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Lessons from a week-long binge

I was traveling and socializing recently, most of a week. Due to this, I cast normal dieting out the window. No time-restricted feeding, no macronutrient optimization, not even processedness minimization nor any attention paid to fatty acids compositions. As far as I can recall, I ate:

  • eggs (breakfast option at the hotel),
  • various meats (chicken, pork, fish),
  • apples and other fruits,
  • croissants (mostly plain),
  • and various junk food items like burgers, fries, some restaurant food, plus sundry other ultra-processed foods in relatively small quantities.

I’ve learned that, to my dismay, the unprocessed, protein-heavy diet I use to manage my weight does work to restrict my calorie intake. Going over 3000 kcal is a chore – I’m stuffed, which prevents me from eating more, even if I would like to. Not so with normal people’s junk food – I can overeat thousands of calories per day of that. The only reason I didn’t eat more than three croissants on the way back from the party to the hotel an hour ago, is because the shops were already closed, and I did not want to turn back to the train station to get more from the all-night shop.

I probably would have overeaten even more during the whole time, but for my liking of fresh fruit. Those are quite filling and low-calorie.

Review: The Hungry Brain by Stephan Guyenet

Disclosures

I happen to like Dr Guyenet (from our interactions on Twitter), and am biased in favor of his ideas on obesity. I will attempt to be harsher and more nit-picky than I would have been otherwise, to give his work a fair shake, despite the fact that he hasn’t annoyed me with his Twitter antics like his arch-rival, Gary Taubes.

General impressions

It’s readable – I should know, having read it three times. Some parts are easy to understand, while others are pretty taxing, especially the explanation of how the brain works. The chapter about sleep is boring, IMO, probably because I already sleep well.

Guyenet, surprisingly, paints a very similar picture to Taubes in The Case for Keto. Pretty much all of the unobjectionable parts of TCFK are present in THB, in different words. The eminent differences being that Taubes doesn’t really buy into the calories concept (or at least not using the same causality arrows), whereas Guyenet does, and that Taubes blames dietary carbohydrate for obesity, whereas Guyenet blames convenient junk food in general.

If I were to give an elevator speech about the core claims of the book, it would be something to the tune of:

Changes in adiposity reflect energy balance, which is managed primarily by the unconscious parts of the brain. These systems are not adapted to the deliciousness, abundance and convenience of modern food. This causes chronic overeating, and therefore obesity in genetically susceptible individuals.

The unobjectionable

  • Energy balance determines changes in adiposity1,5. If you are getting fatter, you must be in a positive caloric balance; if you are getting leaner, you must be in a negative caloric balance.
  • Americans are eating more now than they were eating in the 1960s2. Even adjusting for uncertainty due to faulty methods, it seems likely to be true.
  • Highly palatable, ready-to-eat, industrially produced human foods (“junk food”) are exceptionally fattening in animals and in humans3. This happens through increased, spontaneous consumption.
  • The brain regulates appetite and energy expenditure4,5, by collecting information emitted biochemically by other tissues. This functionality has been in there for a long time, at least since primitive fish8. Damaging the hypothalamus in specific ways can induce ravenousness or disinterest in food7.
  • Food preferences are learned and socially constructed to some extent, but the brain is mostly concerned with calories and salt, while avoiding toxins9. Micronutrients are unmanaged in general, while calorie returns for time spent are maximized10. Some foods (like meat10) are regarded more valuable than their calorie content would imply.
  • Processing and refining increases the reward value (as the brain perceives it) of foods5.
  • Satiety is sensory-specific, and variety increases energy intake5.
  • How hard you are willing to work for food predicts weight gain. How impulsive you are predicts weight gain11. Reinforcement pathology is the mechanism here12.
  • Hunter-gatherers have diets that are low density of reward factors, limited variety, low ability to refine foods, and are very lean13,14.
  • Market forces are behind the increase in food environment obesogenicity15.
  • Convenience and cost of food have changed in ways that make them better deals under Optimal Foraging Theory5,10,15.
  • Congenital leptin deficiency causes extreme obesity in animals and humans5. In normal obesity, leptin is elevated, and adding more has little effect5,16. There probably exists some unidentified factor that defends against overfeeding6.
  • People gain fat as they age6. This doesn’t happen in primitives14,17,18.
  • Exercise (inasmuch as it maintains fitness) is probably good for you19.
  • High protein intake is good for you20.
  • Endogenous high insulin doesn’t cause obesity21.
  • Many different dietary approaches work (poorly)22.
  • Feasts without famines, and overeating should be avoided6.
  • Simple whole foods have high satiety value23.
  • Susceptibility to obesity, given the right environment, is genetic5,6. Some few people are resistant, most are not6. This seems enormously polygenic aside from a few really bad monogenic mutations24.
  • Sleep deprivation causes overeating25.
  • Fighting one’s own brain regarding hunger is a losing battle, success is not expected26.

The objectionable

Palatability and food reward

Guyenet uses the following definitions:

Food that brings us pleasure when we eat it is described as palatable. Palatable food tastes good. It’s a sign that the brain values a food, either as a result of instinct or reinforcement learning.
The brain presumably values certain food properties above others because they would have increased the reproductive success of our ancestors. The most highly palatable foods tend to be dense in easily digested calories and combine multiple innately preferred food properties in highly concentrated form: ice cream, cookies, pizza, potato chips, french fries, chocolate, bacon, and many others. These are the foods that are most likely to cause cravings and a loss of control over eating, because their physical properties make them exceptionally reinforcing, motivating and palatable. Researchers have an umbrella term for this combination of effects on the brain: food reward. Highly rewarding foods are those that seduce us.

He considers these to be a dominant factor in the common human obesity. This is plausible, and there is experimental evidence that lowering the tastiness of food results in weight loss29,30, but there are some corner cases that cast some doubt on this.

For one, it is possible to engineer a non-fattening diet that tastes good to the point of being universally preferred over a fattening diet – at least in rodents28. It is plausible to me that many of the successful individuals in dietary trials (individual variation in body mass delta is extreme, while the mean result is uninspiring31) owe their success to finding a diet that for them happens to be non-obesogenic and highly preferred over alternatives.

For another, recent (THB was written years before, mind) highly-controlled inpatient trials32,33 show that calorie intake can vastly differ between diets even when self-reported palatability is the same. Given the magnitude of these effects, it’s not clear to me at all that palatability or food reward drives modern obesity. It may be as simple as the fact that the current environment is pretty much never calorie-restricted and the set point ratchets upwards after every incomplete recovery from an overfeeding session6.

Behavioural advice

Guyenet gives some advice, summaries in brackets mine:

1. Fix your food environment [remove food cues from your perception]

2. Manage your appetite [eat foods with high satiety per calorie]

3. Beware of food reward [avoid junk foods problematic for you]

4. Make sleep a priority [fix anything that prevents good amount and quality thereof]

5. Move your body [physical activity every day]

6. Manage stress [fix causes of stress and meditate, don’t cope with food]

Again, this is all plausible and common sense… but at the same time, trials don’t really back up any sort of behavioural treatment for obesity much as truly effective at resolving the condition 34,35. Even if Guyenet’s specific advice were twice as effective, that’s barely a dent in the problem.

It’s not that this advice is wrong per se, it’s just that I think it’ll primarily help the sort of people who are already capable of supreme personal discipline, and just needed information on what specific procedures to implement.

Exercise

In particular, I object to exercise or physical activity having much to do with body fatness. Trials consistently indicate that the difference that exercise makes for body weight is about 1 kg36,37. Furthermore, total energy expenditure doesn’t explain the differences between obesity across countries38 and even hunter-gatherers don’t have different expenditures compared to the civilized39, so any effect of exercise would have to be via intake regulation (as Guyenet hypothesizes) – and that looks highly individual-dependent in terms of response40.

Conclusions

Overall, I like the work, and I think it’s closer to concordance with reality than Taubes’ book, and it’s academically valuable, but the advice is really not all that useful unless you don’t know the first thing about weight management. If you’ve got an iron will and unflinching discipline to apply them, the instructions will likely help, but if not, I doubt Guyenet’s program will be much more effective than existing behavioural weight management strategies.

References

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  2. Hall KD. Did the Food Environment Cause the Obesity Epidemic?. Obesity (Silver Spring). 2018;26(1):11-13. doi:10.1002/oby.22073
  3. Lalanza JF, Snoeren EMS. The cafeteria diet: A standardized protocol and its effects on behavior. Neurosci Biobehav Rev. 2021 Mar;122:92-119. doi: 10.1016/j.neubiorev.2020.11.003. Epub 2020 Dec 10. PMID: 33309818.
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  5. Michael W Schwartz, Randy J Seeley, Lori M Zeltser, Adam Drewnowski, Eric Ravussin, Leanne M Redman, Rudolph L Leibel, Obesity Pathogenesis: An Endocrine Society Scientific Statement, Endocrine Reviews, Volume 38, Issue 4, 1 August 2017, Pages 267–296, https://doi.org/10.1210/er.2017-00111
  6. Lund J, Lund C, Morville T, Clemmensen C. The unidentified hormonal defense against weight gain. PLoS Biol. 2020;18(2):e3000629. Published 2020 Feb 25. doi:10.1371/journal.pbio.3000629
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  8. Tessmar-Raible K, Raible F, Christodoulou F, Guy K, Rembold M, Hausen H, Arendt D. Conserved sensory-neurosecretory cell types in annelid and fish forebrain: insights into hypothalamus evolution. Cell. 2007 Jun 29;129(7):1389-400. doi: 10.1016/j.cell.2007.04.041. PMID: 17604726.
  9. Rozin P. Acquisition of stable food preferences. Nutr Rev. 1990 Feb;48(2):106-13; discussion 114-31. doi: 10.1111/j.1753-4887.1990.tb02912.x. PMID: 2407977.
  10. Hawkes, Kristen, et al. “Why Hunters Gather: Optimal Foraging and the Aché of Eastern Paraguay.” American Ethnologist, vol. 9, no. 2, 1982, pp. 379–398. JSTOR, www.jstor.org/stable/644682. Accessed 1 Aug. 2021.
  11. Bénard M, Camilleri GM, Etilé F, Méjean C, Bellisle F, Reach G, Hercberg S, Péneau S. Association between Impulsivity and Weight Status in a General Population. Nutrients. 2017 Mar 1;9(3):217. doi: 10.3390/nu9030217. PMID: 28257032; PMCID: PMC5372880.
  12. Epstein LH, Salvy SJ, Carr KA, Dearing KK, Bickel WK. Food reinforcement, delay discounting and obesity. Physiol Behav. 2010 Jul 14;100(5):438-45. doi: 10.1016/j.physbeh.2010.04.029. Epub 2010 May 21. PMID: 20435052.
  13. King BM. The modern obesity epidemic, ancestral hunter-gatherers, and the sensory/reward control of food intake. Am Psychol. 2013 Feb-Mar;68(2):88-96. doi: 10.1037/a0030684. Epub 2012 Dec 17. PMID: 23244211.
  14. Pontzer H, Wood BM, Raichlen DA. Hunter-gatherers as models in public health. Obes Rev. 2018 Dec;19 Suppl 1:24-35. doi: 10.1111/obr.12785. PMID: 30511505.
  15. Pierre Chandon, Brian Wansink, Does food marketing need to make us fat? a review and solutions, Nutrition Reviews, Volume 70, Issue 10, 1 October 2012, Pages 571–593, https://doi.org/10.1111/j.1753-4887.2012.00518.x
  16. Farr OM, Gavrieli A, Mantzoros CS. Leptin applications in 2015: what have we learned about leptin and obesity?. Curr Opin Endocrinol Diabetes Obes. 2015;22(5):353-359. doi:10.1097/MED.0000000000000184
  17. Lindeberg S, Berntorp E, Nilsson-Ehle P, Terént A, Vessby B. Age relations of cardiovascular risk factors in a traditional Melanesian society: the Kitava Study. Am J Clin Nutr. 1997 Oct;66(4):845-52. doi: 10.1093/ajcn/66.4.845. PMID: 9322559.
  18. Zeng, Wu & Eisenberg, Dan & Rubio, Karla & Undurruga, Eduardo & Nyberg, Colleen & Tanner, Susan & Reyes-García, Victoria & Leonard, William & Castano, Juliana & Huanca, Tomás & Mcdade, Thomas & Godoy, Ricardo. (2011). Adult Body Mass and Body Fat Associated with Consumption of Traditional Food and Good Health: Evidence from Native Amazonians.
  19. Blair SN, Kohl HW 3rd, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989 Nov 3;262(17):2395-401. doi: 10.1001/jama.262.17.2395. PMID: 2795824.
  20. Santesso N, Akl EA, Bianchi M, Mente A, Mustafa R, Heels-Ansdell D, Schünemann HJ. Effects of higher- versus lower-protein diets on health outcomes: a systematic review and meta-analysis. Eur J Clin Nutr. 2012 Jul;66(7):780-8. doi: 10.1038/ejcn.2012.37. Epub 2012 Apr 18. PMID: 22510792; PMCID: PMC3392894.
  21. Hall KD, Guyenet SJ, Leibel RL. The Carbohydrate-Insulin Model of Obesity Is Difficult to Reconcile With Current Evidence. JAMA Intern Med. 2018 Aug 1;178(8):1103-1105. doi: 10.1001/jamainternmed.2018.2920. PMID: 29971320.
  22. Ge L, Sadeghirad B, Ball G D C, da Costa B R, Hitchcock C L, Svendrovski A et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials BMJ 2020; 369 :m696 doi:10.1136/bmj.m696
  23. Holt SH, Miller JC, Petocz P, Farmakalidis E. A satiety index of common foods. Eur J Clin Nutr. 1995 Sep;49(9):675-90. PMID: 7498104.
  24. Farooqi IS, O’Rahilly S. Monogenic obesity in humans. Annu Rev Med. 2005;56:443-58. doi: 10.1146/annurev.med.56.062904.144924. PMID: 15660521.
  25. Al Khatib HK, Harding SV, Darzi J, Pot GK. The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. Eur J Clin Nutr. 2017 May;71(5):614-624. doi: 10.1038/ejcn.2016.201. Epub 2016 Nov 2. PMID: 27804960.
  26. Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health. 2015 Sep;105(9):e54-9. doi: 10.2105/AJPH.2015.302773. Epub 2015 Jul 16. PMID: 26180980; PMCID: PMC4539812.
  27. (removed)
  28. Tordoff MG, Pearson JA, Ellis HT, Poole RL. Does eating good-tasting food influence body weight? Physiol Behav. 2017 Mar 1;170:27-31. doi: 10.1016/j.physbeh.2016.12.013. Epub 2016 Dec 15. PMID: 27988248; PMCID: PMC5250539.
  29. Hashim SA, Van Itallie TB. Studies in normal and obese subjects with a monitored food dispensing device. Ann N Y Acad Sci. 1965 Oct 8;131(1):654-61. doi: 10.1111/j.1749-6632.1965.tb34828.x. PMID: 5216999.
  30. M. Cabanac, E.F. Rabe. Influence of a monotonous food on body weight regulation in humans. Physiology & Behavior, Volume 17, Issue 4, 1976, Pages 675-678, ISSN 0031-9384. https://doi.org/10.1016/0031-9384(76)90168-2.
  31. Gardner CD, Trepanowski JF, Del Gobbo LC, et al. Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial. JAMA. 2018;319(7):667–679. doi:10.1001/jama.2018.0245
  32. Hall KD, Guo J, Courville AB, Boring J, Brychta R, Chen KY, Darcey V, Forde CG, Gharib AM, Gallagher I, Howard R, Joseph PV, Milley L, Ouwerkerk R, Raisinger K, Rozga I, Schick A, Stagliano M, Torres S, Walter M, Walter P, Yang S, Chung ST. Effect of a plant-based, low-fat diet versus an animal-based, ketogenic diet on ad libitum energy intake. Nat Med. 2021 Feb;27(2):344-353. doi: 10.1038/s41591-020-01209-1. Epub 2021 Jan 21. PMID: 33479499.
  33. Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, Chung ST, Costa E, Courville A, Darcey V, Fletcher LA, Forde CG, Gharib AM, Guo J, Howard R, Joseph PV, McGehee S, Ouwerkerk R, Raisinger K, Rozga I, Stagliano M, Walter M, Walter PJ, Yang S, Zhou M. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019 Jul 2;30(1):67-77.e3. doi: 10.1016/j.cmet.2019.05.008. Epub 2019 May 16. Erratum in: Cell Metab. 2019 Jul 2;30(1):226. Erratum in: Cell Metab. 2020 Oct 6;32(4):690. PMID: 31105044; PMCID: PMC7946062.
  34. LeBlanc ES, Patnode CD, Webber EM, Redmond N, Rushkin M, O’Connor EA. Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;320(11):1172–1191. doi:10.1001/jama.2018.7777
  35. Helen P Booth, Toby A Prevost, Alison J Wright, Martin C Gulliford, Effectiveness of behavioural weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis, Family Practice, Volume 31, Issue 6, December 2014, Pages 643–653, https://doi.org/10.1093/fampra/cmu064
  36. Wu, T., Gao, X., Chen, M. and Van Dam, R.M. (2009), Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis. Obesity Reviews, 10: 313-323. https://doi.org/10.1111/j.1467-789X.2008.00547.x
  37. Marion J. Franz, Jeffrey J. VanWormer, A. Lauren Crain, Jackie L. Boucher, Trina Histon, William Caplan, Jill D. Bowman, Nicolas P. Pronk. Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Weight-Loss Clinical Trials with a Minimum 1-Year Follow-Up. Journal of the American Dietetic Association, Volume 107, Issue 10, 2007, Pages 1755-1767, ISSN 0002-8223. https://doi.org/10.1016/j.jada.2007.07.017.
  38. Dugas LR, Harders R, Merrill S, Ebersole K, Shoham DA, Rush EC, Assah FK, Forrester T, Durazo-Arvizu RA, Luke A. Energy expenditure in adults living in developing compared with industrialized countries: a meta-analysis of doubly labeled water studies. Am J Clin Nutr. 2011 Feb;93(2):427-41. doi: 10.3945/ajcn.110.007278. Epub 2010 Dec 15. PMID: 21159791; PMCID: PMC3021434.
  39. Pontzer, H., Raichlen, D.A., Wood, B.M., Emery Thompson, M., Racette, S.B., Mabulla, A.Z. and Marlowe, F.W. (2015), Energy expenditure and activity among Hadza hunter-gatherers. Am. J. Hum. Biol., 27: 628-637. https://doi.org/10.1002/ajhb.22711
  40. MELANSON, EDWARD L.1; KEADLE, SARAH KOZEY2; DONNELLY, JOSEPH E.3; BRAUN, BARRY4; KING, NEIL A.5 Resistance to Exercise-Induced Weight Loss, Medicine & Science in Sports & Exercise: August 2013 – Volume 45 – Issue 8 – p 1600-1609 doi: 10.1249/MSS.0b013e31828ba942

Traditionis Custodes

There’s recently been an interesting development – regulation of the use of the Tridentine Mass has been delegated to the diocesan bishops, with instructions not to create new groups using it. This has force of law, it’s not a polite suggestion.

I’m not sure what to think about it. On one hand, I would like less schismatic-like activity. On the other hand, I don’t see anything wrong with preferring one form of Mass or another. It doesn’t affect me much, as I attend Novus Ordo parishes – I’ve been to a Tridentine Mass exactly once in my life.

Reference

APOSTOLIC LETTER ISSUED “MOTU PROPRIO” BY THE SUPREME PONTIFF FRANCIS. «TRADITIONIS CUSTODES». On the Use of the Roman Liturgy Prior to the Reform of 1970.

Protein restriction and FGF21

In order to broaden my horizons, I’ve been hitting the protein restriction literature. It’s pretty interesting. For the organisms studied (AFAIK, so far they’ve done monocellulars, invertebrates and rodents), it seems to work similarly to calorie restriction (which has been studied even in primates), ie. extend lifespan. It shares the same issues in early life, too, namely being unsuitable for childhood, and for reproduction, never mind physical performance or bodybuilding. But it does extend lifespan in a geriatric context.

The primary mechanism identified is dramatically increasing FGF21, a liver enzyme that basically makes your metabolism inefficient, funneling energy into thermogenesis over storage. This normally works in the context of a low-protein, high-carbohydrate diet, but I suppose the low-protein ketogenic diets may work this way as well, given that they do raise energy expenditure slightly. Side-effects include weight loss and increased insulin sensitivity, but also lack of satiety (which might cancel the weight loss, but usually not).

The cutting edge of the last few years is optimizing the individual amino acids to get the benefits, but avoid some or all the drawbacks. The 2017 study by Piper et al is pretty brilliant in my opinion1,2.

What they did was take genomic data, convert it into protein (since DNA codes for proteins), and analyze those proteins for their component amino acids. Then they compared what the critters they were studying ate on a protein-restricted diet, and filled in the apparent deficiencies to make the profile more like proteins the critter’s genetic code describes. The critters benefited both in reproduction, longevity and satiety – essentially had their cake and ate it, too.

Last year, some Danes did a similar analysis of human genetics3, finding that leucine, methionine, and threonine were the “limiting” amino acids in the low-protein dietary situation. The protein restricted diet was described in a supplement to another article4 and to quote, it “comprised of (by weight) 51% fruits and vegetables, 25% bread and pasta, 17% juice, conserves and condiments, 4% sweets, 1% meat, 1% dairy products, and 1% nuts and oils.”

The protein-restricted diet wasn’t super low in protein, mind. At 85kg, I’d be getting about the same amount of grams in protein per day. Experiments on animals are usually about half to two-thirds that, oscillating on the very edge of viability.

For reference, the Estimated Average Requirement (EAR) is 0.66 g/kg and the RDA is 0.8 g/kg5. This is well above the RDA. The EAR and RDA are on the basis of nitrogen balance, however, which probably underestimates protein requirements. Negative nitrogen balance is where the organism cannot compensate further for low protein intake.

I made a comparison of some common protein sources – biased to what I currently eat.

Eggs look really good, with no large differences in essential amino acids, and only two conditional amino acids underrepresented (and plenty of substrates to make up the difference).

Sources

  1. Piper MDW, Soultoukis GA, Blanc E, et al. Matching Dietary Amino Acid Balance to the In Silico-Translated Exome Optimizes Growth and Reproduction without Cost to Lifespan [published correction appears in Cell Metab. 2017 May 2;25(5):1206]. Cell Metab. 2017;25(3):610-621. doi:10.1016/j.cmet.2017.02.005
  2. MacArthur MR, Mitchell JR. Feeding the Genome: In Silico Optimization of Dietary Amino Acid Composition. Cell Metab. 2017;25(3):486-488. doi:10.1016/j.cmet.2017.02.015
  3. Sjøberg KA, Schmoll D, Piper MDW, Kiens B, Rose AJ. Effects of Short-Term Dietary Protein Restriction on Blood Amino Acid Levels in Young Men. Nutrients. 2020;12(8):2195. Published 2020 Jul 23. doi:10.3390/nu12082195
  4. Maida A, Zota A, Sjøberg KA, et al. A liver stress-endocrine nexus promotes metabolic integrity during dietary protein dilution. J Clin Invest. 2016;126(9):3263-3278. doi:10.1172/JCI85946
  5. Traylor DA, Gorissen SHM, Phillips SM. Perspective: Protein Requirements and Optimal Intakes in Aging: Are We Ready to Recommend More Than the Recommended Daily Allowance?. Adv Nutr. 2018;9(3):171-182. doi:10.1093/advances/nmy003

Nomenclature

I dislike every currently-used term to describe a diet composed of “only” “animal foods”.

“Zero carb”? It’s not literally zero carb, particularly if you eat stuff like liver and eggs. Nevermind dairy or honey.

“Carnivore”? Even disregarding the phylogenic classification (the order Carnivora does not consist solely of meat-eating animals), even an animal that consumes a diet composed of less than 30% meat (by calories? by weight? who cares?) is considered a carnivore.

“Meat-based keto”? That’s only the low-protein version. “Meat-based low-carb”? That could mean eating your meat with lower than usual amounts of bread.

“Meat-only diet”? It’s not meat only. Eggs are acceptable, maybe dairy, too. Those aren’t meat. Don’t get me started on the classification of fish.

“Animal foods only diet”? “Plant-free diet”? That would sound good except apparently people find coffee and tea acceptable. Those are plant-derived.

And that’s not even getting into stuff like inherent unreliability of dietary anecdotes. I have no idea what exceptions to the general rule people find acceptable and which they don’t. Maybe there’s someone out there who thinks Mountain Dew is perfectly fine to drink while claiming to be “strict carnivore”.

I can only describe what I, myself, eat and disregard grumbling about definitions.

Review: The Case for Keto by Gary Taubes

Disclosures

I am biased against journalists, Gary Taubes in particular (due to his stated unwillingness to change his mind1,2) and his model of obesity (doesn’t work for me). I am biased in favor of low-carbohydrate diets, however.

General impression

The book is quite readable, and Taubes is a skilled wordsmith. The pacing is good, and repetition is kept at a tolerable level. I’d say it’s about as good, writing-wise, as Atkins’ first book4, better than Atkins’ second book5 – but decidedly inferior to the Drinking Man’s Diet6.

If someone without any nutritional knowledge whatsoever picked this book up, they would probably find the narrative compelling, the advice to be reasonably clear, and would, in turn, probably lose weight if not already constitutionally thin. Probably being a key word – to my knowledge, there is no ad libitum diet, even in clinical conditions of near-perfect adherence, that works to reduce everyone. Even when you exclude intractable cases like congenital leptin deficiency7, pituary tumours8 and the like. At best you can hope that the average person slims down a bit, and some people on one tail of the distribution drop weight like a stone35.

The biggest problem in the book is Taubes’ continued adherence to the Carbohydrate-Insulin hypothesis of obesity. In my opinion, Taubes would do himself a great favor by never mentioning insulin or carbohydrates being uniquely fattening again, and instead focusing on aspects of the LCHF diet that he can actually prove – or at least those that aren’t at stark odds with mountains of evidence to the contrary, including experiments specifically meant to test the hypothesis, funded in part by his own research organization. I don’t see why “you’ll be less hungry and lose weight” would be any less compelling than “your insulin will go down and you’ll lose weight” to someone who has no background in obesity research, such as the median self-help book reader. Yes, the problem is hormonal, but the hormone isn’t insulin18.

The unobjectionable

For all his faults, Taubes gets some things right – quite a few of them, and I’m surprised how much overlap there is between his book and The Hungry Brain34 by Dr Stephan Guyenet – in my opinion, of course, although I do try to have solid backing for my opinions. I have tried to interpret Taubes’ statements, if they were ambiguous, in a way that matches evidence.

  • Attempts to turn obese people into lean people have met, as yet, with resounding failure13,14,15 – neither diets nor exercise16 work in the long term, and usually don’t work in the short term either – at best you can produce temporarily reduced obese people. You would be hard-pressed to find anyone remotely informed, establishment nutritionist or not, who disputes this. The most effective, if also most drastic solution to obesity we currently possess is bariatric surgery17, and even that may not stick.
  • Eating behaviour is clearly driven by unconscious forces18. Calorie and energy balance calculations are a research tool, not an effective strategy for durable weight loss. I know of no evidence whatsoever of an outpatient dietary treatment of any kind that transforms the typical obese person into a lean person permanently.
  • Obesity has a strong genetic component19, at least as much as other strongly heritable traits like height or intelligence. In a premodern environment18, very few genetically susceptible people had the opportunity to manifest the obese phenotype, however. With highly convenient, delicious and cheap foods available, the impact of genes of obesity is maximized30.
  • Low-carbohydrate diets on an ad libitum basis do work for weight loss at least as well as any other dietary intervention20,21, perhaps slightly more so. If there is to be something like dietary guidelines, this kind of diet should be an option, rather than rigidly prescribing a moderately low-fat, high-CHO diet as they presently do.
  • Obesity is chiefly a hormonal issue18, not a behavioural one. The lean and obese don’t have vastly different psychological traits22,36. It’s just that the obese seem to target a fat mass that is vastly greater than with the lean23, which target they reach and sustain by eating more.
  • Not being an uncontrolled diabetic or highly insulin-resistant is probably far more important than maintaining ideal LDL levels24,25,26.
  • Ultra-processed junk foods and liquid calories, whether alcoholic or not, are enemies of maintaining one’s weight27. These are not, in general, foods to which we are particularly well adapted evolutionarily, for want of adequate exposure time to do so. Even a neolithic diet of mostly grain would probably be healthier than what people normally eat and drink.
  • What is regarded as healthy is in large part backed by nutritional epidemiology, which is chiefly based on self-reports, and those are not valid scientific instruments28. This is weak evidence to be basing national guidelines on.
  • Voluntary or externally involuntary overfeeding29 is not the cause of common obesity. In overfeeding trials, subjects tend to fairly quickly return to their normal weights, whatever they were.

The objectionable

There is only one claim in the book that I would strongly object to – aside from fairly trivial things like the definition of ‘tautology’ (not quite33 the same thing as ‘circular logic’, but fair enough) or whether Dr Ted Naiman32 and Dr Blake Donaldson31 advocated LCHF or ketogenic eating (don’t and didn’t, respectively; they’re not against it, but they’re at best adjacent) or unverifiable assertions about the psychology of obesity researchers (painted as somewhat dumb and malevolent in TCFK), and that is the Carbohydrate-Insulin model of obesity, paraphrased:

Carbohydrate is uniquely fattening because among macronutrients it has the greatest insulin response on ingestion.

This is inconsistent with reality, as shown by Guyenet with his mountain of citations3 for the 2019 debate (a painful thing to watch). The arguments there are as valid today as they were then, and more evidence9,10 has surfaced that makes this model even less likely than it was before (to be fair, there was also one piece of potentially supportive material11, but that one may have measurement issues12). Taubes is nothing if not tenacious and capable of raising both attention and funds to run clinical trials. The only thing missing now is a ketogenic overfeeding trial to put the final nail in this coffin.

Continued belief in this perplexes me. This model doesn’t have to be even remotely true for low-carbohydrate diets, ketogenic or not, high-fat or not, to work. Just about the only use for it I can think of is making rubes feel special, and drive adherence through zealotry. In my view, it’s another “Fat Mobilizing Hormone” (a hypothetical factor that Atkins mentioned in his book4, which turned out not to exist; Taubes even mentions it in TCFK) that opponents can use to discredit the dietary framework.

Conclusions

Overall, I think the advice contained in this book is healthy, and I will not be applying for a refund (not just because I don’t want to doxx myself). Just ignore the attempts to explain the mechanism of operation. You don’t need to know it for things to work, and you’re better off reading Guyenet’s The Hungry Brain34 if you really do want to know a thing or two about adiposity regulation.

References

  1. MAY 20, 2015 by STEPHENHOW, Gary Taubes vs. Alan Aragon EPIC Debate. Original URL: https://2lbsofstarch.com/2015/05/20/gary-taubes-vs-alan-aragon-epic-debate/
  2. SCIENCE, STORIES, AND SIDE-STEPPING: THE STEPHAN GUYENET VS. GARY TAUBES DEBATE. WRITTEN BY: LAYNE NORTON. APRIL 4TH, 2019. Original URL: https://www.biolayne.com/articles/research/science-stories-and-side-stepping-the-stephan-guyenet-vs-gary-taubes-debate/
  3. References for my debate with Gary Taubes on The Joe Rogan Experience. March 19, 2019 by Stephan Guyenet. Original URL: http://www.stephanguyenet.com/references-for-my-debate-with-gary-taubes-on-the-joe-rogan-experience/
  4. Atkins, Robert C. Dr. Atkins’ Diet Revolution Bantam, 1972.
  5. Atkins, Robert C. Dr. Atkins’ New Diet Revolution M. Evans and Company, 1992.
  6. Cameron, Robert. The Drinking Man’s Diet. Cameron Books; Revised ed. edition (June 1, 1964).
  7. Paz-Filho G, Mastronardi C, Delibasi T, Wong ML, Licinio J. Congenital leptin deficiency: diagnosis and effects of leptin replacement therapy. Arq Bras Endocrinol Metabol. 2010;54(8):690-697. doi:10.1590/s0004-27302010000800005
  8. Müller HL. Craniopharyngioma. Handb Clin Neurol. 2014;124:235-53. doi: 10.1016/B978-0-444-59602-4.00016-2. PMID: 25248591.
  9. Hall, K. D., Guo, J., Courville, A. B., Boring, J., Brychta, R., Chen, K. Y., … Chung, S. T. (2020, May 6). A plant-based, low-fat diet decreases ad libitum energy intake compared to an animal-based, ketogenic diet: An inpatient randomized controlled trial. https://doi.org/10.31232/osf.io/rdjfb
  10. Hall, K.D., Guo, J. & Speakman, J.R. Do low-carbohydrate diets increase energy expenditure?. Int J Obes 43, 2350–2354 (2019). https://doi.org/10.1038/s41366-019-0456-3
  11. David S Ludwig, Stephanie L Dickinson, Beate Henschel, Cara B Ebbeling, David B Allison, Do Lower-Carbohydrate Diets Increase Total Energy Expenditure? An Updated and Reanalyzed Meta-Analysis of 29 Controlled-Feeding Studies, The Journal of Nutrition, , nxaa350, https://doi.org/10.1093/jn/nxaa350
  12. Tweet from Dr Kevin Hall. Original URL: https://twitter.com/KevinH_PhD/status/1334905961220206595
  13. Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health. 2015;105(9):e54–e59. doi:10.2105/AJPH.2015.302773
  14. Clinical Psychology Review. Volume 11, Issue 6, 1991, Pages 729-780. Confronting the failure of behavioral and dietary treatments for obesity. David M.GarnerSusan C.Wooley https://doi.org/10.1016/0272-7358(91)90128-H
  15. Mann, T., Tomiyama, A., Westling, E., Lew, A., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: diets are not the answer. The American psychologist, 62(3), 220-233. http://dx.doi.org/10.1037/0003-066x.62.3.220 Retrieved from https://escholarship.org/uc/item/2811g3r3
  16. Franz, Marion & VanWormer, Jeffrey & Crain, A Lauren & Boucher, Jackie & Histon, Trina & Caplan, William & Bowman, Jill & Pronk, Nicolaas. (2007). Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Weight-Loss Clinical Trials with a Minimum 1-Year Follow-Up. Journal of the American Dietetic Association. 107. 1755-67. 10.1016/j.jada.2007.07.017.
  17. O’Brien PE, Hindle A, Brennan L, et al. Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding. Obes Surg. 2019;29(1):3-14. doi:10.1007/s11695-018-3525-0
  18. Lund J, Lund C, Morville T, Clemmensen C. The unidentified hormonal defense against weight gain. PLoS Biol. 2020;18(2):e3000629. Published 2020 Feb 25. doi:10.1371/journal.pbio.3000629
  19. Elks CE, den Hoed M, Zhao JH, et al. Variability in the heritability of body mass index: a systematic review and meta-regression. Front Endocrinol (Lausanne). 2012;3:29. Published 2012 Feb 28. doi:10.3389/fendo.2012.00029
  20. Johnston BC, Kanters S, Bandayrel K, et al. Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults: A Meta-analysis. JAMA. 2014;312(9):923–933. doi:10.1001/jama.2014.10397
  21. Ge Long, Sadeghirad Behnam, Ball Geoff D C, da Costa Bruno R, Hitchcock Christine L, Svendrovski Anton et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials BMJ 2020; 369 :m696
  22. A FAILURE TO FIND DISTINCTIVE PERSONALITY FEATURES IN A GROUP OF OBESE MEN. NORRIS WEINBERG, MYER MENDELSON, and ALBERT STUNKARD. Published Online: 1 Apr 2006. https://doi.org/10.1176/ajp.117.11.1035
  23. Hall KD, Guo J. Obesity Energetics: Body Weight Regulation and the Effects of Diet Composition. Gastroenterology. 2017;152(7):1718-1727.e3. doi:10.1053/j.gastro.2017.01.052
  24. García RG, Rincón MY, Arenas WD, Silva SY, Reyes LM, Ruiz SL, Ramirez F, Camacho PA, Luengas C, Saaibi JF, Balestrini S, Morillo C, López-Jaramillo P. Hyperinsulinemia is a predictor of new cardiovascular events in Colombian patients with a first myocardial infarction. Int J Cardiol. 2011 Apr 1;148(1):85-90. doi: 10.1016/j.ijcard.2009.10.030. Epub 2009 Nov 17. PMID: 19923024.
  25. Jeannie Yip, Francesco S. Facchini, Gerald M. Reaven, Resistance to Insulin-Mediated Glucose Disposal as a Predictor of Cardiovascular Disease, The Journal of Clinical Endocrinology & Metabolism, Volume 83, Issue 8, 1 August 1998, Pages 2773–2776, https://doi.org/10.1210/jcem.83.8.5005
  26. Francesco S. Facchini, Nancy Hua, Fahim Abbasi, Gerald M. Reaven, Insulin Resistance as a Predictor of Age-Related Diseases, The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 8, 1 August 2001, Pages 3574–3578, https://doi.org/10.1210/jcem.86.8.7763
  27. Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, Chung ST, Costa E, Courville A, Darcey V, Fletcher LA, Forde CG, Gharib AM, Guo J, Howard R, Joseph PV, McGehee S, Ouwerkerk R, Raisinger K, Rozga I, Stagliano M, Walter M, Walter PJ, Yang S, Zhou M. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019 Jul 2;30(1):67-77.e3. doi: 10.1016/j.cmet.2019.05.008. Epub 2019 May 16. Erratum in: Cell Metab. 2019 Jul 2;30(1):226. Erratum in: Cell Metab. 2020 Oct 6;32(4):690. PMID: 31105044.
  28. Archer E, Pavela G, Lavie CJ. The Inadmissibility of What We Eat in America and NHANES Dietary Data in Nutrition and Obesity Research and the Scientific Formulation of National Dietary Guidelines. Mayo Clin Proc. 2015;90(7):911-926. doi:10.1016/j.mayocp.2015.04.009
  29. Obesity Reviews. The biology of human overfeeding: A systematic review. George A. Bray, Claude Bouchard. First published: 08 June 2020. https://doi.org/10.1111/obr.13040
  30. Komlos, John and Brabec, Marek, The Trend of BMI Values Among US Adults (March 2010). CESifo Working Paper Series No. 2987, Available at SSRN: https://ssrn.com/abstract=1573500
  31. Donaldson, Blake. Strong Medicine. Literary Licensing, LLC (July 21, 2012).
  32. Naiman, Ted. The PE Diet: Leverage your biology to achieve optimal health. November 1, 2019.
  33. Miriam-Webster Dictionary on tautology. Original URL: https://www.merriam-webster.com/dictionary/tautology
  34. Guyenet, Stephan. The Hungry Brain: Outsmarting the Instincts That Make Us Overeat. Flatiron Books (February 7, 2017).
  35. Gardner CD, Trepanowski JF, Del Gobbo LC, et al. Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial. JAMA. 2018;319(7):667–679. doi:10.1001/jama.2018.0245
  36. Is Dietary Nonadherence Unique to Obesity and Weight Loss? Results From a Randomized Clinical Trial. Emma J. Stinson Paolo Piaggi Susanne B. Votruba Colleen Venti Barbara Lovato‐Morales Scott Engel Jonathan Krakoff Marci E. Gluck. First published: 17 August 2020 https://doi.org/10.1002/oby.23008

Strong Medicine

I’ve recently read Blake Donaldson’s book, “Strong Medicine”. A very interesting book, to be sure, hilarious at times, with a mix of cunning observations and outdated scientific propositions.

First of all, the man is a tremendous shitlord and darwinist. Consider some of these quotes:

“Dispensary” probably means “public dispensary”, and the patients in question are poor people.
To a woman who got fat and her husband started sleeping around.
On allegies.
On what to do about alcoholism.
Medical technology’s deleterious effect on human health.

Donaldson is known for his all-meat diets, but that’s not exactly what he proposes. All-meat is his go-to for simple obesity, but for other things, he allows several other things to go with the meat (at least optionally). If anything, his stance is very Paleo, starting with observations on the state of dental health of primitive peoples:

The kind of foods he found to be adequate, besides fatty meat, are tubers, a limited variety of vegetables and fruits. He identified the chief problem foods as:

Still, there’s apparently nothing wrong with eating just meat:

Donaldson has a fair amount of opinions that are quite strange, but aren’t obviously wrong (such as the suggestion that smoking doesn’t cause cancer). His stance on salt is basically “never eat any” (reasonable from a Paleo template viewpoint), same as his opinion of eggs (which are kind of a gray area with Paleo thinking) and his stance on coffee is “drink exactly three half-cups per day”. The latter might be simply a reflection of the times and the culture of the land.

Overall, it’s a good book, which I recommend anyone interested in nutrition to read.

Finally, a collection of quotes I found noteworthy or funny:

How did these become popular? Could be that Donaldson is just weird.
Doubly true a century later.
I can confirm that eating too much cheese causes constipation. It’s probably the low water content.
More shitlording.
Therapy for an underweight patient.
This is probably even truer now. Yet people take even more vitamin pills.
Karen sighting.
General allergy treatment.
Amusing, yet important – savages don’t drink milk, yet have good teeth.
More allergy treatment.
The darwinism is strong with this one.
Demolishing myths.
Interesting. PUFA at work?
Interestingly, time restricted eating is largely unimportant in Donaldson’s view.
The one thing that troubles me greatly is the egg indictment.
Insanity that is mainstream thought to this day.
I confirm this. Too little fat – constipation. Too much – diarrhea.
On low-calorie diets.
The basic treatment.
Full agreement here – people can’t follow orders. Especially orders that don’t make sense to them.

Pre-carnivorous diet

If you ever wondered how I ate before I adopted a carnivorous diet, here’s my recollection of what I might eat on a typical day or three.

These are all recollection-based of what I was doing about four years ago, so take it with a huge grain of salt. Any criticism that applies to food frequency questionnaires applies here twofold. If anything, I probably underestimated how much I ate in a given day, by filtering out snacks and exact amounts.

Almost everyone is metabolically ill

Originally posted on Wykop here.

Prevalence of optimal metabolic health in America

At least if you’re American. Only about 1 in 8 people are metabolically healthy, by the metric of having none of the classic signs of metabolic syndrome (central obesity, hyperglycemia, hypertension, high triglicerides, low HDL). What’s even more interesting is that more than half of those who are underweight are metabolically unhealthy, suggesting that most of them are “skinny-fat”.

Source: Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Joana Araújo, Jianwen Cai, and June Stevens. Metabolic Syndrome and Related Disorders 2019 17:1, 46-52