The New Paleo Diet Study: Just the Fats Ma'am

I don't know that this study is worth three posts -- grin -- but I decided to break it up anyway.  I blogged on the diet itself here, and the weight loss here.  This post will address the impact on ectopic fat.  So first, I want to mention the "misleading title" peeves.  Ectopic fat is defined in the abstract:
Ectopic fat accumulation in liver and skeletal muscle may be an essential link between abdominal obesity, insulin resistance and increased risk of cardiovascular disease after menopause.
Here's the relevant synopsis of the results:
Liver triglyceride levels decreased by 49% whereas IMCL [intramyocellular lipid] levels in skeletal muscle were not significantly altered.
Which apparently garnered the conclusion:
A modified Palaeolithic-type diet has strong and tissue-specific effects on ectopic lipid deposition in postmenopausal women.
Rather than "tissue-specific effects on ectopic fat deposition" this title should have just stated "hepatic triglycerides" or something like that.  I also believe that a the caloric reduction and/or weight loss should have been "credited" in the title, if you're going to credit anything using the *causes* word.   They saw a large effect in liver fat.  Say so!  Furthermore, they saw reduction of existing fat while the title gives the impression that the "paleo diet" alters fat deposition patterns.  So this wording is awkward.

Without a control group, there is no justification for the words "causes" or "effects".  There was fairly significant weight loss -- about 10 lbs average -- in a relatively short time -- 5 weeks.  This weight loss alone, irrespective of diet composition, may well have been the cause of the reduction in liver fat observed.   That's what I tend to believe based on the various and sundry studies that have demonstrated reductions in liver fat with weight loss, especially fairly rapid, short term losses.

So here are the ectopic fat results:

Intramyocellular lipid to water ratios:
Tibialis ant:
  • before:   Q1= 51   , Median= 93   ,   Q3= 166
  • after:     Q1= 100 ,  Median= 114 ,  Q3= 173
  • before:  Q1= 187  ,  Median= 343  ,  Q3= 573
  • after:     Q1= 243  ,  Median= 560 ,  Q3= 795

Hepatic Fat/Water Ratios:
{values estimated from plot}

Q1= 1.5 , Median= 8.0 , Q3= 10
Q1= 0.5 , Median= 1.5 , Q3= 8.0

It would be interesting to have plots like the one at right for the muscle fat, weight changes and change in caloric intake for the individuals.   As it looks like the IMCL trended upwards if not statistically significant.  This may not be a bad thing, but this was a pretty low carb diet so one might expect a bit more "fat burning" going on and IMCL "local stores" to increase a bit (as they do in trained endurance athletes).  This might also account for differences in both weight and fat loss between LC and HC diets as lipid stores shift slightly to lean tissue with less associated intercellular water mass (see the two related posts here).

But I won't speculate more on the muscle lipids since we have no individual data. The liver fat is quite interesting but I'm glad they gave the individual data as the 49% reduction (in the mean) is somewhat misleading in both negative and positive ways.  Looking at the plots we learn:
  • 40% of the women didn't have significant liver fat to begin with.  Thus not all overweight/obesity is associated with fatty liver as some tend to portray.
  • Of those with low starting lipid content, there is negligible loss of liver lipids. This is as to be expected. 
  • The two women with really fatty livers lost substantial liver fat! While the content didn't go down to "normal", the reduction was greater than the 49% mean.  Another way to put it, is that the mean reduction in liver fat for the 60% with fat to lose, the loss was likely around 100%.  
  • One individual gained liver fat (doubtful it is significant) on paleo.  That's just one, but that is 10% and I'd love to know the intake and weight changes for this person.  
So basically, without any control group we have no evidence that diet composition impacted the ectopic fat.  If anything, the IMCL increased on the 40% fat diet which may have been the reason why whole body insulin sensitivity didn't improve.  But this study does demonstrate that if you "drain the swamp", with a dramatic reduction in intake (25% average) and lose a bunch of weight (10 lbs) relatively quickly (5weeks, 2lb/wk), you stand a good chance of reducing your liver fat substantially if you have any accumulated there in the first place.  My speculation is that the IMCL response may have differed with diet composition, but the hepatic fat "drain" is probably more of a function of the caloric deficit than composition.

There have been some discussions on sat fats and fatty liver that I will try to get to.  If folks could repost the links here I'd greatly appreciate it.

Eades Fact Check:

I was also reminded in comments on the last post of the confusion the Eades are partly responsible for in some ways about types of fat, etc.

In 2009 I purchased their 6 Week Cure for the Middle Aged Middle because I still thought Eades actually had a clue about nutritional science at the time.  I was promised research would back up their diet to specifically reduce belly fat.  

The first two weeks of this plan (low carb SlimFast = shakes and 1 meat and LC veggie meal) were for detoxifying your liver.  They presented a hodge podge of studies to reduce "visceral fat" that were actually studies -- like this one -- showing losses in liver fat.  Now visceral fat is adipose tissue surrounding our internal organs, within our abdominal cavity under the muscle wall.  Liver fat is fat in the organ itself.  To be fair, it is often included in the general term visceral fat, but these are different things.  If I have liver fat, and lose it, it's likely not altering my waistline.  It's not "belly fat".  (I note that Eades advises you to give blood after this phase to rid yourself of toxins -- and give them to others, but don't worry about that as you aren't really doing that somehow.  If you don't, they'll just find their way back into your liver!)  

In any case, hepatic fat, that might interfere with liver function, and visceral adipose tissue, which is considered more "metabolically active", are two different things. Circulating free fatty acids (FFA or NEFA) are largely regulated by release from upper body fat.  If you have a lot of visceral fat you have a "beer belly" (NOT a wheat belly!  LOL) that protrudes but is relatively hard.  If you have a lot of subQ belly fat you have the "muffin top", the "pannus", the "belly roll", the "Michelen Man" look, etc.  There is evidence that this is less harmful and/or associated with risk than visceral fat, but there is a TON of confusion and conflict to be found in this regard vis a vis the type of abdominal fat.  So sorry Dr. Lustig, you aren't entirely off the hook if you just have excess glucose induced subcutaneous adiposity.

In the end, if you take to this version of LC, you'll lose weight and some of it will come off your belly. There's no magic "targeting" backed by credible science to be had here.


Unknown said…

Chapter 11Human Perceptions and Preferences for Fat-Rich Foods
Unknown said…
Unknown said…
$26.95 for pre-order!! Can you believe it?

Cholesterol Clarity: What The HDL Is Wrong With My Numbers?
Jimmy Moore, Eric C. Westman

Here's a good picture of JM
Unknown said…

Clinical Interests
Evaluation and treatment of complicated lifestyle-related conditions including type 2 diabetes, obesity, polycystic ovary syndrome, metabolic syndrome, sleep apnea, fatty liver, tobacco dependence

Research Interests

My research interest is disease prevention. Because smoking and obesity are the major causes of morbidity and mortality in modern society, my research involves clinical trials examining new therapies for smoking cessation and obesity.

I serve as Medical Director of the Duke Center for Nicotine and Smoking Cessation Research, in collaboration with Jed Rose in the Department of Psychiatry. I am course coordinator for a Fourth-Year Medical Student Elective on the Medical Management of Obesity, and I am a faculty member of the Duke Clinical Research Training Program.

I belong to the Society of General Internal Medicine, the Society for Nicotine and Smoking Cessation Research, NAASO: The Obesity Society, and the American Society of Bariatric Physicians. I am also on the Editorial Board of Nutrition & Metabolism.

Vaclav K. said…
"$26.95 for pre-order!! Can you believe it?"

LOL, Nuttyk is as Nuttyk does.
CarbSane said…
I'm hoping that's an "error" , much as Mark Sisson is listed as author on the new PHD on Amazon. It's sad Westman would write an intro to anything Jimmy does, but I cannot imagine he would co-write a book with him.

Anyone who would buy this book other than to critique it needs their head examined. He talks of interviewing dozens of experts. You cannot be assured what makes the book is an accurate interpretation even if he surveys a variety of views.
Unknown said…
It's also strange that Dr Westman has no MD after his name.
Unknown said…
Dr. Jack Kruse
Josh said…
"There have been some discussions on sat fats and fatty liver that I will try to get to. If folks could repost the links here I'd greatly appreciate it."
Unknown said…
Apparently Kruse's latest theory involves the electromagnetic field

That's some damn good gibberish.
CarbSane said…

Josh said…
And then on the low carb side of things ...
Metabolic syndrome is associated with greater histologic severity, higher carbohydrate, and lower fat diet in patients with NAFLD -
"We have recently shown that intense nutritional counseling with dietary modification focusing on a diet improving IR and decreasing carbohydrate consumption, results in histologic improvement in NASH."

Which cites this study -
Which used a diet of
40–45% of daily calories from carbohydrates with an emphasis on complex carbohydrates with fiber,
35–40% fat with emphasis on mono and polyunsaturated fats, and
15–20% protein.

Also cited in first study - Non-alcoholic fatty liver disease and the metabolic syndrome: effects of weight loss and a review of popular diets. Are low carbohydrate diets the answer? -

Vaclav K. said…
Maybe book writing not going so well for Jimkkkins.

Feb 24th 2013

"And yet here's a book telling people to eat LESS saturated fat and MORE whole grains and even starch-laden potatoes. REALLY?!?!?!"

"I could go on and on wasting more time and brain cells telling you what's wrong with this book"
Anonymous said…
Jimmy better hurry up & get this book out. According to Nature, the cholesterol guidelines are probably going to change later this year:

Maybe make it an e-book? Bundle it with 30 other paleo e-books? Could we have a lipid-panel-interpreter certification course?
Unknown said…
Is this what it's coming to??

The Primal Blueprint Certification - Coming in 2013

"The Primal Blueprint Certification program will be an online course for Primal Blueprint enthusiasts to deepen their knowledge and become empowered to teach others to live Primally. While the program has been inspired by demand from certified fitness professionals, it will be open to all interested parties with no prerequisites. That said, it will be an intensive, college-level course designed for passionate students who have decent exposure to the Primal Blueprint philosophy from reading books and Internet content.

The Primal Blueprint Certification is being designed around the eight Key Concepts and five Action Items that comprise The Primal Blueprint 21-Day Total Body Transformation book. There will be 14 Modules – one for each Key Concept and Action Item plus a Summary - consisting of reading material and videos followed by an examination (T/F and multiple choice). You will be able to proceed with your reading, viewing, and test taking at your own pace, logging into the course at any time and picking up where you left off.

The Certification will be available in 2013. Stay tuned for updates."

Paleo is coming close to jumping the shark - an intensive, college-level course designed for passionate students who have decent exposure to the Primal Blueprint philosophy from reading books and Internet content.

Taught by WHO - Professor Jimmy Moore!!
Travis Culp said…
Whaddya mean "coming close to?" That shark is (nautical) miles back, over the horizon.
Unknown said…

"n the latest research scientists uncover a mechanism by which omega-6 fatty acid supplementation increases lifespan in simple animala.

In the study it was shown that supplementation of omega-6 fatty acids extends the lifespan of C Elegans roundworms through the induction of autophagy. Autophagy is the process of cellular renewal in which defective and damaged structures within the cell are broken down and recycled. Autophagy itself is associated with lifespan extension, and defects in autophagy is linked to aging and disease.

Further in the study, the researchers demonstrated that the same response to omega 6 supplementation was observed in human cells.

The authors offer the robust conclusions:

The malfunctioning of autophagy has been linked to a wide range of pathological conditions, including neurodegenerative diseases, chronic inflammation, infection, and cancer. Several of these pathologies are ameliorated by dietary supplementation
with v-3/6 PUFAs. The overlap between the beneficial effects of activating autophagy and the salubrious effects of v-3/6 PUFA consumption, together with the data presented here, suggests that v-3/6 PUFAs could counteract the deterioration of the autophagic system normally occurring during aging. Our data suggest that v3/6 PUFAs could be used, and/or analogs could be developed, to activate or even inhibit autophagy, both of which would be of great help in the prevention and treatment of multiple pathologies."

Unknown said…
Ketogenic diets may delay the effects of aging

"Scientists at the Gladstone Institutes have identified a novel mechanism by which a type of low-carb, low-calorie diet -- called a "ketogenic diet" -- could delay the effects of aging. This fundamental discovery reveals how such a diet could slow the aging process and may one day allow scientists to better treat or prevent age-related diseases, including heart disease, Alzheimer's disease and many forms of cancer."

"Dr. Verdin and his team examined the role of the compound β-hydroxybutyrate (βOHB), a so-called "ketone body" that is produced during a prolonged low-calorie or ketogenic diet. While ketone bodies such as βOHB can be toxic when present at very high concentrations in people with diseases such as Type I diabetes, Dr. Verdin and colleagues found that at lower concentrations, βOHB helps protect cells from "oxidative stress" -- which occurs as certain molecules build to toxic levels in the body and contributes to the aging process."
Harry's Acolyte said…
Tsimblist said…
Looks like Raz is off his meds again.
CarbSane said…
Yeah, it's pathetic. Please go away Raz. Gary Taubes needs more of your commentary.
Diana said…
You are all wrong. The secret to longevity is to eat cholent.

Gabriella, I have a feeling you are the type interested in indigenous/international cooking styles. You will really like this article. I can't make cholent 'cos my stovetop oven would shut off after a few hours, my regular oven doesn't get low enough, and I don't have a slow-cooker.
CarbSane said…
Got an email that this made it look like Charles was Razwell since I sent Razwell's recent spate of rants to spam. Nope, there is one and only one mentally deranged troll of his caliber. Gary Taubes hosts his commentary regularly so I figured I'd direct him where he is welcome.

BigWhiskey said…
Well, then, we can "have our cake and eat it, too"; cook enough Cholent for a week at a time in the proportion of "New Paleo Diet" and have at it. This is the New KISS Paleo Diet!!!
Unknown said…

Still Believe 'A Calorie Is a Calorie'?
Robert Lustig, M.D.Professor of Pediatrics, UCSF Benioff Children’s Hospital

"If you do, you fly in the face of mounting and incontrovertible evidence that some calories -- in particular, "sugar calories" -- are jeopardizing both your and your family's health. Physicians and politicians who cling to the dogma that "all calories should be treated equally" imperil our country's health care system, food supply and standing in the world for the next hundred years."

BigWhiskey said…
Well, allow me to include the link below to express why I read this Blog and other scientific based blogs of nutrition researchers. I decline to be a consumer. I don't want to be on the Menu. Thanks for the tireless efforts of Evelyn and the contributors for helping me work things out.
Unknown said…
I think he realizes that the window of opportunity is closing and he better cash in while he can.

I agree with Travis that the shark was jumped quite some time ago, now people follow it just for the laughs.

/Still waiting for Kruse to blame obesity on space aliens
Unknown said…

"Why do cravings matter? Because they are the engine of addiction, and can lead people to “throw away all the things that really matter to them in exchange for a short-term fix that is often over before it even starts.” When Dr. Manejwala asked a group of patients to explain what they were thinking when they relapsed, their answer was often the same: “I was so STUPID.” But the author had tested these people. “I knew their IQs.” And the best explanation these intelligent addicts could offer “was the one explanation that could not possibly be true.”

Why are cravings so hard to explain? One reason is that “people use the word to mean so many different things.” You don’t crave everything you want, as Manejwala points out. Cravings are not the same as wants, desires, urges, passions, or interests. They are “stickier.” The brain science behind craving starts with the downregulation of dopamine and other neurotransmitters. As the brain is artificially flooded with neurotransmitters triggered by drug use, the brain goes into conservation mode and cuts back on, say, the number of dopamine receptors in a given part of the brain. In the absence of the drug, the brain is suddenly “lopsided,” and time has to pass while neural plasticity copes with the new (old) state of affairs. In the interim, the unbalanced state of affairs is a prime ingredient in the experience of craving.

Cravings are “disturbingly intense” (Manejwala) and “incomprehensibly demoralizing” (AA). Alcohol researcher George Koob called craving a state of “spiraling distress.” Cravings are not necessarily about reward, but about anticipating relief. “The overwhelming biological process in addictive craving is really a complex set of desperate, survival-based drives to feel ‘normal,’” says Manejwala"
Diana said…
Gosh. Sometimes I crave salads. Sometimes I crave liver. Do they count as "desperate, survival-based drives to feel 'normal'"?
This comment has been removed by the author.
Gosh is right. If your cravings for salads or liver do not impact your life in a negative way, no, they do not count as "desperate, survival-based drives to feel 'normal'."

Hence the reason for pointing out that “people use the word to mean so many different things.”
Anonymous said…

Her favorite food is mackerel sushi.
Gabriella Kadar said…
well, Diana, my father made his 'version' of this stuff ONCE. He was tasked to eat the whole thing by himself. Beans, beef, and whatnot just did not go over very well with the rest of the family.

My daughter makes the 36 cloves of garlic brisket recipe from Epicurious and it's totally awesome. She overheated it last time and it developed a beautiful crunchy top. Amazing.

The first time she made it I went over and asked to have a look. She had the oven set too high. It all went down like : "Poke it." "No." "Poke the damn thing." poke. "See?
It's bouncy. Turn the heat down to 250F and leave it for the rest of the day." She did. It was gorgeous.

Diana said…
Garlic & cholent, best of both worlds.

To 120! (If you want that.)
Diana said…
Didn't Bray (and others) prove that macronutrient balance matters? It's how you interpret that fact that causes the arguments.
Unknown said…

Chocolate, Cheese, Meat, and Sugar -- Physically Addictive
Neal Barnard MD discusses the science behind food additions. Willpower is not to blame: chocolate, cheese, meat, and sugar release opiate-like substances. Dr. Barnard also discusses how industry, aided by government, exploits these natural cravings, pushing us to eat more and more unhealthy foods. A plant-based diet is the solution to avoid many of these problems. Neal Barnard is the founder of the Physicians Committee for Responsible Medicine (PCRM).
blogblog said…
Physicians Committee for Responsible Medicine is merely a front for the extreme vegans of PETA. It s not a legitimate scientific body. PCRM ignores any research that doesn't supports it's extremist agenda.

No vegetarian hunter-gatherer society has even been discovered. In fact most HGs eat vastly more meat than Westerners.
Diana said…
"Chocolate, Cheese, Meat, and Sugar" - Tell that to the French!
Gabriella Kadar said…
On that note, I"m just reading Albert Brooks' '2030: The Real Story of What Happens to America'..... cancer, alzheimers' are cured, plastic surgery makes people over age 80 look 30 years younger, the young people are burdened by paying for their grandparents medical care.........I'm only at page 83 and there's been THE EARTHQuAKE in Los Angeles.

One of my patients gave me his copy of the book. INitially I wasn't really all too interested in reading it. It's not the sort of book I'd buy for myself but it's got humourous moments.

Unknown said…
"PCRM ignores any research that doesn't supports it's extremist agenda."

One could say the same about the paleo community ignoring studies that don't agree with their agenda. You show me your studies and I'll show you your studies.

Explain the longevity of the Okinawan's on their high carbohydrate diet or the Icaria's

BTW - is it the caloric restriction or the diet

"This is a very interesting slide show, of faces reconstructed from ancient bones. Of course such reconstructions always involve a lot of guesswork, but it does put a face on things.

This one is an "old man" Neanderthal of 40-50 years old. What is interesting is that he is, in fact, and "old man". He was "well taken care of" by his clan, but he was afflicted with severe arthritis and walked hunched over. This led to researches believing for years that the Neanderthals walked with a hunched posture.

Here is the thing though. With some current cultures, notably the Japanese mountain villagers, people can live far longer, without having the arthritis. This Neanderthal was eating what would be considered the ideal "paleo" diet ... lots of fresh meat and vegies, and plenty of exercise too!

The Neanderthals, of all the people of that era, probably had the highest level of "meat" in their diets. They were robust people, living in a cold climate where one of their major foods were large ruminants. Apparently they killed these large animals using just hand spears (not throwing them from a safe distance).

Now, the current WAPF stance is that these ancient peoples died early, usually in accidents, but if they did live longer, they had a healthy old age. I question that though. While some eating patterns seem to result in healthy old age, it's unclear to me that the populations used as a pattern for the "paleo" diet, are one of them.

I still have not found an example of a population ... or even an individual ... who lives into a healthy old age where ruminant meat is the main protein. I am not sure why this should be ... it could be the neu5gc issue, or the high iron levels in red meat, or the fact fish has better stuff in it, or some other factor. But in this case, you certainly cannot blame the guy's health on factory farming, GMO corn, pesticides, or any of the other common scapegoats!"
blogblog said…
"Explain the longevity of the Okinawan's on their high carbohydrate diet or the Icaria's."

Pretty simple actually:

a) Japan has massive welfare fraud. There are literally MILLIONS of dead Japanese claiming pensions - some have been dead for more than 30 years. This grossly distorts the longevity statistics.

b) Ikaria - high levels of physical activity, low intake, regular fasting.

Neanderthals are NOT Homo sapiens.
Anonymous said…
The reason the Japanese live so long:
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