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Welcome all seeking refuge from low carb dogma!

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~ Charles Darwin (it's evolutionary baybeee!)

Monday, August 26, 2013

Will NuSI clear the bar?

Gary Taubes is out with a new article in Scientific American ... rehashing the same old same old, and essentially getting paid to write a press release for NuSI.  

What Makes You Fat: Too Many Calories, or the Wrong Carbohydrates?

Rigorously controlled studies may soon give us a definitive answer about what causes obesity—excessive calories or the wrong carbohydrates

We get the rehashing of how WWII stopped Bergmann and Bauer's Lipophilia Hypothesis from becoming the working hypothesis for obesity, and yet another primer on calories vs. carbohydrates.  We again are asked to ignore the obvious -- that Americans are definitely eating more, on average, with no concurrent need for those calories, and likely moving a bit less as well.   The obesity epidemic that supposedly was instigated by the low fat craze is blamed on the fact that much of our additional caloric load is in the form of carbohydrates.  This is not supported by one of Gary Taubes' own paradoxical cultures, the Pima, who did not eat a low carb diet prior to the 1900's, let alone billions of humans all over the globe.   Or .... despite the "modern paleo's" insistence, the paleolithic diet in the literature -- both cited for the basis of the diet and that used in clinical trials.  


But most importantly, this does not even pass the smell test based on every assessment of the American diet circa 1970 and 2000+.  There are minor differences between NHANES and some other studies, but generally the macronutrient composition of the SAD has changed very little.  More importantly, they all point to us eating on average somewhere in a 300-500 cal/day range more.  (I seem to recall one study even putting that surplus in the 600 range).  While protein has stayed roughly constant as a percent, fat was reduced by 3-4% as carbs were increased by the same percentage.  A generous "rounding" of the dietary changes would have protein at 15% and a swing from carb/fat from 45/40 to 50/35.    We could even go further than that and look at 55/30 as the "prescribed" SAD.   Of course we would have to ignore the fact that Americans are not eating less (in absolute amounts) of any macronutrient (there's one that has men eating a few grams less, insignificant), but:

Iff* the obesity epidemic is due to some hormonal effect brought on by the macronutrient composition of the diet, we should be able to see this studying a macronutrient change within  the range -- even an exaggerated one as above -- that has been associated with this obesity epidemic.  This would seem to be plain logic.  If you say A causes B, then that is what you should test.    *Iff = if and only if

So the press release begins:
Why do so many of us get so fat? the answer appears obvious. “The fundamental cause of obesity and overweight,” the World Health Organization says, “is an energy imbalance between calories consumed and calories expended.” Put simply, we either eat too much or are too sedentary, or both. By this logic, any excess of calories—whether from protein, carbohydrate or fat (the three main components, or “macronutrients,” in food)—will inevitably pack on the pounds. So the solution is also obvious: eat less, exercise more.
The reason to question this conventional thinking is equally self-evident. The eat less/move more prescription has been widely disseminated for 40 years, and yet the prevalence of obesity, or the accumulation of unhealthy amounts of body fat, has climbed to unprecedented levels.
I would point out that the publication of Atkins' first book -- all in all his books read by millions and tried by countless more -- dates to just about 40 years ago, to no greater long term success.

But of the any-macro strawman, while it doesn't add to fat mass, excessive protein does "pack on the pounds" as shown in the recent Bray study blogged on HERE.  This metabolic ward RCT involved overfeeding roughly 40% of weight stable calories (around 950 cals) on one of three diets by protein content:  low (5%), middle (15%) and high (25%).  It was relatively small (n=25, LP=8, MP=9, HP=8) and overfeeding lasted 8 weeks.  I constructed the table below of the results:

Try as Richard Feinman may, he could not convince JAMA of his carbophobic agenda and they rejected his letter.  This was likely because all of the surplus calories were in the form of fat and/or fat and protein, and as you can see from the table, the carb consumption actually decreased slightly.   So here is a metabolic ward study demonstrating that when you eat surplus fat calories, you add fat mass, and if you consume sufficient-to-surplus protein along with that caloric surplus, you add fat mass and lean mass to really pack on the pounds.  No carbohydrate induced additional fat-trapping insulin required.  Indeed, the lowest insulin-stimulating diet, LP, resulted in a trend, if anything, towards higher fat mass gain (not stat.sig.).

This is but one study, I'll discuss a few more.  But the long term success rate of weight loss diets does not invalidate the calorie law (I will call it such as I am not aware of any metabolic ward study where subjects failed to gain weight on a caloric surplus or lose weight on a caloric deficit regardless of composition).  But back to the NuSI-is-funding-a-study promo ... pre WWII blah blah ... hormones ... carbs ... insulin ... blah blah ...:
After a decade of studying the science and its history, I am convinced that meaningful progress against obesity will come only if we rethink and rigorously test our understanding of its cause.  ... [plug for NuSI] ...  The investigators will follow the evidence wherever it leads. If all works out as planned, we could have unambiguous evidence about the biological cause of obesity in the next half a dozen years.
Almost a year ago, now, I wrote a blog post entitled NuSI Again: A Bar Too High, Occam's Razor and Rabbit Holes.  I've already discussed the Occam's razor part -- that being the "obvious" calorie connection.  But let's refresh about how NuSI is setting the bar very high.  Gary Taubes has been overusing the term rigorous in relation to science a lot lately.  Anyone who has read this blog even a little, or read this post on Taubes' blog or listened to even a smattering of his lectures on YouTube is well aware of the disregard and contempt in which he holds obesity researchers specifically, and pretty much all scientists in general.  
Is it fair to say that I think they are all idiots? A surprisingly good question.
Certainly one subtext of my talk (and my work) is that a journalist is getting it right and sixty-odd years of nutritionists and obesity researchers got it wrong (with maybe a half dozen exceptions who were marginalized for their beliefs.) So, yes, it was fair to say that I think a large body of otherwise very smart people, Ph.D.s and M.D.s all, were operating with suboptimal intelligence. Certainly in a pursuit — science — in which the one goal is to get the right answer, getting the wrong answer on such a huge and tragic scale borders on inexcusable.
~ Gary Taubes
OK ... fine words from someone who wrote three PhD theses worth on cherry-picked, often outdated, and even more often misrepresented science.   Interviewer: "There is a problem lying behind the calorie issue, is what you are arguing", Taubes responds:
Yes, well, this is one of the many arguments against. But the alternative hypothesis…I spent about 10 years studying this. My background was in rigorous science, I started out in physics, but I moved into nutrition and was stunned at how bad the science was. And I started going back in time to try and find some baseline experimental data that you could believe in.
So in the course of my research I ended up reading the European literature prior to World War II. Science is effectively a European invention, done best in pre-World War II Germany and Austria. ...

Rigorous science?  But the NuSI founders, Taubes and Dr. Peter Attia, do make an attempt to summarize the so-called "bad science" they intend to replace with the "good" HERE.   All meaningless and useless.  No DEFINITIVE answers.  Perhaps that's true, but tons and tons of evidence explicitly refuting the plausibility of  what I call TWICHOO (Taubes Wrong Insulin-Carb Hypothesis of Obesity).   Please read the Bar too High post for details regarding the 7 points of discontent NuSI lists on this research page.  But these boil down to:
  • Free-living studies are useless (except when you need to quickly replace your smashed G3P theory with a carbs v. calories analysis using such a study, Shai).
  • Metabolic ward studies are expensive and thus are short and small in number. 
  • The low carb diets tested aren't low carb enough and/or studies do not vary carb content.  
Interestingly, and why I discussed it previously, one of the studies they have nice things to say about in their summary is that Bray overfeeding study.
Well-performed over-feeding study that addresses the effects of overfeeding on fat and protein, but not the relevant question -- the effect of carbohydrates on weight regulation. The carbohydraete content of all three diets was equivalent - roughly 40 percent of calorie. The trial also assumes that overconsumption of calories is the fundamental cause of fat/weightt is gained. This is also a hypothesis to be tested. 
Well, it's true that this study didn't look at carbohydrate overfeeding, but so what?  Surely this demonstrates that eating too much, or adding fat and/or protein on top of a baseline maintenance diet caused fat gain.  And yet, there was another overfeeding study that did make the summary cut, Horton et.al. Fat and carbohydrate overfeeding in humans: different effects on energy storage.  Here's what they said about this study:
Hypercaloric diet, 14-day trial, adding 50% excess carbohydrates or fat to a baseline diet that could already be carbohydrate-rich. Neither diet would reduce insulin levels below baseline. 
Neither diet would reduce insulin levels below baseline?  Are they still trying to prove the you-can't-gain-fat-without-eating-carb nonsense?  While it is not specified in the study, that "could" was easy enough to ballpark from information in the study.  Baseline diets were determined from two weeks of careful logging of the usual diet.  For the lean subjects, calories were ~2650/day assuming 15% protein and the 36% fat reported, works out to around 100 g each of protein and fat and ~325g/day carbs (did I mention these were the 9 lean subjects?).  The obese consumed ~3350 cal/day assuming 15% protein and 33% fat reported, works out to about 125g/day each of protein and fat and ~430 g/day carbs.   This would mean that the lean subjects were overfed around 1300 calories of fat only (~145g) or carbs only (~325g) for a total carb intake of  750 g/day.  The obese worked out to ~1650 cals, 180g fat or 415g carb overfeed, a whopping 850g carbs/day in the carb overfeed!   

Apparently nothing in the abstract where the study authors state that 75-85% of the excess carb energy was stored while 90-95% of the excess fat energy was stored was of interest to whomever compiled the NuSI research summary.  But further:
Carbohydrate overfeeding produced a very different picture. Progressive increases in both carbohydrate oxidation and total energy expenditure were seen with carbohydrate overfeeding. Both were evident on the first day of overfeeding and reached maximum by day 7. The increased energy expenditure seen with carbohydrate overfeeding was approximately double that which could be explained by the combination of increased TEF and increased body mass. Thus with carbohydrate overfeeding, more of the excess energy was oxidized and less stored in the body than was seen during fat overfeeding. 
This was a pretty well designed study but did suffer from the limitations of metabolic ward studies -- size and duration.  Definitive answers?  No.  Some answers?  Yes.  Pointing towards calories or carbs as culprit?  The calories have it, because you gave obese subjects an insulin tsunami and they gained less calorie-per-calorie than the same subjects gained from the fat bombs.

Back to our press release.  Under the heading "rigorous experiments" Taubes suggests that 20 years of experiments have indicated that low carb advocates are on the right track and his borrowed long-defunct hypothesis is indeed correct.  He then waxes poetic and expands this to diabetes, heart disease and even cancer!  Carbs kill and NuSI is going to prove it.  *SIGH*  He then goes on to discuss how the causes of obesity are difficult to test because it takes a long time for obesity to develop.  (True, but they can get significant weight gain in reasonable timeframes nonetheless).  Thus NuSI will first test their hypothesis in the context of weight loss .... by ... drumroll please ... manipulating macronutrient composition in a weight-maintaining isocaloric state.  

NuSI is actually funding a study about to get under way!

  • It is going to be a metabolic ward study. Good. 
  • Sixteen subjects. Eh ... more than some, but far from large enough to render the proposed study superior to any of the multitude of prior metabolic ward studies already in the books. 
  • Overweight and obese subjects.  
  • The baseline diet will be 50% carb (15% sugar), 35% fat, 15% protein -- The caloric level of this diet will be "carefully manipulated" until they are sure this is a weight maintaining level, and then ...
  • The ISOCALORIC study diet: "The total carbohydrate content of the new diet will be exceedingly low—on the order of 5 percent, which translates to only the carbohydrates that occur naturally in meat, fish, fowl, eggs, cheese, animal fat and vegetable oil, along with servings of green leafy vegetables." They will keep calories and protein constant ... meaning this will verge on the NuttyK at 80% fat.  
  • " The idea is not to test whether this diet is healthy or sustainable for a lifetime but to use it to lower insulin levels by the greatest amount in the shortest time."
  • Metabolic rate, etc. will be determined in a metabolic chamber.  Good.
  • Unspecified study duration - both the duration on the baseline maintaining diet and on the study diet.
It sounds to me like they are trying to prove some sort of metabolic advantage -- inefficiency -- of a very extreme form of the low carbohydrate diet.  Not answering the question of how we get fat.  They plan to do this with a diet, I might add, that is virtually impossible with real, whole foods and requires including large amounts of refined fats.  Even bacon is like 70/30 fat:protein and eggs so you're talking a lot of butter, cream and/or oil.  They do know that the Buttertons are fictional, right?  How is this superior rigorous science in action?  Some questions, comments:
  • Do they really expect to see weight loss?   
  • If they saw weight loss, of what relevance to real life situations would this have?  Even the Inuit ate diet averaged under 50% fat and almost 45% protein (three times what this study diet will contain).
  • Will they do a full metabolic workup including liver function?  Body composition including intramuscular and organ fat content?  That might make the cost of the study worthwhile and answer some of the real questions about extreme LCHF diets.
  • There is no mention of food quality on the baseline diet.  Will the 15% sugar be in the form of soda, juice drinks and candy or will it be mostly from fruits as the current dietary guidelines clearly stipulate?  This is important, because NuSI's mission is supposedly to revamp the guidelines that have inadvertently caused an obesity epidemic in their eyes.  In this case it likely won't matter as they will have to include refined dairy fats and oily dressings in the test diet to make it palatable to normal people (that haven't convinced themselves that swigs of bacon fat are delicious).   Still, if the test diet is going to be meat/poultry/fish, cheese, eggs and fats, the baseline diet should include a range of whole carb sources like beans, tubers, fruits and real "whole" grains and not just white flour pancakes with syrup, sugary low fat milk and such.  

I realize health is not the issue here ... only it should be because the purpose of NuSI is to solve the burdens the obese place on the world.  Supposedly this means they care as much about health as changes in weight.  Or not?


In Conclusion:


This study will not clear the bar NuSI set.   It will also not provide any more information than is already available from existing metabolic ward studies such as Grey & Kipnis (request access) and Leibel/Hirsch et.al.  Even the recent Ebbeling et.al. study (link to blog post) was well controlled (albeit with some design flaws that marred the conclusions that could be drawn) even though it was not a metabolic ward study.  The macros varied widely but in the end, when calories were cut and subjects adhered to the restriction, they lost weight.  When calories were increased to a degree, they maintained weight regardless of the macro composition of the new weight maintaining caloric levels and despite differences in metabolic rate ascertained by their methods (likely measurement error or otherwise compensated for elsewhere).  

Similar happened in Weigle (also link to a blog post) although the time frames were too short, perhaps, to see the effect of protein-for-fat swap.  Calories aren't given but in this study subjects ate 50% carb throughout, 15/35 P/F to weight maintenance then 30/20 for two weeks calorie matched to weight stable, then ad libitum for 12 weeks of the 30/20.  By spontaneously cutting about 440 cal/day subjects lost weight -- if one presumes 2500 cal/day to start, we're talking a reduction of carbs from just over 300 to around 250g/day.  Just another of seemingly infinite studies demonstrating that calories and not carbohydrates are what counts in the weight gain/loss game.  Protein seems to be the only macro that alters body composition (and often in conjunction with specific activity).  

In the press release Taubes writes:
One drawback to this rigorous scientific approach is that it cannot be rushed without making unacceptable compromises. Even this pilot study will take the better part of a year. The more ambitious follow-up trials will probably take another three years. As we raise more funds, we hope to support more testing—including a closer look at the role that particular sugars and macronutrients have on other disorders, such as diabetes, cancer and neurological conditions. None of these experiments will be easy, but they are doable.
There is absolutely nothing more rigorous about their proposed study than many of the metabolic ward studies that preceded them.  Nothing.  Where would the results of this pilot study lead them?  Let's just say for the sake of argument that these people lose a statistically significant and clinically significant amount of weight on this diet over, say, an 8 week period.  Would they continue the study for a longer period?    Is this of any practical relevance to the current obesity epidemic?   If you think so, check your skirt, your bias is showing.

I keep coming back to the obvious.  Occam's Razor.  Humans never ate such a diet so it would be interesting to see if this even meets the ethics threshold, especially if it is going to last a significant amount of time.   It will, however, be a way to spend some millions of dollars, get paid to write more press releases, draw a salary from the non-profit and pretend to be doing it all in the furtherance of saving the human population from itself.  

64 comments:

podocat said...

So what do you think makes us fat?
1) Excess calories
2) Abnormal hormones (insulin)
3) Both


Is it proven beyond doubt?


(Not interested in NUSI. Please tell me what you think)

Anna Friebe said...

Hm, with few subjects and unspecified study duration you may be able to reach a significant value for something you want to support at some point of time. If you were dishonest you might interrupt the study at that time.

Jorgen Schäfer said...

I hope I'm not imposing if I answer this (Evelyn can answer as well :-)), but I think the current best scientifically-supported hypothesis is:


We're becoming more fat because we eat more calories than we expend.


We eat more calories than we expend because of a wide range of compounding factors (stress, lack of sleep, less-satiating food, increasingly simple/sedentary life style, genetics, etc.), none of which alone would lead to the current situation, but all of them combined apparently do. Obesity also has self-reinforcing factors, such as reduced satiety feelings due to leptin resistance and other factors, so once you start down that path, it gets more and more tricky.


All of these attempts to find "the single culprit" (it's the fat! it's the carbs! it's the sugar! it's the HCFS! it's the … dunno what's next) miss out on the very complex interactions. And when they try to explain aware the common mechanic of calorie overconsumption, they also contradict pretty much all studies in the field. As Evelyn says, there's not a single study where a negative energy balance would lead to weight gain, or a positive energy balance would lead to weight loss, no matter the diet composition. Hence the recent JAMA "call to end the diet debates"–macronutrient composition is the wrong path.


And no, science never proves anything "beyond doubt". But this is the simplest explanation that fits all observed data.

podocat said...

Thank you for your considerate answer! But my curiosity still lingers if you'd bear with me.


So your answer is "excess calories". Therefore are you saying that
supposing that calories are held at absolute constant, the different macro-nutrient compositions of diets would absolutely not result in different weights, and/or different body compositions for the same individual?


If so, are you so sure about it that you think it needs no further probing?


Again thanks for you patience.

Jorgen Schäfer said...

There's some terminology confusion there.

Science tests hypotheses. You propose a hypothesis, make a prediction, test it, and then either have a hypothesis that has more support, or a hypothesis that is refuted. (Note: You never have a hypothesis that is "proven").

The hypothesis put forth by Taubes and friends is "it's not calories, it's carbohydrates that make us fat". That's ok. Then you use science and test it. We did. Calories are the main driving factor of weight gain, regardless of carbohydrate content. More so, study after study shows at best minor differences in weight loss between macronutrient compositions.

A good scientist would now say: Oh, shucks, I guess I was wrong.

Hence this call by JAMA to end the silly macronutrient debates: http://jama.jamanetwork.com/article.aspx?articleid=1730520

Not so Taubes and friends. If evidence contradicts their hypothesis, then the evidence must be wrong.

Now, no one has proposed the hypothesis that there would be absolutely no differences at all. There clearly are differences. Proteins help to build muscle mass, hence high-protein diets favor that. The article you comment on has a link to study that showed that high dietary fat intake leads to more body fat accumulation. Low-carb diets tend to lose a lot of water in the first weeks. And so on.


But all those changes are small and not very relevant to the question of obesity. Calories is what drives the majority of weight gain or loss. Everything else is secondary.


Now, these secondary effects are certainly interesting. Every macronutrient has various advantages and disadvantages for health. Hence why official dietary advice gives rather balanced numbers, and don't go for any extreme. Analyzing such effects further is important.



But clinging to a pet theory ("it must be the carbs!!!") and running study after study to try and prove it, and simply claim studies must be wrong when they don't actually do prove it, is silly.


In the end, the evidence we have is that obesity is primarily caused by calories. Not by insulin, not by carbohydrates, not by dietary fat. Simple as that.


We should focus on actually interesting questions, not on defending Taubes' pet theories.

Nigel Kinbrum said...

"Therefore are you saying that supposing that calories are held at
absolute constant, the different macro-nutrient compositions of diets
would absolutely not result in different weights, and/or different body
compositions for the same individual?"
Pardon me for poking my nose into someone else's conversation, but Fig. 1 from http://ajcn.nutrition.org/content/55/2/350.full.pdf indicates that body weight remains constant given a constant energy intake, for widely-varying macronutrient compositions.

Body composition varies with macronutrient composition, and exercise volume & intensity (which affects nutrient partitioning).


Referring to your initial question, unstable serum glucose & insulin levels can cause increased consumption (also reduced energy expenditure). Therefore, abnormal hormone levels can indirectly make people fatter.

Sanjeev Sharma said...

IMHO isolated biochemistry would be the wrong place to put research $$$$ today.


Adherence is the only thing that needs further research



Two angles must be clarified for real people to use in their lives.


diet: engineering one that people can do automatically - one that peopl can do easily would be ideal


people: how to get them to stay on an roughly optimal one

Sanjeev Sharma said...

> your answer is "excess calories".



It's often Taubes' answer too, when it suits his purpose-of-the-moment.


Parse his language carefully (an effort he tries to defeat by writing ENDLESS, SOMNAMBULISTIC copy) and you'll see how he facilely slips between positions ... slips so much cr*p in there that his "answer" is so qualified it really means nothing. He's abandoned his original cudgel then taken it up again then abandoned it ...

Sanjeev Sharma said...

I wonder if the SciAm piece is paid-for. SciAm does take pseudo scientific advertising.



IIRC There was a piece of expensive exercise equipment that was advetised in there for many years making completely unrealistic claims, supported by minimal research.

podocat said...

Never mind Taube. And also never mind the terminology. The question is if I eat 2000 cal a day pure sugar, would I get fatter or leaner than if I eat all that in pure butter. So you think it won't make a difference? A call by JAMA is hardly the way to answer this question I think. And you think the matter is settled already sufficiently because of couple papers out there? I cant personaly fathom such a clear cut answer unless one is already committed to some dogma.

carbsane said...

Just about every genetic trail scientists have been led down has turned up mostly empty -- leptin comes to mind. While we can create the ob/ob mouse, this animal is useful in elucidating the function of leptin, but this metabolic defect doesn't exist in humans.

Genetics predisposes about 2-3% of the population to obesity when humans have to get their food somewhat like wild animals. Not entirely, but mostly subsisting on locally available staples generally not in huge abundance.


Everyone is so convinced that activity levels have nothing to do with it either. And it may not be a huge factor, but looking at just exercise is a strawman. If you add up all the little stuff we had to do in the 70's vs. even 10, let alone 30 years later. Little stuff like having to get up to manually turn a dial on the TV .. answer the corded telephone ... roll down the car windows ... walk around the car to open the other door or at least lean way over the seat ... put the bags down to open the trunk then lift them back up to put them in ... power steering ... power brakes ... etc.etc.etc.


Money would be better spent avoiding obesity in our youth, but I'm afraid that will involve more than a never ending litany of school programs ... Kids need parents around, extended families or other adults around ....

carbsane said...

As time is short, I'd say Jorgen (thanks!!) answered quite well.


There is no doubt that the "simple" obesity epidemic is almost all about calories. The engineered foods are a factor in eating too much as is the practice of consuming pre-prepared meals at home or meals prepared outside the home. "Passive overeating" is easy to do. Any of the hormonal mechanisms I've seen lack substantiating evidence.


As to hormones and the epidemic? Insulin? No. TWICHOO doesn't explain the obesity epidemic. This was a main point in the post because most of the evils were already readily available when I was a kid and my generation did OK.


Once one becomes a certain degree overweight, the equation changes a bit. I believe the metabolic milieu is altered to protect the new setpoint or whatever you want to call it that makes maintenance difficult. But there are other factors. Insulin isn't one of them.

carbsane said...

That would be interesting. Should it not state paid advertisement somewhere?

carbsane said...

Interesting thought there. One of the problems with studies on extreme interventions is that you almost always see some dramatic change in something. Some enzyme, hormone, etc. (Look at fasting insulin in the Grey & Kipnis study ... by the end of each 3 week switch it appears to be returning to some middle ground, but we don't know because then they switched it up again) ... long term we can see the opposite.


This is one way fructose and alcohol appear to be similar. Both are thermogenic and boost metabolism in sporadic acute doses, but constant exposure for a period of time apparently lowers metabolic rate.

carbsane said...

Well said. Welcome!

Nigel Kinbrum said...

Let's assume that your energy expenditure is 2000 kcals a day.

In
the short-term, you'll gain a few pounds of water-weight on a 2000
kcals/day pure sugar diet as your glycogen stores fill to the max, and
lose a few pounds of water-weight on a 2000 kcals a day pure fat (if
clarified butter) diet as your glycogen stores deplete.

In the
long-term, you'll lose muscle mass, waste away & die on both diets due to a lack of essential amino acids (also vitamins & minerals).

Sanjeev Sharma said...

> also not provide any more information than is already available from existing metabolic ward studies such as Grey & Kipnis (request access) and


yeah ... double underline there ... is this a good faith attempt at anything or is this taking a move out of the homeopathy & acupuncture playbook?



As Steve Novella points out[0] , those folks ignore the already concluded, reviewed and replicated large, well controlled trials and they endlessly repeat smaller, less well controlled pilot-scale studies.


WHY?


[0] more advertising: Dr. Novella has a "great courses" dvd series out on skepticism & critical thinking.

Sanjeev Sharma said...

small world - I was trying to hack on Sawfish a little just yesterday

Jorgen Schäfer said...

Small world indeed! :-) Also … Sawfish is still around? O_O

Jorgen Schäfer said...

Thank you! :-)

Sanjeev Sharma said...

> Sawfish is still around?


Another attempt to learn a little Lisp in more & varied contexts.

It's been a long time since I coded professionally so now I plod slowly. Scheme/Lisp is an interesting intellectual exercise - expands the mind[0] from what I used to do.


[0] mind or repertoire? mind ... may be an overstatement, but understanding the Y combinator felt like an achievement, and I still am not facile with Church numerals

Sanjeev Sharma said...

the draw to reductionism is just too, too strong.

Like I heard on a podcast recently: we measured the mass of the electron what, 90 years ago? NINETY YEARs ... yet despite x to the nth power of trying to pin down a reductionist biochemical "answer" to obesity, people insist we need to keep looking down the reductionist rabbit hole.

And yes, I suppose it could be true - a good drug may come up tomorrow. And commercial interests will keep funding that line in hopes of uncovering pharmaceuticals, and in hopes of clearing up surrounding pathways that may give rise to pharmaceuticals targeting the same systems but for other diseases, but the biggest bang for the buck may be research similar to what the food companies do to push food, but with the opposite intent.

> better spent avoiding obesity in our youth,
Too bad societies can't take the techniques of the tobacco industry and others and re-target in the opposite direction

carbsane said...

But Nigel, the sugar might make you weigh more, but that would be lean mass ;-) The fat will make you fatter before the sugar will. But these 2000 calories of just X vs just Y are ridiculous.

Sue Staltari said...

Its ridiculous because its not relevant. You're not going to eat this way as your normal daily diet. So it doesn't really matter. What's important is to eat in a way that you enjoy for life whilst maintaining a healthy weight. For a lot of us we need to learn not to over-eat constantly. As Sanjeev - talks about - adherence is what we need further research on.

carbsane said...

And maintenance.

grinch said...

The one thing Taubes is right about is that "eat less, move more" is a completely unscientific pile of nonsense. "Eat less, move more" is not a practical solution to obesity. It is basically a summary of how short term fat loss will occur. It completely ignores human psychology, particularly the physiology of the brain which 100% controls all behaviors, including eating and exercise habits. I don't know how you can year after year promote this garbage while remaining completely ignorant of the human brain in all of this.


40 years of telling people they are fat slobs and you really think another 40 years of the same thing is going to make a difference? LOL.

grinch said...

Occam's razor shows that human beings as a whole are not genetically capable of adapting to the modern food environment (ie. hyper-palatable fast food, processed foods) without developing obesity. If you were to force every alcoholic you know to live in a bar, do you really think any of them would ever give up drinking? Of course not, the environment would be too much for them. Same with obesity. In order to become and stay obese, there has to be a genetic factor and an environment to promote it. Its proven beyond a reasonable doubt with twin studies. There's a lot of variation when it comes to each person's susceptibility, but our environment is pretty bad. If its not the environment and genetics per se, then why do the japanese do much better? Are they inherently of moral superiority over Americans?

Sanjeev Sharma said...

> ignores human psychology, particularly the physiology of the brain which 100% controls all behaviors ... don't know how you can year after year promote this garbage

you're trying to hitch that wagon on the wrong horse.

You may have missed the more than 2 years that this blog's auteur[1] and regulars have been promoting many of Stephan Guyenet's cohort's ideas.

You may also have missed the 3 years Taubes and HIS cohort [0] has spent trying (in vain) to marshall every trick in the book, no matter how small, ugly or full of cr*p, to discredit those scientists and their studies and arguments.

[0] although Attia has given some approving nods in that direction.

[1] yes, I chose that word & didnt do my regular murder of the spelling

grinch said...

If Evelyn or anybody else here really looked at this problem honestly, they would stop talking about calories. The calorie crap is beating a dead horse. Talking about calories doesn't help the millions who have known about calories for years, if not decades, but have not been sufficiently motivated by this simple and *proven* advice to actually maintain any type of weight loss.

Sanjeev Sharma said...

Please write a lot more, very interesting.\

grinch said...

The macro-nutrient stuff is a dead end. The only options are to develop new drugs, outlaw or tax certain foods (scary proposition since the government bases all of its current recommendations on pseudoscience), or to completely repackage the current advice in a way that motivates more than a miniscule percentage of the population.

grinch said...

There are many things wrong with the idea that activity levels contribute to this problem in a meaningful way. For one, the evidence just isn't that strong. It may affect some, but there are certainly quite a few people whom it doesn't. It doesn't even work for me. I have went from casually running (15 miles per week) to marathon training (45 miles per week) and gained weight. How can you even reconcile that. Did I lie about my increased mileage? My performance was certainly consistent with increased training, but my theory is that the excess exercise actually caused my selection of food choices to weaken, hence over-compensatory eating of fattening foods.


Plus considering how much effort is to burn X calories while exercising at a high intensity, I fail how to see minor activities we do around the house can really add up to much.

carbsane said...

ELMM is NOT telling people they are "fat slobs" or using the morality charged words gluttony and sloth. It is stating the obvious. It is often difficult to do and to maintain for the long run. You obviously don't read this blog.

grinch said...

Fair enough. ELMM still ignores basic psychology. Imagine if we dealt with crime by informing criminals that they must commit less and contribute more, citing evidence that committing less crime will lead to a happier life. Do you really think this would reduce crime? Of course not. Crime is reduced because we are rewarded for good behavior and punished for bad behavior. Psychology 101. Why would eating behavior be any different? There are a lot of reasons to overeat, most of which are physiological and meant for survival while in the environments in which our ancestors lived. There is very little reason not to. I think the 40 years of failure that Taubes cites is enough to say that informing people of the facts of ELMM is not sufficient to motivate the majority of people to make permanent behavioral changes.

carbsane said...

Crime? Irrelevant analogy.


Most of the reasons the collective we overeat are not physiological or psychological (in the pathologic sense).


Need I point out that ELMM is about behavioral changes?

grinch said...

Is crime not also about changing behavior? I fail to see how it is irrelevant.

weilasmith said...

my brother is a full-time farmer eating the SAD in addition to fruits and vegetables from his farm. he is not a corporate farmer. he picks along side others and fixes and mechanical problems and loads produce for market. he has a santa claus stomach and is constantly hungry. he is chewing on granola bars whenever i see him. you think he is not moving enough? i'd like to see you all do the amount of physical labor he does in one day. meanwhile i am sitting on my butt most of the time except for a leisurely 30 minute bike ride and occasional weight lifting and i am maintaining a 15% of body weight loss since 2009 eating moderate low carb. i would post a picture of my brother, but it would be disrespectful. like i said, picture a santa claus tummy working in the hot fields for hours a day.

weilasmith said...

carbsane said: "Everyone is so convinced that activity levels have nothing to do with it either. And it may not be a huge factor, but looking at just exercise is a strawman. If you add up all the little stuff we had to do in the 70's vs. even 10, let alone 30 years later. Little stuff like having to get up to manually turn a dial on the TV .. answer the corded telephone ... roll down the car windows ... walk around the car to open the other door or at least lean way over the seat ... put the bags down to open the trunk then lift them back up to put them in ... power steering ... power brakes ... etc.etc.etc."


yeah, that really explains my brother's case. read below.

grinch said...

It seems obvious to me why it is wrong. The potential for calorie intake to influence calorie balance is far greater than that for energy expenditure. Any one of us can overeat by thousands of calories in a given day if you put us in the right environment. But burning thousands of additional calories, that requires immense effort. I am all about exercise but I just don't think its reliable for weight control. The eating definitely has to be under control, by whatever means possible or the diet will not work.

Sanjeev Sharma said...

yeah, she was specifically trying to explain your brother's case.


Even had his file on her desk as she was writing that.

Sanjeev Sharma said...

> Crime is reduced because we are rewarded for good behavior and punished for bad behavior


Skinnerism ... ? ... ???



It is 2013 isn't it? lemme check the date ...



the world's pre-eminent expert (based on the absolutism and
aggression of the assertions) on brain, diet, diet-and-brain, calories, obese people AND psychology writes as if Skinnerism's state of the art.

wow

My mind would boggle except my boggle needle already redlined

Add all the above expertise to also being the worldwide expert on what's been written on this blog, (must be, to have written this:

> I don't know how you can year after year promote this garbage
while remaining completely ignorant of the human brain in all of this.

grinch said...

You have contributed nothing to this debate. What exactly is wrong with my reasoning?

Sanjeev Sharma said...

do you understand burden of proof ?

Sanjeev Sharma said...

> I don't know how you can year after year promote this garbage
while remaining completely ignorant of the human brain in all of this.

grinch said...

Why can't you construct any of your arguments in a coherent way? Burden of proof regarding what? Crime? Changing behavior? What is it that you disagree with and why?

Sanjeev Sharma said...

>contributed nothing to this debate.

I'm not debating, not interested in that at all. I'm on the internet to get good answers, well supported by skeptical reasoning and good studies, to my own questions.

But besides that, you've debated NOTHING.

You've asserted.

David Pete said...

Weather its irrelevant or not, I feel your statement on crime is not even accurate. See also "The war on drugs"

grinch said...

Now I'm starting to understand the point you're trying to make.

Let me first say the statements I make are my opinion. I thought that would've been implied since I'm just a commenter and not a person claiming to be of any authority.

I guess you want me to back up my assertions / opinions with references. Well that would be a huge waste of time since most of those will be ignored or disputed anyways and there is nothing you probably haven't seen before. However if there are specific arguments I have made that you think are wrong, I'd be willing to debate them further, assuming you respond in a way that is understandable.

grinch said...

I never said the punishment is all that matters with regards to crime. The problem with drugs is they have their own rewards (money for dealers, high for users) that may override the threat of punishment.

Would you say that imprisonment for any other reason than isolation is completely pointless at deterring anybody from committing a crime?

weilasmith said...

and you know his case is so exceptional- there are so few manual laborers who are overweight/obese lol

weilasmith said...

my other brother does the same amount of labor with roughly the same SAD diet-both their wives are obese- except this second brother is a smoker and moderate drinker- and he's skinny and muscular. both brothers, in their 40's- have full heads of hair with little to no gray. lot more going on here than CICO

carbsane said...

We all have to eat, nobody has to commit a little crime every so often. We don't have a criminal homeostatic mechanism that can go awry.

carbsane said...

My comment regarding activity is "on the whole" -- yes there are active folks who have difficulty maintaining weight and/or normalizing appetite, and there are sedentary folks who are rail thin. I'm talking about our population on the whole. You don't suppose if he replaced those granola bars with a bowl of steel cut oats with a little whole milk and a spoon of honey it might make a difference?

Imagine what your brother would look like if he didn't have his activity level.


Congratulations on maintaining your weight loss! That is truly the difficult part and to be commended.

carbsane said...

I responded to the follow-up comment. I don't understand your point here.


NEAT makes up a large chunk of metabolic expenditure and as grinch said, intake can eclipse even high activity levels. Then you have ex-athlete syndrome.

Lighthouse Keeper said...

You answered that question adequately yourself in the sentence that followed it.

Sanjeev Sharma said...

maybe you missed the point so bear with me as I try again

even when it's accurately reported,

with full information
diligently and meticulously collected


anecdote has close to zero probative value, especially in the medical realm,

Sanjeev Sharma said...

yes, the burden of proof comment was regarding the alleged similarity between crime and diet.

I've not seen simple Skinner type proposals for anything but simple animal training in a long time, despite the late 70s push to extend animal training success to people.

The context seemed clear when I wrote it. having clear dialong may be much easier with narrowly focused material to work with, without multiple threads to work with per comment.

I'll return to my usual quoting style

grinch said...

I think you have actually proven my point. Its actually easier to make behavioral changes to prevent committing a crime because there is less of a physiological need to do so, hence its high risk, low reward. Despite all that, we still have a very powerful form of reinforcement in place (ie. imprisonment, inability to obtain employment, social stigma, etc.).


We have no such reinforcement in place when it comes to eating, and the risk is much lower and reward much higher. The reward is the body and hormones want the food, the risk is that down the road you might develop health problems, maybe you become less "date-able". Seems obvious to me the reward far exceeds the risk for most of us. Some of us who are *already* motivated will do well on ELMM, but history shows most of us are not motivated by a simply instruction. We need incentives. This is precisely why I think ELMM is nonsense as anything more than a statement of how short term body fat loss occurs.

grinch said...

Since reinforcement doesn't affect behavior, do you have any references I should look at for a more modern view of this?

Sanjeev Sharma said...

here's what I wrote

> lack of success in this effort at extending the techniques beyond the simplest tasks

which means operant conditioning does work in many ways. I don't understand how to get from there to

> Since reinforcement doesn't affect behavior,

.... then your next request
> any references I should look at for a more modern

the closest workable modern descendant you`ll find is likely the work of Brian Wansink's cohort.

also google "executive function" - include the quotes. this is one of the more promising fields that dovetails with the work Guyenet and Wansink popularize..

as I wrote above I haven't kept current with operant conditioning directly - , and I have seen no compelling reason to add it back to my reading / research list. Maybe if I were an animal trainer - dogs, horses & marine mammals apparently respond very well. cats & pigs somewhat less so.

One reason I stopped following the field: I never found any workable operant conditioning or Skinnerian regimen real free-living people could apply to real issues in their daily lives. Even with long term professional guidance.

If you find anything tested, proven and workable let us know. I just did a quick skim to refresh my memory here:

https://www.google.ca/search?q=operant+conditioning++%22complex+problems%22&ie=utf-8&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&gws_rd=cr

en.wikipedia.org/wiki/Behavior_management‎

http://en.wikipedia.org/wiki/Behavioural_change_theories

this is to suggest some search terms.

https://www.google.ca/search?q=behaviour+change+skinner+current+state+of+the+art&ie=utf-8&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&gws_rd=cr#q=behaviour+intervention++%22executive+function%22+skinner+current+&rls=org.mozilla:en-US%3Aofficial

Sanjeev Sharma said...

I do NOT know how this slipped my mind: there is now apparently a large volume of research showing simple reward/punishment works TERRIBLY BADLY in humans, often producing the opposite of the intended results


Alfie Kohn and Daniel Pink are 2 popularizers of these ideas


not my field so I can't evaluate the quality of the studies, but these critiques look solid so far

grinch said...

Read an interview from Kohn, read about executive function. None of that is inconsistent with my stance. Kohn thinks giving someone candy as a reward is not reinforcing good behavior. Instead what he does is say reward and punishment is all wrong, but all he's doing is redefining what is a reward. He thinks engaging kids in learning and providing a supportive community is more effective to encourage behavior. Well guess what, to a child's brain that is a REWARD! That is positive reinforcement even if not defined the same way as Skinner. The concept is the same. BTW, I never cited Skinner at all. I think Guyenet is the only blogger who truly understands obesity, nothing I say is inconsistent with him.

What it all comes down to is there is no magical willpower fairy, unbound by the laws of physics, that grants each person the ability to make decisions independent of their genetics and learned behaviors.

Eat less, move more, is not motivating, hardly informative, and downright condescending. This is probably why it doesn't work.

Sanjeev Sharma said...

Quite a talent you got there; arguing with ideas no one ever stated

> Eat less, move more, is not motivating, hardly informative, and downright condescending. This is probably why it doesn't work.


Hitch slap.

grinch said...

The feelings are mutual on this.

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