Dec 14 2009

Still On That Low-Carb Diet

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59 Responses to “Still On That Low-Carb Diet”

  1. Eternally Learningon 14 Dec 2009 at 10:12 am

    “‘Well, it worked for me’ is the almost ubiquitous response.”

    I’ll tell you, that is something I’ve heard over and over again from people I know that go on these diets or take vitamin regimens and so on. The other thing though that I hear from pretty much all those same people is, I think telling about why people defend their diets so fervently, and that is, “Trust me, I’ve done my research.” Usually, I end the conversation there unless I’m looking for a full-on and heated debate, but I would question what sources they’ve chosen to rely on since these same people tend to have an inherent distrust in medicine (including vaccines) and inherent trust of anything “Natural” which I interpret to mean “Alternative,” which of course really means “Not Science-Based.” So these people come to think of these diets as products of their own research and any negative statement as to the efficacy of what they are doing seems to be taken as an offense against their intelligence.

  2. Rob T.on 14 Dec 2009 at 10:37 am

    I passed this on to a coworker who is an Atkins fan, and his response (in part) was:

    “But my biggest issue is with this statement that leads the article. ‘I have never been a fan of the low-carb diet craze.’ Blows the credibility of what follows. He is reading the data with a predisposition to validate his agenda. He’s not a neutral party looking at the data.”

    I suggested to him that if having an opinion renders a scientist’s evaluation invalid, then there can be no more scientists.

  3. aaronheltonon 14 Dec 2009 at 10:53 am

    I actually have some experience with the whole weight loss thing. A couple of years ago I made it my mission to slim down, as I was less than happy with my weight at the time. Being a science-minded guy, I knew that the most successful formula would have 2 components: 1) fewer Calories, and 2) convenience. I had no other considerations (unlike many who embark on a diet). So I started with meal replacement shakes (think Slim-Fast, then look down on the bottom shelf for the store brand; hey, I’m a cheapskate too :P ). Of course they worked. Quite well. TOO well, actually. I dropped about 55 pounds far more quickly than was probably advisable, giving myself gall bladder problems as a reward. Once I got to my target weight (which I have happily maintained since then), I tried to redesign my diet around a very simple formula. Take the 2000 Calorie intake suggested on nutrition labels and divide it up like this: for breakfast, 500 Calories. For lunch, 500 Calories. For dinner, eat whatever, around 1000 Calories. Oh, and avoid snacks pretty much all the time. What I found is that I really do need more than 2000 Calories to sustain my weight, so I still get a buffer. It means I can indulge just a little bit every day. It’s also trained me to look for hidden Calories, which prompted me to cut the sugar and creamer from my daily coffee habit (now I drink it black). What’s more, with some practice, you can actually get pretty good at estimating your Caloric intake just by looking.

    So in summary, science FTW! :P

  4. superdaveon 14 Dec 2009 at 10:54 am

    Since there do seem to be people who have lost weight on the atkins diet, maybe it would be better to frame the argument not that the atkins diet doesn’t work, but that it doesn’t work how you think it works. People who have lost weight on this diet may more readily accept this response.

  5. Rob T.on 14 Dec 2009 at 11:00 am

    @superdave: “You keep using that diet… I do not think it works how you think it works…”

    “Inconceivable!!!”

  6. jameson 14 Dec 2009 at 11:17 am

    Skeptics can diet too! Please don’t presume all weight-loss nuts are, well, nuts.

    I was 305 lbs when I decided I needed to lose the weight. I did a lot of research using many of the techniques I learned from the skeptical movement and decided on a food log to track calories. This seemed to have the most evidence for success. Using these tools I changed my entire lifestyle. I no longer keep the diary and have added a fun exercise regimen to my lifestyle but have no maintained a weight of 185 lbs (+/- 5) for 14 months.

    I can honestly say in this case science based dieting worked for me and Steve’s advice is spot on.

  7. Eternally Learningon 14 Dec 2009 at 11:31 am

    In my experience, anytime the topic turns in any way to “I may know something that you don’t,” people’s defences go up. That’s why I usually just stick to asking questions unless people are searching for answers or just looking for my take. If they feel that they’ve found the answer, it seems very similar to religion in that they don’t want to let that answer go.

  8. MKandeferon 14 Dec 2009 at 12:40 pm

    I’m curious if in your search of the literature you turned up any studies that that analyze the complement to healthy weight loss, healthy weight gain? I cannot tell you how many advertisements for diet programs that promise a muscular male physique if you take creatine before working out (or is it after?), or consume X% of your daily calories as protein.

  9. Michael Varneyon 14 Dec 2009 at 1:10 pm

    “Eat a varied diet, mostly plant-based”

    Mostly plant based? Humm… well, I would ask for references as to why you promote this, but then it is a tit-for-tat with other papers supporting a larger portion to be from animal protein.

    This is an emotionally charged subject. At this point, I have simply gone to observational evidence as to how food affects my body.

    I have done this with various measures, such as metabolic panel, fasting blood glucose and triglycerides etc.

    Then I tried several permutations of grains, meat, vegetables, processed carbs etc. And, I have repeated these permutations to measure if the effects are consistent.

    Conclusions?

    1. I have a wheat allergy.

    I eat wheat and my skin becomes inflamed and sore around the scalp and in my beard. Then I get severe dandruff. My joints in my fingers ache, and I feel like I have a mild flu. After a couple of weeks of eating wheat based products my stomach is doing me in and I have to eat tums like candy.
    Within a week of stopping consuming wheat, these symptoms disappear. I have tried this various numbers of times, logging my results with pictures etc.
    I discovered this by trying a reduced carb diet. *shrug*

    2. Fasting triglycerides are ~ 4000 on my usual diet (Yes… 4000… seems to be a family trait as my mother had the same issues) of refined carbs and grains, moderate vegetables and small amounts of meat.

    Within three months of changing to a diet of meat, vegetables and fruit my numbers drop to around 100 with a really good LDL HDL ratio.
    My weight drops at a nice rate of 1 lb per week without much problem, faster if I exercise (but not all that much faster).

    I go on a veggie diet (no grains, since I have established my problems with wheat), and my numbers creep back up (HDL/LDL slowly, but triglycerides at a moderate pace to about a maximum of about 740), and I feel like crap. I start getting more hungry and eat more.

    So, for me the data pretty well indicates that I do best physically on a diet of reduced carbs, no refined carbs if I can avoid it, and various meats of various cuts and fat percentages.

    Anybody making blanket statements about how people should eat is someone I would question. What works for me, does not work well for my wife for instance.

    As with most epidemiological studies, the data is inconclusive, and can be tuned to show what a researcher wants to show, or used by a marketing company to support their views.

    And what is surprising is that you would promote a largely vegetarian diet from such a study. Or is it that you personally do well on such a diet, and the study only serves validate as to why?

    They only thing I personally would promote is to try various combination of food for a fixed period of time while monitoring various indicators of health, blood work, and simply how you feel, and repeat a few times until you find something that works for you. Then try to stick with it if you can afford it.

  10. lostmountainson 14 Dec 2009 at 1:43 pm

    I went on an atkins style diet once in highs school to lose weight, for about a month. It was the worst diet experience I’ve ever been on, I felt hungry all the time because I wasn’t eating food I like and weighed down from the fat. I started feeling so weak that my legs would tingle and feel as though they were going to buckle when I walked upstairs. I can’t believe I kept it up even that long, considering the awful effects, but I was desparate to lose weight and had been convinced this was the answer.

    I later learned what actually constitutes a healthy diet. I’m actually vegan now (though I don’t think one needs to be vegan to be healthy) and I’ve lost 20 lbs over 4 years. I feel great and I’ve finally been able to stick to an exercise plan. Yay

  11. Steven Novellaon 14 Dec 2009 at 1:46 pm

    Superdave – that is what I say, the evidence shows that you lost weight because of reduced caloric intake and/or increased expenditure. But some insist that it was not overall calories but the low-carb thing. The evidence just does not support that.

    Rob T. – tell your friend that I was never a fan of low car because of the evidence – not because of any a priori agenda. I have nothing invested in this issue – other than, perhaps, I have to work to control my own weight and want to know what the evidence shows. I am just giving my reading of the evidence, which is in line with the consensus.

    Michael – my opinions, as I stated, are not based on my own experience but on the literature – the research. I do not put much faith in individual anecdotes. They are too misleading.

    The evidence clearly shows that fat from plants is good, and fat from animals is bad, so for heart health eating fruits, veggies, legumes, and nuts are good. I am not a vegetarian. Getting protein from lean meats and fish is fine. Just don’t overdo it.

    Fruits and veggies are also a good way to get vitamins and minerals. But you need some meat also. Unless you are very careful and know how to have a vegetarian diet, it is easy to get vitamin deficiencies on a vegetarian diet. I see patients all the time with low B12 from an all veggie diet.

    The consensus of opinion based on the evidence is that a varied diet is best, and most people could stand to eat more fruits and veggies.

  12. Michael Varneyon 14 Dec 2009 at 2:25 pm

    Sorry Steven, but the evidence is no more clear that fat from plants are”good” and fat from animals are “bad”, than the evidence for the opposite. Buzz words such as “heart health” do not convince me, as they are ill defined.

    There is no consensus on dietary fat sources in general, or at least one that seems to last more than about 12-15 years. (Eggs will kill you! Cholesterol will be the death of you! Oh wait, eggs aren’t bad for you…. etc.)

    Anybody who points to the literature in this matter and asserts that one or the other is better, I would have to question how thorough they were in their literature research, how much they understand about the subject, or what their agenda may be.
    (Well, those are questions I always ask regardless of topic… but you understand that mode of thought.)

    The data is fairly clear about bio-absorbency nutritional densities for meat as compared to plant based diets. Such data is not only verified by nutritional assays, but in-vitro, in-vivo and in-situ tests for absorbency… (at least as accurate as any test for such absorbency can be)

    The data is also a little more telling on certain hydrogenated fats, but even then much more study is needed.

    I have read literally hundreds of medical studies and journal articles ranging back about 40 years. I have read studies without bias. All that can be stated with certainty is that in various decades the pendulum of opinion has swung back and forth as to which fat source is “healthier”.
    Some decades have a spate of conclusions based on one stance, then the next it swings to the other side. No conclusion can be derived from such a data set.

    Individual anecdotes are horridly misleading, and that is why I clearly state that what I did works for me and made no assertions to how it would affect others.
    I also applied a large number of controls, and accounted for many variables in my personal tests. I applied the scientific method as best I could without having the ability to prepare an ensemble of identical test subjects.
    So, while not willing (and unable) to state conclusively what is a better diet, I am more than willing to trust my own observations over that of some random doctor as to what works for me.

    Another skeptic such as yourself could look at the studies and journal articles out there, and write a snarky titled blog “Still on that organic vegan breathairian diet?” and have just as much science to back them up.

    Considering the crappy state of nutritional science (a soft science if there ever was one at this time) the best any lay person can do is research the effects on themselves until they find something that works.

    The best thing a doctor can do is support such an exploration rather than picking a side and espousing that view.

    Regards,

    Mike

  13. Rob Heberton 14 Dec 2009 at 2:36 pm

    For myself, the problem has always been about gaining weight. High school wrestling also programmed in a few bad habits that had to be broken, but now it’s pretty simple: complex carbohydrates, fruit, lean proteins (as well as beans, nuts, etc.), and so-called “good fats” like nuts, avocados, and olive oil. Oh, and fiber. I think that’s the pretty standard prescription.

    I think most people who are actually concerned about healthy eating know what’s healthy, but real life gets in the way (you’re late for work, so coffee is your breakfast, you have to wolf down a burger during a half-hour lunch break, then you have to pick up the kids, so you just grab pizza for dinner and so on). For my girlfriend, it was all about meal spacing and portion control, just putting the amount that she was supposed to eat in a separate bowl until she had trained herself to recognize the proper amount.

  14. Steven Novellaon 14 Dec 2009 at 2:42 pm

    Mike,

    We disagree as to the state of the evidence. No need to appeal to ad hominems.

    Yes, the evidence is complex and often contradictory – like every complex medical question. You could use that argument to deny any almost medical conclusion.

    But there is a strong signal in the noise. Through the 1980s research focused on total fat, and for a while cholesterol, and the predictions of the low-fat recommendations were never verified. It turned out that avoiding total fat was neutral and even possibly negative on cardiac outcomes.

    Over the last 20 years it has become increasingly evidence that some dietary fats increase LDL, which increases cardiac risk, while others increase HDL, which has a protective effect. The science on this is now quite strong, in my opinion. Generally speaking, animal fat raises LDL while plant fat raises HDL.

    This is the current consensus, and it is absolutely not irresponsible to recommend this.

    I am not saying this is rock solid. There is still uncertainty – but these are reasonable recommendations and the best we can currently do.

    The problem with the “what works for me” approach, is you don’t want to wait until you have a heart attack to know if you are on the right diet or not. We need experimental and epidemiological data. Using markers, like cholesterol and triglycerides, is reasonable, but it is impossible to control for variables, and these are only markers for clinical risk. It’s nice to have data from net outcomes.

  15. Michael Varneyon 14 Dec 2009 at 4:02 pm

    Steven,

    The problem with stating things in terms of generalities is that information can be lost, and erroneous conclusions can be drawn by the uninformed.

    For instance, lets assume for the sake of argument there is indeed a well linked coronary risk factor with consumption of saturated fats. I.e increased LDL, which is but one indicator and may not even be the most important one. (And there are peer reviewed studies that indicate otherwise.)

    Animal fat is primarily saturated fat.
    Saturated fat increases LDL.
    Increased LDL is a marker for increased risk of negative cardiac outcomes.
    (Therefore) Don’t eat animal fat.
    What is left to eat? “Plant fats”
    Eat plants instead.

    Well…
    Various nuts and legumes are very high in saturated fats, as well as palm oil and coconut oils and the fat profiles of several other plant based foods. But no distinction is made on what plants to eat.

    So where does that leave us? Advocating a diet derived from plants in general by no means guarantees us a diet free from the proposed causal substance, namely saturated fat.

    Heck, there are even studies in sub-composition of various fatty acids that comprise saturated fat that indicate that those fatty acids can lower LDL etc.

    Such a deductive chain also does not address the fact that plant matter “in general” is a poor source of complete protein, or other nutritional issues such as the good fat that you allude to that is present in significant quantities in animal meats.

    Such a deductive chain may obscure a true causal mechanism, such as the possibility of phytochemicals in plants lowering the LDL rather than the absence of saturated fats.

    There are also direct studies with large sample sets that a completely veggie free diet with only meat and fat lowers LDL, raises HDL and reduces triglycerides.
    So how does current nutritional science explain this (or discount this)?

    Well, frankly it cannot. (Yet)

    And here is possibly the main problem with nutritional science:
    It is not a predictive science (yet).
    It has not reached the state where it can predict an outcome for a broad range of situations. It is still stuck in the “butterfly collecting” phase, where there are studies, correlations, meta-studies, epidemiological studies and the like. But there is very little predictive power in the field.

    And without at least a modicum of predictive power, forming a consensus and making recommendations based on such a “weak science” may not be the best thing to do.

    Regards,

    Mike

  16. orestesmantraon 14 Dec 2009 at 7:02 pm

    Steven, what do you think of the work of someone like Gary Taubes, particularly his book “Good Calories, Bad Calories”?

    To deny that macronutrient composition has any effect on weight control seems absurd in light of the fact that carbs spike glucose levels, which then leads to an increase of insulin, which then shovels fat into adipose tissue. So, on the metabolic level, it seems clear that eating carbs rather than protein or fat has a direct control over fat gain.

    Caloric theories of weight gain miss the point that adipose tissue development is directly linked with the influx of carbs and moderating your metabolism so as to increase its ability to burn fat is much more important than trying to control for a oversimplified input-output model of metabolism.

    Moreover, if the caloric theory is true, then why do you have cases where people are, say, have fat only on one half of their bodies but are skinny on the other? These cases seem to be the result of problems in metabolism, not caloric input/output. Eating under the caloric baseline might reduce weight, but controlling for macronutrient profiles will guarantee that you lose fat tissue, rather than muscles mass.

    I recommend reading some of Gary Taubes research and then reevaluating the evidence for standard caloric theories. As Taubes shows, the overall evidence for both the fat-is-bad-for-your-heart hypothesis and the caloric weight gain theory is inconclusive and/or outright contradictory.

  17. Michael Varneyon 14 Dec 2009 at 8:59 pm

    @orestesmantra

    “Moreover, if the caloric theory is true…”

    It is. Pretty fundamental physics requires this.
    If you eat less than your body burns in a given period of time, you lose “weight”.

    I give you 2000 kcal of sugar per day, and you burn 2500 kcal and you will have a deficit of 500 kcal.

    I give you 2000 kcal of fat per day, and your burn 2500 kcal a day and you WILL have a deficit of 500 kcal.

    There is no way around this fact.

    Think about this: I give you 2000 kcal of sucrose in water once per day. You drink it all at once, you spike your insulin and it “shoves” the excess calories rapidly into your adipose tissues.
    If you burn 2500 kcal that day, you still have a deficit of 500 kcal, even if you have to burn that adipose tissue to get it (or muscle, organs, tissues or what not.)

    You may be able to eat foods that your body cannot process and wring every last erg of energy from, but all this means is that you can eat more of this type of food to obtain 2000 kcal than you can of other types of food. This does not mean you can violate the laws of thermodynamics.

    Now, you can argue that certain foods can spike hormones that control how satiated you feel after eating, or that triggers you to want to eat more, but again this does not negate the principles of calories out > calories in will make you lose weight. All it does is make it more difficult to keep to this equation.

    You may also argue that certain macro nutrients alter your ability to metabolize food, or render you ill so you cannot burn as many calories in a day. This still does not mean the caloric theory of food is wrong, simply that you need to find ways to increase your burn back up to 2500 kcal.

    Finding a person that is “half fat and half skinny” does not disprove basic physics.

    The calorie in vs calories is not an issue as far as I am concerned, so long as people understand what it means.

  18. Steven Novellaon 14 Dec 2009 at 9:04 pm

    oreste – what you are trying to do is extrapolate from basic science about metabolism to net clinical effects. This is very difficult – to the point of being unreliable by itself. You need clinical studies of net outcomes.

    The research shows that total calories are what matter for weight control- overwhelmingly. The study I cite above is just the latest.

    It is probably true that those metabolic effects average out over time – eventually unused calories are stored. And calories are likely fungible – if you get energy from protein then more calories are available to be stored as fat.

    I am familiar with Taubes position. He is anti low-fat, pro low-carb. But his views are outside the mainstream.

  19. Michael Varneyon 14 Dec 2009 at 9:13 pm

    @orestesmantra

    You may be interested in reading Bray, Obesity Reviews (2008) 9, 251–263 *

    I have not read Taub’s book as of yet, but if he really thinks there can be weight gain while on a caloric deficit (more calories burned than consumed), I have to wonder at the efficacy of his physics education.

    =(

    * http://www.proteinpower.com/drmike/wp-content/uploads/2008/07/bray-review-of-gcbc.pdf

    Is a link to the PDF, even if it is at a pro-protein diet site.

  20. Steven Novellaon 14 Dec 2009 at 9:20 pm

    Mike

    I am not advocating a vegetarian diet. I recommend a varied diet, including some meat.

    My bottom line recommendations were, of course, simplified. But part of the point is, with diet it is better to have some simple rules of thumb that are true most of the time and will work for most people. I focus on the large factors – not fine tuning.

  21. Michael Varneyon 14 Dec 2009 at 9:28 pm

    Steven,

    Point taken.

    I am always going on about societies tendency to pander to exceptions exceptions, to set policy based on those exceptions, and to hinder progress based on those exceptions.

    I guess being aware of those exceptions is enough in this case.

    I am just not convinced yet that nutritional science is able to set those rules of thumb to make exceptions just that, exceptions.

    Regards,

    Mike

  22. David Brownon 14 Dec 2009 at 10:10 pm

    The dispute over calories in/ calories out could probably be settled if the warring factions were to pay more attention to energy apportionment. By this I mean that we are not the only ones consuming the food that passes between our lips. About 2 kilograms of gut flora inhabit the digestive tract, feeding and multiplying as digesting food passes through. In fact, about half of the solid waste that exists our bodies each day is dead gut microbiota.

    Food quality affects microbial activity in more or less predictable ways. For example, consuming lots of refined carbs or pure vegetable oils or separated animal fats tends to deprive microbes of elements they need to multiply efficiently. Thus, energy contained in mineral and vitamin deficient manufactured foods is more likely to be highly absorbed into the bloodstream whereas energy in foods that promote microbial replication would be less absorbed.

    Mike and Steven, you might want to visit Gary Tivendale’s collection of documents for further enlightenment on this matter. http://www.scribd.com/Gary%20Tiv Do read his bio on the left side of the screen.

    Now as for low-carb research, Christopher Gardner gave an interesting presentation a while back entitled Battle of the Diets: is Anyone Winning (at Losing)? http://academicearth.org/lectures/battle-of-the-diets Note what is said about insulin resistant and insulin sensitive study subjects.

    Lastly, it seems like the biochemists are the only ones capable of sorting things out where heart disease is concerned. I urge you both to watch this 37 minute presentation by Dr. Bill Lands. http://omega-6-omega-3-balance.omegaoptimize.com/2009/11/10/why-omega6-fats-matter-to-your-health.aspx You’ll have to register to download the video but you don’t have to buy anything and no one is going to pester you afterward even though it may seem as though they might. The other video presentation I feel everyone should watch is an 89 minute lecture delivered by Robert Lustig. http://www.youtube.com/watch?v=dBnniua6-oM Note what Dr. Lustig says about Dr. John Yudkin’s work from 40 years ago.

  23. modoc451on 15 Dec 2009 at 1:34 am

    I’ve just reached the age of reduced metabolic activity, and it sucks. My body still craves massive amounts of calories, but my growing gut seems to disagree. I’m thinking about cutting out the beer and Izze sodas.

    Also, northern Illinois doesn’t have anywhere good to go hiking, reducing my energy expenditure. Anyone have any good hiking places in northern Illinois?

  24. Kostason 15 Dec 2009 at 2:20 am

    This nutrition/weight managment is a very interesting topic for several reasons:

    First its an open scientific question and that should be interesting enough by itself

    Its controversial which makes it more “spicy”

    The answer isnt clear cut like say with homeopathy so there is some genuine mystery

    and lastly its a real issue and it concerns us all because we all eat and we all want to look good and be healthy !

    Lately i ve found myself preoccupied with this because i decided i should change my lifestyle so i quit smoking , started working out and tried to balance my diet.

    The smoking part was simple and straightforward but the weight training/aerobic training/dieting plan part is a real mess.

    I ve been looking around the net for information on these subjects but i keep finding alot of conflicting vague sources.Clearly theres alot of money at stake here and that muddles the issue.I try to keep a skeptical perspective but when i do i am left with no option but to admit i dont really know anything with any reasonable certainty.

    Does anyone know any sources (preferably online) that treat the issue scientifically and with skepticism ? I am surprised i couldnt find any.Just like we should have science based medicine we should also have science based “fitness science”

  25. Colldenon 15 Dec 2009 at 3:30 am

    Steven

    In regard to “animal fats increase cardiovascular risk”, what do you think of this recent comment?

    http://wholehealthsource.blogspot.com/2009/12/dirty-little-secret-of-diet-heart.html

  26. Tatyanaon 15 Dec 2009 at 8:52 am

    This diet debate drives me batty.

    The general guidelines for a well-balance diet are just that, general guidelines which for most of the public are going to work.

    There is an variation in the requirements for humans.

    If you want an interesting overview of the topic, there is a book called Biochemical Individuality.
    http://www.anapsid.org/aboutmk/biochem.html

    I do think some people will do better on a low carb diet, I think it has its place, however, for the majority of people, this isn’t going to be a diet that can be maintained for life.

    The New England Journal of Medicine recently reviewed the low carb diet (again) and found that there may be risk factors for cardiovascular disease.

    Smith, SR (2009). A Look at the Low-Carbohydrate Diet. The New England Journal of Medicine, 361 (23) 2286-8, December 3, 2009.

    It is basically the review of an animal study:

    Foo SY, Heller ER, Wykrzykowska J, et al. Vascular effects of a low-carbohydrate high-protein diet. Proc Natl Acad Sci U S A 2009 August 24 (Epub ahead of print).

    In ApoE knockout mice fed a high fat diet, they had a greater risk of atherosclerosis in comparison to the traditional Western diet and mice on standard laboratory chow (the control).

    I haven’t seen the full study yet, however, the implications are that if humans who are at a higher risk of cardiovascular disease have this polymorphism and follow this diet, they could be increasing their risk of CV disease.

    And a few more studies from NEJM:

    2. Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003;348:2082-2090. [Free Full Text]

    3. Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009;360:859-873. [Free Full Text]

    4. Smith SR, Wilson PW. Free fatty acids and atherosclerosis — guilty or innocent? J Clin Endocrinol Metab 2006;91:2506-2508. [Free Full Text]

  27. Michael Varneyon 15 Dec 2009 at 3:00 pm

    @ David
    “The dispute over calories in/ calories out could probably be settled if the warring factions were to pay more attention to energy apportionment. By this I mean that we are not the only ones consuming the food that passes between our lips. About 2 kilograms of gut flora inhabit the digestive tract, feeding and multiplying as digesting food passes through. In fact, about half of the solid waste that exists our bodies each day is dead gut microbiota.”

    There really is nothing to settle.
    Calories in < calories out will lose weight. It does not matter how it is done, or the apportionment. If your BODY consumes less calories than your BODY burns, you will lose "weight". If your BODY consumes more calories than your BODY burns, you will gain weight.

    Arguing about apportionment to internal biota is no different than to say you gave half your lunch to your dog, and then you went coprophagous.

    The fact that people erect straw man argument and logical digressions do not mean they can throw thermodynamics out the window.

  28. egmutzaon 15 Dec 2009 at 3:56 pm

    Re: Taubes/Bray and calories in, calories out, this response from Taubes is worth a read:

    http://www.proteinpower.com/drmike/wp-content/uploads/2008/07/taubes-response-to-bray-ob-reviews.pdf

  29. Calli Arcaleon 15 Dec 2009 at 3:59 pm

    Also regarding “apportionment”, your gut flora don’t helpfully step aside while you get on the scale. They are counted as part of your body mass. (So is your undigested lunch, for that matter, and the not-insignificant mass of the gasses in your lungs and the urine in your bladder.)

  30. Michael Varneyon 15 Dec 2009 at 4:22 pm

    Yes, Taubes is arguing a logical fallacy with respect to science.

    “In GCBC, I point out that the first
    law – energy conservation – tells us nothing about what causes obesity. It says that an increase (or decrease) in the energy of an open system – fat mass, in this case – must be associated with an energy intake greater (or less) than that expended. It says nothing about what causes that imbalance. It implies no causality.”

    Energy conservation is not required to say anything about the causality (or as he is insinuating, the why) of fat gain or loss.

    Taubes acts like this is a failing of the first law, and this is just silly as it is no better that claiming that Newtons law gravity did nothing to tell us why the suicide jumper decided kill themselves.

    The first law gives us a mechanism, not a cause.

    Just to make this very clear:

    Science does not tell us the “Why”, only the “How”.

    It is an artifact of our language that when we ask: “Why did the apple fall” that we answer gravity, when the correct question is “how did the apple fall?”

    Ask Taubes what happens if a net caloric energy deficit is maintained? (In controlled clinical situations)

    Better yet, ask him to simply stop feeding his favorite pet… and lets see if there is a weight gain without a positive balance?

  31. Steven Novellaon 15 Dec 2009 at 4:38 pm

    Collden – for some reason (I will refrain from speculating) there is a dedicated minority opposed to the notion that dietary fat is any cardiovascular risk. This is simply not the consensus of scientific opinion. While I am not an expert in this area, I can read the medical literature, and just about every review I read comes to the same conclusion.

    Here is a recent one, which concludes: (link below)
    “Physicians should emphasize diets that are rich in fruits, vegetables, and healthful fatty acids and that limit saturated fat intake.”

    Yes, the evidence is complex, which leaves room to cherry pick and support whatever conclusion you want. The data is also imperfect, and much more research needs to be done.

    But it is easy to promote uncertainty and doubt in science – there is always doubt. But we also have to make decisions with imperfect information. Right now, based on the available information, the above is a reasonable recommendation.

    http://www.ncbi.nlm.nih.gov/pubmed/19378874?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=49

  32. Steven Novellaon 15 Dec 2009 at 4:45 pm

    Taubes and others also confuse two contexts. Sure, there are metabolic differences between people, and that may explain why person A is fat and person B is thin.

    But for any individual, if they want to change their body composition, the best option is to make simple and sustainable lifestyle changes. If you want to lose weight, consume fewer calories and exercise more. If you want to gain muscle, do resistive exercises. If you want to increase your cardiovascular health, do aerobic exercises.

    Yes – this is an oversimplication. But that’s deliberate – it’s simple, but true enough to be effective for most people.

    Most people would be far better off making simple lifestyle changes based upon established clinical principles, than trying to make complex and tweaked changes to their diet and exercise based upon some highly speculative extrapolation from preliminary basic science.

    But the latter sells more books and products.

  33. David Brownon 15 Dec 2009 at 11:19 pm

    Michael wrote, “Arguing about apportionment to internal biota is no different than to say you gave half your lunch to your dog, and then you went coprophagous.”

    Michael, I’m not arguing here. I’m presenting information. Obviously, you didn’t visit Gary Tivendale’s blog and have little understanding of the role of gut microbes in energy apportionment. And your comment about feeding on dung is inappropriate.

    My point is, the quarrel over calories in/ calories out has to do with how many calories are eaten, not how much energy gets absorbed into the bloodstream.

    Each gram (dry weight) of dead microbes in the feces represents 5 kcal of energy that did not get absorbed into the bloodstream and metabolized by the body. That energy DID get metabolized, however. And the heat generated DID get absorbed into the body. Do you get it now?

    Scientists measuring energy balance with a metabolic chamber would detect the heat generated by gut microbes and assume the body’s own metabolism was producing it.

    The heat generated by gut microbes is not trivial. I calculate a daily gut microbe heat output of about 250 kcal for a 160 pound individual. Depending on the quality and amount of food consumed and the capacity of the digestive tract, heat generated by gut microbes could vary either way by dozens to hundreds of kcal. Too bad no one is researching this.

  34. artzy65on 16 Dec 2009 at 12:35 am

    The best way to put it is ‘portion control and exercise’. For me, counting calories sucks. Regular metabolism-burning exercise (read:aerobic) and some weight training will go a long way. Rule-of-thumb re weight loss: No more than 2 lbs a week… “trick the body” as one expert put it, “so it won’t think its starving and slow down your metabolic rate”… the caveman thing. I’ve lost about 18 pounds in the last 7-8 months by adopting a ‘sustainable’ exercise/portion-control routine. Taking up the stationary bike thing (called ‘spinning’ nowadays) in 1979 was really what has amounted over the years to a life-altering decision. I also played tons of tennis, walk a lot in winter, ride my road bike in summer and take subway stairs two at a time.

    A doctor once asked me what do I want to gain out of this kind of lifestyle (expecting me to say, of course, that I want to live to 120) and I replied “To be as healthy as possible on the day I die”. He liked that reply.

    I would recommend a book entitled ‘Vitality and Aging’ which talks about the ‘Rectangular Society’… wherein the ‘bell curve’ of normal aging takes a more rectangular shape… that is: our healthy years are extended and sick years shortened from years, or even decades, down to the last few months, weeks or days.

  35. artzy65on 16 Dec 2009 at 12:52 am

    Oops, I meant to say ‘fat-burning’ or ‘metabolism-raising’ exercise, not ‘metabolism-burning’

  36. Jason Jarredon 16 Dec 2009 at 12:52 am

    Hi Steve,
    Love your blog and podcast. This post in particular interests me as I am a student studying a Diploma of Fitness Speciality.
    I have a keen interest in the science behind physical exercise and health, and was hoping that you could perhaps provide some recommended reading material that is skeptical and scientific in nature that would be informative (as a poster above mentioned), for somebody like myself.

    Cheers,
    Jason

  37. micwaton 16 Dec 2009 at 1:18 am

    I enjoyed the post and the post-post debate.

    But one irony occurs to me. In the ads powered by Google section of your web page, there is a rash of weight loss ads. One of them is “diet free weight loss” and others that seem to be promoting low carb diets – full of personal testimonials and no evidence. The exact opposite of what you are advocating.

    I know you have a disclaimer above the ads, but its pretty small.

    Recently on the Skeptics Guide you interviewed Dr Rachel Dunlop who was criticising the practice of pharmacists (at least in Australia) of stocking their shelves full of fad products, vitamins, naturopathic remedies etc (as well as the behind-the-counter prescription only medications). She was calling on pharmacists to be more responsible and not stock that stuff just because it sells well. You seemed to agree.

    But these ads on your site look somewhat similar. I guess you could rely on the fact that most people coming to your site are presumably skeptics or neurologists, not those looking for weight loss advice. But, I just wonder whether you really have not control over this?

    Please don’t get me wrong. I’m not making an ad hominem attack. I am a big fan of the Skeptic’s Guide, and have made a donation to aid your Australian trip. But is there no way through this ethical problem?

  38. studio34on 16 Dec 2009 at 6:34 am

    Hi Steve,

    Great article. Just wanted to add that the South Beach diet does utilise aspects of the glycemic index which is a good thing but it does have some ridiculous “phases” where certain carbohydrate foods are eliminated without any sound basis. Removing high GI fruits for example is ludicrous because the amount of carbohydrate in a given portion is generally negligible. Most fruit and veg should be regarded as free foods with only white potatoes being a veg that should be eaten in moderation because 1) they are calorie dense in normal portion sizes and 2) have a very high GI.

    The terms simple and complex carbohydrate are redundant. What was once thought to be a simple sugar and therefore would generate a large glycemic spike is in fact not true. Table sugar, for example, is 50% fructose which is low GI (the liver must convert it into glucose, a rate limiting step) and thus sucrose has an intermediate GI. It always amuses me how sugar is frowned upon as “evil” yet glucose is the preferred fuel for the brain.

  39. David Brownon 16 Dec 2009 at 9:49 am

    For studio34:

    You wrote, “Table sugar, for example, is 50% fructose which is low GI (the liver must convert it into glucose, a rate limiting step) and thus sucrose has an intermediate GI. It always amuses me how sugar is frowned upon as “evil” yet glucose is the preferred fuel for the brain.”

    I urge you to watch this 89 minute video presentation by Dr. Robert Lustig entitled Sugar: The Bitter Truth. http://www.uctv.tv/search-details.aspx?showID=16717 You’ll learn that most of the fructose is converts to triglycerides in the liver, not glucose.

    Sugar is no longer considered benign. Since 2001 researchers have been finding that excess consumption of fructose causes all manner of metabolic injury. Dr. Lustig goes so far as to call it a poison.

    While you’re at it, I suggest you watch another video featuring Dr. Bill lands. Hardly anyone in the USA is aware of the poisonous properties of excessive omega-6 fatty acids. Omega-6 seed oils are the other major health-damaging ingredient in the modern food supply. http://omega-6-omega-3-balance.omegaoptimize.com/2009/11/10/why-omega6-fats-matter-to-your-health.aspx

  40. egmutzaon 16 Dec 2009 at 9:58 am

    “Energy conservation is not required to say anything about the causality (or as he is insinuating, the why) of fat gain or loss.
    Taubes acts like this is a failing of the first law, and this is just silly as it is no better that claiming that Newtons law gravity did nothing to tell us why the suicide jumper decided kill themselves.”

    Michael, you’re completely misunderstanding Taubes and the context under which he’s discussing the first law. He’s not arguing that the first law fails or is lacking because it doesn’t tell us anything about causality. He’s merely defending his position (against the charge that it violates the first law) by pointing out that *he* is talking about causality, so the first law really isn’t relevant to his argument. He’s actually making the exact point that you are.

    Starting with reading his book, rather than his critics, might help you understand where he’s coming from.

  41. David Brownon 16 Dec 2009 at 10:20 am

    Steven,

    You wrote, “Collden – for some reason (I will refrain from speculating) there is a dedicated minority opposed to the notion that dietary fat is any cardiovascular risk. This is simply not the consensus of scientific opinion. While I am not an expert in this area, I can read the medical literature, and just about every review I read comes to the same conclusion.”

    I used to think that sugar, not saturated fat, was the major cause of clogged arteries. But after listening to Dr. Bill Lands discuss the connection between excessive omega-6 seed oil intake and heart disease. http://omega-6-omega-3-balance.omegaoptimize.com/2009/11/10/why-omega6-fats-matter-to-your-health.aspx I suspect that the proportionate risk is greater for Omega-6. I also think the reason why consensus of opinion targeted saturated fat for so long is due to fact that few people are willing to put forth the effort to resolve controversy. That, coupled with behind the scenes political activity by the edible oils industry likely explains why saturated fat has been demonized for so long. http://www.sciscoop.com/controversial-saturated-fat.html

    Is consensus of opinion ever a valid reason to embrace a controversial opinion?

  42. cuervoon 16 Dec 2009 at 10:32 am

    micwat :In the ads powered by Google section of your web page, there is a rash of weight loss ads.”

    Wow, people use the internet without blocking ads? How quaint!

    @Steve… what do you think about Kurzweil’s regimen?

  43. Calli Arcaleon 16 Dec 2009 at 4:00 pm

    Is consensus of opinion ever a valid reason to embrace a controversial opinion?

    I would think that “consensus” and “controversial” would generally be mutually exclusive. Controversial means there isn’t a consensus.

  44. Michael Varneyon 16 Dec 2009 at 5:20 pm

    @egmutza

    He cannot defend his position if he states that a person can gain weight during an period of extended net calorie deficit.
    He can back pedal and obfuscate if he believes this, and he can correct his sloppy wording if he did not believe this.

    And I directly quoted the passage where he claimed that the first law did not explain causality. I would ask him so what if it did not explain causality? That he even wrote this down is a sign of a red herring, or a mis-understanding of the first law.

    An organism under a net caloric deficit for an extended period of time cannot store excess calories as fat, as tissue or as anything. It is a simple as that.

  45. Michael Varneyon 16 Dec 2009 at 5:38 pm

    @ David

    “Michael, I’m not arguing here. I’m presenting information. Obviously, you didn’t visit Gary Tivendale’s blog and have little understanding of the role of gut microbes in energy apportionment. And your comment about feeding on dung is inappropriate.”

    You state “obviously” like you actually know what I have read. You do not.
    If you were simply presenting information, you would not have read the “feeding” on dung” as directed to you, as it was directed at Gary’s opinion.

    “My point is, the quarrel over calories in/ calories out has to do with how many calories are eaten, not how much energy gets absorbed into the bloodstream.”

    Only by those ignorant of what it means for an organism to “consume” food.
    Swallow the dog first if it makes you feel better.
    All this crap about “ahh, but what about the food your body does not absorb due to x process” is digressing from the point that if an organism consumes (processes and can extract) fewer calories than it burns (through whatever mechanism the organism can provide) then it will lose “weight”.

    As for what scientists assume about what generates heat, well try and fix it. If indeed they make these sort of mistakes, then correct the error and publish a better experimental method. We don’t want those pesky organisms eating all the food and making the person lose weight faster than physics say they should!

    If you can point to a peer reviewed publication of Gary’s, then I will read it. But wading through a long list of self published letters is not a worthwhile use of my time.

  46. jc072on 16 Dec 2009 at 6:15 pm

    Steve –

    While I agree with the majority of what you’re saying in this article, I think making a blanket statement like “Low-carb, high-fat diets are likely not heart healthy” is misleading. In this statement you ignore the fact that different types of fats exist, and that different fats have different effects on the body. Not to mention that it ignores the critical role that protein plays in one’s diet.

    For example, would you say that the following “low carb/high fat diets” are equal?

    1. Bratwurst, sausage, bacon, cheese, no/very little vegetables, fast food cheeseburgers minus the bun.

    2. Lean meats, fish, vegetables, oils, nuts.

    Both are low carb. Both would yield “weight loss” if consumed at sub-maintenance calorie levels. Are both equally healthy or unhealthy? To be fair, number 1 seems to be what most Atkins fans and low carbers in general advocate (“source doesn’t matter, as long as it’s low carb!”) and the one it sounds like you are against.

    Like I said, I think most of what you said is definitely good advice for most people who just want to fit into the same size jeans they wore in high school. It just breaks down after a certain point, though. I think that it is fine to say to the general public that a calorie is a calorie, but it seems like you’re ignoring the fact that the nutrients which make up the calories have different effects on body composition and health.

    I’m of the opinion that anyone who actually wants to look “fit” or change their body composition (muscle/fat ratio), as opposed to those who simply need to get into a “normal” BMI range or be not-obese, needs to take a more critical approach to the types of nutrients they consume, their macro-nutrient ratios, and experiment with different approaches on themselves. (I don’t believe you were claiming anything to the contrary of this… it’s just a personal rant.)

    I may have misinterpreted your article. If I did, let me know.

  47. David Brownon 16 Dec 2009 at 11:23 pm

    Michael,

    I take it you did visit Gary Tivendale’s collection of documents, read something, but assumed that everything was written by Gary himself. That much is clear. So I apologize for using the O word.

    Since I can’t read your mind, I have to guess at what you’re trying to convey. I’m not good at that, especially when the rhetoric is laced with sarcasm.

    You said, “All this crap about ‘ahh, but what about the food your body does not absorb due to x process’ is digressing from the point that if an organism consumes (processes and can extract) fewer calories than it burns (through whatever mechanism the organism can provide) then it will lose ‘weight’”.

    You state the obvious here. There is no argument about the obvious. The argument is about whether a person can change certain qualities of food intake without changing caloric intake and still lose or gain weight. That is what the quarrel is all about. Do you agree?

  48. Steven Novellaon 17 Dec 2009 at 8:25 am

    jc – I did not say that all low-carb/high fat diets are equivalent. And I do distinguish types of fat later in the article.

    The point is, that adjusting the macronutrient ratio so that overall carbs are low and overall fats are high is of no long-term advantage to weight control and may have deleterious effects on heart health – partly because it is easy, on a high-fat diet, to get too much of the wrong kind of fat.

    I also specifically say later on, “For heart health, the amount of total fat may be a factor, but this is unclear. What is clear is that they type of fat is a significant factor.”

  49. Michael Varneyon 17 Dec 2009 at 11:54 am

    “I take it you did visit Gary Tivendale’s collection of documents, read something, but assumed that everything was written by Gary himself. That much is clear. So I apologize for using the O word.”

    Apology accepted. Now lets work on your use of the “A” word.
    You assume that I thought everything was written by Gary himself. Self published does not mean everything there is Gary’s work. Self publication is when anybody uses a non-mainstream method (such as the web, vanity press, blog, twitter, facebook etc.) to espouse their ideas.
    My comments on this blog are self publication. So are yours. Your blog is self published, even if the the content is not all yours.

    “You state the obvious here. There is no argument about the obvious. The argument is about whether a person can change certain qualities of food intake without changing caloric intake and still lose or gain weight. That is what the quarrel is all about. Do you agree?”

    Food intake, food consumption… swallow the dog. Hey, swallow the straw man.

    How about promote bulimia? Oh wait, we have to make exception for purging, as that negates the concept of “consumption”. **roll eyes**

    Read the literature. Read the self published blogs. Most of the argument is about people claiming they can have a net caloric deficit and still gain weight. That is simply not the case.
    If the point of contention really was that obvious, and people understood some basic physics, then they would not make those claims, and it would not not taken a 5 post interaction between us for you to finally figure out what I was talking about.

    Even after I have clearly defined my parameters, and exactly what I was talking about, many people STILL wanted to go on about apportionment, or yapping about how “a calorie is not a calorie” or “all calories are not the same”. I was waiting for somebody to at least try and bring up “thermal effects of feeding” or the like.

    Hey, want to have fun?

    Find some very low calorie food, chill it down to the freezing point of water, and eat a teaspoon full of it. Calculate how much energy your body takes to warm the food up to body temperature as it consumes it. Calculate how many calories the body can extract from said food.
    If you do this right, you can claim it is a negative calorie food, publish a book and make millions.

    Oh… but thermodynamics is still untouched, and that was yet another digression.

  50. David Brownon 18 Dec 2009 at 3:26 am

    Michael Varney writes, “Read the literature. Read the self published blogs. Most of the argument is about people claiming they can have a net caloric deficit and still gain weight. That is simply not the case.”

    What I see in the self published blogs is comment about switching to higher fat intake and lower carb intake with accompanying weight loss. I’ve also seen comments about restricting fat intake, and experiencing constant hunger. I don’t see those as arguments, just people wondering what’s happening to their bodies. Some are delighted that they have lost weight without having to count calories. Others are disturbed that they cannot maintain weight loss no matter how much they exercise and how careful they are about restricting caloric intake.

    On the flip side, there are those who are very enthusiastic about the low-fat/high exercise approach. I say, if it works for them, great.

    As for those claiming to gain weight on a net caloric deficit, they don’t know what they are talking about. It’s like breatharians. Under observation they deteriorate rather quickly. So, any claims about weight gain or loss in relation to caloric intake are not credible unless accompanied by data.

    Michael Varney further commented: “If the point of contention really was (should be ‘were’) that obvious, and people understood some basic physics, then they would not make those claims, and it would not (have) taken a 5 post interaction between us for you to finally figure out what I was talking about.”

    I mostly knew what you were talking about. And I agree with your position. I took physics and chemistry courses for several years. But I’ve also spent more than three decades researching nutritional controversies. I was hoping to teach you something important.

    Michael also wrote, “Even after I have clearly defined my parameters, and exactly what I was talking about, many people STILL wanted to go on about apportionment, or yapping about how ‘a calorie is not a calorie’ or ‘all calories are not the same’. I was waiting for somebody to at least try and (should be ‘try to’) bring up ‘thermal effects of feeding’ or the like.”

    Your responses to my comments were not all that clear. You want to be clear? Dispense with the sarcasm. And what’s this about “many people STILL wanted to go on about apportionment, or yapping about how ‘a calorie is not a calorie’ or ‘all calories are not the same.” I’m the only one who mentioned energy apportionment. And was I yapping?

    I would have enjoyed a serious discussion but your attitude makes sharing information difficult.

  51. SteveDon 19 Dec 2009 at 4:31 pm

    Thanks for the article Dr Novella, I have been curious about this myself and wanted to hear your viewpoint.

    I have read Taubes book and I found it interesting and as a result I tried a low carb diet. Anecdotally I can say that a low carb diet has worked better for me than strict calorie counting.

    Looking at pub med, I can see that there are studies that show a low carb diet to be no worse or slightly better than a more conventional higher carb diet but there is still a lot of research to be done on the entire mechanism of weight loss. I would characterize my survey of literature as saying the effectiveness of the low carb diet is no worse than a standard diet and slightly better in some trials. As you say, the heart-health indicators are mixed some good, some bad, some saying no long term impact.

    As someone who actually likes the low carb diet, I want to make clear the following points after reading the comments —
    Do I believe a calorie is a calorie ? Yep.
    Do I believe you need to eat below your total energy expenditure to lose weight ? Yep.
    Do I believe you need to exercise for maintaining weight loss ? Yep (with the caveat that you might be better off avoiding long cardio and work on shorter harder intervals of resistance training and sprinting but that is a whole another discussion).
    Do I believe what you eat matters ? Yep (avoid processed sugar and grains, eat more vegetables and fruit, don’t be scared of fat but be sensible about it).

    Why did this work better for me ?

    Well everything here is personal story and supposition but I think the result of removing processed sugar and most grains from the diet tilted the diet to more fat and protein which resulted in me feeling less hungry which meant for me that I kept with my diet far longer than I normally would.

    To me, that is the important thing to keep in mind about this type of diet — it may be it allows easier compliance for people to keep going while they are trying to lose weight and that ultimately is a determining factor in its increased efficiency. Any diet that can be maintained several months longer as long as it operates in some sort of caloric deficit will be more effective.

    I find myself in agreement with all the points your article and this is someone who actually likes a low carb diet ;)

    Maybe we should tell people to focus on reducing sugar and eating more vegetables while dieting and they would get the same results without all the shouting ;)

  52. David Brownon 21 Dec 2009 at 10:11 am

    SteveD,

    Suggest you Google “Battle of the Diets: Is Anyone Winning (At Losing?)” and “Omega-6 Research News”

  53. Colldenon 15 Jan 2010 at 5:07 am

    Steven
    What is clear is that they type of fat is a significant factor. Vegetable sources of fat have a protective effect, while animal fat increases cardiovascular risk.”

    This just in a few days ago
    http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27725v1

    “A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.”

    So, basically, it is not clear that animal fat increases cardiovascular risk.

  54. Satoruon 20 Jan 2010 at 4:11 am

    To chime in with my own experience. I lost about 25lbs over 6 months. I did it with the ‘magic’ of

    1) Putting less food in my mouth
    2) Getting off my ass every day and exercising for 20 minutes

    It really hasn’t been much of a ‘diet’ in the traditional sense. I make a good effort to eat more vegetables at dinner. I cut out drinking soda, swapping for black tea (which hasn’t done wonders for my dental work :P ). I try to only snack at specific times. But it hasn’t been any kind of carb only/fat only/juice only/tofu only diet. Just eating less stuff.

    But I also realize that it’s not a sin to pig out once and awhile! Though I try to avoid getting to the ‘so full it hurts’ kind of thing.

  55. gs_jacksonon 30 Jan 2010 at 1:23 pm

    Hi Steve

    I have two questions relating to your article:

    “All diets that result in weight loss do so by reducing calories, and the macronutrient make up of those calories is irrelevant (to weight loss). Apparent advantages of low-carb diets are likely related to decreased hunger, which results in decreased caloric intake – but this effect is short term (3-6 months at most) and there is no long term advantage.”

    Q: Where’s your evidence for this? If 100 calories worth of bread (hi carb) is less filling than 100 calories worth of meat (low carb) today, why should it not still be less filling in 1 year, 2 years, 3 years?

    “Weight loss diets, in general, do not work. Most dieters will experience short term weight loss, but about 95% will fail to maintain their weight loss long term. Regular exercise seems to be critical for long term weight management.”

    Q: But what about permanent diet changes, rather than dieting for weight loss? If you have changed both diet and exercise, and this is a change that you stick with ad infinitum, why would a diet change fail in the long term?

  56. Steven Novellaon 30 Jan 2010 at 1:59 pm

    gs – all the studies that show that low carb diets have a weight loss advantage (and that have long enough follow up) also show that any such advantage is short lived – less than 6 months. I am not sure of the mechanism – but it is probably related to why fat and protein are more filling in the first place.

    Permanent changes to diet and exercise are exactly what I recommend. They should work. The problem is that it is difficult to do (apparently, since so few people do).

  57. elion 21 Mar 2012 at 2:10 pm

    Hi, Steven

    You write:
    “Long term weight control efficacy seems to be largely a factor of ease of compliance.”
    …..
    “Apparent advantages of low-carb diets are likely related to decreased hunger”

    I agree on both statements, but would you consider that decreased hunger is a factor that will ease long term compliance? – it seems to me, that being constantly hungry will be detrimental to “long term compliance”.
    This is exactly the benefit of LC – you feel less hungry. Atkins and Taubes have theories on why this happens, but it is really not important to accept them.
    (Taubes’s is off course well researched and he presents his case very compellingly – which can’t be said for most of his critics.)

    You write:
    “Regular exercise seems to be critical for long term weight management”

    “employ reasonable portion control and exercise regularly”

    In many other instances you dispense the same message, in SGU, other blogs, TTC etc…
    What is the scientific evidence for this? as far as I know there re is none.

    For example in the AHA/ACSM 2007 (American Heart Association/American College of Sports Medicine), Physical activity guidelines.
    http://circ.ahajournals.org/content/116/9/1081.long
    They conducted a review of the literature, they write:

    “The conclusion and consensus statement from this meeting
    were based on systematic reviews of the literature.
    Panel members also conducted extensive searches of
    the literature on physical activity and health to 2006.”

    And they write the following:

    “It is reasonable to assume that persons with relatively high
    daily energy expenditures would be less likely to gain weight
    over time, compared with those who have low energy
    expenditures. So far, data to support this hypothesis are not
    particularly compelling.”

    *So far, data to support this hypothesis are not particularly compelling*
    It can’t be doubted that due the ideological leaning of AHA/ACSM they looked hard for any shred of evidence.
    There is also no doubt that many attempts were made to show this effect since the 60′s (since Jean Myer).

    Isn’t continuing dispensing this “move more” recommendation is the same as other types of pseudo science which have no scientific basis?
    I guess people “simply know it must be true”.
    It is also goes very well with the implications of of cal-in/cal-out and the conscious control of food intake (food dairies, portion sizes, palatability etc..) – i.e. the obese are lazy and gluttons.

    If indeed as research points out it is impossible to loose weight by altering calories-out, what are the implication on the whole calories-in/calories-out hypotheses?

    Also you give more advice:
    “Whatever you do for weight control, make sure it is sustainable long term. You should be happy with your diet and exercise should be fun and convenient. Anything that seems burdensome will likely not last and be of no long term utility.”

    Very few things will add to the enjoyment of your chosen long term lifestyle – as not being ravenously hungry – by for example, eating less of the hunger inducing carbs (this is the implication “low-carb diets are likely related to decreased hunger” your statement from above).

    And a last one:
    “And most importantly – completely ignore diet fads, diet books, or any product that promises easy weight loss. They are scams.”

    This is a very problematic statement, sure there are scams, but some are not, some books are the only outlet for clinicians that do not accept “eat-less/move-more” “truism” – but they greatly and substantially help many people.
    This is a weird metric to use to decide the issue, and seems more of an ideology or some kind of an original sin type thing – i.e. you been lazy and indulgent – you will need to suffer to atone for your sins.

    But:
    You give the following advice, which is excellent, and should be number 1:
    “Limit carbohydrates with a high glycemic index (simple sugars and starches)”

  58. ccbowerson 21 Mar 2012 at 2:33 pm

    eli-

    “This is exactly the benefit of LC – you feel less hungry. Atkins and Taubes have theories on why this happens, but it is really not important to accept them.”

    You have missed Steve’s point, which is correct. The data regarding low carb diets does not demonstrate a long term effect (though a short term effect is noted). Before you hypothesize on how something works, lets first establish that it does work. The problem with short term impacts on weight is that they are not helpful, but appear to be detrimental.

    One thing I agree with you on is that the data supporting the importance of excercise in weight loss is pretty poor, and it makes sense… it is far easer to eat a thousand calories with the food currently available than to exercise it off. There are definitely studies implying that excessive intake is the main problem, but this for the weight consideration only…there are other benefits of excercise/physical activity.

  59. Helgeon 11 Feb 2013 at 9:10 am

    Here is an iteresting article:

    http://www.dietdoctor.com/a-low-carb-diet-superior-for-overweight-children-once-again

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