Quality Low Carb Science?

A while back I asked if anyone had any evidence that insulin blocks leptin action in the brain.  There were many responses both here and on Twitter -- thanks!! -- one of which referenced the following study:  Suppression of insulin secretion is associated with weight loss and altered macronutrient intake and preference in a subset of obese adultsPA Velasquez-Mieyer, PA Cowan, KL Arheart, CK Buffington, KA Spencer, BE Connelly, GW Cowan, and RH Lustig.  If you're the person pointed me to this, I apologize for not naming you.  Ahhhh Robert Lustig.  Haven't spent much time on him here, but as he muscles his way into the (misguided) War on Insulin, this too shall change.  

I will have much more to say about that study on the whole at some future date.  They gave some people an insulin-lowering drug (a drug that does more than just suppress secretion) and some lost "significant" weight, some lost a wee bit, and some even gained weight.  In reading the intro, I'm becoming increasingly dejected over the quality of peer review these days ... but that too will be part of the subsequent analysis of this study as a whole.

But what caught my eye was this idea of specific cravings and/or addiction to carbohydrates being essentially an accepted premise in the study.  One of the "scientific assessments" made in this study was for carbohydrate craving.
Carbohydrate craving was measured using the carbohydrate addiction scale developed by Heller and Heller. The questionnaire consists of 17 weighted questions with a total score of 60. Based on scores, individuals were classified as being a doubtful carbohydrate craver (score < 21), having mild carbohydrate addition (score 22–30), moderate carbohydrate addiction (score 31–44) or severe carbohydrate addiction (score >45).
Reference #26:  Heller RF, Heller RF. Are you a carbohydrate craver? The carbohydrate addict’s diet. Signet, New York, NY. 1991. 
ARE YOU KIDDING ME???   They make this scale sound like it's some sort of scientifically developed scale or diagnostic criteria, like for clinical depression or somesuch.   This is why I asked if anyone knew what the questions are, and in short order we have it!  (Thanks Aging Hippie & Frosty)
1. _____ I frequently get tired and/or hungry in the mid-afternoon. (4)
2. _____ About an hour or two after eating a full meal that includes dessert, I often want more of the dessert. (5)
3. _____ It is often harder for me to control my eating for the rest of the day if I have a breakfast, containing carbohydrates, than it would be if I had only coffee or nothing at all. (3)
4. _____ When I want to lose weight, I find it easier not to eat for most of the day than to try to eat several small diet meals.(4)
5. _____ Once I start eating sweets, starches, or snack foods, I often have a difficult time stopping. (3)
6. _____ I would rather have an ordinary meal that included dessert than a gourmet meal that did not include dessert. (3)
7. _____ After finishing a full meal, I sometimes feel as if I could go back and eat the whole meal again. (5)
8. _____ A meal of only meat and vegetables (no potato) often leaves me feeling unsatisfied. (3)
9. _____ If I’m feeling down, a snack of cake or cookies makes me feel better. (3)
10._____ If potatoes, bread, pasta, or dessert are on the table, I will  often skip eating vegetables or salad. (3)
11._____ I get a sleepy, almost “drugged” feeling after eating a large meal containing bread or pasta or potatoes and dessert, whereas I feel more energetic after a meal of only meat and salad. (4)
12._____ When I am not eating, the sight of other people eating is sometimes irritating to me. (4)
13._____ I sometimes have a hard time going to sleep without a bedtime snack. (3)
14._____ I sometimes wake in the middle of the night and can’t go back to sleep unless I eat something. (3)
15._____ Before going to dinner at a friend’s house, I will sometimes eat something in case dinner is delayed. (5)
16._____ Now and then I think I am a secret/sneak eater.  (3)
17._____ At a restaurant, I almost always eat too much bread, even before the meal is served. (2)

Carbohydrate cravings/ addiction -- specifically -- really???  Gotta love #8, here I thought meat and veggies were the bomb!  But c'mon, who at a restaurant hasn't eaten too much bread before the meal is served on occasion.  Addiction?  Craving?   Have you been to Red Lobster and eaten those biscuits?  I don't think the carbs are the addictive component there ....  This reminds me of the Leptin Questionnaires.  What's next,  Cosmo relationship quizzes?!  This is seriously used in a paper in the International Journal of Obesity &  Related Metabolic Disorders?  A survey from a diet book?   This makes me want to scream!

So, let's see, there's even weighted point scores -- in ( ) -- and this presumes we're all a bunch of carb craving addicts.  Because even if you score <21 you're only a "doubtful craver" -- there's still the possibility ya know.   But it gets better:
For the entire cohort, significant insulin suppression was achieved with simultaneous improvements in insulin sensitivity, weight loss, and body mass index (BMI). Leptin, fat mass, total caloric intake, and carbohydrate craving significantly decreased.  ...  Carbohydrate intake was markedly suppressed in HR {high responders} only, while carbohydrate-craving scores decreased in HR and LR {high and low responders}. 
For the entire cohort, the average score was 27.3 (SD 1.54) and the final average score was 19.2 (SD 1.78).    So, according to the Hellers, the entire cohort was smack dab in the middle of, at worst, mild carbohydrate addiction -- MILD.  (Soooo, remind me again how carbs make us fat if this is the case?).  Administering this drug lowered them into upper doubtful range.  This is so silly when you think about it.  I do not want to go into the possible reasons for reduced intake and all of that -- that will have to wait for the full analysis -- but let's look at what 8 points on this scale is.  It's not sometimes feeling like you could eat another meal immediately after finishing one and no longer thinking you're a sneak eater.  

Eight points on an arbitrary scale for which there's no evidence such behavior is linked to an intrinsic preference/liking/craving for carbs in particular.   Sigh.  The dumbed down science of slim??

You might be interested in my analyses of the insulin drug suppression trials:

Hyperinsulinemia, Insulin-Suppressive Drugs & Obesity (and Lustig)
More Hyperinsulinemia, Insulin-Suppressive Drugs & Obesity (and Lustig)


ProudDaddy said…
Speaking of "science of slim", I'd hazard a guess that you don't consider an (unexplained) "clog" as a universally accepted reason for obesity.
If you haven't read the book, don't bother. It's filled with irrelevent references to make it appear scientific, but is just another insulin-makes-you-fat story. I checked many of the references, and, like a lot of such books, they were seldom on point. I sent it back to the library after only reading the first few chapters.
CarbSane said…
I've read a few entries on Jonathan Bailor's blog. Feh, more rehashed same old same old. Like I said in a recent post (or comments), I can sort of understand protecting the franchise you're tied to. For example Taubes is so tied to insulin, he can't now say that leptin is the real culprit. Oddly enough Lustig was far less into insulin -- and is on record saying it's NOT carb -> insulin -- until recently. Odd tack given the current climate. But the new comers surprise me like this Bailor guy and Attia. If one presumes they have researched what's out there and still build their business on it? SIGH is all I can say :(
LeonRover said…
I find it risible that researchers devise a questionaire based on feelings of discomfort, and use that to devise an Addiction Quotient when the scoring system has not been validated by using measures of dopamine, serotonin etc., or other physiological correlates of the addiction response.

This provides me with an opportunity for personal gripe with many reports - whether multi-person formal study, personal case study, N=1 or the new variety, N-1 (sic):
that is, reports of insulin reset effects without insulin results; leptin reset effects without leptin results and the like.

Please, PLEASE do not tell me that changes in X have resulted in changes in Y unless you produce before and after readings in Y. (This NOT you, Evelyn.)

You know that the saying "I heard it from the horse's mouth" did not mean "The horse spoke to me". No, dear old Roger Bacon was referring to the (then) new idea of COUNTING the horse's teeth to find out how many it had, and not use the 12th century methodology of Socratic Philosophical Argument used for determining "how many angels can sit on the point of a needle" and such-like puzzles.

It is called Empiricism, and one of it's essential notions is consistent reproducibility.

Taubes failed my test, not as with you WRT G3P(?), but failing to distinguish between fasting insulin effects and prandial insulin effects. (OTOH, I already knew most of what wrote, but he went into more depth and had references. So the book is in my library. But "as Taubes has told us" huh? what? Who canonised him?) At least one Cordain paper failed my agreement with his conclusions as there was no change in postprandial insulins compared with preprandial.

Smoke and mirrors - not empirical.
bentleyj74 said…
Those questions are so obviously leading I'm amazed anyone ever took them seriously.
Unknown said…
Off target - but maybe heat is better than CT


nfluence of passive lower-body heating on muscle metabolic perturbation and high-intensity exercise tolerance in humans.

The purpose of this investigation was to determine the influence of heat stress on the dynamics of muscle metabolic perturbation during high-intensity exercise. Seven healthy males completed single-legged knee-extensor exercise until the limit of tolerance on two separate occasions. In a randomized order the subjects underwent 40 min of lower-body immersion in warm water at 42°C prior to exercise (HOT) or received no prior thermal manipulation (CON). Following the intervention, muscle metabolism was measured at rest and throughout exercise using (31)P-MRS. The tolerable duration of high-intensity exercise was reduced by 36% after passive heating (CON: 474 ± 146 vs. HOT: 303 ± 76 s; P = 0.005). Intramuscular pH was lower over the first 60 s of exercise (CON: 7.05 ± 0.02 vs. HOT: 7.00 ± 0.03; P = 0.019) in HOT compared to CON. The rate of muscle [PCr] degradation during exercise was greater in the HOT condition (CON: -0.17 ± 0.08 vs. HOT: -0.25 ± 0.10% s(-1); P = 0.006) and pH also tended to change more rapidly in HOT (P = 0.09). Muscle [PCr] (CON: 26 ± 14 vs. HOT: 29 ± 10%), [Pi] (CON: 504 ± 236 vs. HOT: 486 ± 186%) and pH (CON: 6.84 ± 0.13 vs. HOT: 6.80 ± 0.14; P > 0.05) were not statistically different at the limit of tolerance (P > 0.05 for all comparisons). These results suggest that the reduced time-to-exhaustion during high-intensity knee-extensor exercise following lower-body heating might be related, in part, to accelerated rates of change of intramuscular [PCr] and pH towards 'critical' values that limit muscle function.


Acute heat stress prior to downhill running may enhance skeletal muscle remodeling.


Once again, the obvious message of this study is: Not he who trains the most, but he who regenerates and rebuilds the best, gains the most! And adequate rest aside, preconditioning in a hot (not a "cold thermogenic" bath ;-) can help dampen the exercise induced damage and accelerate your recovery.
v/vmary said…
i just wanted to say that after being fooled by jack kruse and periodically wasting time reading crap from the old fart saint nicholas, you've got a new fan. i can now use the time i wasted on the other two blogs to come here and actually learn something.
Josh said…
Just by coincidence I went on a nerdathon through the DOMS literature yesterday and came across one of those studies. The takeaway I got in terms of minimising DOMS was - get heart rate elevated first, then do resistance training, take cold bath or shower afterwards.

It is interesting that heat immediately before exercise caused greater rates of muscle damage and reduced tolerable duration by 36%. It would be interesting to know how it affected recovery. Other studies that used pre-exercise cooling have shown that time to exhaustion is inversely related to initial body temperature. Maybe the new mantra should be train hot, race cold!
Asclepius said…
"Ahhhh Robert Lustig. Haven't spent much time on him here, but as he muscles his way into the (misguided) War on Insulin, this too shall change."

This made me smile - you do have a way with words! Looking forward to your analysis of Lustig's work.
Tomas said…
Hmmm I clearly remember Lustig being unimpressed by the proposition of touting long-term LC diet, see his JM podcast, I think 2010 it was
CarbSane said…
Yes, that's the one I'm referring to. He was pretty definitive that he thought insulin had something to do with it but it wasn't carbs that caused the hyperinsulinemia. He discussed the kids with hypothalamic lesions.

What got me started on Lustig was this newer video from him on Eenfeldt's site: http://www.dietdoctor.com/the-1-cause-of-obesity-insulin
At the very end of this he ties obesity to leptin by stating that insulin blocks leptin in the brain. He actually says something like "if you follow someone around and inject them with insulin they'll eat a ton and get fat". Ummm ... yeah, hypoglycemia does tend to stimulate appetite. But what causes hyperinsulinemia? I forget his exact designation, modern industrial diet maybe? Hmmmmm ... that video is "currently unavailable" (on YouTube too).
CarbSane said…
Welcome to the Asylum! I'm happy to have you here :P
CarbSane said…
:-) As Tomas commented below, he's changed his tune. I'm intrigued to learn the video I'd like to start with is no longer currently available.

I've got a Rock'Em Sock'Em Robots fun look at Taubes v. Lustig in the works. Should be fun!
CarbSane said…
This whole Kruisegate has unfortunately sidetracked so many people. No doubt CT has its place, but so, too, does heat. I had a bulging disc, sciatic problem several years ago. My physical therapy included some traction treatments. The stretch contraption looked like something out of a medieval torture chamber! I recall they had a heavy heat blanket placed on my back for 15 min or so before the treatment. I don't remember any cold being part of my therapy, but in 4 weeks combined with some exercises, I was back to normal.
LeonRover said…
My eyebrows rise, indicating my internal contempt, when Merry Lustig poses the idea of wandering around with equipment, and ARBITRARILY increases fasting insulin.

It is a thought experiment in the tradition of Einstein or Richard (Bongoman) Feynman - I have all his published work. Lustig shares a German patronymic with such eminent scientists, but little else.

While this mimics what T1 diabetics need to do to manage their basal, it has no relevance to those with functioning pulsatile insulin or glucagon secretion.

He tries to conflate endogenous secretion and exogamous delivery.

This is intellectual "smoke & mirrors", and he demeans himself, by employing it.

I had a brief run-in with Eenfeldt when he used this model, and Eenfeldt refused to accept the point.

When persiflage is used, those employing same lose credibility as "experts", and as clinical spokespersons.
Alex said…
Epic take-down? Or the tearing down of value by someone who has no value to add?
Sanjeev said…
Epic, yes. Also
"the stuff of LEGEND"
"in a thousand years mothers will scare misbehaving children straight with 'Keep doing the Lustig and AA will get you'"
"seriously dude? you brought a Lustig to an Aragon fight?"

One thing that fascinated me in that discussion was how some showed up writing (paraphrased) "Lustig says it right there, depends on the dose" and others would show up writing "it's a poison. Lustig proved it. There's no way it canNOT be a poison; Aragon's insane".

Alan created enormous value by flushing some bull cr*p where it belongs.

IMHO the single biggest contributor to human longevity and quality of life was sewage systems. Alan's following in that grand tradition. Lustig ... creates the stuff the sewage system removes.

Anyway, I've wanted a forum to spread Alan's response to the 60 minutes cr*pfest[0] this update (or complete with some history, this

to be work safe, here are the 2 above for you to copy & paste

[0] the ONLY part that didn't invoke a retch was the brain imaging segment
Allen Ernst said…
About the Scale: I am a carbohydrate researcher that has been successfully using this scale. Like other scales, the score correlates positively with depression scores. In addition, it correlates very strongly with Alpha brain waves and can discriminate between subjects with and without fibromyalgia. The authors claim that it has been validated but I have not seen anything puclished. Good luck.