Guyenet v. Taubes: Is There a Working Hypothesis for Obesity?
In re-reading this I realize there are a number of redundancies and it is hopelessly long. I don't really have the time/desire to chop it down to a more concise version, so posting it up as is with apologies!
With his English language blog, appearances at various conferences and LLVLC events/cruises, and the apparent rise in popularity of low carbing in Sweden, Andreas Eenfeldt is a rising star promoting low carb diets. Therefore, I think his comments on Stephan's recent debunking of Taubes Wrong Insulin Carbohydrate Hypothesis Of Obesity, TWICHOO, and the post on his blog about same deserve some attention. One of the things that is disturbing about GCBC and Taubes' presentation of the science is that he frequently says "we don't know XYZ because the experiments haven't been done". The "Diet Doc" seems to have taken this to heart as he views TWICHOO as a "working hypothesis" and he seems unaware of the state of knowledge possessed by researchers on various obesity related topics.
Some excerpts of Andreas' first comment in response to Stephan's debunking:
First of all: You state that low carb diets do indeed work well for weight loss most of the time, and that you see that as a fact. Kudos to you for acknowledging it. However, you can't say for sure why they work, if not through insulin, so maybe we should not rush to conclusions yet.
What Stephan said was:
I'd like to begin by emphasizing that carbohydrate restriction has helped many people lose body fat and improve their metabolic health. Although it doesn't work for everyone, there is no doubt that carbohydrate restriction causes fat loss in many, perhaps even most obese people. For a subset of people, the results can be very impressive. I consider that to be a fact at this point, but that's not what I'll be discussing here.
Now Andreas' summary is not horribly misrepresenting what Stephan actually said, but I believe it's indicative of his bias. Stephan did not say that LC diets do work most of the time, he said LC causes fat loss in many, and perhaps even most obese people. Indeed it does seem to work well for most obese, but the results are far less predictable for those who are less overweight. The fact that Stephan didn't speculate on why LC diets work when they do is irrelevant to his debunking of TWICHOO. However does Andreas really believe that nobody can "say for sure why they work" just because Stephan didn't expand on that point? This is the more recent claim by Taubes, his hypothesis that all diets work, when they do, because of carbohydrate restriction. This related hypothesis is also easily debunked, using, again, even the very same studies Taubes and those of like mind use to support it. Indeed in my opinion, this has been demonstrated so many times that it should be considered a fact.
You also claim that obesity and metabolism researchers do not take the carbohydrate theory seriously. Well, as they have so far failed spectacularly to come up with anything useful for obesity I'm not sure that is a bad thing.
In the face of massively increasing obesity rates there is only one drug approved in Europe (where I work as a doctor treating obese patients), orlistat, and everyone pretty much agrees that it sucks. The only solution proposed is to cut away healthy stomachs to stop fat people from eating. Yikes.
The failure of obesity and metabolism researchers during the last decades is of epic proportions. It makes the Hindenburg look like a success story. Please don't tell me we should care what they think.
Couldn't we say that bariatric physicians have also failed spectacularly and in epic proportions in treating the obese? It sounds like Andreas is upset the researchers haven't succeeded in creating that magic pill that would reverse obesity effortlessly. Again, why are we talking weight loss here? The TWICHOO is about how a person gets obese. That these researchers haven't found the solution is irrelevant. But since Andreas brought it up and he treats obesity with LC, and at the risk of sounding rude and mean, I ask: Has Andreas ever looked around the room when he gives a presentation on those LC Cruises? The problem with treating obesity is not that folks can't lose weight. Most are able to without even resorting to pharmaceuticals. It is with maintenance and, frankly, part of this is out of the realm of researchers and doctors to solve. There is no drug nor diet that will help a person make a permanent change in their eating habits. It seems that many of those who do with the LC approach, remain significantly overweight.
On to your three so called "falsifications":1: Take a look at Robert Lustig's lecture during AHS. Hyperinsulinemia gives leptin resistance. Problem solved. Moving on.
Huh? I haven't watched this yet. Does Lustig discuss what causes hyperinsulinemia? As far as I can gather, Lustig doesn't believe in TWICHOO.
2. Insulin results in fat being pushed into fat cells BUT insulin also signals satiety in the brain... problem? No. Like most hormones (cortisol is a good example) insulin has short term and long term effects: Short term it increases satiety in the brain. Makes perfect sense as it normally means that we just ate. Long term hyperinsulinemia, on the other hand, increases fat storage and makes us eat more. At least partly through the resulting leptin resistance, like professor Lustig pointed out. Again, problem solved. Nothing "falsified".
Is Lustig a proponent of the "starving cells" notion? As I recall, Lustig deals with hypothalamic obesity where hyperinsulinemia results from injury to the hypothalamus following treatment for brain cancer. This is a special case where you actually have a defect in fat metabolism caused by something other than carbohydrate ingestion. How does this support TWICHOO?
3. You claim that not just (especially refined) carbohydrates increase insulin, so does protein to some degree. Sure. But we all need protein and low carb diets are mainly about switching carbs to fat. Carbs release lots of insulin, fats do not. There are plenty of studies showing that low carb diets drastically reduce insulin levels during the entire day. If you'd like references just say so. Again, nothing falsified.
I've seen comparison studies that don't demonstrate huge changes in insulin AUC between reducing diets. But even if they do show drastically reduced insulin throughout the day, doesn't the comparable weight loss seen, when protein and calories are controlled for, blow the TWICHOO right out of the water? I'd say so. Grey & Kipnis really put a nail in this coffin.
To summarize:Of course not all carbs are evil all the time. But refined carbs (sugar, easily digested starch) can be a huge problem for sensitive people (obese, diabetics). It seems we agree on that, as well as that low carb diets can be most helpful in those conditions. What is really being questioned here is the explanation behind the way the world works. And perhaps it is not quite so simple as Taubes and others once thought. However, if we complicate the theory just a little bit it still works fine. Let's not rush to "falsify" a working hypothesis when we have nothing better to replace it with.
I would say that first we have to accept that TWICHOO is a working hypothesis. It should never have been a hypothesis to be tested in the first place. Taubes formulated a hypothesis then cherry picked from the studies and texts for things that supported it. This is not how science works. He ignored vast swaths of information that falsified it. No ... that's not quite true. He even misrepresented some of the research/writings, claiming they supported his hypothesis, when in fact they did not. Taubes is fond of lamenting that "the studies will never be done" to test his hypothesis. It would not be so damning if it were just the newer research he ignored and has no time to look at now. But as it turns out, most of the studies HAD been done. Repeatedly in many cases.
The discussion turns to insulin resistance when Stephan answered some of Andreas' points:
Stephan: "But then we're left with the question: what causes insulin resistance? That factor is not carbohydrate per se, although refined carbohydrate and sugar may contribute."
Andreas: Ah, the million dollar question!My guess: too much refined carbs and sugar for a long time, combined with insufficient exercise (which would have burned the carbs), combined with a genetic vulnerability.Speculation: The chronically elevated insulin combined with already filled-up glycogen deposits makes the cells down-regulate the insulin receptors, as only a few are needed under those circumstances. Thus: The elevation in the insulin levels and the insulin resistance would develop hand in hand. And then we can argue about what is the chicken and what is the egg, while in reality (if this is true) they happen at the same time.
This is one enduring legacy of GCBC -- misleading folks into thinking that carbohydrates cause insulin resistance. That somehow you've done some irreparable damage to your metabolism by eating carbohydrates. Only amongst the fat metabolism experts Taubes quotes and has interviewed and had discussions with on multiple occasions, there is a working hypothesis. Let's call it the Fatty Acid Hypothesis. Again, one can never name drop the name Keith Frayn enough for my liking in these discussions.
This blog post discusses a 2001 review paper authored by Frayn. That Taubes wrote this in GCBC is journalistic malpractice:
"Over the years, prominent diabetologists and endocrinologists -- from Yalow and Berson in the 1960's through Dennis McGarry in the 1990's -- have speculated on this train of causation from hyperinsulinemia to Type 2 diabetes and obesity. Anything that increases insulin, induces insulin resistance, and induces the pancreas to compensate by secreting still more insulin, will also lead to an excess accumulation of body fat.
He also cites McGarry in GCBC and cites Guenther Boden frequently as well. The fatty acid hypothesis has its roots in a man named Dr. Edwin Bierman who discovered the connection between NEFA and diabetes in the 50's and 60's. And who researched most of his career at .... drum roll please .... Stephan's institution of higher learning with which he is currently affiliated as a post doc: University of Washington. He wrote this classic citation. Those last bits of trivia are, of course, not really relevant to the debate, except it might explain why nobody Stephan works with takes Taubes or his hypotheses seriously.
The FAH is consistent with all observations concerning both hyperinsulinemia and insulin resistance and the relationship to obesity. Tom Naughton's Taubes-inspired adipose-tissue-as-last-glucose-sink schtick is not. That fat cells become insulin resistant last simply is not supported by the evidence.
OK ... so Andreas then moves his discussion over to his blog. Perhaps it's because of a language barrier, but this post really deserves an award for the most misrepresentations and erected strawmen in the fewest words possible.
After the recent fireworks at AHS, perhaps this should not come as a surprise. Neurobiologist and popular blogger Stephan Guyenet has posted on why he does not believe in (refined) carbohydrates as an important cause of obesity. Although he does acknowledge that a low carb diet is effective for making you lose weight.
Sound complicated? It is:
No .... this does not sound complicated! As I mentioned in my Random Thoughts post, that restricting or eliminating carbs results in fat loss doesn't mean carbohydrates are fattening. Because this logic could be applied to anything. Ultimately we can apply this to all food energy! Restricting calories results in fat loss, therefore calorie are fattening. Well, this is true. What do researchers do to fatten someone in studies? They overfeed them. And what works better for that, fat or carbs? Fat.
Excessive amounts of carbohydrates (especially refined carbs / sugar) increases insulin and results in fat gain.
The Carbohydrate Hypothesis, as attacked by Guyenet, looks basically like this:
Guyenets argues in his post that carbs are not necessarily the cause of increased insulin, and insulin certainly do not result in gaining weight (maybe the opposite!). Basically he says that while low carb works, the theory to explain it is wrong.
First ... must we use the word attacked here? Stephan is clearly referring to fasting insulin levels in this section of his post and that postprandial insulin spikes are not the cause of hyperinsulinemia. Here is where the Grey & Kipnis paper is usually evoked because when they cycled some obese women for 3-4 weeks between essentially iso-protein diets of essentially zero fat and zero carb, their fasting insulin did indeed plummet and shoot up accordingly. But as I've discussed before, you can see that by the end of each phase the fasting insulin levels appear to be normalizing . In any case, the theory put forth by Andreas' and the rest of the Taubesians as to how and why low carb diets work has been falsified by me here before. First, again with Grey & Kipnis, and more recently with the Krauss study evoked by Eades in his AHS presentation.
Under eucaloric (weight maintaining levels) conditions, with protein held constant, weight loss is not seen even with wide variations in the percentages of the remaining calories coming from carbohydrate or fat. Under hypocaloric (energy deficit) conditions, again with protein held constant, weight loss is observed. Further where fat mass is accurately measured, the fat loss is almost invariably consistent with that expected with that rough 3500 cal/lb factor. Therefore:
All weight reducing diets work, when they do,
by reducing caloric intake so as to establish a caloric deficit.
The Carb-Insulin Hypothesis for LC weight loss has been falsified. Carefully controlled studies support the CICO Hypothesis. Or is that a tautology? Andreas continues:
However, as every doctor who has ever treated diabetics with insulin (and their patients) probably knows, injecting insulin certainly does tends to increase fat gain. And in untreated type 1 diabetics, with no insulin, weight plummets. Guyenet does not mention that.
Because the effects of exogenous insulin are irrelevant to TWICHOO. Carbs and proteins elicit a very complicated insulin release and other hormones. Furthermore, when an obese person progresses through type 2 diabetes to the point of requiring insulin, why doesn't their weight plummet?
Thin people usually have low insulin levels, obese people usually have high levels of insulin. Guyenet does not believe that is significant.
What kind of insulin levels does a straw man have? Stephan said no such thing. The correlation does not indicate causality. The FAH is consistent with this observation with the direction of causality being that obesity leads to the hyperinsulinemia not the other way around (absent something like hypothalamic lesion, insulinoma, etc.). Fat cells lose their insulin sensitivity first --> inappropriate NEFA release --> elevated circulating NEFA --> increased basal insulin production. It is not controversial that fasting insulin secretion is stimulated in part by free fatty acids, and I've presented several papers that demonstrate that lowering NEFA decreases insulin and raising them increases it. Two such blog posts here and here. Andreas then published his comments from Stephan's blog which I've already addressed. He concludes with:
Whether we bother to add the step with leptin or not, this still seems to be true:
Excessive amounts of carbohydrates (especially refined carbs / sugar) increases insulin and results in fat gain.
He goes on to discuss different carb tolerances. That this must always be explained pretty much falsifies TWICHOO in itself. Those middle aged obese women with T2 diabetes were not always that way. The evidence does not support the hypothesis that eating carbohydrates per se had anything to do with it. Then, the bottom line:
Some very smart people disagree why low carb works. But we all seem to agree that it does work.We don't all agree that it does work, and it is irrelevant if it does or how.
Carbs drives insulin (postprandial) drives fat accumulation is WRONG. It has been thoroughly debunked by yours truly, James Krieger and, now Stephan Guyenet. And I'm sure there have been others. Perhaps it is the dogged insistence that it is a working hypothesis by those who believe it is part and parcel of why no actual researcher in the field takes it seriously.
For those who have a memory as faulty as mine: Taubes' Wrong Insulin-Carbohydrate Hypothesis On Obesity - TWICHOO
The carbohydrate theory predicts that, as calories become available from the fat stores, calories from the diet will be spontaneously reduced, and that this reduction is an effect of weight-loss, not a cause. Energy balance is maintained.
This raises the possibility that those on a carbohydrate-restricted diet who are forced to consume an arbitrarily selected number of total calories are eating more than they otherwise might, even at a very low level of total calories. In effect, creating a positive energy balance.
Another possibility is that when calorie-restriction, with its well-known effects on metabolism, is combined with carbohydrate-restriction, the rate of weight-loss is slowed, but in this case by creating a negative energy balance.
That dietary calories, and dietary calories alone, determine weight-loss is not the only plausible interpretation of these results.
I should have said, "Energy balance is maintained, but the rate of weight-loss is slowed."
This rests completely on the pre-supposition that carbohydrate/insulin "locks" calories into adipocytes.
That's already disproven - both Evelyn (one of the Frayn posts) and Stephan point to studies showing this.
The calories are ALREADY available from fat stores, because the fat stores are insulin resistant.
That's why the blood lipid tests are bad.
There must also be a huge component of willingness to believe BS in my psyche somewhere, to have fallen for the dogma, ignoring inner skeptic (he's VERY loud most of the time) , AND ignoring the GLARING feedback of just looking at my body. or feeling the stress on my knees of climbing stairs.
"Long term hyperinsulinemia, on the other hand, increases fat storage and makes us eat more"
ummmmm ... proof, please?
> no insulin, weight plummets. Guyenet does
> not mention that.
Stephan doesn't write about diabetics but he does cover this case ...
Search for Amylin in that post.
COME ON ... one of the things that stood out for me from James' insulin myths series was this new knowledge for me ... and I clearly remember even there James credited Stephan for that massively important piece of knowledge.
> most of the time)
I wish I could make him preferentially obese, and starve my inner gull ; (
OMG !!!!!!!!!! LUSTIG !!!!!!!!!!!
starts with the "sugar high" !!!!!!!!!!!!!!!
STARTS WITH IT !!!!!!
(did i mention my reaction:(!!!!!!)?)
Am I completely out of touch, hasn't this been debunked many, many, MANY TIMES ???? !!!!!!!!!!!
A long post devoted to me? I feel honored (no irony).
You say here you feel genuinely honored. Yet in your reply you instead say that
I suppose I should feel honored
rather implying you don't. Hmm...
Yes I know. I do and yet I don't. Conflicting emotions suck. :)
The irreducible complexity of the human condition! I know it well!
So your over-reacting title of your post is a bit telling.
Your overarching message seems to be that TWICHOO is actually correct based on LC weight loss successes. This IS irrelevant to the hypothesis of how we get fat. This is basic science method stuff here. If carbs make you fat, then you have to remove carb and control for protein and total calories and see what happens. What happens? In G&K, Krauss, Leibel, and countless other studies, nothing. No fat loss despite plummeting insulin levels in the extreme cases like G&K.
Only a few years ago Taubes, Eades, Westman, etc. would tell you that ultimately calories count. Go read Eades' blog circa 2008.
Welcome to my blog! I do hope you'll actually read the various GCBC and Taubes fact check posts before passing judgment.
If you had actually read my post to the bottom you would have seen that I acknowledged that you did not yet call me a fraud. ;)
Regarding the rest of your comment: You seem to be forgetting the possibility that excessive carb intake can make people WANT to eat more calories than they expend long term i.e. make them hungrier. There is of course no way to disprove that by citing calorie-controlled lab trials.
Extra carb on a carb heavy diet does not produce this result...but it does in a low carb diet. That's rather supportive of food reward theory.
So, in a nutshell...on a diet which includes most reward factors already [low carb] adding the final reward factor in significant amounts produces increased appetite. How entirely predictable. Must be the insulin.
But There is of course no way to disprove that by citing calorie-controlled lab trials. ... well, actually there is. Because there have been studies looking at satiety. I don't have time to track down the citation, but Google Holt satiety and you'll find them. I'm sure I've blogged on that here. Most satiating food tested? Potato.
Atkins spoke of fat mobilizing hormone in his first book. And he put forth an energy balance argument that caused many of his followers to develop eating disorders fearing a few grams of carbs kicking them out of ketosis. Now the heirs to his throne do similar with their own schticks, convincing so many that if their blood glucose spikes above 150 for even a few minutes or even hours, they are damned to the evils of glycation. Or that if they eat one piece of fruit, or a bowl of rice, or even -- gasp -- a donut on occasion, they are going to gain fat. It's down right cruel to do this to people if you ask me.
I ask again. Have you looked around at your fellow speakers and out into the audience on those LC cruises? Many of these folks are buying the dogma and remaining obese despite that. So convinced are they that they've broken their metabolisms eating carbs they live in fear. And those who binge on carbs periodically get needlessly distraught over the carb consumption itself.
And, that last paragraph of yours is what we call "moving the goal posts" when your hypothesis fails to be supported by the evidence.
Sure, potatoes (not the worst kind of carbs) are fairly satisfying, at least short term. But low carb tends to be more satisfying long term, as evidenced by the number of trials showing statistically significantly better weight loss with advice on strict low carb diets over 3-6-12-24 months.
Regarding the audience on the low carb cruise, that argument is a blatant ad hominem fallacy if I ever saw one. I can tell you that audience looked splendid compared to the non-low carb guests next to the ice cream machines on the boat. But then I would be guilty of the same sin. :)
Please. The weights of long term low carbers are pertinent to this discussion as are the weights of proponents of any dietary solution to obesity. Comparing them to folks next to the ice cream machines? C'mon doc. ANY diet is better than the CAF-eteria Standard American Diet. That tells us nothing! I'd say they don't stack up very well to most of the audience/speakers at AHS where many of them eat a relatively high carbohydrate diet not filled with crap. Kind of like the diet Stephan eats.
The TWICHOO tries to claim that certain carbs can be blamed more than others. Taubes cites glycemic index these days. Potatoes are not the worst kind of carb, but they are notoriously high on the GI scale -- near the very top! A snickers bar is pretty low. And yet now it's the sugar/fructose that's truly fattening. Can you folks please make up your minds?
You can find links to all the studies showing significantly more weight loss with advice to eat low carb here:
Regarding the ice cream machine: My point exactly. So let's please stay away from those cheap arguments.
The main weakness of the GI scale is pretty apparent: Fructose gets a low value, as it has to be converted to glucose in the liver before showing up as blood glucose. Yet fructose is probably even worse than glucose in large amounts.
I do not recommend the old over-simplified GI scale. And I do not think I have to defend the "folks" (whoever that is) who do.
Similarly, I watch the Dr. Oz show pretty often. He's constantly giving diet advice. But look at his audience. These tend to be people who fanatically follow him, and are overjoyed to be there. But if they are following his diet advice, its not working.
The same should apply to a dietary convention. If there are lots of people who are still obese despite following the diet, that tells something about the diet. As for the ice cream cart, that's a simple application of my restaurant rule.
I'm not asking you to defend anyone, but you are the one who is defending Taubes in your recent commentary. HE is the one lately making that GI argument in case you are not aware. The carbs-drives insulin-drives fat accumulation is the theory you are defending.
14-0 eh? I did ask if Shai was among those ... was it? Cherry picking is a fun past time but it's not science.
@Duffy -- that's surely a good rule of thumb!! The appropriate comparison to the denizens of LC and adherents is to look at those championing and following other approaches. One thing I find most troubling about low carb is the numbers of adherents who do not lose weight. Generally with other approaches it is failure to adhere or adhere in the long term that is the problem, not the diet itself. In this regard LC seems an even less effective long term solution.
That said, it works for many. No doubt. But it does so by limiting intake plain and simple. Part of that is no doubt due to protein satiety, and the rest can be attributed to psychological advantages of ad libitum and ... erm ... food reward!!
Oz has the exact same type of audience Gary Taubes would have IF Taubes had an audience. Oz actually has more of a dynamic TV presence than Taubes - yes, the audiences would be nearly identical, but a smattering of Taubes' audience would be dozing in their seats. I mean, come on.
If you want to find a slender audience, look at the audience made up of mainly people in their early 20s.
The audience at AHS was also tilted a bit to the young. One lovely commenter on Peter's blog told me I should have done something when I was younger. Because folks like to listen to early twenties hotties (Denise Minger) as opposed to old post meno bags like me. LOL
** Something that has often struck me as odd, as if I'm going to sit through a bunch of presentations, even on sea days on a cruise ship, I'm hoping to learn something new that I don't already know. Not this preaching to the choir crap!
That we eat recreationally I'm guessing.
Andreas may want to check out page 12 from "50 Great Myths of Popular Psychology"
and fill in "the great fourfold table of life"
Consider these populations:
1. all that have done low fat and kept the fat off
2. all that have done low carb and kept the fat off
3. all that have done 1. with an enthusiastic physician propagandizing
4. all that have done 2. with an enthusiastic physician propagandizing
A huge part of Andreas' argument (and Kurt Harris' before he left in defeated huff) is comparing population 1. with pupulation 4.
That is philosophically and epistemelogically and ABSOLUTELY, WHOLLY, INVALID.
Now add these cases:
5. those that have lost fat and kept it off AND were on low fat
6. those that have lost fat and kept it off AND were on low carb
7. entire populations that are not obese and generally eat low fat
8. entire populations that are obese and generally eat low carb
Add populations to this matrix as desired, ENSURING GENERAL COVERAGE and NOT excluding populations to your heart's content.
Try not to add populations that are not comparable (drawing conclusions about the general population from diabetics ... please ... this is like trying to find out how far regular people can run by looking at people who just broke a femur).
the weight of the evidence favours low fat.
OTOH, the weight of cognitive biases ...
 rhetorical question. Cherry picking is SO MUCH FUN ...
"The ice cream point is not your point really. You are comparing LC vs. SAD not vs. other weight reducing diets. This is, indeed meaningless. "
Thanks for telling me what my point is. Unfortunately you seem to have missed it.
"14-0 eh? I did ask if Shai was among those ... was it? Cherry picking is a fun past time but it's not science."
Then why are you so interested in just one of the studies? Having fun?
But look at the common menu at your typical steakhouse. The appetizer is likely to be something like a Blooming Onion at Outback, or maybe a healthy wedge salad with blue cheese dressing, bacon, and croutons. Then with the steak, you will see people getting fries of some sort, or a baked potato swimming in butter, sour cream and cheese. That, with a side of creamed spinach. And then there is cheesecake or key lime pie for dessert. Yup, its the meat that's doing it.
Fried fish places typically serve the fish with a side of fries. Around here, you get hush puppies too. (Nothing like a nice corn fritter). And then there's cole slaw swimming in a dressing laden with sugar. Here again, its not the fish that I would judge, but the restaurant itself.
Basically, if the people who eat someplace tend to be fat, that tells me that the restaurant appeals to fat people. If you find a place that appeals to people who are thin (and especially if its a place that doesn't cater to, or promote itself, as being a dieting or "healthy" restaurant), then its probably better.
Evelyn: I find it a bit scary that people can adhere to LC diets, have the diet fail them, and still continue their adherence. It brings to mind the definition of insanity attributed to Einstein. It's much easier for me to understand the failure to adhere to diets, or to maintain. But even there, there are lots of people who continue to fail (either in adherence or maintenance), and then having failed, go back and do the same thing again.
There's an absolutely hilarious skit by Peter Cook and Dudley Moore, where Moore interviews Cook about his failed restaurant, The Frog and Peach. It's here:
The interview ends with Moore asking: Do you feel that you have learned from your mistakes?
Cook: Oh certainly, certainly. I've learned from my mistakes, and I'm sure I could repeat them exactly.
Andreas Eenfeldt wrote:
You can find links to all the studies showing significantly more weight loss
Who are you arguing against? EVERYONE has admitted that for many people low carb can work well.
So what do your 14 studies supposedly prove ... a point that everyone agrees to anyway?
Really, are you serious?
"I have 14 studies that agree with you.
TAKE THAT !!!!!
You should make a 70s Batman TV series.
Just to remind you, the discussion is on Stephan's debunking of Taubes' fevered fantasy (TFF) (it's not a theory, it's definitely NOT a working theory).
So, since that's the point, which of those studies support TFF
(which is:: carb → insulin → increased fat mass)
To count as any kind of validation of TFF your studies will need to have, at minimum, measured insulin and fat mass in response to varied carbohydrate.
"without carbs and the subsequent insulin one cannot gain fat mass"
and the equivalent
"insulin is such a strong stimulus to fat accumulation that it does not matter that g3p is not rate limiting"
I guess I haven't run across a steak house yet that wasn't filled with fat people. But I have an inkling that it is because so many people are fat in this country.
Pointing fingers at the appetizers, which can be as fatty as the meat, doesn't explain it. All of the things you go on to list add - surprise - calories. As caloric as a huge hunk of meat. Fatty meat. Delicious, fatty, well-marbled meat.
The seafood place I described has this wonderful feature: you can have a baked potato (with pats of butter on the side) just as easily as you can have fries. What I notice: the prices. The sizes of the portions. Whether it's a 'family' friendly place where it's affordable to be served large portions.
There you have it. Cheap calories. Meat portions the size of your head - THAT would never make a person fat, now, would it?
Basically, if the people who eat someplace tend to be fat, that tells me that the restaurant appeals to fat people
It's a business that knows a few thing:
1. a LARGE fraction customers will not return if they feel the portions were too small
2. it doesn't cost much on the margin to provide large portions. Certainly more money will be lost on the margin than will be saved with small portions
They do the math & voila ... a race to top of the scale.
The consumers' economic incentives match up ... why go to a place to eat if you don't get enough and have to go to another place sooner, or right away, to feel as full as you're accustomed to?
Take that together with the social conditioning to clean off the plate and you have the current situation.
Even if the food reward theory turns out to be completely wrong, everyone's economic incentives and social conditioning conspire to shove high calories to the public.
There's a reason Hall & Chow wrote nothing about insulin and g3p ... in the end they don't matter.
you may need to scroll up a couple of pages, bottom of page 11
or to ensure yourself it's work safe, manually
But then, what are the chances that one of those diners would order the 16 oz Wood Fire Prime Rib. It's not many more calories: 995. It serves 1. Yeah!
Reminds me of how shocked I was when I recently ordered, and ate, an IHOP (International House of Pancakes) patty melt. Thinking it's just a burger, right? 940 calories. No fries, just the patty melt. Did it taste good? Oh, my, yes.
You never answered back on Stephan post.
What about the critic of those studies you cite where protein are not matched? Protein effect on satiety is well known. Why do you keep insisting that it has to be insulin? What if it was simply from protein?
Also, if I understand well, you discard the others studies I cited that shows no effect of switching carbs fot fat regarding weight loss, because you acknowledge that calories matter, but what matters to you is to know why people eat less on LC, is that it? Again, what about protein?
Even if the food reward theory turns out to be completely wrong, everyone's economic incentives and social conditioning conspire to shove high calories to the public."
This is important in light of the claim often made in favor of LC: that a person doesn't need to pay attention to caloric intake, since the satiety of the diet takes care of that. And I think that this approach is the reason for the quick and notable losses *and* the inability to continue to lose after those initial losses.
My personal experience: I can eat a breakfast of two eggs and three strips of bacon and feel satisfied until late afternoon. I can also eat a breakfast of three eggs, five strips of bacon and four pork sausages and feel satisfied until late afternoon. Neither of those meals would cause me to feel so full that I would *have* to stop eating. But the second one provides a significantly larger amount of calories.
That particular breakfast works better for me than oatmeal or cereal (grains do very bad things to my GI tract). And it keeps me feeling satisfied for much longer than a high/moderate carb meal would. I believe that I'd definitely be ingesting more calories if I was mindlessly eating more carbs vs mindlessly eating more protein and fat.
But when I mindlessly eat, I eat too much, regardless of the nutrient breakdown. Oh, I'll lose a lot of fat (most of my 40lb weight loss over the past two years was from eliminating sugar, but I also cut back quite a bit on starch and other carbs). But I will not lose all of the excess fat around my waist, and I won't hit my target weight. Even when I'm eating the right foods, there has to be some attempt at control and discipline, else I fall short.
I think that this is what happens to many who try LC for the first time. They find that they don't eat nearly as much as they did before, and they lose weight quickly and feel great. But they're still eating more than they need to, and thus they fall short of their goals. And since they are told that they are, in fact, eating exactly as much as they should (your body knows!) they look for some other explanation for the stall, or for the surprising regain.
I think LC is a good diet and works for many people, but only to an extent. At some point it becomes imperative that we start to take note of our portions and eating schedule and make the changes that will get us where we want to be. Trusting our bodies to do that for us almost never works-- if we could trust our bodies, we wouldn't have been fat in the first place!
That is of course the problem with any study on diet. If you remove one thing you basically have to replace it with something else, or several things. So what is responsible for the effect then? You can't know for sure.
What we do know from these studies is that advice to eat strict low carb diets work: it gives weight loss and improvement in all metabolic risk factors (blood sugar, HDL, trigs, blood pressure).
So can slightly more protein be part of the explanation? Sure, that seems likely. But I doubt that is the entire explanation.
Bottom line: we know advice on strict low carb diets works pretty good for obese and diabetic patients. We do not know if high protein high carb diets would work even nearly as well.
Here is what Grey & Kipnis did in their study. They let a bunch of women eat ad libitum/weight stable diet to determine their maintenance intake. They then changed their diet to the same number of calories and ~25% protein and ~75% carb or fat. They maintained their weight. They then took another group and repeated the experiment, only now the 25/75 diet phases were for 1500 cal/day. Those subjects lost weight consistently despite being switched between extremes of carb and fat content. Throughout they measured fasting insulin. The scatter plot is HERE. This is a well designed, controlled and carefully monitored (as in metabolic ward not free living) study.
Thanks for your answer.
But then we do have more carefully controlled study where the only change was to swtich carbs for fat with no effect. So it's very likely that carbs has nothing to do with it; the variables left are calories and protein. Grey & Kipnis being one. There are a few others, althought they did not measure insulin level, but it does really matter since the weight loss is the same when you control for calories and protein.
There seems to be much talking past one another here. So, in an attempt to clarify:
Do you accept that in isocaloric diet studies conducted in metabolic wards, weight loss amongst subjects is (very) similar on (1) high carb/low fat diets and (2) low carb/high fat diets?
Yes. At least in weight loss trials, i.e. when calories are on the low side.
Will the same thing happen when overeating calories? Not sure, that kind of trial has not been done. Anecdotally some people seem to be able to eat massive amounts of low carb calories (e.g. 4000/day) without gaining weight.
Before anyone objects, this obviously can't contradict the laws of physics. If someone really eats 4000 calories a day (and absorbs them) without gaining weight it means he/she burned them all.
See answer above. Sure, when strictly calorie-controlled and with calories on the low side, the macronutrient ratios will not matter much, if at all.
This, however, is far from the reality that humans usually live in. There normally is no shortage of calories around. So if you eat a diet that makes you hungrier long term (sugar, starchy foods) you will likely end up eating more calories.
I'm glad to see we are on the same page, after all.
You're right about overeating, never been done. We can't really say for sure, but I don't see why overeating would be a good thing in the first place. Why are these people eating so much? If calorie restriction, as it looks like, increase lifespan, I can't see overeating as a good thing. I don't see why we would want a diet that makes it possible to overeat.
Now, where we probably disagree is on why people eat more. I think it has more to do with the obesegenics environnement and lifestyle than carbs per se. If one eats, most of the time, a mixed meal of high quality food (high in micronutriments, fibers, low-calorie density) with a lots of veggies, with sufficient protein and fats, I don't think that something like potatoes, quinoa, rice would be a problem regarding hunger.
Do you think this is false?
I really don't believe in a single cause for obesity. But I think the reward hypothesis probably plays a much bigger role than the carbs hypothesis.
Carbs have always been around. We've not always been that obese, tho. What changed? Many, many things, not just carbs consumption and quality per se.
The book The End of Overeating make a pretty compelling case as to why it's very easy to overeat in our current society, and the biggest culprit are foods containing a mix of fat and sugar that are very palatable.
Do you believe that only insulin can explain the drive to eat more?
Thanks. You've also helpfully answered another question that was beginning to form in my mind: whether, in addition to human isocaloric weight loss studies, any human isocaloric weight gain studies have been performed? I'm slightly surprised and rather disappointed that they haven't.
I've just found this paper on isocaloric weight gain in rats. The rats on a high fat diet gained more.
Evelyn, Andreas, others
I'd be interested to hear your hunches on whether you think weight gain would be similar on an isocaloric study of, say, 5,000 calories a day in groups that ate high carb/low fat and high fat/low carb.
Wonder if recruiting volunteers would be a problem?
Wrote my previous post before seeing yours!
There has been overfeeding study done, but no overeating study done on a LC plan, ie. there is no study looking at the effect of overfeeding fat when at 5% carbs, says.
What we know is that on a higher-carb diet, dietary fat is more effeciently store as body fat than carbs. Note that carbs per se are never really store as fat, a tiny fraction only trought DNL, what usually happen as you overeat carbs is that you'll start using them for energy, and any fat eaten will be store as fat. So carbs are ''indirectly'' fattening, if you want.
You are right, why overeat? It seems like an unnecessary thing to do. Although if you accidentally do it once in a while it could be a good thing to not gain weight.
I also agree that it seems perfectly possible to eat good quality food including potatoes, rice etc. and not get fat or too hungry. In fact a lot of populations have done this, e.g. Asians, Kitavans etc. etc.
However none of these populations have been eating large quantities of sugar and refined carbs, like white flour.
If you can find me a population that did eat that and stayed healthy/slim, then I will rethink this. But as of now I believe large quantities of sugar/refined starch is enough to start an obesity/diabetes epidemic. Of course this epidemic will speed up if the population becomes afraid of fat (for no good reason), and begins eating even more sugar/starch instead. And it will get worse still if the population is not physically active enough to burn off a lot of the refined carbs.
Thanks for the welcome and for the link to the paper. I look forward to perusing.
This is the strawman myth that needs to be dispelled. The obesity epidemic was not caused by fat-phobia or replacing fats with refined carbs. Indeed we eat just as much fat as we ever did, on average, and have added more carbs (mostly our obsession with sugary drinks) on top of that. If you look at the SAD of obese people, it is actually relatively low carb by percentage: ~40-45% carb and ~40-45% fat with the remainder between 10-15% protein.
If we want to know why we got fat all we need to look at is what those who are fat eat. It's not low fat that's for sure. And TWICHOO mentions degree of refinement and sugar, but it does not explain this. Dairy products are some of the most insulinogenic foods yet they are not implicated in obesity. I believe Lustig gives lactose a pass. Taubes hypothesis has millions thinking boiled potatoes are as fattening as pizza because it is all about the carbs, just the carbs, and not anything else.
You are moving goal posts.
I wrote this post because it is important to scrutinize that said by "prominent voices". I await your feedback on the insulin resistance part which you basically ignored.
As RR points out, you can provide a zillion weight loss trials demonstrating superior results for LC and none of them validates TWICHOO -- Taubes is clearly discussing how we become obese. Our fat cells go wild and accumulate fat is his theory. Where is there evidence of this? Where is there evidence that insulin resistance makes us fat? There is none. Meanwhile you ignore the mountain of evidence that getting fat makes us insulin resistant.
Be careful. It's not a good thing to be so certain of things, especially if you really base it on cherry-picked observational data.
The main part of the modern obesity epidemic has taken place after the early 80s. There is three times more obese people (!) in the US now, compared to less than three decades ago. That just happened to be the time when the US started to promote official guidelines to avoid fat. That's when the low-fat craze really hit.
You are basically saying that you are certain that this is just a big coincidence. But I do not think there is any way of ruling out the possibility. In fact I think it is exceedingly likely, using our 20 20 hindsight.
Andreas, I grew up before the epidemic. Kids in my generation ate refined carbs -- although I wasn't one of them for the most part. Ever see My Big Fat Greek Wedding? I wasn't bringing mousaka to school, but I was soooo envious of my friends with PB&J or bologna on Wonder Bread sandwiches, with their Twinkie for dessert. Snacks? Saltines and fruit rollups (misnomer, these were fruit flavored sugar gel sheets) were snacks. And I don't know if you have them there, but we had Pixie Stix and Lick 'em Ade. These were nothing but pure flavored sugar, the former in a straw-like package, the latter came with a tongue depresser like thing to lick,dip,lick. McD's super yummy fries were fried in tallow. This list has no end.
Even with all this stuff back then, we didn't have a lot of obesity, women averaged just over 1500 cal/day and men just under 2500 cal/day. Yes, that's right ... women were starving in 1970 apparently!! We eat roughly 300 cal/day more and it has nothing to do with replacing fat with carb, we just add it on top. THAT is the reality.
What I'm about as certain as one can be of is that this magical carb driven fat accumulation theory of Taubes is utter nonsense. It made no sense to me when I first heard it from what I recalled from my physiology and biochemistry classes, and it makes even less sense now. The wheels are coming off that cart. Might want to consider getting off before it goes off the cliff.
What do you think of Keith Frayn's fatty acid hypothesis?
Yes, I think you are pretty good at choosing what you want to see. You say that people eating more today has "nothing to do with" replacing fat with carbs. Yet you can go into any supermarket today and see entire shelves filled with low fat products where they have done just that: replaced the fat with more sugar and starch.
Here is a good example:
Obese people in this country are NOT eating low fat diets consistently. They may claim to be, but one night out at Olive Garden would more than undo an entire weeks worth or more of doing so. We have not replaced fat with sugar and starch. We've either added it on top or added more fat too.
Dieting itself is a contributing factor -- it causes folks to obsess about weight, measurements, etc. (such obsession over carb grams is rampant as well), and cycling suppresses metabolism. Passive overeating of high density carb+fat foods is the other. That's how you make rats truly fat and metabolically deranged.
Government guidelines on fat consumption have little impact on people's choices. The food pyramid just became another logo connoting "health" (along with the American Heart Association and American Diabetes Association logos - which are not government agencies) that companies could slap on their products to reassure you that Ritz Crackers, representing "grains," are part of a healthy diet. Industry groups make up their own silly logos, too - like the "Whole Grains" logo that's started appearing lately.
The only groups government guidelines have a chance of affecting are people who eat meals made according to government guidelines, like in schools or possibly the military. From what I've read, compliance with those guidelines is not complete even there.
Yes, some people have adopted a low-fat diet, and I know at least one dear lady for whom it's done nothing for her weight or her heart disease.
I know people who are vegans and fat, low-fat and fat, foodies and fat, merry carnivores who are fat, and people who eat without much thought about what they're eating who are fat. I don't know too many people who eat low-carb, but I've met some online who are fat.
I think 24-hour easy access to food you hardly need to prepare, that's very palatable, easy to chew and swallow - verily, often drinkable (studies have shown liquid calories to be the most suspect in weight gain) - and, yes, full of crap, however you define it - and all the factors Evelyn pointed out and more - are more the culprits in the obesity epidemic than low-fat eating, which a minority is truly following anyway.
You can get low-fat treats and convenience foods and scarf them down without thinking and you can get high-fat versions, too. Studies have shown that when people think their cookies are low in fat, they tend to eat more - so there's a psychological factor at play. But it's not because they're low-fat that the people are getting fat on them, it's that they're eating more of them.
The biggest change in our food supply has been to the quality of the "food" on offer... with much of it having more to do with a nutritional chemist's laboratory and industrial manufacturing processes than a farmer's field.
A major driver in this "franken-food" revolution has been the creation of "low-fat" alternatives to real food... driven by misguided government policies which still promote the needs of the food-lobby groups over public health.
Your school-friends may well have been eating full-fat yogourt and I'm willing to bet that they were more satisfied with that than with a low-fat varieties which came along soon after. More satisfied means: more likely to not be hungry after, hungry and reaching for something else later.
Look to the *quality* of our food rather than focus on the *quantity* -- that is the reality.
I basically agree with what you say, but see "low fat" products driven less by government recommendations than by seeing a market opportunity, a market that also includes niches for "convenient," "crunchy," "cheesy," "fun food that kids will eat," "microwavable," "sinfully rich," and so on. Weight loss and health are always great selling points, and "low fat" seduces dieters to buy.
I agree that government recommendations are sullied by food industry lobbyists. They represent a number of competing interests, all converging to create relatively useless tools like the two food pyramids and now the healthy plate that have been promoted in my adult life (I'm 45).
The food industry doesn't have a low-fat or high-fat agenda. They just want to sell value-added products.
There was a good article in The New Yorker a couple of months ago about PepsiCo CEO's Indra Nooyi efforts to healthify their snacks to combat the obesity epidemic.
If Stephan Guyenet is right, her efforts will fail even if she succeeds in selling snacks with less sugar and salt and more fiber, because they'll still be mass-produced snacks. Maybe snacks with more health-giving antioxidants, but gulping down tasty, easy food from a bottle or a bag - or sucking down a gel pack of blueberry-oatmeal smoothie - is still going to pack on the pounds.
In essence, I feel you and I agree, except on the role that the low-fat mantra has played in all this.
It's the top of my list when someone asks me if I know of a low-fat, high-protein snack. The food police will have to step in and snatch my non-fat yogurt from my cold, dairy-stained hands, but only after wrestling me to the ground. There hasn't been any weight-gain with this awful yogurt addiction yet!
I once believed the low fat products were to blame.
A value meal at a typical fast-food joint will probably have 1000-1600 calories. Even though we may have been lured there by the "healthy" menu featuring 500 calorie salads (which are provided with 300 calories of salad dressing on the side), we walk out with the burger and fries. But hey! They're healthy! They're cooked in vegetable oil!
Go through your super-market and what you see is all manner of high-calorie heat-and-serve meals and every sort of snack food under the sun, and they all imply that they're actually quite good for you. Lower in fat, lower in sodium, good for your heart, good for your cholesterol, and so on. And you DO want to look like that gorgeous super model who swears that he/she eats it every day, don't you? If it did that for him/her, imagine what it can do for you!
I don't think it's that we're eating less fat. I think it's that we BELIEVE we're eating less fat, and meanwhile we're eating as much or more as we used to, along with a lot of sugar and carbs and protein and... CALORIES. Lots and lots of extra calories.
The thing about the yogurt was that these girls were hungry very soon after because a cup of semi-liquid is not all that filling. A salad with a little oil and vinegar and ... gasp! ... a sandwich with lean cold cuts or hard boiled eggs or something would have been more filling for the same calories.
Low fat dairy is great for protein. I've been told on LC forums that my 2% cottage cheese is a no no because it contains more sugar. Poppycock. By percent yes, but it's as natural as full fat as are the low fat cheeses I eat. Full fat dairy is notorious for weight stalls and gains on low carb.
Sue, Jimmy was certainly an outlier, but a lot of Americans eat not all that differently, especially the obese. This is the passive overeating thing and it's something that is more difficult to do with home prepped food. There's something about these processed foods -- the emulsifiers? -- that allows them to pack way more fat than anyone would tolerate in a home cooked meal. I mean really, I make chili every now and then and if I don't drain the fat from the meat, I have to later skim the fat from the top or it would be inedible. I don't like "greazy". And yet when one reads the amount of fat in canned chili they would expect it to be swimming with fat. But it's not. Welcome to the wonderful world of emulsifiers. And somehow with that added fat, more salt is needed or tolerated and a little added sugar now seems to make sense. Before you know it you've got a calorie laden junkfest!!
I'm a low-fat (2%) Fage addict, too! I was addicted to full-fat yogurt before that, and that, coincidentally, is when I got chubby.
It's embarrassing how much yogurt I eat. I'm not fat anymore, though. (I think that is due to several factors, however.)
I'm also changing views on what is meant by "routinely" for eating certain things. I know that as I've laxed my carb restriction I see less of a reason at any given moment to not eat something. In the short run this works fine, but in the longer run I have to watch it because if I routinely allow certain foods, I tend to eat too much of them. Does that mean those foods cannot be consumed routinely for my metabolism? I don't think so. Indeed when I'm mindful of substitution -- e.g. if I want X today, I'll forego Y -- I do just fine again.
BTW ... where are you living these days? I know you said you were visiting Mom for a while but I take it you're back?
I was surprised how well IF and food spacing protected me from gaining weight during my long visit to Russia. It required a lot of discipline, or course. Eating eggs for breakfast and meat + salad for lunch every day would be much easier.Getting my mom on a diet helped too- created safer environment. Also, living on the 4-th floor without an elevator and walking at least 4 hours a day is much better than 1 or even 2 hours of cardio in a sport club. Now in Florida heat I miss an endless opportunity to walk. Sure, people didn't evolve to sit as much and drive around.
We , who have to deal with a weight issue, are in the situation when it is necessary to observe our eating all the time and rethink our strategy. I don't know what kind of observation led Jimmie to abandon IF. Fasting BS came into my mind. I remember reading one of Woo's comments on Hyperlipid blog (http://www.blogger.com/comment.g?blogID=36840063&postID=7192456705019852144) about too active glyconeooginesis in middle-aged obese pre-diabetic or T2 people who basically can't loose weight doing LC only and can't cure their obesity for that reason. Could be related to LC cruise older crowd.
It is not simple to deal with our issue, we have to learn, observe and practice discipline.
My point is - we have to watch for what brings us out of control and avoid it.Don't eat food you can't stop eating, don't eat food that makes you hungry in 1 - 2 hours. According to one of comments here somebody is addicted to yogurt - then drop it without thinking that it is healthy or fit into LC or LF or whatever food group you prefer eating at the moment.
Sorry for my rant. Sometimes I just can't help it.
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