaf coffee concentrate. This is very satisfying and will keep me going strong till breakfast time at 7:00.

2nd course: If I’m hungry at breakfast I’ll enjoy a pint of raw milk straight. If I’m not hungry yet, I’ll wait till later in the morning at 9:00 or 10:00 to drink the second pint.

3rd course: Lunch is a 16 oz homemade kombucha. This also is served over ice in a tall glass. I find this immensely satisfying. I’m not sure why. It is just fermented organic tea with powerful probiotics, enzymes and beneficial yeasts and has very few calories.

4th course: A third pint of raw milk makes an attractive mid-afternoon refresher.

5th course: The fourth and last pint of raw milk is served as Raw Kefir fruit smoothie. Kefir is simply raw milk fermented (like kombucha) with probiotics, enzymes and beneficial yeasts. I count it as one of my raw milk servings. The fruit ratio is ½ cup of fruit to the pint of kefir. The picture shows a delicious organic strawberry kefir smoothie ready to drink.
Note: I drink additional water anytime throughout the day when thirsty.
You may want to use prunes in the fruit smoothie. :)

So that is it, folks. How does it work and how can one lose weight while drinking all that full-fat milk? It is simply this: raw fats and proteins so completely nourish and satisfy every cell of your body that there are very few cravings and little hunger. Yet the actual calorie intake is very low. A pint of raw milk is 320 calories, so 4 pints plus a 100 calorie kombucha and a ½ cup of fruit is only about 1500 calories max. And sometimes I feel so nourished that I skip the pint before lunch which puts total calories down to 1200.

Richard Nikoley - is now following this diet - it's his latest "diet hack"

Eric said…
I see this making the rounds as well.

Let us not forget 2 items. Calories in is only half the equation and calorie counts by survey are notoriously wrong, but that won't stop CDS from latching onto this latest news as proof that they are correct.
Unknown said…

As you know, I’ve been hard at work on my new book helping the lay public understand what their cholesterol test results mean. While I am certainly no expert on this subject, I do have a few friends in the medical, nutrition and research realm who do. I’ve logged nearly three dozen interviews with the world’s top lipid experts for my book Cholesterol Clarity: What The HDL Is Wrong With My Numbers? that I’m co-authoring with a practitioner and researcher named Dr. Eric Westman. I’d love to have YOU involved in this book project if you’d be willing to share your cholesterol information. I’m looking for men who have a total cholesterol of 220 or less and women with a total cholesterol of 250 or less who were told by their doctor that they have hypercholesterolemia (“high” cholesterol) and need to eat a low-fat diet and/or go on a statin drug. E-mail me at if you want to participate. I’ll be in touch!

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Travis Culp said… he still a sloppy fat "man?" When I saw this picture of him: I thought he was a female to male transgendered person sucking in their gut. No body hair, ample breasts, no effect of DHT on hair follicles even at an advanced age and 25%+ body fat. Is taking hormones to become a man "freeing the animal?"
Unknown said…


He does seem to have great lipids, however.
Travis Culp said…
Lipids or lipid stores? I think all of the 17β-estradiol, estrone, estriol and prolactin in that "full fat" milk might boost this person up to a D cup. Can't wait for that picture.

One more reason why this "community" is a self-parody. Can't believe how bad it is at self-policing. There's no way the vegans are like this. If someone eats a vegan diet for 10 years and is sloppy, they're gonna keep him/her locked in a vault, not at the forefront. Instead, "less fat" is a perfectly viable credential. Pathetic.
blogblog said…
Nuts need to be ground to a fine flour and cooked to release most of the calories. Otherwise they mostly pass straight through you.
CarbSane said…
I've seen a lot about fecal transplants to cure resistant infections. I would do it if I were to contract one and reasonable other measures didn't work. Not sure it would be my first option, but that's just me.

I tend to think that a goodly portion of the gut dysbiosis is not real. What used to be candida is now all manner of acronyms requiring special protocols and supplements. I swear in my real life I've never known so many people who shouldn't be able to function!

There was a small human study on fecal transplants for weight loss and diabetes. My recollection was that there was some improvement in glucose tolerance but no weight loss. I've looked for a follow-up but have been unable to even locate the original study.
CarbSane said…
I tend to think adipocytes do remodel with time and fewer new ones form if they are not needed as excess die off. The notion that the number is fixed in adulthood has been challenged a number of times.

I do believe it is possible to eff up your metabolic rate with starvation diets, but unfortunately just eating more doesn't fix that problem. One of the more recent studies involved TBL contestants where they used a regression line for the general population to predict that their metabolic rates were lower than they would be were they to have been their reduced weight to begin with. There are many problems with such analyses.

I think most of us have to work with what we were given or what we have. I do believe lots of the adrenal fatigue is the body thinking it is starving due to prolonged VLC however. Just my thoughts though.
CarbSane said…
It's been a while since I looked at a lot of these studies. Many are very recent -- like 2 months after significant weight loss -- so I think it changes a bit over time.

In terms of metabolic rate, of course it will be lower than when you weighed 30, 50, 100 lbs more. The problem may lie in not adjusting to this reality.
CarbSane said…
^^^ What Travis just said! Maybe he'll volunteer for the one-way colonization of Mars.
CarbSane said…
Your point is well taken Grinch. I'm probably not articulating part of this very well because there were a whole bunch of things I wanted to lump in one post that got very long and disjointed. In breaking it up some of the points that related to all of the cases and an "overall take" if you will, got lost.

There is a prevailing theme that because we are (supposedly) following the (bad) advice to eat less and move more and obesity keeps climbing, it can't be the calories after all. Certainly the LC crowd is dominated by those who deny the role of calories, and even when they do it is almost always with the caveat that it's because carbs broke them or something.

Certainly quality of food matters in many cases but just eating good quality food doesn't magically fix most people. Where improved health is concerned, there's where we really don't have a lot of science behind most of the diets in the IHC, and there are no cultures whose diets they even pretend to emulate. Grassfed cows are not seals or caribou or deer. Or insects and snails for that matter.

However it seems that in many cases it is only in very high quantities and/or chronic caloric excess that many of these so-called low quality foods do damage. My next installment if I ever get to it (not the one published today) is about this because much of the research on calories was done from the point of providing adequate nutrition not concerning with the potential to overeat.

Malnourishment on any Western diet seems the least likely to me.

CarbSane said…
The Cuban "experiment" is difficult to counter.

Where fructose is concerned, most experiments are unnatural. For example that study where they fed 25% of calories as isolated fructose sweetened beverages. That was like 650 cals -- not very applicable.
blogblog said…

"However it seems that in many cases it is only in very high quantities and/or chronic caloric excess that many of these so-called low quality foods do damage."

I totally disagree. Many foods are harmful in extremely small amounts. Probably 80-90% of the people in the world are affected to some extent by dietary FODMAPs. Sometimes it takes only a few grams of FODMAPs to cause serious health problems.
Travis Culp said…
What do you mean? He already did. He just assumed the "MRSA Colony" label on the vial was written by someone with his attention to detail and that it was a vaccine against Martian viruses.
CarbSane said…
Needs attention much? LOL
CarbSane said…
In addition to CO being part, here's the reason -- we increased 314, decreased 74. By my math that means we're still over eating 240 cal/day. The last curves I saw, the epidemic does appear to be slowing.
CarbSane said…
I think it would be fair, since he is co-authoring the book, to ask Dr. Eric Westman what he thinks of Jimmy Moore's publicly shared health markers. What do you think he thinks? What would he say?
CarbSane said…
1. Many, not all
2. Never knew what a FODMAP was until sometime in 2011. If they were a serious health risk to humans we'd be extinct ;-)
Sanjeev said…
> 80-90% of the people in the world are affected to some extent by dietary FODMAPs. Sometimes it takes only a few grams of FODMAPs to cause serious health problems
I was about to write that these claims don't even pass a cursory reality check

BUT if you
1. lower your requirements low enough "affected to some extent"
> are affected to some extent by dietary FODMAPs

2. cast a wide enough net (all the foods you want to include)

(from this page:

or copy & paste this to your URL text bar:

Excess Fructose: Honey, Apples, Mango, Pear, Watermelon, High Fructose Corn Syrup, Corn Syrup Solids

Fructans: Artichokes (Globe), Artichokes(Jerusalem), Asparagus, Beetroot, Chicory, Dandelion leaves, Garlic (in large amounts), Leek, Onion (brown, white, Spanish, onion powder), Raddicio lettuce, Spring Onion (white part), Wheat (in large amounts), Rye (in large amounts), Inulin, Fructo-oligosaccharides.

Lactose: Milk, icecream, custard, dairy desserts, condensed and evaporated milk, milk powder, yoghurt, margarine, soft unripened cheeses (eg. ricotta, cottage, cream, marscarpone).

Galacto-Oligosaccharides (GOS): Legume beans (eg. baked beans, kidney beans, bortolotti beans), Lentils, Chickpeas

Polyols: Apples, Apricots, Avocado, Cherries, Longon, Lychee, Nectarines, Pears , Plums, Prunes, Mushrooms, Sorbitol (420), mannitol (421), xylitol (967), maltitol (965) and Isomalt (953).

So at this point I question this category

> Sometimes it takes only a few grams of FODMAPs to cause serious health problems.

"sometimes" - yeah, sure, just like peanuts "sometimes" can make the statement valid but I think we usually discuss "most people most of the time"

so 80-90% of the population is affected TO SOME EXTENT by any one of a HUGE LIST of food, SOMETIMES with as little as a few grams.

cool. Some "REALLY Useful Info"®™© there.
Unknown said…
"Lipids or lipid stores? I think all of the 17β-estradiol, estrone, estriol and prolactin in that "full fat" milk might boost this person up to a D cup. Can't wait for that picture."

Ahahahahahaha! Travis, dude. . . you're killin' me 'ere.
blogblog said…
"I tend to think that a goodly portion of the gut dysbiosis is not real. What used to be candida is now all manner of acronyms requiring special protocols and supplements. I swear in my real life I've never known so many people who shouldn't be able to function!"

Unfortunately you falsely assume that everyone is a hypochondriac suffering from imaginative diseases.

Do you know what it's like to suffer explosive diahorrea because you ate an icecream or be doubled over in pain because you drank a cup of coffee? Throw in profuse night sweats, severe depression, bone pain and skin rashes. I've had them all. None of them are imaginary and all can be traced to (medically diagnosed) gut dysbiosis.

CarbSane said…
I did not say that. "Goodly portion" OK? I'm glad you were medically diagnosed and (hopefully) treated.
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Glenn Dixon said…
Bacteria seem to survive transit, in fact...
MacSmiley said…

Someone recently wrote a comment on Dr Greger's to the effect of 'Get rid of FODMAPS' but "Stay vegan." How can you even DO that?? :-D
MacSmiley said…
You mean weight gain plateaus just like weight loss does?
MacSmiley said…
When was the last time you saw a paleo dieter go rat hunting!?? LOL
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