I feel so stupid I did not find this website earlier. I live in the Netherlands and all the negative feedback on the Dr.oz show has not reached us..I was blindly believing him..Quite stupid

Science-Based Medicine » Dr. Oz Doubles Down on Green Coffee Bean with a Made-for-TV Clinical Trial…

It’ll be interesting to see if this complaint can set a precedent, especially since claims endorsed by Dr Oz (as this one is, which is mentioned in the advertisement) are often called “miracles”.

One book that is a major proponent for coconut oil basically says it is the same as palm oil, health-claim wise.

I’ve been wondering about coconut oil for a while (ever since my wife really got caught up in listening to the advice of various “nutritionists”. Has anybody taken an SBM look at the various claims of coconut oil? So many people swear by it for so many purposes, and then there are some that reject it on the soul basis that its a saturated fat (while the supporters say that its healthy because its a medium chain S.F. Does that matter?)

I’ve been wondering about coconut oil for a while (ever since my wife really got caught up in listening to the advice of various “nutritionists”. Has anybody taken an SBM look at the various claims of cocunt oil? So many people swear by it for so many purposes, and then there are some that reject it on the soul basis that its a saturated fat (while the supporters say that its healthy because its a medium chain S.F. Does that matter?)

“…why you think that would have invalidated the results.”

Because the results of the study are dependent upon what people ate. Imagine it. Imagine if I told you I had some results from a study where people were told to eat x, y & z. If you started asking me questions as to how sure I was about what they ate, I wouldn’t be able to answer with much confidence.
You: Oh, well those are some interesting results, Mr. Libbie. What did they eat?
Me: They ate x,y & z.
You: How do you know that?
Me: Well, we told them to.
You: But how do you know they did what you told them to?
Me: Well, I guess I don’t really know, ma’am. We asked them twice in two years (via phone call) to tell us what they ate in the previous 24hrs of us calling. And not all of them by the way, just 50% of them. I guess you could say it’s on the honor system. It’s the best we could do with the money we had.
You: Okay, so it’s possible these people ate anything under the sun, right?

See what I mean? It’s just not solid. To take the results seriously, the input needs to be known.

“Do you have any reason to think subjects in one group were less compliant or honest than in the other groups?”

No. All of the groups could’ve followed the diets to the letter, or not at all. We don’t know. They weren’t monitored. The study says food logs were given and a computer system was offered to them, but there’s no mention of the data from those sources.

“Isn’t it nevertheless possible that your advice results in lower total calorie intake?”

Yes, it’s possible, but unlikely. I have my clients take pictures of each meal and send it to me via text. They follow my instructions of adding the approved foods in place of the proscribed foods, so that their not eating tiny, unsatisfying amounts of food. Furthermore, they usually add a fat back to their diet that they had stayed away from because of all the conventional wisdom. But I have thought about how maybe the overall calories go down; I’m not closed off to the idea, and am only interested in what works for my clients. I wondered that in my own situation, but it just seems sooooo unlikely. I eliminated grains and legumes from my diet a few years ago and began eating completely uncontrolled amounts of mono and saturated fats. I never measured things, but I can tell you without a doubt that the overall amount of calories I consumed had to have went up. It was a personal experiment and it astonished me. I though for sure it would lead to me getting bigger, but I actually leaned out by about 5lbs. I don’t pretend to know what’s going on. It could be that the body adjusts to the new calorie intake by not absorbing it all, something like the body fat set point idea by a guy who devotes his entire life the study of obesity http://wholehealthsource.blogspot.com/2009/12/body-fat-setpoint.html. I don’t really know. It defies all I was ever told. But the observed phenomenon is remains. Try it for yourself sometime. Add a tablespoon of coconut oil to your life daily. Just do a little N=1.

Isn’t it nevertheless possible that your advice results in lower total calorie intake? Studies like this http://www.ncbi.nlm.nih.gov/pubmed/12684364 indicate that weight loss relates to calorie intake rather than to macronutrient content.

I understand that the study doesn’t prove what people ate, but I don’t understand why you think that would have invalidated the results. Do you have any reason to think subjects in one group were less compliant or honest than in the other groups?

Note: Please don’t refer to Dr. Novella as “Mr. Novella.” It comes across as a mark of disrespect, whether or not you meant it as such.

I’m just going back to the purpose of the citation. You and Mr. Novella would present this study as proof that macro ratios do not matter (which I mostly agree with), but this particular study doesn’t prove anything to someone who reads carefully how the people were monitered. Nothing serious can be taken from this study because it doesn’t come close to proving what the people ate. We don’t even know if they stuck to the maco ratios they were told to. I do understand that it’s not like we can hold 800 people prisoner and make sure they eat what the study needs them to. I think the people in this study did the best they could. Still, if I proposed it to you, you would’ve tore it to shreads, too.

@Run

I have some letters after my name, but nothing that carries the impression ‘MD” does. I own my own personal and group training business. About 40% of my clients want weightloss. My method is to review the foods they currently eat and go from there. The guiding principle is removing nutrient sparse foods from the diet and replacing them with nutrient dense, whole foods. This means grains and legumes must go (typical junk food like candy and soda are obvious). But (and this relates to the calories in/calories out idea) I make sure they don’t purposefully restrict calories. In other words, if they remove bread from their meals, I want them to replace it with something that’s nutrient dense (meat, including organs, seafood, eggs, veggies or fruit). The key is to not allow them to become hungry. The body will not allow itself to be starved, so the overal satiating quantity of food must be maintained if you want long lasting results. Sure, I have people fail because they can’t resist tasty, nutrient sparse foods, but they don’t fail because I’m restricting their food intake. It works like a dream. People lose weight without any powders, pills, shakes or crap like that. And it never comes back until they begin eating nutrient sparse foods again.

But that’s equally true of all the groups, so we are controlling for those confounders. The study didn’t use the kind of low-carb or high-fat diets you would ideally like, but the fact remains that there is no good evidence that macronutrient content makes a real difference to success in weight loss.

Well, before I get too far into it, let me outline the study as I understand it. I might be wrong about some things.

This study took 811 overweight/obese men and women and took initial measurements of weight, waist circumference (and some blood and urine stuff), current eating patterns and current exercise patterns. After this baseline was established, they were randomly assigned to four different diets. These diets differed in macro-nutrient ratios and were 750kcal less than what the individuals were currently used to eating. The study says meal plans were given (but doesn’t tell us what the meals were). At the end of the Supplementary Appendix there are two daily meal plans (they show one breakfast, one lunch, one dinner and one snack for one day), one for 2,000kcal and one for 1,400kcal, but there’s no explanation of what they mean or are in reference to.
Also the participants were told to increase their physical activity to 90mins/week of moderate to intense activity throughout the study, but we don’t know if this was adhered to.
The participants were given meal plans and food logs, but there was no way to know if these were followed. Food logs were given, but there’s no mention if they were used. Dietary intake was assessed in a random sample of 50% (~330 people) of the participants by 24-hour recall during a telephone interview at 6 months and at 2 years. (That’s twice in two years.) The study tells us that there were times when the food data was to be collected from the participants, but doesn’t say anything about adherence. In essence, we don’t know what the people in the study were eating. 645 people completed the study. 645 provided body weight at the end of 2yrs. 599 provided waist circumference after 2yrs. The daily intake of calories among the four groups ranged from 1,862 to 2,015 with a deviation of 505 to 599kcal (please think about that deviation one for a second).
The results were that the participants lost between 6 and 15lbs over two years, with most of the weight loss coming in the first six months. Also, this study uses the intent-to-treat paradigm. I know this isn’t anything new these days, but making up data about the people who dropped out of the study and reporting it as part of the study is something I think everyone should be aware of.

If we agree that what I’ve stated is factual, my point is that this study doesn’t give us any reliable numbers. We don’t know what they ate. We don’t know how close they stuck to the study. It’s useless. I wouldn’t know what type of conclusion I could draw from a study that has so many uncertainties. Which should be good news for Novella because that means calorie restriction (750 CALORIES RESTRICTED!!!) leads to a paltry 6-15lbs weight loss, and it takes six months to two years to accomplish. If that were true, it would be the worst way to lose weight ever.
Also, I understand that this study was meant to compare different macronutrient diets, but not one of the diets could be considered low-carb or high-fat. Even when it comes to carbs and fats, there are differences among them that need to be discussed rather than broadly speaking of “carbs” and “fats”, so I know that’s a whole other discussion I’m sure we have both had many times.

Yes, I had read that research paper as soon as it was published (I subscribe to that journal), and I even mentioned it and its accompanying editorial in a blog post of my own http://www.sciencebasedmedicine.org/index.php/why-we-get-fat/ And I read a lot of other studies, some of which I cited in that post. What is your point?

I read the blog post by Steven Novella, but more importantly I read the research paper he based his post on. Did you read the research paper he cites?