Dr. Eades on Starvation Diets

When the recent news broke that a Crash Diet (600 cal/day) cured diabetes, discussed HERE,  HERE,  HERE, there was the inevitable invoking of the Minnesota Starvation Experiment in the low carb circles.   A while back, I addressed the MSE in a post entitled Starvation Diets shortly after I had blogged on a study in which one part involved putting three obese women on a 1500 cal/day liquid reducing diet.

The point of that last blog post was that  in the 1970's, the average intake of American women was 1550 cals.   Now folks, keep in mind that averages mean that some women ate less and some ate more.   Dr. Michael Dansinger -- he of the famous diet comparison study and consultant on The Biggest Loser -- told Jimmy during his interview with him that they generally cut the contestants' intake in half on that show.  I don't have time to go back and listen, and the exact numbers aren't really all that important, but the women generally start out eating around 3000 cal/day, so their reducing diet is 1500 cal/day.  Lots of low carbers sneer at TBL as, of course, being the wrong way to lose weight, they could just go low carb and achieve the same results by eating more.  

This is the huge myth of low carb started by Dr. Atkins (I've been re-reading his first book for "research") and handed down through the years to just about every purveyor of a low carb diet out there that I hope to do my part to dispel.  But low carbers recoil in fear of TBL's "starvation diets", and when the contestants lose weight hand over fist it's obviously because any balanced diet that is that low in calories must also be low in carbohydrate!  But forgetting macronutrient ratios for the moment, what we really have is women who became obese because they eat around twice the normal maintenance calories for the average woman, and they lose the excess weight when they cut intake to the average maintenance caloric level.  

Bottom line, 1500 cal/day is not a starvation diet for most people under most circumstances, and to suggest so -- particularly for shorter women , particularly when context is neglected -- is irresponsible.  In the MSE, they put lean men on a "starvation diet" for six months!

Reader Sue asked me over on the discussion boards if I had addressed the MSE and linked to the following print interview of Dr. Eades by Tim Ferris:

The Science of Fat-Loss: Why a Calorie Isn’t Always a Calorie

Eades first discusses the MSE:

The subjects came to the University of Minnesota where they were housed in the cavernous area underneath the football stadium for the course of the study. They were basically kept under lock and key for the study so that Keys and his colleagues could ensure compliance. At the start of the experiment the men were fed sumptuously for the first 12 weeks.

...  A typical days food would include

"a typical lunch… [that] consisted of fricasseed lamb with gravy, peas, and a carrot and raisin salad. For dinner…the men ate roast beef with gravy, whipped potatoes, tomato salad, and ice cream for dessert."

Although the three meals per day the men received added up to around 3,200 calories, which they were told approximated the normal American diet, the men said that they had never eaten better in their lives.

So, we discover that the men ate around 3200 cal/day of luxurious meals.  As Eades and company would have you believe, this was the "maintenance" caloric level for a man in the mid 40's.  Now I don't know about you, but if I was a lean man volunteering for a starvation study knowing I would be starved for six months, I'm eating as heartily as I can while the eating is good!   Indeed they did just that saying  "they had never eaten better in their lives".  And then:

On day one of the starvation portion of the study, February 12, 1945, the rations were cut substantially.

The group shifted overnight from the three relatively generous meals of the control period to only two Spartan meals per day, a breakfast at 8:30 AM and supper at 5:00 PM.

"The meals were designed to approximate the food available in European famine areas, with a heavy emphasis on potatoes, cabbage, and whole wheat bread. Meat was provided in quantities so small that most men would swear in later years that none was included at all."

Quite often when the MSE is discussed, folks only mention that the calories were cut from "baseline" -- presumably maintenance -- intake to half that.  This is misleading.  I contend that baseline intake was probably  considerably more for three months, and not only were the calories cut, but the fat and protein cut considerably more than the carbs.  So one of the meals is given in the article, I put it through Calorie King as best I could ...

EDIT 10/30/14:  In response to comment by Heyman, I have updated this table.  Not only were protein numbers not added properly in the original, but there was some sort of problem so that none of the macros were.  I also adjusted to 1570 calories this time as that was what Eades used for the Keys study.   I have also edited some of the text which follows to reflect these corrections.

This makes for about 65g protein a day presuming the other meal was equal in protein content or actually a high carb diet.  As you can see, despite the meal consisting mainly of legumes, pasta, root veggies and potatoes, this diet came out to be somewhat "standard" macros.  Now, I'm not sure where Eades gets his numbers that he presents for comparison of the "starvation diet" but he should really know better to see there had to be a mistake.   Here is how Eades describes their diet:

The men in this study consumed macronutrients in the following amounts daily: protein 100 gm, fat 30 gm, and carbohydrate 225 gm. If you express these intakes as percentages, you come up with 25.5% protein, 17.2% fat and 57.3% carbohydrate.

Now I generally ate perhaps 150 g protein on my very low carb days, and while not ideal, an entire large can of chunk chicken breast from Costco was something I'd snack on.  This can contains approximately 200g of chicken breast (drained), that amounts to just over 45g protein.  On a diet that was so low in meat, that Eades' own quoted description stated "quantities so small that most men would swear in later years that none was included at all" these men somehow consumed the equivalent of two big Costco sized cans of chicken breast should have set up a red flag.  But not to a man with an agenda!  I mean for a man who has titled several books with the word "protein" in them, did the 25.5% protein claim not strike him as just a little off for a diet composed mainly of bread, pasta and potatoes?   I mean, MAAAYYY-be if he didn't compare it to another diet, but he does just that presenting the data side by side.  C'mon man.  You expect me to believe that eating the same calories of foods on the MSE-diet could possibly exceed the protein content in Yudkin's diet where the subjects were instructed to:

take between 10 and 20 oz milk daily (about 300-600 ml), and as much meat, fish, eggs, cheese, butter, margarine, cream and leafy vegetables as they wished.

You put up the graphic of a comparison with your numbers Dr. Eades, and nothing looks "off" to you?  Below is an adaptation of that table and includes my macros.

EDIT 10/30/14:  Table also updated

I mean if the protein didn't getcha, surely the fat content would?  Mac n cheese and lard for that supper and we're expected to believe the men received only 30 total fat grams?  Granted, at 33% this is still "low fat" to the LC advocates, but fat intake was almost double that claimed by Eades.  I cannot write this off as an honest mistake.  Not when this was a print interview and not when a person with his knowledge of the macro composition of foods could look at that menu and claim these men were averaging 100g protein in a day and getting more than a quarter of their calories from protein.  I must say I was surprised the protein content came out as high as it did. 

But we're supposed to even make any comparison between these two studies?  Yudkin gives no data on the characteristics of their 11 subjects, only that they were "apparently normal".  Also the length of the LC phase is unclear, but one can presume it was of the same 2 week duration as the phase to establish normal intake lasted.  It is interesting that Yudkin discusses how a standard CRD keeping macro percentages fixed would result in the subjects consuming approximately 2/3rds of their normal protein intake, but that the "average" subject on the diet consumed upwards of 90% of his usual protein intake.  Indeed the averaged absolute protein intake for all subjects was virtually unchanged from baseline.  Meanwhile, the MSE subjects were feasting on rack of lamb and whatnot (3000 cals worth) for three months then reduced to 15g of ham as their only meat source of protein ... yeah ... that's a valid comparison.  

For comparison:
Keys baseline ~3000 calories, Starvation Diet  roughly 50% baseline calories
Yudkin baseline calories roughly 80% baseline calories in Keys
Yudkin LC Diet calories roughly 65% of their baseline caloric intake

And yet the apparently shameless Eades tries to make one:

Both studies provided between 1500 and 1600 kcal per day, but with huge differences in outcome. In the Key’s semi-starvation study (high-carb, low-fat) the subjects starved and obsessed on food constantly. In the Yudkin study (low-carb, high-fat), the subjects, who had no restriction on the amount of food they ate, volitionally consumed the same number of calories that the semi-starvation group did, yet reported that they had “an increases feeling of well-being.” Instead of lethargy and depression reported by the Keys subjects on their low-fat, high-carb 1570 calories, those on the same number of low-carb, high-fat calories experienced “decreased lassitude.”

It turns out Key's diet was not quite so high carb or low fat after all, but even presuming that ...

Both groups of subjects were consuming the same number of calories, but one group starved while the other did just fine. One group had to be locked down to ensure they didn’t eat more than their alloted 1570 calories; the other group voluntarily dropped their intake to 1560 calories and felt great. What was the difference?

Umm ... do you REALLY have to ask?  Seriously, if this sort of thing is what passes for some sort of expert analysis by an MD who has treated countless patients for obesity ....  Furthermore, Eades ignores the considerable physical activity requirements in the Keys study which make any comparison to Yudkin even more absurd.

Let's see ... you recruit a bunch of lean men (the pictured guy in the starvation study looks like he was awfully lean to start) and TELL them they are going to be starved for 6 months.  You don't think this might just play with their minds a bit around 3 months in?  They are not only starved of calories, but of protein and Eades has to know this and that the 100g he's suggesting is in error.  Still, he compares this to 4 weeks eating normally and eating low carb in a free-living setting?    Amazing!  He continues ...

Subjects in both groups ate the same number of calories.

Maybe, just maybe it’s not the number of calories that makes the difference, but the composition of the calories instead.

Well DUH doctor!  If you read Yudkin you would see that they focus on how a low carb diet tends to maintain protein intake to usual levels, and I do believe you are aware of the satiating properties of protein.   Indeed this study lends credence to a sort of "proteiostat" in terms of intake.  That we ultimately eat to satisfy protein needs.  When we choose calorie-dense foods, low in protein by percentage, we overeat to meet our needs and get fat. 

Now to be fair, Eades acknowledges the issue of his stupid comparison:

I know that I’m not truly comparing apples to apples with the Keys and the Yudkin studies. But ...

More like comparing potatoes to steak.  IOW, there really is no reasonable comparison between these two studies.   NONE.  Eades continues:

I’ve had many, many patients who have stayed on low-carb diets for much, much longer than the men in Keys’ experiment stayed on their diets of roughly the same number of calories.  

And obese patients losing weight on around 1500-1600 cals/day are starving -- by any measure -- exactly how?

What Yudkin shows is actually that low carb diets work, when they do, for weight loss because they result in a decreased caloric intake.  For all the bluster in his original book, Atkins basically says the same thing.  And you will notice that the subjects in Yudkin actually decreased their fat intake ... yes! DECREASED ... from an average of 124 g at baseline to 105g on LC -- an almost 20% decrease.    

The other thing Eades fails to mention is that the "normal" diet of Yudkin's subjects was hardly high carb and low fat!  

Baseline P/F/C grams:  84/124/216 ; Percents P/F/C = 15/48/37

LC P/F/C grams:  83/105/67 ; Percents P/F/C = 21/61/17

(I would note that Eades is contending that the men starving in the MSE were getting 16g/day MORE protein than the baseline Yudkinites!)

The real "kicker" folks is this:  Eades just spoke of the elephant in the room!  A LC diet works because you REDUCE caloric intake.   In the case of the Yudkin study, while carbs were the major source of caloric reduction (596), fat was reduced by 171 calories (or 1 Tbs + 2 tsp butter).  Eades point appears to be that calories were reduced to starvation levels -- and yet didn't produce skeletons?  What is known for sure is that the subjects do NOT eat more calories as so many on the internet try to convince you they do.  There's nothing magical or in contrast to how "conventional" reducing diets work.  It's the EL = eat less after all.