Defending the indefensible: Gary Taubes and *that* statement about gluttony.

Here's another "video" (it has sound and static images only). As I haven't learned how to embed a YouTube video that starts at a specific time, here's a link to it and a picture of it:- Gary Taubes' "Why We Get Fat" IMS Lecture On August 12, 2010 (Part 8 of 8), starting at 8 minutes and 8 seconds in.

To quote: "You can basically exercise as much gluttony as you want, as long as you're eating fat and protein."

I was told that Taubes was being ironic i.e. he was joking. I call bull-shit on that, for the following reasons.

1) You don't joke about something as important as diet, in a video that's likely to be heard by many people.

2) If you're foolish enough to joke about something as important as diet, you make 100% certain that listeners know that you're joking, by stating in the very next sentence that the preceding sentence was a joke. Taubes didn't do that.

3) I didn't hear chortling or any other audible clue that Taubes was joking. Did you?

I therefore conclude that the person who made the statement that Taubes was being ironic, is hearing (and seeing) the world through "cognitive bias" Weird Filters , resulting in her hearing what she wants to hear. Sorry!

No fat belly: no rocks and no hard places.

I finally defeated Google Image Search!

 Boo-Ya, Google!

I've been blogging about the problems associated with having a fat belly. It therefore figures that not having a fat belly is advantageous. I was asked whether "skinny-fat" people might have problems with high serum NEFAs when on a very-low-carbohydrate diet (≤50g/day of carbohydrate).

In my opinion, if fat cells in the belly area aren't stretched to the max, they won't be spewing NEFAs into the blood. Therefore, even "skinny-fat" people can safely go on a very-low-carbohydrate diet and stay on it indefinitely.

Not exactly rocket science, is it? Part 2

If there's a deficiency in "X", taking supplement "X" will correct the deficiency in "X".
If problem "Y" is caused by a deficiency in "X", then taking supplement "X" will fix problem "Y".

If there's no deficiency in "X", taking supplement "X" won't do anything.
If problem "Y" isn't caused by a deficiency in "X", then taking supplement "X" won't fix problem "Y".

If a person spends a lot of time outdoors in skimpy clothing in sun that's higher than 45deg in the sky, it's highly probable that they will not be deficient in Vitamin D3. Therefore, supplementing with 5,000iu/day of Vitamin D3 will highly probably do nothing.

If the above person has type 2 diabetes, supplementing with 5,000iu/day of Vitamin D3 won't fix their type 2 diabetes.

Not exactly...

Rocket Science!

There will be some people for whom all of the supplements & exercise that I recommend don't help their type 2 diabetes. Sorry about that. A low-carb (but not very-low-carb) diet will minimise your serum glucose level fluctuations without increasing your serum NEFA level excessively. See The problem with Diabetes.

Ketogenic diets - when they're not ketogenic.

High in the Arctic, Eskimo!

It's generally assumed that eating less than 50g/day of carbohydrate results in ketosis. Assume makes an ass out of "u" and "me". From Lyle McDonald's book The Ketogenic Diet:-

The Ketogenic Ratio (KR) = K/AK, where K = Ketogenic stuff and AK = Anti-ketogenic stuff.

K/AK =  (0.9*Fat + 0.46*Protein)/(1.0*Carbohydrate + 0.1*Fat + 0.58*Protein) where Fat, Protein & Carbohydrate are in grams.

For the treatment of epilepsy (very strongly ketogenic), K/AK must be greater than 1.5. For people who want to get into benign dietary ketosis, K/AK can be lower.

Eskimos eat a diet containing virtually zero dietary carbohydrate (~50g/day as muscle & liver glycogen). However, they are not in ketosis. See STUDIES ON THE METABOLISM OF ESKIMOS.

Eskimos eat so much protein that the Anti-ketogenic effect of Protein offsets the Ketogenic effect of Fat + Protein. Table IV is interesting, as it shows how much energy is lost as ketones on the third day of successive fasts in non-Eskimos (Subject #1 fasted once only). Note:- Beta-hydroxybutyric acid  produces 5kcals/g.

Subject #1:- 10.5kcals. ?kcals, ?kcals.
Subject #2:- 100.5kcals, 7.0kcals, 2.75kcals.
Subject #3:-  9.75kcals, 0.0kcals, 0.0kcals.

The answer is "not a lot" (except for Subject #2 on the first fast).

Low-glycaemic diet seen to reverse diastolic dysfunction of diabetes.

From http://www.medscape.com/viewarticle/802947?nlid=30763_1301&src=wnl_edit_dail (Medscape log-in required):-

"Of 32 overweight or obese diabetic patients (mean body-mass index, 34) without cardiac disease who were engaged in a "rehabilitation program in order to lose weight" that included two hours of supervised aerobic exercise per day, half followed a low-glycemic diet (25% carbohydrate, 45% fat, 30% protein) and the other half a low-fat diet (55% carbohydrate, 25% fat, and 20% protein) for three weeks. The diets provided the same amount of calories. Those on the low-fat diet then switched to the low-glycemic diet for an additional two weeks"

"....the two diets led to about the same declines in weight and waist circumference..."

The diet was 25% carbohydrate, 45% fat, 30% protein.
It was a low-carbohydrate/low-glycaemic load diet.
It was not a very-low-carb diet.

Dr. Richard K Bernstein on insulin for type 2 diabetics, and some definitions.

Dr. Richard K Bernstein:-

Dr. Richard Bernstein, the world's leading low-carb diabetologist, says in Diabetes: The Basics:-
"Many people (including the parents of diabetic children) view having to use insulin as a last straw, a final admission that they are (or their child is) a diabetic and seriously ill. Therefore they will try anything else - including things that will burn out their remaining beta cells - before using insulin. Many people in our culture have the notion that you cannot be well if you are using medication. This is nonsense, but some patients are so convinced that they must do things the “natural” way that I practically have to beg them to use insulin, which is as “natural” as one can go. In reality, nothing could be more natural. Diabetics who still have beta cell function left may well be carrying their own cure around with them - provided they don’t burn it out with high blood sugars and the refusal to use insulin."

Some definitions:-

From Low-carbohydrate diet:-
"The term "low-carbohydrate diet" is generally applied to diets that restrict carbohydrates to less than 20% of caloric intake, but can also refer to diets that simply restrict or limit carbohydrates."
A typical woman consumes ~2000kcals/day. A typical man consumes ~2,500kcals/day. Therefore...

Very-low-carb diet = <10% energy from carbs ≡ <~50 or ~62.5g carbs/day.
Low-carb diet = <20% energy from carbs ≡ <~100 or ~125g carbs/day.
"Healthy eating" = >55% energy from carbs ≡ >~275 or ~344g carbs/day.

The unusual suspects.

In The usual suspects., I banged on about deficiencies in Vitamin D3, long-chain omega-3 fatty acids (EPA & DHA) and Magnesium.

It's the one on the right. Our right, not their right.

According to Jane Karlsson, the iron-manganese ratio and the zinc-copper ratio are also very important. Very-low-carb diets can in theory cause iron overload (if lots of red meat is eaten) and deficiencies in manganese and copper. This may be why people on such diets often find that their glucose tolerance doesn't improve.

Dietary copper and risk of coronary heart disease.
Meat diets and fragile bones: inferences about osteoporosis.
PubMed search for Klevay LM[Author]

For the top 999 foods highest in Manganese per 100g serving, see HERE.

For the top 468 foods highest in Copper per 100g serving, see HERE.

Not exactly rocket science, is it?

If Paul (astrophysicist) Jaminet met Jack (neurosurgeon) Kruse ;-)

The paleo diet was recently ridiculed as a food fad in Natural’s Not In It. It also came last in a US News Best Diets survey.

Ways of eating such as very-low-carbohydrate, low-carbohydrate, low-reward, paleo, primal, ancestral, just eat real food etc discourage the consumption of manufactured food products and encourage the consumption of produce. If a large percentage of the population stop filling their shopping baskets with manufactured food products and start filling them with produce, who suffers? Not exactly...

This is why the food manufacturing industry tries to ensure that the population gets the best nutritional and dietetic advice that money can buy. See also New study: Big Food’s ties to Registered Dietitians.

While libertarians and anarchists moan about freedom from government interference, the food manufacturing industry has the freedom to crap all over the aforementioned diets and influence people to buy manufactured food products. Morbidity is also very profitable for healthcare and drug companies.

I think that I've now flogged this particular horse to death!

A comment, a simile and insanity.

A lot of my recent titles contain three items.

1) The comment: I'm just about to leave the following comment on Peter (Hyperlipid)'s blog post Insulin and the Rewards of overfeeding. I thought that it was so good at summing-up, I'll post it here first!

"All,

Insulin increases the amount of glucose & FFAs entering fat cells, muscle cells & the liver.

Insulin decreases the amount of glycerol & FFAs exiting fat cells & the amount of glucose exiting the liver.

Hyperinsulinaemia (which can produce sedation) results when one or more of the following tissues loses insulin sensitivity:- fat cells, muscle cells & the liver.

So, why do people keep saying that hyperinsulinaemia locks nutrients away in fat cells only, thus robbing other cells of nutrients, thus causing lethargy?

The relative insulin sensitivity of tissues determines the relative partitioning of nutrients into those tissues.

When tissues lose sensitivity to insulin, blood glucose control becomes impaired. This results in a roller-coaster blood glucose level after eating high-glycaemic carbohydrates. A rapidly-falling blood glucose level can cause ravenous hunger. I have experienced this during medically-monitored tests (OGTTs & an insulin shock test).

Low-carb/ketogenic diets don't result in a roller-coaster blood glucose level and therefore don't cause ravenous hunger. Simples!

Over-eating due to ravenous hunger is NOT gluttony, just as under-moving due to sedation is NOT sloth.

THIS is gluttony."

EDIT: This didn't go in my comment but should have:- "Low-carb/ketogenic diets result in the avoidance of moreish & calorific foods such as sweets, chocolate, cake, biscuits, pizza, Pringles etc. A single bite of such foods has a negligible effect on blood glucose & insulin levels, but encourages another bite and another and another ad nauseam due to Food Reward.

2) The simile: I use similes. I used the simile "As happy as a pig in shit" in a comment somewhere on Woos blog. Now, you may (or may not) have noticed that my user-name is Nigeepoo. We Brits are obsessed by two things - The weather and our bowel movements. I find things to do with poo and farting amusing (schoolboy humour, I know!). I used the simile "As happy as a pig in shit" because it is amusing to me.

3) The insanity: According to Woo in the following comment:-

"Re: the comment...Sorry, not convinced.
You are basically refusing to admit your choice of words implied moral judgement. The phrase "happier than a pig in shit" is always applied to examples of people being content in immorality/bad behavior particularly gluttony and sloth... unless it is used ironically. Only an autistic or a non-english speaker would believe this crap."

Woo, you are as mad as a March hare. IMO of course, like everything I write. Duh!

We are not all the same.

Cont'd from Everyone is Different.

Lyle (McDonald) brought the following study to my attention to illustrate that "We are not all the same":- Some Metabolic Changes Induced by Low Carbohydrate Diets. On a very-low-carb diet, one subject’s total cholesterol rose to 12.9mmol/L (500mg/dL in US units). The others didn't.
See also LDL cholesterol goes sky high on fatty diet.

I posted the study in various blogs to make the above point. Here are some of the replies I got:-
"Lyle? Lyle McDonald? Is that where you got that study, Nigel?" and... "I’m usually a pretty polite guy, Nigel. But based on this quote from the beginning of the study you mentioned, the people who wrote this study were a bunch of f**kwads, and really don’t deserve our attention. It’s a hatchet job."
"That was a weird study (1967) what I could make of it." and... "The men did all the stages but the women only did 3 stages of the diet."
"The fats were mostly omega-6 PUFA 13-35 grams worth..."
"The report you cite is so old and out of date that it makes me cry..."

My point was well & truly missed. I got the distinct impression that people thought I was criticising very-low-carb, high-fat diets. I wasn't. The simple fact is that there is no "One True Diet" that suits absolutely everybody. In the olden days everywhere & in poor countries nowadays, people that ate/eat the wrong diet for their body died/die young. Nowadays in rich countries, they get put on drugs e.g. oral hypoglycaemics (to lower blood glucose) & hypolipidaemics (to lower blood cholesterol/triglycerides).

Please note that omega-6 PUFAs tend to lower serum cholesterol rather than raise it, as per Fig. 2 of Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review. However, don't rush off and eat shed-loads of omega-6 PUFA (e.g. corn oil) in the mistaken belief that it will make you live any longer. See (1971) Incidence of cancer in men on a diet high in polyunsaturated fat - Pearce.

Finally, for a little light relief, here is the latest result for Google Fight between "Healthy "low-fat diet"" and "Healthy "low-carb diet"". Oh, YES!

Cont'd on Everyone is Different, Part 2.

Everybody knows.........Part 2

.........that ketogenic diets like the Atkins diet destroy your kidneys and rot your bones, right? Wrong!
.........that the Atkins diet causes ketoacidosis which is a very dangerous condition requiring urgent hospital treatment, right? Wrong!

There's a lot of nonsense spoken about ketogenic diets by people who really should know better. I suspect that they have been taught wrongly at uni or med school as per the quote in Everybody knows.........Part 1.

Benign Dietary Ketosis is NOT Ketoacidosis.

Consider the following four cases:- Note: Figures are from "Introduction to Nutrition and Metabolism" By David A Bender (Senior Lecturer in Biochemistry, UCL)

1) Healthy human, fed state: Glycogen stores are replete. Serum glucose = ~5.5mmol/L. Serum fatty acids = ~0.3mmol/L. Serum ketones = 0mmol/L. No gluconeogenesis is taking place. Amino acid pool is replete. Cortisol level is normal so there is no loss of muscle mass.

2) Healthy human, fasting for 7 days: Glycogen stores are depleted. Serum glucose falls to ~3.5mmol/L. Serum fatty acids rise to ~1.2mmol/L. Serum ketones (mainly D-3-hydroxybutyrate) rise to ~4.5mmol/L (not high enough to cause acidosis). Gluconeogenesis is occurring. Amino acid pool is depleted. Cortisol level is high, causing slow loss of muscle mass. This is bad ketosis.

3) Healthy human, low-carbohydrate diet: Glycogen stores are depleted. Serum glucose falls to ~5mmol/L.
Serum fatty acids rise to ~1.2mmol/L. Serum ketones (mainly D-3-hydroxybutyrate) rise to ~4.5mmol/L (not high enough to cause acidosis). Gluconeogenesis is occurring. Amino acid pool is replete (due to protein intake). Cortisol level is normal so there is no loss of muscle mass. This is good ketosis.

4) Human with untreated type 1 diabetes: Glycogen stores are depleted. Due to lack of insulin, the Glu-T4 transporters in cells cannot move to the surface so glucose cannot enter cells. Serum glucose = >20mmol/L. This causes major damage to kidneys, arteries, eyes, nerves etc by cross-linking with proteins (glycation) resulting in major disability and eventual death. As the body is forced to run on fatty acids & ketones, metabolic processes are out of control and ketones rise to much higher levels than in 2) or 3) (I don't know how high exactly) resulting in acidosis and eventual death. This is ketoacidosis.

Conclusion: Low-carbohydrate, very-low-carbohydrate & ketogenic dieting is similar to fasting in that serum glucose levels are lower than normal and glycogen stores are depleted. The body is encouraged to burn less glucose and more fatty acids & ketones, but the metabolic processes are all under control. The big difference between low-carbohydrate dieting and fasting is in the amino acid pool and cortisol levels.

Everyone is Different.

Updated text in bold green.
If there is one thing that I have learned over the years of research into Diet and Nutrition, it's this: Everyone is Different. When I first discovered Low-carb Diets (thanks to the late Dr Atkins), I thought that it was the One True Diet, and I became a bit of an "Atkins Diet" bore telling everyone how wonderful it was and suggesting that everyone should be on it.

I now know that what suits me doesn't necessarily suit someone else. So why do "Healthy Eating" guidelines assume that everyone is the same and tell everyone to get 15% of their total calories from proteins, 55% from carbohydrates and 30% from fats?

To illustrate just how different people are, here's Fig. 2 from Determinants of the variability in respiratory exchange ratio at rest and during exercise in trained athletes. Used with permission.

Respiratory Exchange Ratio (RER) (a.k.a. Respiratory Quotient (RQ)) is the ratio of carbon dioxide breathed out to oxygen breathed in. This ratio depends on the fuel that the body is burning for energy. For example, if the body is burning 100% fat, RER = 0.7. If the body is burning 100% carbohydrate aerobically, RER=1.0. If the body is burning 100% carbohydrate anaerobically (flat-out sprinting), RER > 1.0. RER goes up and down depending on intensity of exercise, food intake (eating protein and/or carbohydrate increases it and extended fasting reduces it). Increasing cardiovascular fitness reduces RER.

The top diagram is a histogram of fasted RER and % fat oxidation vs. number of subjects. At the left-hand end of the histogram, there are two cyclists with a fat oxidation of 93 - 100%. At the right-hand end of the histogram, there is one cyclist with a fat oxidation of 20 - 27%.

There's a helluva big difference between burning 93 - 100% fat at rest and burning 20 - 27% fat at rest. Interestingly, average fat oxidation is 66%, which means that average carb oxidation is 34%. So, on average, at rest, people burn twice as much energy from fat as from carbs. So why do current "Healthy Eating" guidelines recommend almost twice as much energy from carbs as from fats for everyone, including sedentary people?

As exercise intensity increases, the peak in the histogram shifts to the right as shown in the lower diagram. At 25% full work-load, mean fat oxidation is ~53%. At 50% full work-load, mean fat oxidation is ~37% and at 75% full work-load, mean fat oxidation is ~13%.

I suspect that at 100% full work-load, mean fat oxidation is 0% i.e. 100% of energy is obtained from carbs when sprinting flat-out. Somebody on a very low carb diet like Atkins induction (~20g net carbs/day) could keel over with hypoglycaemia if they exercise for any length of time at this rate.

As there is so much variation from person to person, you must find out for yourself your own optimum proportions of proteins, fats and carbohydrates and these depend upon the intensity and volume of exercise you do. It all sounds a bit complicated but it isn't really.

Just apply the principle of "Eat, monitor and adjust accordingly" as Toxic Toffee (ex-Muscletalk member) always used to say. The eating bit I will advise on in future Blog posts. The monitoring bit does not involve the use of bathroom scales.

Hang on, isn't "dieting" all about losing excess weight? Not necessarily. Remember the old joke: Q. What's the best way to lose 5lbs of ugly flab? A. Cut your head off! As your body is made up of water, muscle, fat, bones, cartilage, tendons, organs, glycogen, skin etc and your scales can't tell the difference between them, losing weight the wrong way can make you less healthy. However, losing weight the right way will make you more healthy.

If you starve yourself or skip breakfast or go for a fast run before eating breakfast, as your body is lacking in glycogen and amino acids, a large amount of a corticosteroid hormone called cortisol is secreted which converts muscle into amino acids, then glucose. It also suppresses your immune system and weakens your skin and bones.

Unless you have a lot of muscle to spare, it's body-fat that you should be losing, and to monitor this, either use a tape-measure around your waist, or check how loose/tight your clothes are, or strip-off and jump up and down in front of a full-length mirror. As Big Les (Muscletalk Moderator) says, "If it jiggles, it's fat!".

So, what happens if you eat too many carbs but your body doesn't burn them fast enough? Initially, carbohydrate intake tops-up liver and muscle glycogen stores, which increases carb-burning to compensate. The liver can store about 70g of glycogen and muscles can store about 400g of glycogen. If, despite increased carb-burning, more carbohydrate is consumed than is burned, glycogen stores continue to fill. When glycogen stores become full, RER increases to 1.0 and 100% of energy is derived from carbohydrate. Getting 100% of energy from carbohydrate means that zero fat is burned, so filling glycogen stores by eating loads of carbohydrate is not a good idea if you want to burn body-fat. Once glycogen stores are full, any additional intake of carbohydrate beyond that which is burned passes through the lipogenesis pathway - this basically means that carbs are turned into fat - which you end up wearing as body-fat. But there's even worse news. On the way to being worn as body-fat, fat is in the blood as triglycerides. This is bad for the cholesterol particles in your blood. See the Blog on Cholesterol and Coronary Heart Disease. What happens if you eat too few carbs? As stated above, a "carb-burner" taking in insufficient carbs could get hypoglycaemia.

How many grams of carbohydrate per day does it take to promote lipogenesis? Someone at rest burns ~1kcal/minute. If this is derived 100% from carbohydrate, this is equivalent to 0.25g of carbohydrate /minute, or 15g of carbohydrate /hour, or 360g of carbohydrate /day. Therefore, sedentary people who consistently eat more than 360g of carbohydrate /day will produce significant triglycerides. People who have The Metabolic Syndrome/Syndrome-X (a high proportion of people who have excess belly fat) have increased lipogenesis and higher serum triglycerides than healthy people.

Just discussing weight again for a moment, it's often said that all diets are the same, as weight loss is all about calories. This is true. See Is a Calorie a Calorie? However, body composition is determined by a combination of macro-nutrient proportions (i.e. the relative amounts of protein, carbohydrates and fat that you eat) and the intensity and volume of exercise.

So, if all you're interested in is weight loss, just count calories. If however, you wish to lose body-fat without losing muscle, you need to know how to determine what proportions of proteins, carbs and fats to eat (it's not that critical, but many people get it totally wrong). You need to know the difference between good carbs and bad carbs and good fats and bad fats. You need to know the best times to eat proteins, carbs and fats (it's not that critical, but many people get it totally wrong). You need to know the difference between good exercise and bad exercise.

Cont'd on We are not all the same.