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Should you be “Eating Clean”?

Like many of you I’m interested in the science of good nutrition. In general, I’ve come to be pretty skeptical of the nutritional literature, as so many studies seem to follow the same trajectory that we see with drug studies: Trivial changes in non-relevant outcomes, a failure to consider the results in the context of the accumulated scientific evidence and often, significant conflicts of interest. What’s worse, “real world” nutritional studies aren’t blinded and they’re rarely prospective. So we’re left to dig through observational studies and try to sort out correlation from causation. It’s little wonder that so many consumers are confused about the basics of healthy eating. Many believe that vitamins supplements are both beneficial and routinely necessary (they are not) and that the latest “superfood” is all that’s standing between themselves and immortality. But nutritional science is important, and I’m always pleased when patients initiate discussions about weight loss, or just improving their dietary habits. After all, obesity is a significant risk factor for an array of chronic illnesses. Improving our dietary patterns should pay off with improved health.. A regular challenge I face is that my patient that has already decided to use a highly restrictive weight loss plan in order to achieve a specific weight loss goal. I always caution them to take a long-term view. Weight loss is easy. Maintaining that loss is the challenge. Most “diets” fail. So I’m critical of useless interventions (like food intolerance blood tests) or faddy diets (like going gluten-free) with the hope of easy weight loss. At its core, weight loss and weight maintenance comes down to caloric balance. Permanent weight loss requires permanent dietary changes. And how we spend our “calories” matters.

Over the past few months I’ve seen a few friends and colleagues announce that they’ve decided to transform their diet, lose weight, and “eat clean”. When I asked what was “clean” food, no-one seems to have a consistent answer. The most common response was that “eating clean” meant cutting out processed foods. But to others, eating clean meant avoiding meat, anything with GMOs, wheat and sometimes milk. It seemed to mean something different to everyone. It reminds me a bit of Humpty Dumpty in Through the Looking Glass:

‘When I use a word,’ Humpty Dumpty said, in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

Is “eating clean” just a faddish buzzword? There are a number of personalities competing in the “eating clean” dietary space. The pioneer seems to be Tosca Reno, who has the Eat-Clean Diet and about a dozen related books based on the same idea. But  she’s not alone, as there are several other books with related names, including Terry Walters with her “Clean Food” books. Success breeds competition, it seems. Given Reno’s book appears to be the most popular, I’ll take her plan as the template. She outlines the principles of how she defines eating clean in her 2007 book. I’ve added my comments after each principle.

Eat 5 or 6 small meals every day. There’s nothing inherently wrong with this approach, but there’s no good evidence to say that it’s necessary. Obesity specialist Yoni Freedhoff notes that while smaller, spaced meals may reduce cravings and hunger, meal spacing is often individualized and shouldn’t be forced into any specific schedule. The best schedule is what works for you.

Eat every 2 to 3 hours. This is somewhat redundant with the above. Eating regularly may reduce the risk of snacking.

Combine lean protein and complex carbs at every meal. Protein promotes satiety, and the requirement to combine it with complex carbohydrates is presumably based on the idea that it will result in more stable blood sugar levels. There’s nothing unorthodox about this advice, but neither has it been shown to be always necessary.

Consume adequate healthy fats each day. This is a reasonable recommendation, and one that’s supported by good evidence. Substituting saturated or trans fats with refined carbohydrates is either neutral or negative as a health benefit. Substituting monounsaturated and polyunsaturated fats for saturated and trans fasts helps lower the risk of heart disease. So the advice to consume would be better phrased as guidance to substitute

Drink at least 2 liters, or 8 cups, of water each day. This is unfounded advice. There’s no persuasive evidence to demonstrate that we need to consume that much water each day. It’s such a pervasive urban myth that there’s even a Snopes page on the statement. Water may be supplied in beverages but also in food. Thirst is a acceptable guide – there’s no reason to force fluid consumption.

Never miss a meal, especially breakfast. Again, this is somewhat redundant with the advice above. While there is some evidence to suggest that regular eating, including breakfast, can help manage hunger, it’s not an absolute rule. Some people don’t prefer to eat breakfast, and it’s often an individual decision.

Carry a cooler loaded with Eat-Clean foods to get through the day. This is reasonable advice if accessing foods is difficult or expensive. But not always necessary.

Avoid all over-processed, refined foods, especially white flour and sugar. Here’s where we finally get into some specific dietary advice. This is largely reasonable, as heavily processed foods tend to be higher in salt and calories, and may also be less nutritious. There is is very little scientific debate that whole grain products are superior to those that contain mainly white flour, which is missing the most nutritious parts of the grain. There’s also good evidence to suggest many people obtain an excessive number of calories from sugar, and from refined carbohydrates in general. However, advising that all white flour and sugar be avoided is very difficult, and there’s no reason they cannot be consumed in moderation. What matters is the overall caloric balance.

Avoid chemicals, preservatives, and artificial sugar. This simply an appeal to the naturalistic fallacy. It’s not possible to avoid “chemicals” in your diet; chemicals ARE your diet. The same can be said for preservatives. Salt is a preservative. Added ingredients need to be evaluated on their own merits, not avoided wholesale. The same can be said for artificial sweeteners. Reno demonizes sugar substitutes claiming they “work against you just as much as white sugar does.” Yet there is no persuasive evidence to demonstrate that artificial sweeteners are harmful, or will compromise dietary goals. The same cannot be said for sugar.

Avoid saturated and trans fats. There is no good evidence to suggest that a high fat intake is inherently harmful, or that total amount of fat in one’s diet must be limited. However, as noted above, the types of fats matter. Avoiding saturated fats completely is difficult and probably inadvisable as many sources of healthy fats will usually contain some saturated fat (e.g., fish, nuts).  Trans fats from prepared foods, however, should be avoided, as there’s good evidence to suggest that their consumption is associated with negative health outcomes.

Avoid sugar-loaded colas and juices. Reno’s advice here is consistent with most dietary advice that identified colas and juices as low-nutritive, high-calorie beverages. Beverages can be a significant source of calories. In these circumstances, minimizing their consumption is probably warranted. While most liquid calories are treated the same as colas and juices, these two categories are commonly consumed and represent easily modifiable changes in one’s diet. However, Reno also says products like honey and maple syrup are acceptable substitutes for sugar when used in moderation, ignoring the fact that calories are calories, and these substitutes differ little from sucrose from a nutritional perspective.

Consume adequate healthy fats (EFAs) each day. This advice is largely sound. Essential fatty acids (EFAs) are “essential” because they cannot be synthesized by the body.  Polyunsaturated fatty acids like eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are healthy fats are associated in prospective and observational studies with a number of cardiovascular (and other) benefits. Fatty fish consumption (e.g., salmon) at least twice per week is the usual recommendation for those without known disease, with supplements only when justified in those that don’t eat fish. Daily consumption, however, hasn’t been established as necessary.

Avoid alcohol-another form of sugar. While alcohol can be a source of calories, and contains no nutritional benefits, the health effects of alcohol are mixed. Alcohol may reduce the risk of cardiovascular disease, while raising cancer risks slightly. For many, alcohol can be consumed in moderation without any expected significant health effects.

Avoid all calorie-dense foods that contain little or no nutritional value. This is a general statement that speaks to caloric and nutrient density. On balance we want to maximize the nutrition within a given amount of food consumed. But while intuitively appealing, studies don’t show a strong relationship between caloric density and weight. It may be that we increase overall consumption in response to deliberately cutting calorie density. Whether these types of foods need to be avoided completely hasn’t been established – it’s a restrictive rule, and it’s probably better to consider the consumption of these products in the context of the overall diet. Forbidding “treat” foods entirely may be more difficult to manage than accommodating them within daily or weekly eating plans.

Depend on fresh fruits and vegetables for fiber, vitamins, and enzymes. Fruits and vegetables are good sources of nutrients, fiber and vitamins. but so are other foods, such as grains. Insisting on “fresh” produce is unnecessarily restrictive, as frozen or canned versions can offer the same nutritional benefits.  Enzymes are large proteins that act as catalysts for biochemical reactions throughout the body – but our body produces what we need, and digests the ones we consume.

Stick to proper portion sizes-give up the super sizing! This is also reasonable advice. Portions sizes, particularly in restaurants, have grown over time.  While Reno doesn’t mention calories, they’re the fundamental energy unit of diet.

The Good

Reno’s plan emphasizes whole grains, lean cuts of meat, healthy fats and lots of fruits and vegetables. No classes of foods are completely banned, and the plan promotes an overall balanced diet of grains, fruits, vegetables, fats, and protein. Consequently, I can see the program being easier to maintain for some people than diets that advocate dramatic shifts in habits (e.g., Atkins and paleo). The recipes she promotes look nutritious and some look quite tasty. Depending on your current diet, following the principles may significantly improve your dietary habits, and help you break established bad habits. Like most diet plans, exercise is encouraged, particularly weights, which is a good recommendation.

The Bad

Reno is a certified Nutritional Therapy Practitioner, an accreditation offered by the Nutritional Therapy Association. The NTP certificate program’s required reading include books on detoxing and adrenal fatigue (a non-existent condition). This non-science-based background is evident in Reno’s recommendations. Much of her advice is based on anecdotes, not science:

She says that calories don’t matter. She’s wrong.

We now realize that different foods react in different ways in our body.  Whereas we may lose weight on 2000 calories per day of Clean food we may gain weight on 1600 calories per day of junk. Many, many people have messed up their metabolisms by worrying too much about calories and not enough about just getting good nutrition regularly throughout the day.

Tell that to Mark Haub, who lost 27 pounds eating only Twinkies. Calories matter, no matter how you spin it. If you eat excessive amounts of the foods she recommends, you will gain weight, just as sure as a consistent calorie deficit will cause weight loss. While some of the recommended approaches (small, spaced meals, each with protein) may help with satiety, they are no guarantee that you’ll lose weight by eating clean (if that is your goal).

Even more questionable is the advice to take supplements and even drug treatments, with recommendations (depending on the book) ranging from human growth hormone, to bee pollen, wheat germ, L-carnitine, vitamin K, tumeric, green tea extract, and raw apple cider vinegar. No references are provided to substantiate claims of benefit that range from burning fat to improving abdominal definition. She recommends “natural” hormones such as pregnenolone for “memory”, and states that that bioidentical hormones are a safe natural alternative for hormone replacement.  They’re not.

Reno advocates “detoxing” and believes it has an effect on your body’s pH, reducing acidity which she attributes to be a cause of disease.

Eliminating all processed foods is something that Reno emphasizes repeatedly. This may be very difficult to do, and the incremental benefits are unclear. Eliminating frozen meals is one matter, making your own condiments and crackers is something entirely different. It’s not necessary to eliminate all processed foods to benefit from the best elements of the eating plan.

Other “Eat Clean” Advice

Several other authors and personalities that advocate some form of “eat clean” use the same formula as Reno: Combine some reasonable dietary advice and recipes using unprocessed foods with bizarre statements and suggestions that reflect a strong belief in the naturalistic fallacy and a lack of basic science knowledge. Terry Walters has some nice recipes in her Clean Food cookbook, but also suggests you chew your food well “to avoid putting stress on your digestive organs.” She calls aluminum “a known carcinogen” and says to avoid it, as well as plastic and teflon. She believes that some foods make the body acidic and recommends cooking them with minerals (e.g., sea salt) to “neutralize this effect”. She also attributes specific effects to specific foods (“Dark leafy greens lift our mood, heal our organs, and counteract the damage resulting from out stressful lives.”) Root vegetables “help us feel longer and ‘rooted’”. Squash is “blood -alkalinizing”. And so on. She argues organic food is “cleaner” and believes that organic foods are grown without the use of pesticides or herbicides (wrong).

Conclusion

Categorizing foods as or diets as “clean” is clearly a successful marketing strategy, but is less useful when it comes to daily decision-making about good nutrition. Some of the concepts that underlie “eating clean” are supported by good scientific evidence. But the “eating clean” philosophy is imbued with a considerable amount of pseudoscience and a large amount of the naturalistic fallacy. Calories matter, and supplements probably don’t. For that reason, I would not recommend any of the “Eat Clean” and related books. There are too many inaccuracies to compensate for the good advice buried within. Dietary design needs to be based on good evidence, not anecdotes and logical fallacies.

 

Posted in: Nutrition

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118 thoughts on “Should you be “Eating Clean”?

  1. Alia says:

    Wow, it seems that when I decided to change my dietary habits and lose weight three years ago, I accidentally and unknowingly stumbled upon “eating clean”. Because I did most of the things that are described here as reasonable. And within a year I lost something like 50lb. I might have regained a few (I don’t check my weight very often) but I still wear the same size of clothing, so that wasn’t much.
    Anyway, I’m one of those people for whom eating regularly, every 3-4 hours or so, works very well. If I allow myself to get very hungry, I will then eat everthing within my reach and still feel hungry.

  2. Janet says:

    Your post is almost verbatim the talk I was planning to give at my local Skeptics Group! The only thing I was going to add was the food availability angle–we have twice the calories available as in 1980 and food is literally everywhere, all the time. Then there’s marketing–especially to children. Sticking to any eating plan can be extremely difficult in such an environment.

    The sad thing is that when I was at my gynecologist’s office the other day, he very excitedly told me that he wanted to “share” with me his new diet because he knows I’m “interested in these things”. Seems he has “discovered” Gary Taubes, has “made some changes” and lost 20 lbs (he’s young, fit and was never fat). He seemed crestfallen when I attacked Taubes and his books as just another faddish theory that wouldn’t result in any more permanent weight loss than any of the rest. Then we got into the calories argument. Taubes has him convinced that “calories don’t matter”. I referred him to Marion Nestle’s “Why Calories Count” and, of course, he’s never heard of her. I told him to get back to me when he’s kept the weight off for six years. His lack of basic science knowledge and gullibility frighten me, and I think I will be looking for a new gyn.

    Thanks so much for this very straightforward look at the latest in diet fads. It’s a very good and concise summary–one I will forward immediately to my gynecologist.

  3. WilliamLawrenceUtridge says:

    There are too many inaccuracies to compensate for the good advice buried within.

    Not to mention the reasonable suggestions are simply the same that you get from any other mainstream, evidence-based authority. Eat unprocessed food. Don’t eat saturated fat. Geez, you don’t need a diet book to tell you this, it’s not magic.

    I would love to see a study of the health effects of avoiding preservatives. I’ve a hypothesis that it results in more expensive food and higher rates of food poisoning. I see it as a trade-off; less money in your wallet and increased bacterial contamination now, versus a hypothetical and extremely speculative minor decrease in cancer risk several decades in the future.

  4. mousethatroared says:

    Occasionally I buy the Clean Eating magazine, because well, it’s food porn and it has some interesting healthy recipes many without diary (husband lactose intolerant). I tend to be rely on the old saying about not letting the perfect become the enemy of the good. The clean eating trend isn’t perfect but it’s got alot of good ideas to try out. It’s nice to have a source to help separate the good from the bad, though. Thanks!

    Just as an aside. Recently, I started consciously drinking water, this is based on a discussion with my doctor about blood tests, possible GI motility issues, possible dehydration. I do feel better for it, so personally I’m all for advising folks to drink more water. That said, I’m not sure if I fall into the norm or this would be considered home care for mild symptoms of something or other.

  5. Calli Arcale says:

    Huh. And here, I thought “eating clean” would just mean making sure to wash the dirt off your produce, keep your countertops clean and sanitized, cook meats thoroughly, and avoid cross-contamination. ;-)

    The healthiest I ever was was when I was eating McDonald’s every weekday — quarter-pounder, medium fries, medium Dr Pepper. A quarter-pounder is actually quite delicious, and although it does contain a preservative and flavor enhancer, it’s black pepper. ;-) (It’s only there for flavor; they preserve the meat by freezing it.) That’s about a 1,000-calorie meal, but here’s the key: I was walking about half a mile to the restaurant and another half mile back, every day. And I was walking a half mile to and from the bus stop as well. I’m convinced the walking had more to do with my good health at the time than my diet. Now I’m in a job where I sit on my butt all the time; I’ve only started getting healthy again by starting up an exercise regimen.

  6. mousethatroared says:

    Calli Arcale – !? What did you eat for breakfast and dinner? There’s no way I could eat a 1000 calorie lunch and not gain weight. I think the typical women’s weight maintenance calorie consumption is like 1400 to 1800 calories. 2 miles of walking is not that much. I do like quarter pounder’s though, they are one of my ‘treats’. Don’t tell anyone.

  7. mousethatroared says:

    WLU – Whether or not you spend more money or not on food without preservatives is going to depend upon your approach. Whether or not you risk food poisoning is going to depend upon which preservatives you are avoiding and your storage methods.

    If you are focusing on avoiding preservatives, such as in lunch meat, buying a lump of raw meet (beef or turkey) and roasting it is actually quite a bit cheaper than buying preserved lunch meat. Between the freezer and the fridge and standard safety measures, your risk of food poisoning should be minimal. One can get bread without preservatives (other than salt) for the same price as standard bread in standard grocery stores. Once again, use of the freezer prevents undue spoilage due to mold.

    Frozen meals and veggies are often preservative free. Boxed and canned goods often have more. If you are focusing on avoiding “processed foods” you are going to drop the need for alot of preservatives.

    You’d avoid soft drinks and canned fruit drinks.

    One issue that I’ve come across is that most preservative free cereals are not fortified.

    I suspect that the major consequence of avoiding preservative would be decreased convienience and a possible increase in spoilage (money lost) although this would depend upon your shopping and storing habits.

    Am I missing a food group that people typically buy preservative free that has a record of causing food poisoning?

    But – hey – when you get that research in, I’ll view your results with an open mind. :)

  8. Angora Rabbit says:

    Speaking as a Professor of Nutrition at a Tier-1 research university, thanks for a largely solid review. As you say, the so-called “Eat Clean” diet is not too different from diet recommendations of the Institute of Medicine and American Dietetics Association, apart from some of the suggestions made at the end. Some specific comments:

    Reno’s eating every 2-3hr and 5x daily is not necessarily wise. It could keep insulin higher throughout the day, which would be anabolic rather than catabolic. I think the trade-off is that multiple meals ought to have reduced portion size nd so the insulin elevation would be lower than with the large meal. What I do is keep peanuts in a desk drawer; nuts have a high satiety index and when there’s a hunger pang midAM or mid PM I have a few. Works like a charm.

    8 cups water misconstrues our requirement. People interpret it to mean drinking water. What those claims neglect is all the water we intake as part of the food itself. Drinking 8cups water daily can come to harm as it could enhance urinary potassium losses, which is something a lot of Americans don’t consume sufficiently. (Good potassium sources are whole foods like veggies, fruits, nuts and meat – it’s lost in processing.) The best advice is to listen to one’s body and drink when you’re thirsty.

    There is an Essential Fatty Acid recommendation, which is 1-3% of total calories. We stress omega-3s over omega-6, but both are important. We store it nicely so the requirement isn’t for daily.

    I agree with you too about preservatives. Preservatives include vitamin E, C and sodium. We make 4g nitrate in our bodies daily. The anti-fungal sorbate is nothing more than a very short chain fatty acid; we burn that for energy nicely. Dimers of BHA and BHT are used for cardiovascular disease treatment. And the lack of preservatives puts toxins in the diet from fungi and microbial contamination. It’s the use of preservatives that substantially lowered the incidence of stomach cancer in the US.

    I do love how Reno worries about body acidity (what rot) but then endorses vinegar consumption. Hello?

    The key, and we nutrition professionals have been saying this for years to deaf years, is to eat in moderation, eat a variety of foods, and cook for yourself as much as you can, because this is the best way to control portion size, quality and nutrient composition. It really ain’t rocket science, but people prefer gimmicks over common sense.

    However, as someone who publishes in the field, I do take exception to the author’s blanket, negative comments about the primary nutrition literature. It’s no better or worse than any other field. As with other fields, the quality really rests with the reviewers and the editors. Possibly you are referring to nutritional epidemiology literature? which indeed has its strengths and weaknesses.

  9. William B'Livion says:

    “However, advising that all white flour and sugar be avoided is very difficult, ”

    That really depends on how you define “sugar”. For most of these nitwits “sugar” is either High Fructose Corn Syrup, or that what granulated stuff that you pour into cookies and cakes.

    If you take that definition of “sugar” it’s pretty easy to avoid both white flour and sugar. It sucks, but it’s not hard.

    If you take the more scientific and accurate position then you basically cannot and do not want to avoid sugar.

    “Avoid alcohol-another form of sugar.”

    Phuq Dat Noise.

    “Eliminate Processed Foods”

    There is a difference between a Twinke, Sausage, and Meatloaf. All three are processed. Some are more processed than others.

    As to the bathtub theory (aka “Calories in, Calories out”), I suspect (with scant evidence mind you) that it’s *literally* true (physics and the laws of Thermodynamics says it has to be), I wonder if the mouth is the most accurate place to measure calories “in”, and how much of a role gut flora plays a significant role in nutrition. There has been some success reported in (this is icky) fecal transplant helping with obesity.

    We “know”, for example, that phytic acid can bind with certain important minerals (calcium (sometimes), magnesium, iron, and zinc) and prevent their absorption in the intestines (or at least this is reported by fairly credible sources). Older style baking, using long rise yeast, destroys most of the phytic acid in breads. Overnight soaking of beans and nuts will cause most of the phytic acid in them to be neutralized or at least greatly minimized.

    If you do something to increase nutrient (as opposed to caloric) uptake of essential vitamins, might not overall caloric intake go down?

    Isn’t that to some degree what things like olestra and some other molecules do–they prevent the digestive track from absorbing fats or other things?

    I’ve been reading about nutrition, diet and exercise ranging form “Men’s Fitness” (two lies in two words) to primary research papers (admittedly with less understanding).

    The results (as you indicate in your article) are very contradictory and seem more to substantiate the bias of the researcher.

    After looking at all the available information I think that the best thing to do is eat lots of fresh vegetables and fruits. Eat as much lean meat and fish as I can, eat seeds and nuts in moderation, and minimize the intake of breads and cereals–mostly because the latter are more calorically dense and don’t offer much nutritionally that I can’t get from the rest of my diet.

    But I temper that with the quote from the Philosopher Jim Morrison who said “No one here gets out alive” and from Neil Gaiman who wrote (via Death) “You lived what anybody gets, Bernie. You got a lifetime. No more. No less.”

    The idea isn’t to live forever, you can’t and you won’t. The idea is to be able to keep moving and shooting right up until the end.

    Which is the other side of the coin–exercise.

    Eat less, move more.

  10. Harriet Hall says:

    Alia said something that intrigues me: “I might have regained a few (I don’t check my weight very often).”

    I’ve heard this from patients and family members, and I just don’t understand it. If you have lost a substantial amount of weight, why not keep weighing regularly? If your weight starts to slip upwards again, don’t you want to know about it right away? It’s so much easier to lose 1-2# now than to fight 20# later.

    I’m not criticizing you for not weighing, I’m just trying to understand the mind set behind it, because I suspect it’s a major factor in the near-universal tendency to re-gain lost weight in the long term. I’d appreciate any insight.

  11. Alia says:

    Dr Hall – the answer is very simple, I haven’t owned scales in my life. I do check my weight when I visit my mother-in-law (her scales do not help her though, she’s overweight), but that’s not very often. What I use is my clothes – everything is fine as long as I can fit into jeans size 10 that I bought when my BMI returned to normal and I decided I do not need to lose anymore (and, frankly speaking, it was the moment my pelvic bones started sticking out, which was rather unpleasant).
    And, in some psychological aspect, I dislike weighing myself. Which probably comes from the time when I saw 200 lb on the scales.

  12. WilliamLawrenceUtridge says:

    I suspect that the major consequence of avoiding preservative would be decreased convienience and a possible increase in spoilage (money lost) although this would depend upon your shopping and storing habits.

    Am I missing a food group that people typically buy preservative free that has a record of causing food poisoning?

    I agree with your consequences, though I wouldn’t call them major (a sentiment I think you’d agree with). I would also expect a small up-tick in the incidences of food poisoning, but given the controls over the food supply overall, it might be hard to confirm.

    Given the trend towards preservative-free food is relatively recent (in its mass-market form) I wouldn’t be surprised if there’s not much data on it. I’m not aware of any preservative free foods being associated with greater food poisoning. Mostly I’m just bristling at the antiscientific nature of the objections. Taking actions that lead you to avoid preservatives (focussing on fresh fruits and vegetables, making your own food and cooking your own meats) are reasonable. Avoiding preservatives is a reasonable rule of thumb for avoiding heavily processed foods, which is sensible. Specifically avoiding preservatives because you think they cause cancer or similar is scientifically questionable and I would suspect reasonable proxy evidence for someone who lives by the naturalistic fallacy.

    I’ve heard this from patients and family members, and I just don’t understand it. If you have lost a substantial amount of weight, why not keep weighing regularly? If your weight starts to slip upwards again, don’t you want to know about it right away? It’s so much easier to lose 1-2# now than to fight 20# later.

    I’m not criticizing you for not weighing, I’m just trying to understand the mind set behind it, because I suspect it’s a major factor in the near-universal tendency to re-gain lost weight in the long term. I’d appreciate any insight.

    Weight can be deceptive though, and cause either obsessive interest or improperly contextualized information. I prefer clothing – if my clothes get tighter, I’ve put on weight and need to up my exercise or down my food intake. For women it can be distressing, disturbing or damning because of the idea that a specific number is desireable rather than a shape or health. A 20 pound weight gain will show up in your clothes and seems more reliable than a scale which can vary by a pound or two just depending on when you weigh yourself (before/after eating/peeing/a big poop or all three). Changes in body composition (increased muscle versus increased fat) can cause the same weight gain but the health implications are totally different.

    For me, my belt is a more reliable and meaningful indicator than a scale (which I don’t even own). Perhaps as a doctor you’ve got a more reasonable handle on what they mean, in much the same way a blood pressure, hematocrit or temperature reading is more meaningful to you than to “civilians”.

  13. LovleAnjel says:

    @ Harriet

    I’ll often skip weighing myself because I think I might be gaining – it’s like closing my eyes, if I can’t see the monster, it can’t see me. I can pretend that I’m still okay and put off feeling guilty for awhile longer. Similarly, if I’ve been on a spending spree I’ll avoid looking at my checkbook for a few days.

    I know it’s totally irrational, and eventually I suck it up and look. Some people take longer to brave the scale.

  14. DerekF says:

    This sounds like yet another of the “what’s good isn’t new, what’s new isn’t good” advice books. I think I’d rather listen to (watch) Jean Reno.

  15. jt512 says:

    Steve, a couple of technical points: First, all the major studies in nutritional epidemiology have been prospective. These include the Nurses Health Study, the Health Professionals Follow-Up Study, the Adventist Health Studies I and II, the EPIC study, and others.

    Second, regarding essential fatty acids, there are only two: linolenic acid (omega-6) and alpha-linoleic acid (omega-3). Without these in your diet, you will develop serious nutritional deficiency disease. The long-chain omega-3′s, EPA and DHA, are healthy fatty acids, but they are not nutritionally essential.

  16. jt512 says:

    Oops. I meant to address my previous comment to Scott, not Steve.

  17. tuck says:

    “…ignoring the fact that calories are calories…”

    Er, no.

    “Prof David Haslam, chair of the National Obesity Forum, says that all calories are not created equal. “It’s extremely naive of the public and the medical profession to imagine that a calorie of bread, a calorie of meat and a calorie of alcohol are all dealt in the same way by the amazingly complex systems of the body. The assumption has been made that increased fat in the bloodstream is caused by increased saturated fat in the diet, whereas modern scientific evidence is proving that refined carbohydrates and sugar in particular are actually the culprits.”

    http://www.guardian.co.uk/commentisfree/2013/jan/24/defence-of-sugar-confection-scientists

    “..all white flour and sugar be avoided is very difficult…”

    Again, not really. Give it a shot: you might be surprised at what you discover. Your dental bills will certainly go down…

    “Avoid alcohol-another form of sugar….” Huh? Protein-another form of sugar. Fat-another form of sugar. Both of those statements are more accurate than your statement. (Protein can be converted into sugar, fat created from sugar. Alcohol isn’t made from sugar, converted to sugar, or metabolized in the same way as sugar, in the human body.

    “Sugars and their polymers and derivatives are called carbohydrates. (Alcohol, that is, ethanol is not a carbohydrate).”

    http://rdfeinman.wordpress.com/2012/02/14/organic-biochem-nutrition-3-aldehydes-ketones-sugars/

    But he’s a just a biochemist teaching at a medical school. What does he know?

    You’re also completely missing out on overconsumption of omega-6 fatty acids from seed oils. There’s an enormous amount of scientific literature pointing out the manifold ills of modern over-consumption of polyunsaturated seed oils…

    “Substituting monounsaturated and polyunsaturated fats for saturated and trans fasts helps lower the risk of heart disease.”

    And increase the risk of cancer.

    “The importance of the ratio of omega-6/omega-3 essential fatty acids.”
    http://www.ncbi.nlm.nih.gov/pubmed/12442909

    Other than all that, not a bad post.

  18. Harriet Hall says:

    If you have diabetes, you buy a glucometer and monitor your own blood sugar.
    If you have obesity, why not buy a scale and monitor your weight? Bathroom scales are inexpensive. If you can’t afford to invest $20 in your health, you have far more serious problems.

    Sure, weight fluctuates within a small range from day to day depending on water retention, etc. But averaging readings on the scale over time corrects for that. Belts are a far less reliable measure of weight.

  19. tuck says:

    @jt512: “Second, regarding essential fatty acids, there are only two: linolenic acid (omega-6) and alpha-linoleic acid (omega-3). ”

    Linoleic acid is the omega-6 FA, and alpha-linolenic acid is the omega-3 FA; you’ve got it backwards. ALA is converted (poorly, if not blocked entirely by over-consumption of linoleic acid) into what your body actually needs, which is the longer-chain omega-3 FAs.

    So while you’re technically correct that the RDA is for ALA, and not for EPA and DHA, this RDA (and definition of “essential”) is in error, as is demonstrated by omega-3 deficiency in those who only consume ALA and over-consume LA.

    “Can adults adequately convert alpha-linolenic acid (18:3n-3) to eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3)?”

    http://www.ncbi.nlm.nih.gov/pubmed/9637947

    “Essential Fatty Acids”
    http://lpi.oregonstate.edu/infocenter/othernuts/omega3fa/

  20. tuck says:

    “Belts are a far less reliable measure of weight.”

    But they’re a better measure of health.

    “…Waist–hip ratio (i.e. the waist circumference divided by the hip circumference) was
    suggested as an additional measure of body fat distribution. The ratio can be measured
    more precisely than skin folds, and it provides an index of both subcutaneous and intraabdominal
    adipose tissue (Bjorntorp, 1987). The suggestion for the use of proxy
    anthropometric indicators arose from a 12‐year follow‐up of middle‐aged men, which
    showed that abdominal obesity (measured as waist–hip ratio) was associated with an
    increased risk of myocardial infarction, stroke and premature death, whereas these
    diseases were not associated with measures of generalized obesity such as BMI (Larsson et
    al., 1984). In women, BMI was associated with increased risk of these diseases; however,
    waist–hip ratio appeared to be a stronger independent risk factor than BMI (Lapidus et al.,
    1984).”

    http://whqlibdoc.who.int/publications/2011/9789241501491_eng.pdf

  21. philosophia says:

    I’ve been wondering about organic foods. I subscribe to the Center for Science in the Public Interest newsletter, which I’ve always felt has been science-based. However, they printed an article strongly in favor of organic foods:

    http://www.cspinet.org/nah/articles/going-organic.html

    Note the answer to the last question: “…the single most important diet change you can make is to eat more fruits and vegetables and less bad fat, added sugar, and highly processed foods. The second most important thing is to seek out organic fruits and vegetables.”

    But your answer is organic foods make little difference:

    http://www.sciencebasedmedicine.org/index.php/no-health-benefits-from-organic-food/

    Any comments on why I should believe you and not the CSPI article?

    Thanks,
    Philo

  22. mousethatroared says:

    Regarding the scale as a healthy measure. It kills me when I work hard to get down to a healthy (normal) BMI and I go to the doctor’s and suddenly I’m overweight and higher risk again… just cause I’m wearing clothes.

    Clearly I’m more healthy naked. Who says the naturalist fallacy is always wrong, eh?

    Sorry, guys, just a bit of humor based on my daily trials with the scale.

  23. denisex says:

    I have a question re supplements.

    Years ago, my doctors told me that supplements were unnecessary except for calcium, and so I never took them. Then suddenly one year they started testing everyone routinely for vitamin D, and I and almost everyone I know was told that they were deficient and needed a supplement.

    Naturally this makes me wonder about other deficiencies. I know people who go to doctors who routinely test patients for blood levels of many vitamins and minerals and prescribe supplements. These doctors are considered outside the mainstream and possibly quacks. But in light of the changed thinking about vitamin D is there any reconsideration about this? Are there valid tests for levels of other vitamins and minerals that could indicate that supplements are needed?

  24. Calli Arcale says:

    mousethatroared:

    Calli Arcale – !? What did you eat for breakfast and dinner? There’s no way I could eat a 1000 calorie lunch and not gain weight. I think the typical women’s weight maintenance calorie consumption is like 1400 to 1800 calories. 2 miles of walking is not that much. I do like quarter pounder’s though, they are one of my ‘treats’. Don’t tell anyone.

    I think breakfast was usually a can of Mountain Dew back then. :-P Dinner varied; it’s been a long time, so I don’t really remember what I was having for dinner most of the time. But the fact that I didn’t have a car and had to walk everywhere made a big difference. Once I started my current career, and could afford a car, and also started having breakfast regularly, I gained ten pounds. ;-)

  25. JJ Borgman says:

    mtr,

    Your doctors office factors an average weight for clothing prior to a physical weigh-in. I’ve had the same concern, but even those plebeian assistants have figured that one out. ~:^)

  26. Calli Arcale says:

    BTW, I found a thingie that would estimate your caloric needs. Plugging in general SWAGs based on my physical activities and condition at the time, it said I’d need a little over 2,000 calories a day to maintain. So the quarter pounders obviously weren’t a big deal. Today, I have a more indolent routine, so quarter pounders are more of an occasional treat.

  27. mousethatroared says:

    Calli Arcale – Ah, walking everywhere and probably being younger increases your calorie allowance, then. Makes sense.

  28. Harriet Hall says:

    @tuck,

    It’s not belts, but waist-hip ratios. And even that is just one risk factor, not a measure of health.

  29. Narad says:

    I do love how Reno worries about body acidity (what rot) but then endorses vinegar consumption. Hello?

    I imagine there are several “explanations” for this, as with lemons, but this is a fun one: “Apple Cider Vinegar in itself is alkaline because of its ‘ash’ content, which means if the apple cider vinegar was burned, what is left over becomes ash. When you check for the pH of that ash and dissolve it with water, the content is alkaline. Whenever our body digests anything it undergoes oxidation, which is similar to burning and the end result is that you can determine whether the end product was alkaline or acid.”

  30. Narad says:

    ^ Sorry, forgot the blockquote tags.

  31. WilliamLawrenceUtridge says:

    If you have diabetes, you buy a glucometer and monitor your own blood sugar.

    [snip]

    Sure, weight fluctuates within a small range from day to day depending on water retention, etc. But averaging readings on the scale over time corrects for that. Belts are a far less reliable measure of weight.

    But I doubt belts and blood sugar readings have the same irrational emotional impact as a number on a scale.

    Rationally, yes, a scale makes sense as one measure of health. But body weight is strongly linked to appearance, and I suspect (particularly for women) isn’t always a rational thing. Also, a scale isn’t the only proxy measure of health – there is general appearance, regularity of activity, diet, belt and clothing fit and others. I wouldn’t bother with a scale because I get a lot of exercise, eat a lot of fruits and vegetables, and try to keep my belt loop within one notch of my “ideal”. The important thing is that I keep doing these things, not how much I weigh, but if I do these things, I will weigh less.

    Depending on the sophistication, awareness and a person’s emotional reaction to the number on the scale, it might or might not be a good thing to have. I would argue that it’s never the weight that’s important, it’s where the weight is coming from (fat, muscle, bone, edema) and there are other indicators than just weight. A raw weight doesn’t necessarily inform that.

  32. agitato says:

    @angora rabbit

    I enjoyed reading your comment especially this bit: “The key, and we nutrition professionals have been saying this for years to deaf ears, is to eat in moderation, eat a variety of foods, and cook for yourself as much as you can, because this is the best way to control portion size, quality and nutrient composition. It really ain’t rocket science, but people prefer gimmicks over common sense.”

    I couldn’t agree more.

    I’m interested also in this statement you made: “It’s the use of preservatives that substantially lowered the incidence of stomach cancer in the US.” I didn’t realize it was that clear-cut.

  33. egstra says:

    WilliamLawrenceUtridge

    ” I get a lot of exercise, eat a lot of fruits and vegetables, and try to keep my belt loop within one notch of my “ideal”.”

    Just wait… I am now 67, and weigh what I did 30 years ago. I eat lots of fruits and vegetables, lift weights 4 days a week, and get aerobic exercise daily. Despite all that, pants that I wore comfortably 5 years ago no longer fit in the waist, and the scale is the only measure I have of how well I’m maintaining. To get my waist down to what it once was, I would probably need to lose 10+ lbs, somewhat below what is desirable (or maintainable) for my frame.

    Perhaps it’s different for men, but women’s weight shifts over time… despite one’s best efforts.

  34. tyro says:

    What’s the evidence regarding eating 2-3 meals/day vs eating 5+ meals (every 2-3hrs)? Angora Rabbit hinted that this could actually cause greater difficulties. I have heard this advice many times but I’m very dubious.

    I have a couple anecdotes which don’t prove anything, but it does make me wish for more information. First, when I got a new cat she was a little plump and would beg for food a lot. To make her feel better I fed her every 2-3 hours in small portion. She would be fine for an hour or so after eating but would then go right back into begging. After a few months I shifted to 2x/day feedings and she seems far more relaxed and calm. She still gets cravings/begs for the 30mins before her feeding but is calm and relaxed for the rest of the day. A huge change from the frequent feedings.

    I too tried following the frequent eating advice and would regularly snack throughout the day. I found I was always hungry and always thinking of food. No meal would every fill me up and I’d often be counting the minutes till the next snack, which would just see me through to the next snack. After a year, I got braces and had to brush after every meal so I would eat 3x/day. After a couple of days I found that my hunger pangs virtually disappeared. I wasn’t counting down the minutes and felt pleasantly satisfied after meals. My total calorie consumption was the same but I felt much, much better.

    I know, I know, poor sample size. I’d like to see research on more people. But for the moment, I am leaning strongly to the view that keeping a few (2-3) meals per day is a much better way of controlling hunger than snacking regularly. I don’t even need my bag of nuts which I’d dip into nervously throughout the day!

  35. rork says:

    Maybe Michael Pollan has affected me too much, but some things I’ve been seeing or trying aren’t about the scientific details, but the culture that goes with the things you eat. Like Rabbit’s “and cook for yourself as much as you can” for example. Growing (and killing) as much of my own food as I can, and almost never eating anything someone else fiddled with, changes what I end up eating I think – I don’t expect to see a study about this. I think it makes me more mindful. I plan what’s going to get cooked more. There’s less “whatever” about my choices.

    I observe about exercise: My weight goes up and down dramatically with the amount of physical work or play. (Got very skinny this year thanks to the “tornado workout” – and I got to eat ~5000 cal/day.) There may be some kind of body awareness in there – exercise makes me feel good and I look better (I think), and this positive feedback makes me more prone to do other healthy things like eat better. And I’m more likely to do even more physical things. Things snowball somehow.

  36. mousethatroared says:

    # JJ Borgman

    “Your doctors office factors an average weight for clothing prior to a physical weigh-in. I’ve had the same concern, but even those plebeian assistants have figured that one out. ~:^)”

    Well that’s nice to know. Although, I don’t think my doctor’s capable assistant is Plebeian – I would guess Ukrainian if I had too. ;)

  37. WilliamLawrenceUtridge says:

    @Egstra:

    Your comment suggests your scale is a meaningful and useful indicator of your own body weight and a useful proxy of certain aspects of your health. It looks like we’re following comparable lifestyles – if I can maintain mine until I reach your age, a scale might be more valuable to me. For now, I don’t seem to need it and see no reason to get attached to a number.

    Works for me, doesn’t work for everyone. I must come across as a lot more declarative in text than I do in my head, or I’m just expressing myself badly this week.

  38. LovleAnjel says:

    @tyro

    Cats and kittens like a schedule. They know when food is coming, so they feel comfortable if their dish is empty for awhile beforehand. Our kitten gets his dish filled before I leave for work, so even if he empties it before I get up in the morning, he doesn’t bother me for food – he knows it’ll come just after I put on my coat. He gets wet food while we eat dinner, so when I call the family to the table he immediately runs in and starts meowing. If you were feeding at irregular times, kitten didn’t know when her next meal was coming, and would start to worry, and thus beg.

  39. mousethatroared says:

    Egstra “Perhaps it’s different for men, but women’s weight shifts over time… despite one’s best efforts.”

    Yes, I do think where a woman carries their weight is somewhat different depending upon where they are with menopause. (pre-peri-post). Seems I read that, but can’t remember where. This is somewhat separate from their overall pear, apple body shape that describes a woman’s particular shape throughout her life.

  40. mousethatroared says:

    @rork – I’m with you about the snowball effect. I’ve was thinking about that reading the comments, but didn’t know how to express it.

  41. Amalthea says:

    If there’s anyone lurker who’s wondering why the pros here are down on the blood allergy tests I can provide some anecdotal examples.
    I had both RAST ( http://en.wikipedia.org/wiki/RAST_test ) and skin tests done within two months of each other eleven years ago.
    There are quite a few discrepancies. Also my doctor told me to ignore the RAST results which were Class I or lower while the test results mark Class I as the bottom end of significant.
    Barley: RAST: Class I, while the skin test was negative.
    Yeast, Baker’s: RAST: Class 0, while the skin test said 1+

    I decided to believe the skin tests.

  42. Amalthea says:

    Argh, that should have been “lurking”.

  43. mho says:

    disclaimer: I’m not a medical person.

    An indicator of possible ovarian cancer is increasing girth without increasing weight. (Ovarian cancer isn’t rare, but it isn’t common either) So, in that instance, having both weight and “belt” measurements would be really helpful.
    For some women, losing weight without changing eating or exercise can be a symptom of cancer. In those cases, a scale would only give you part of the information your health.

    Finally, I’ve heard the term “eating clean” and to my ears, it oozes with judgement about someone else’s diet. What is a “dirty” way to eat?

  44. pharmavixen says:

    I’ve been trying the “eat clean” diet off and on for a few months now because of friends who had impressive results, and as Scott notes it’s not too offensively faddish. I have noticed, however, that the people who advocate for “eating clean” also suggest a concurrent heroic exercise program. Today, for instance, my “eat clean” Facebook friends are advocating for 100 push-ups. Like, today. Though to be fair you don’t have to do them all at once; 20 here, 20 there.

    And to be honest, I’m feeling a bit guilty sitting here typing in my comfy chair instead of getting in some push-ups.

    I think what this diet does is what Atkins does, which reduces your total calories under the guise of a “fat-burning” formula for eating. So it isn’t so much the wonderful foods you’re eating, but the foods you’re not eating, like the Timbits a coworker brings in, or danishes, toast with jam, plates of greasy fries, Oreos, fast food in general, etc.

    I always lose weight if I quit drinking completely. But it’s not because I’m munching organic walnuts dipped in unpasteurized honey, or avoiding white flour and caffeine.

  45. Angora Rabbit says:

    Hey, Tyro. I think the big concern with the many meals is that caloric intake could actually increase and the person could overeat. The recent published study about patterns of eating is very interesting in that light. It found that putting more calories earlier in the day (breakfast lunch) as opposed to late in the day (late evening – the study was done in Spain if you know their eating habits!) led to increased weight loss. We’re still talking 2-3 meals per day. There are thoughts this may relate to circadian rhythms in hormones that control appetite and metabolism. N=1 study but it’s an idea that’s been banging around for awhile, so nice to see it done.

    @denisex – Micronutrient requirements can change as we get better data. This is what happened with Vit D. Vit C got bumped up a little while back too. It’s actually pretty difficult to precisely pinpoint a requirement, in part because it’s unethical/hard to make people really deficient, and because there are multiple endpoints for “deficiency” plus variability in responses within a group of people. But we know this, so the requirements add fudge factors to cover as broad a sweep of the population as reasonably possible (97.5% of a given population). The other micronutrients adults in North America might be a little low in are B12, potassium, iron (for menstruating women), copper, zinc, and calcium (for women). A complete vitamin / mineral supplement 2-3x a week would address this nicely. I buy Walgreens since it’s cheap and all the vitamins are supplied by the same four international companies anyway. (They got busted for price fixing a few years back.)

  46. Angora Rabbit says:

    @agitato: the relevant figure is from CDC where they plot cancer deaths by type and gender. Their charts make very interesting reading. For both sexes there’s a remarkable drop in age-adjusted stomach cancer deaths from at least 1930 onward, from about 38 to about 5 per 100,000. The shift is due in large part to shifts in preservatives, moving away from high salt and pickling plus limited refrigeration, to safer preservatives and storage methods. Mycotoxin levels in food have dropped substantially; these are potent carcinogens. A striking example occurs in Willa Cather’s book “Oh, Pioneers”, where a major character dies from what is stomach cancer. Countries like Japan, China and in Southeast Asia still have high rates because of the widespread use of highly salted foods for preservation.

  47. Alia says:

    dr Hall – there’s one more aspect of not buying scales in my case. I have several friends who suffer from various eating disorders. And while I try to eat well, at the same time I consciously do not focus on my weight. And it seems to be working.
    I am active, exercise regularly and do a lot of walking (no car works miracles). And I cook my own meals, too.

  48. egstra says:

    Alia – “I have several friends who suffer from various eating disorders. ”

    A significant issue for many. I used to have a number of clients with eating disorders and the scale was both a feared enemy and a best friend. If it said they had gained, “Oh, I might as well eat a bag of cookies; what difference does it make.” If it said they had lost, “Oh, I can eat a bag of cookies; my weight is down.”

    I use the scale at the gym; it helps prevent obsessiveness.

  49. Alia says:

    I have one more reflection on successful diet and I though I’d share it here. I think that some people (at least some people that I’ve met) perceive diet not only as a way to lose weight, avoid health problems and feel better. For them it’s also a kind of mortification. So one day they eat Chinese or Mexican takeway, pizza, chocolate bars and cookies, and drink sweetened beverages, and the next day they have bland boiled chicken breast, a handful of rice and some lettuce, without any garnish. And of course they do not stick to this diet because it’s too bland and they miss all the tasty dishes.
    So, when I decided to change my eating habits I decided that I won’t force myself to eat anything, just because it’s perceived to be healthy or good for losing weight. When cooking, I use a lot of herbs and spices, so while it may be chicken breast and rice, it’s at least chicken breast marinaded in curry. And it seems to be working.

  50. WilliamLawrenceUtridge says:

    @pharmavixen

    I think what this diet does is what Atkins does, which reduces your total calories under the guise of a “fat-burning” formula for eating. So it isn’t so much the wonderful foods you’re eating, but the foods you’re not eating, like the Timbits a coworker brings in, or danishes, toast with jam, plates of greasy fries, Oreos, fast food in general, etc.

    I believe there’s a study or analysis out there somewhere that looked at Atkins and other fad diets and concluded that basically all of them were simply calorie restriction in the form of eating restrictions. You forbid someone from consuming carbohydrates, you’re essentially forcing them away from a large number of easy calories; instead you substitute high-fiber vegetables, meats and fats that are very satisfying and take time to cook (i.e. much less convenient). Most are basically restrictive ways to change eating habits. Ornish forbids eating meat (I think) and you can only consume highly complex carbohydrates with very few fats. Wheat belly means you eat less wheat, and a lot of convenient foods are also high calorie processed foods that are wheat-based.

    Most fad diets shoehorn you into some form of eating according to some aspect of the USDA guidelines, or simply restrict how much you can eat. The result is usually less processed food, lower calorie intakes and weight loss. ‘Tain’t magic, ’tain’t tricking your biology, it’s just eating less. It’s also usually unsustainable since they tend to be repetitive and people get bored.

    Michael Pollan’s advice (eat food, mostly plants, that taste good) is good advice. Cook most of your meals, get good recipes that are tasty and exercise. Basic medical advice. Might be boring, but it has the advantage of actually working ’cause it’s a lifestyle change, not just restriction.

  51. RUN says:

    I thought this was funny regarding clean/healthy eating…
    http://www.nwedible.com/2012/08/tragedy-healthy-eater.html

  52. DugganSC says:

    I suspect that, as much as anything, it’s actually paying attention to what you’re eating at all that yields the results. Reminds me of how the books on mnemonics tell you that establishing image-name associations don’t actually make you remember better on their own, but rather force you to actually think about someone’s name in the time it takes you to make the association. Most of us forget names because we never really hear the name in the first place, dismissing it as so much noise.

  53. tuck says:

    “It’s not belts, but waist-hip ratios. And even that is just one risk factor, not a measure of health.”

    The math of the waist-hip ratio is such that if your belt size increases, the ratio is indicating (likely) worse health. As the study notes, but you ignore, it’s a better ratio than weight. So why not use it?

    The other commenter’s position that she judges her weight by how her pants fit but not irrational, as you imply, but more scientific than your position.

    “If your weight starts to slip upwards again, don’t you want to know about it right away?”

    If you can’t use the traditional notch on your belt, you know it immediately.

    I know, I know, “Science-based medicine” is far from “Scientific medicine”, but one can aspire.

    1. Harriet Hall says:

      Imagine a controlled study of weight loss that eschewed scales and used belt notches as an endpoint…

  54. estockly says:

    @pharmavixen>>>I think what this diet does is what Atkins does, which reduces your total calories under the guise of a “fat-burning” formula for eating.

    Atkins (which has been around 40+years is not exactly a “Fad” diet) does change your body from a carb burning mode to a fat burning mode. By lowering carb intake your body takes a few days to adjust and begins to produce ketones from the liver. On Atkins you metabolize fat (stored and dietary) ketones and some glucose.

    @WilliamLawrenceUtridgeon
    >>>I believe there’s a study or analysis out there somewhere that looked at Atkins and other fad diets and concluded that basically all of them were simply calorie restriction in the form of eating restrictions. You forbid someone from consuming carbohydrates, you’re essentially forcing them away from a large number of easy calories; instead you substitute high-fiber vegetables, meats and fats that are very satisfying and take time to cook (i.e. much less convenient).

    You’re reading a lot into the data that’s not there. There are studies that have concluded that LCHF diets to involve a reduction of calories. They don’t say how or why. On LCHF diets you eat when you’re hungry and stop when you’re full. On some days that means many more calories than other days, but, in the end you’re consuming fewer calories than before the diet. More important than calorie consumption, you’re keeping insulin down, which means the calories you eat don’t get stored as fat, which would make them unavailable for metabolism. Instead your stored fat is slowly released and becomes available for metabolism.

    >>>Ornish forbids eating meat (I think)

    Limits fat and calories, allows lean meat.

    >>> Wheat belly means you eat less wheat, and a lot of convenient foods are also high calorie processed foods that are wheat-based.

    Wheat belly diet is zero wheat.

    >>>Michael Pollan’s advice (eat food, mostly plants, that taste good) is good advice. Cook most of your meals, get good recipes that are tasty and exercise. Basic medical advice. Might be boring, but it has the advantage of actually working ’cause it’s a lifestyle change, not just restriction.

    That’s consistent with LCHF. Simply add the caveats avoid foods with sugar and starches.

    Pollan’s advice, by the way, is a fad diet.

    ES

  55. Angora Rabbit says:

    @esstockly: actually Pollan’s advice isn’t a fad diet so much as adhering to the IOM / ADA / USDA guidelines. It’s just as a journalist he has a better publicity machine.

    Atkin’s claims to shift a person to ketotic, but the reality is that the weight loss is not due to preferential fuel burning. Several studies have looked at this carefully (you can use double-labeled water to look at fuel choice, which is what we do here) and find that the weight loss from the Atkin’s diet was accounted for by the patients’ reduction in calorie intake, not due to some magic calorie choice. Protein and fat have higher satiety indicies, and so the people on the diet ate less without realizing it. We actually *do* know how these diets work, contrary to what Stockly said.

    The gimmick in Atkin’s is that, by going ketotic for the first few days, you lose a lot of water as you pee out the ketones and nitrogen with all the fat and protein intake. It’s a fake weight loss, if you will. But because the scale shows a presto! change, you get better patient compliance thanks to the immediate reward.

    The dirty secret to Atkin’s, apart from it is not healthy to have the metabolism of a Type I uncontrolled diabetic (which is what Atkin’s does) is that all the fat and meat increases CVD risk. I thought it very telling that when Atkin’s passed, it was refused to look at what his vessels looked like.

  56. WilliamLawrenceUtridge says:

    @estockly

    Atkins (which has been around 40+years is not exactly a “Fad” diet) does change your body from a carb burning mode to a fat burning mode. By lowering carb intake your body takes a few days to adjust and begins to produce ketones from the liver. On Atkins you metabolize fat (stored and dietary) ketones and some glucose.

    I’ve heard this claim for Atkins before, and Angora Rabbit addressed my questions and objections far more ably than I could. The claims of “magical biochemistry” burning more calories (or really, inefficient fuel burning) seems questionable to me, and I also wonder about the long-term consequences of that much animal fat and protein. The ancedotes I’ve heard also point to some issues – trouble concentrating, bad breath and the like. Humans can produce useful sugars through ketosis, whether it is worth doing so and healthy over the long-term is an open question. I wonder about the ability to exercise when your body has to create all the sugar and glycogen through torturous pathways.

    On the other hand, think of how much bacon get to eat :)

    You’re reading a lot into the data that’s not there. There are studies that have concluded that LCHF diets to involve a reduction of calories. They don’t say how or why. On LCHF diets you eat when you’re hungry and stop when you’re full. On some days that means many more calories than other days, but, in the end you’re consuming fewer calories than before the diet. More important than calorie consumption, you’re keeping insulin down, which means the calories you eat don’t get stored as fat, which would make them unavailable for metabolism. Instead your stored fat is slowly released and becomes available for metabolism.

    Have there been any studies on what it does to your cholesterol, heart attack or stroke risks? And again, this seems to be a fancy way of restricting calories, like all diets, rather than biochemical magic through doing mean things to your liver.

    Calories not burned get stored as fat no matter what as far as I know. Low insulin may keep blood sugar down, but unmetabolized calories still end up as storage. One of the advantages of exercise is shifting where that storage is, from subcutaneous and visceral tissues into muscles (fat and glycogen) or liver (glycogen). And again I wonder about how that much fat and protein, with the biochemical steps needed to turn them into sugars, impacts your ability to exercise. Whenever I’m going to do something cardiovascular, I make a point of eating something with carbohydrates in it so I’ve got the blood sugar necessary to exert myself for upwards of an hour.

    That’s consistent with LCHF. Simply add the caveats avoid foods with sugar and starches.

    Questionable caveats in my mind, since many foods with sugars and starches can be quite good for you (potatoes are relatively high calorie, but also high in many vitamins, minerals and fiber, ditto most fruits, figs, carrots and whole grains). Not to mention delicious. And I don’t think the biochemistry claims for LCHF diets have been widely accepted as proven. Perhaps I’m wrong.

    Though I did learn in one class that to convert protein to fat takes a fair number of calories, so you end up storing less actual fat compared to the calories found in a bomb calorimeter.

    Pollan’s advice, by the way, is a fad diet.

    I might be splitting hairs here, but I see a “diet” as restrictive, particularly in quantity. Pollan’s advice is to simplify, not restrict (for the most part, meat is an exception). And what is a fad diet? Pollan’s advice is so very close to the USDA and other expert groups it seems more like a repackaging than something new, more like another way of summarizing the conventional dietary advice than a novel claim for health.

  57. lizz says:

    I’m a bit surprised nobody seems to have mentioned this already, but belts stretch with use. Even leather belts do this. Likewise, trousers tend to stretch with use – I’m sure most people have experienced jeans which become gradually looser the more they are worn . This may be a valid reason why it’s not a good idea to judge your current weight/health as to whether your belt or trousers do up.

  58. estockly says:

    @Angora Rabbit
    >>>Atkin’s claims to shift a person to ketotic, but the reality is that the weight loss is not due to preferential fuel burning. Several studies have looked at this carefully (you can use double-labeled water to look at fuel choice, which is what we do here) and find that the weight loss from the Atkin’s diet was accounted for by the patients’ reduction in calorie intake, not due to some magic calorie choice.

    I would like to see those studies, because I believe you are making claims beyond what the studies found. Their are numerous studies that have found Atkins and similar LCHF diets achieved better results than low fat or calorie restricted diets and that there was also a reduction in calories in LCHF. They also found that LCHF diets are better at burning stored fat while preserving lean tissue and that on a LCHF diet resting energy expenditure and total energy expenditure tended to increase more than on LF or CR diets. Certainly some weight loss is attributed to reduced calorie intake, but there are other fatctors.

    >>>Protein and fat have higher satiety indicies, and so the people on the diet ate less without realizing it. We actually *do* know how these diets work, contrary to what Stockly said.

    I did not say we do not know how these diets work. We know how they work. It’s more complex than calories in/calories out, but not much more.

    Can you tell me why eating less on Atkins is an issue? Particularly since the dieters may eat as much they want?

    >>>The gimmick in Atkin’s is that, by going ketotic for the first few days, you lose a lot of water as you pee out the ketones and nitrogen with all the fat and protein intake. It’s a fake weight loss, if you will. But because the scale shows a presto! change, you get better patient compliance thanks to the immediate reward.

    Right, that lasts the first few days. It’s not a gimmick or a secret (it’s in the Atkins book). But studies show that the comparative weightloss advantage for Atkins lasts much longer than the first few days on the diet.

    >>>The dirty secret to Atkin’s, apart from it is not healthy to have the metabolism of a Type I uncontrolled diabetic (which is what Atkin’s does) is that all the fat and meat increases CVD risk.

    Another common misconception not supported by any evidence whatsoever. The fact is that studies show that dieters on LCHF diets improve their risk factors for chronic disease more than on any other diet. This includes: HDL; LDL (total and particle size); blood pressure; serum triglycerides; A1c; BMI; body fat percentage.

    Lots of fat and meat on a high carb (so-called balanced diet) is a recipie for CVD risk and a multitude of problems. Lots of fat and meat on a low-carb diet is healthy eating.

    ES

  59. Narad says:

    Atkins (which has been around 40+years is not exactly a “Fad” diet)

    Atkins was beaten to the punch by nearly a decade by The Drinking Man’s Diet.

  60. estockly says:

    @WilliamLawrenceUtridgeon

    >>>The claims of “magical biochemistry” burning more calories (or really, inefficient fuel burning) seems questionable to me

    Well if you phrase it as a straw-man, of course it does. There is nothing magical or mysterious about the biochemistry.

    Insulin is the hormone that regulates fat storage in cells. Insulin rises largely in response to blood glucose levels. When glucose is high, insulin is high and there is a lot of fat storage and stored fat cannot be metabolized. When glucose stays low insulin stays low and there is very little new fat storage and stored fat is released. (When there is no insulin –T1 diabetes– there is no fat storage).

    When carbs are low and stored fat is released your body is fueled by fat (dietary and stored), ketones and carbs. (your body makes all the carbs you need, there is no need for any dietary carbs).

    >>>I also wonder about the long-term consequences of that much animal fat and protein.

    That is essentially the diet humans evolved eating. In the long term. There is no evidence that that diet (High fat, moderate protein, low-carb) is not healthy. Plenty of evidence that the “balanced” diet is unhealthy.

    >>>The ancedotes I’ve heard also point to some issues – trouble concentrating, bad breath and the like.

    Bad breath on a ketogenic diet comes when the body hasn’t fully adapted to ketosis and ketones are exhaled and appear in the urine. This is temporary.

    >>>Humans can produce useful sugars through ketosis, whether it is worth doing so and healthy over the long-term is an open question.

    That’s not what happens. In ketosis cells directly metabolize ketone bodies. The body can produce glucose from fat and protein as needed. This happens whether or not you’re in ketosis.

    >>>>I wonder about the ability to exercise when your body has to create all the sugar and glycogen through torturous pathways.

    You don’t need that much if you have plenty of ciruclating free fatty acids and ketones. There are a number of atheletes who do just fine on low-carb and carb restricted diets. Some of the first good studies on Ketones and ketosis were done on cyclists whose performance improved on a ketogenic diet.

    >>>On the other hand, think of how much bacon get to eat

    MMMM Bacon….

    >>>Have there been any studies on what it does to your cholesterol, heart attack or stroke risks?

    Yes, LCHF improves all your risk factors and does so more than any other diet.

    >>>And again, this seems to be a fancy way of restricting calories, like all diets, rather than biochemical magic through doing mean things to your liver.

    The meanest thing you can do to your liver is eat a diet high in simple carbs, particularly sugar (sucrose/HFCS). The next meanest thing is drink heavily. LCHF diets actually improve liver function.

    >>>Calories not burned get stored as fat no matter what as far as I know.

    Only fat gets stored as fat. And fat is only stored when insulin levels are high.

    >>>One of the advantages of exercise is shifting where that storage is, from subcutaneous and visceral tissues into muscles (fat and glycogen) or liver (glycogen).

    One of the disadvantages of exercise is that it can make people hungry and tired. And you actually don’t burn that many calories when you’re exercising. There are even studies that show that energy expenditure can drop so low after exercise that the net effect is a reduction in total energy expenditure.

    Exercise is not a panacea, nor a good weightloss strategy (although it is important for overall health and fitness and should be a part of everyone’s lifestyle, regardless of diet).

    >>>Questionable caveats in my mind, since many foods with sugars and starches can be quite good for you (potatoes are relatively high calorie, but also high in many vitamins, minerals and fiber, ditto most fruits, figs, carrots and whole grains).

    On a LCHF diet you eat lots of green vegetables. You get all the fiber and micronutrients you need.

    >>>And I don’t think the biochemistry claims for LCHF diets have been widely accepted as proven.

    Here’s the thing. There is almost no dispute of any of the specific biochemistry claims. The dispute comes when they are all put together into a cohesive theory, and when that theory forms the basis for diet advice.

    >>>>>Pollan’s advice, by the way, is a fad diet.
    >>>I might be splitting hairs here, but I see a “diet” as restrictive, particularly in quantity.

    That’s one definition. Since LCHF doesn’t restrict quantity does it fit your definition?

    I use the broder definition of diet, which is basically your eating patterns.

    >>>And what is a fad diet?

    A fad is something that has temporary popularity. A diet is an eating pattern. So a fad diet would be an eating pattern that enjoys temporary popularity.

    >>>Pollan’s advice is so very close to the USDA and other expert groups it seems more like a repackaging than something new, more like another way of summarizing the conventional dietary advice than a novel claim for health.

    You can eat a diet high in processed foods with lots of simple carbs and still be withing the USDA guidelines but not within Pollan’s advice.

    Pollan’s advice is more compatible with the LCHF model (even with the meat).

    ES

  61. Narad says:

    The math of the waist-hip ratio is such that if your belt size increases, the ratio is indicating (likely) worse health.

    How many men actually still wear their pants an inch below their natural waist?

  62. estockly says:

    @Harriet Hallon

    >>>Imagine a controlled study of weight loss that eschewed scales and used belt notches as an endpoint…

    I once had exactly the same BMI as Arnold Schwarzenegger did when he won the Mr. Universe title.

    Our belt notches were probably a better comparison than our scales!

    ES

  63. Angora Rabbit says:

    @Stockly – eating less IS less calories coming in. When carefully controlled studies do the real math, ALL the calories lost on an Atkin’s diet are TOTALLY accounted for by a reduction in intake. The studies can all be found in a PubMed search.

    I am beginning to wonder what you really mean by a “low carb” diet. You appear to be sweeping all carb forms under a same rubric, when their metabolism and physiological effects are quite different. Could you define precisely what you mean by LCHF?

    I am also starting to question your knowledge base given your comments such as these:
    “Only fat gets stored as fat. And fat is only stored when insulin levels are high.” This is patently untrue. Moderate insulin levels also drive storage. And of course anything that goes into AcCoA under the influence of insulin goes into fat.

    “The body can produce glucose from fat and protein as needed. This happens whether or not you’re in ketosis.” No. We cannot turn fat into glucose. The two AcCoA carbons do not contribute to a net gain in glycolytic carbon forms. Certain species can do this – chick embryos for example can turn fat into glucose. But we don’t do this. We also cannot meet all our glucose needs – let alone all the other roles that saccharides play in the body – through a diet of fat and protein.

    “You don’t need that much if you have plenty of ciruclating free fatty acids and ketones. There are a number of atheletes who do just fine on low-carb and carb restricted diets. Some of the first good studies on Ketones and ketosis were done on cyclists whose performance improved on a ketogenic diet.”
    Apart from that sports nutrition studies are usually some of the worst studies around, I doubt this statement is actually true. Neurons really prefer to burn glucose over ketones. There’s a perceptual buzz one can get off ketones, but cognitively the brain is much happier burning glucose. The fuel choice in athletics depends on the event, aerobic vs. anaerobic.

  64. DugganSC says:

    @Narad:
    Excellent point. I know that I wear mine relatively high on the hip compared to what’s fashionable, but they still tend to sit right below my belly, which means that weight gain or loss has relatively little effect on how they fit (there’s some, of course, due to mass gained on the hips, pelvis, and buttocks, of couse).

    @eestockley:
    Just to check, you are aware that studies of genetic drift show that humanity developed the genes to survive a high fat diet almost a thousand years after we switched to such a diet, right? Humanity did indeed evolve to survive on a largely meat diet high in fats, but the historical record from the artifacts and bones we’ve found indicate that we didn’t thrive on it for a long time (IIRC, from the account in The Violinist’s Thumb, the gene in question increases our risk of several diseases, but allows us to keep our arteries less clogged with such a diet. Nowadays, almost all of us bear that gene, of course).

  65. WilliamLawrenceUtridge says:

    Imagine a controlled study of weight loss that eschewed scales and used belt notches as an endpoint…

    Sure, but for most people weight loss is not scientific. We could also imagine a study that solely used weight loss as a measure, and found the best intervention was the surgical amputation of four limbs. While I would never argue against weighing subjects as a measure within a scientific study, for real life the emotional reaction of some people to what may be an arbitrary number can be rather negative, and if a comparable way of indicating fat loss is available that is more encouraging and less hurtful (i.e. fit of clothes, belt loops), I don’t see the harm. It may not be good for some people, but I think it’s useful for some.

    I don’t disagree that a bathroom scale can be useful and is more precise, perhaps more encouraging to some than belt loops. But for some it may be discouraging, for others (I’m thinking of people with anorexia or bulimia) it can be a dangerous source of obsession.

    @lizz

    I’m a bit surprised nobody seems to have mentioned this already, but belts stretch with use. Even leather belts do this. Likewise, trousers tend to stretch with use – I’m sure most people have experienced jeans which become gradually looser the more they are worn . This may be a valid reason why it’s not a good idea to judge your current weight/health as to whether your belt or trousers do up.

    Nuh-uh, no they don’t. Crap.

    What’s the quote? For every problem there is a solution that is simple, perfect, elegant and wrong?

    That is essentially the diet humans evolved eating. In the long term. There is no evidence that that diet (High fat, moderate protein, low-carb) is not healthy. Plenty of evidence that the “balanced” diet is unhealthy

    A couple points. First, that’s a bit of the naturalistic fallacy. Second, the range of diets humans can thrive on is tremendously diverse – vegan Jains all the way to raw-meat Inuit. Third, evolution did not stop once we became hunter-gatherers (lactose tolerance being one, and I’ve seen mention of evolution in response to farming). Fourth, the amount of exercise you get chasing down your dinner versus buying it is tremendous. Fifth, I believe studies of current hunter-gatherer tribes show more calories from non-meat sources than meat sources. Sixth, even hugely obese people usually live past child-bearing ages, and once you’ve bred the evolutionary pressures are quite different. Evolution only wants you to live long enough to pass on genes, we certainly aren’t designed to live into our 60s, 70s, 80s and 90s.

    Only fat gets stored as fat. And fat is only stored when insulin levels are high.

    Hm…I wonder about this. Citation needed.

    One of the disadvantages of exercise is that it can make people hungry and tired. And you actually don’t burn that many calories when you’re exercising. There are even studies that show that energy expenditure can drop so low after exercise that the net effect is a reduction in total energy expenditure.

    Exercise is not a panacea, nor a good weightloss strategy (although it is important for overall health and fitness and should be a part of everyone’s lifestyle, regardless of diet).

    Exercise changes where the energy molecules are stored, so less in the gut and more in the muscles – so even the same level of fat could mean significantly different risk (as well as being healthy overall such that “fit and fat” is a good health strategy). And I’ve only lost weight when my exercise increased, my diet rarely changes and I rarely restrict myself. It depends on a lot of things, but I found it to be a good weight loss strategy if maintained over the long term.

    You can eat a diet high in processed foods with lots of simple carbs and still be withing the USDA guidelines but not within Pollan’s advice.

    And you can lose weight eating twinkies. Pollan’s advice is more about eating than dieting or losing weight. It’s simple, aligns with the evidence and contains much common sense. I disliked the way Atkins portrayed itself as biochemical trickery rather than calorie restriction, and the way people are dogmatic about it. I like the way it allows you to eat bacon – but then again, so does Pollan, and so does my “eat what you want but exercise vigorously every week” plan.

    I may change my mind if more evidence rolls in supporting Atkins as a magic bullet. Until then, I’ll rest on my stubborn opinion that it’s unsupported handwaving. I like eating potatoes, and the USDA says it’s just fine.

  66. Angora Rabbit says:

    WLU: thanks for some needed common sense. I’m enjoying your posts.

    It’s true that exercise can increase appetite to compensate for losses, and people do tend to overestimate how many calories they burn exercising. Nonetheless, exercise has many benefits that greatly outweigh these trivial disadvantages. Exercise increases resting energy expenditure and overrides the metabolic slowdown adaptations that occur in response to simply reducing calories. Exercise can increase muscle mitochondrial content, and since fat is the preferred energy for resting muscle, increased muscle and mito mass increases fractional fat catabolism at rest. Or as my colleague likes to joke, he can burn fat by lounging on the sofa. :)

    To weigh in on the Belt Wars :) I actually like the belt / pant test and use it on myself as a useful and informal monitor.* At the professional and clinical level we can do better, but even there we know that no single measure precisely captures body mass and composition. But it’s hard to convince people to let us boil them down for precise analysis. Some tests are cheaper, others very pricey and require expensive equipment. But pragmatically, the gestalt of simply looking at someone is pretty useful and having numbers attached with BMI, waist/hip and skinfold gets a pretty decent snapshot. To my mind the folks who whinge about BMI inaccuracies are being disingenuous.
    *Not to mention that household scales seem to be notoriously inaccurate.

  67. Narad says:

    Nuh-uh, no they don’t. Crap.

    Mine have. I’ve had to drill more holes despite not having lost any weight or embarked on any exercise program, so that’s about a half-inch over time. Nonetheless, I still don’t see belts as being an accurate measure of waist-to-hip ratio for most men. As a clothing-based metric, it seems like the fit of a jacket would be better if one can’t be bothered to get a tape measure.

  68. Mark P says:

    I’m another who judges his weight by his trouser size. If I can’t fit trousers I used to fit five years ago, then I eat less in order to lose weight. Not for health reasons (because I’m still well within any reasonable bounds) but because I am too cheap to buy a new wardrobe.

    What bothers me, however, is the insistence on eating breakfast. Scott says, in reply “Some people don’t prefer to eat breakfast, and it’s often an individual decision. but in my case it’s much stronger than that.

    I dislike eating breakfast quite strongly, and I will avoid eating it even when it is prepared for me and free (such as at a hotel). It makes me feel quite unwell to eat more than trivial amounts early. I don’t even start to get hungry to around 11:00 or so. My children, as they mature out of childhood, are the same.

    Yet when I tell people that I don’t like breakfast, it is as if I have broken some taboo. The breakfast cereal people have worked a PR miracle.

    (Note, it’s different for children, and ours were always given a decent breakfast when they were little.)

  69. lizz says:

    @ WilliamLawrence… Sir, I’m afraid leather actually does stretch during use – one of the primary considerations to be taken when working with leather is to avoid over-working, so as not to stretch or distort it. Similarly, it is leather’s stretching ability which allows it to be used in shoes (over the toes, for example) and in fitted dresses. Furthermore, I assume you’ve seen wooden “shoe-trees” – some people use these to stretch leather shoes that have become too snug, others use them just to prevent the leather from contracting when they do not intend to wear the shoe for a while. Leather belts, in particular, are prone to stretching due to the amount of pressure they have to endure when used.

  70. tyro says:

    @LovleAnjel

    We were feeding the cat using a timer so it was eating at exactly the same time every day. For the last year we moved to a fully automated feeder which dispenses dry food at 4:15. Yet on weekends when the humans are home, the cat will still beg for 30 mins even though we don’t feed it and the dispenser is always on time. I’m confident that if we moved the feeding time to 6:00pm, the cat would be relaxed and only start begging at 5:30 :)

    So while you had a good hunch, it wasn’t irregular feedings that made the cat anxious, I think it was the frequency. I found that the secret to a happy and relaxed cat is to have fewer feeding times. I suspect that the same thing could be true in humans. It seems to have worked for me.

  71. estockly says:

    @Angora Rabbit

    >>>– eating less IS less calories coming in.

    Not necessarily. There is varying energy density of foods. There are some foods with little or no calories that can be metabolized.

    Not to mention the calories in beverages. You could easily eat much less and more than make up for it by drinking sweetened beverages.

    >>>When carefully controlled studies do the real math, ALL the calories lost on an Atkin’s diet are TOTALLY accounted for by a reduction in intake. The studies can all be found in a PubMed search.

    You’re providing language that very few, if any studies use. Studies often report a drop in caloric inctake on LCHF, but rarely, if ever, use terms like “All calories lost are totally accounted for.” I would be suspicious of any researcher making such a broad claim, particularly given the nature of RCT diet studies.

    But even so, on a LCHF diet you eat as much as you want of good, healthy food. If “as much as you want” is less than what you were eating before and less than what you would eat on diets that put an arbitrary limit on your daily intake, what’s the problem?

    >>>I am beginning to wonder what you really mean by a “low carb” diet. You appear to be sweeping all carb forms under a same rubric, when their metabolism and physiological effects are quite different. Could you define precisely what you mean by LCHF?

    That’s the term used to describe diets, like Atkins, that are low in carbs, high in fat and moderate protein. Specifically, most are based on the Atkins protocol which is carbs reduced to very low levels initially (<20 g dialy net carbs; >>>I am also starting to question your knowledge base given your comments such as these: “Only fat gets stored as fat. And fat is only stored when insulin levels are high.” This is patently untrue.

    Maybe I should have been more clear. Fat storage is the process where free fatty acids form triglycerides inside cells in fat tissue (and other tissue) and the breakdown of triglycerides is inhibited. This process regulated by insulin and insulin must be relatively high for high lots of fat storage.

    >>>Moderate insulin levels also drive storage.

    I think I said that when insulin is low there is very little fat storage. On a low-carb diet insulin levels stay low. Your definition of “moderate” may be what I would consider high. And, to be more precise, I should say that the kind of unhealthy fat storage that leads to obesity only happens when insulin levels are chronically high.

    >>>And of course anything that goes into AcCoA under the influence of insulin goes into fat.

    Our bodies can produce fat, but generally on a low-carb diet there is no need.

    >>>>“The body can produce glucose from fat and protein as needed. This happens whether or not you’re in ketosis.”

    >>No. We cannot turn fat into glucose.

    Again, I should have been more precise. The glycerol from the breakdown of triglycerides can be used with amino acids from protein to make glucose. You are right, we do not turn fat into glucose.

    >>>>“You don’t need that much if you have plenty of ciruclating free fatty acids and ketones. There are a number of atheletes who do just fine on low-carb and carb restricted diets. Some of the first good studies on Ketones and ketosis were done on cyclists whose performance improved on a ketogenic diet.”

    >>>Apart from that sports nutrition studies are usually some of the worst studies around, I doubt this statement is actually true.

    These were studies of ketosis done by Steve Finney.

    >>>Neurons really prefer to burn glucose over ketones. There’s a perceptual buzz one can get off ketones, but cognitively the brain is much happier burning glucose.

    Some braincells can only metabolize glucose. Some do better on ketones.

    >>>The fuel choice in athletics depends on the event, aerobic vs. anaerobic.

    I’ve heard arguments both ways for both kinds of exercise. One common argument is that endurance atheletes need high carb content in their diet, but the other side is they’re able to metabolize ketones and FFA and don’t need too many carbs. I’ve also heard that sprinters and weight lifters need high dietary carb content, but then studies show that for most atheletes there is enough serum glucose to power the short bursts of energy needed.

    There are numerous successful atheletes on carb restricted diets doing in a wide variety of sports. (And, of course, many more atheletes on high carb diets.)

    This is not a field where the science is clear or settled.

    ES

  72. estockly says:

    @DugganSC
    >>>Just to check, you are aware that studies of genetic drift show that humanity developed the genes to survive a high fat diet almost a thousand years after we switched to such a diet, right?

    No, and I’m very dubious of that idea.

    >>>Humanity did indeed evolve to survive on a largely meat diet high in fats, but the historical record from the artifacts and bones we’ve found indicate that we didn’t thrive on it for a long time

    Again, very suspicious of those arguments.

    @WilliamLawrenceUtridge

    >>>>>That is essentially the diet humans evolved eating. In the long term. There is no evidence that that diet (High fat, moderate protein, low-carb) is not healthy. Plenty of evidence that the “balanced” diet is unhealthy

    >>A couple points. First, that’s a bit of the naturalistic fallacy.

    Maybe. But here’s the thing. Zoos have found that if they feed animals the food they evolved eating the animals do better. Why would that not be true for humans?

    >>Second, the range of diets humans can thrive on is tremendously diverse – vegan Jains all the way to raw-meat Inuit.

    It is true that but there is no evidence that we evolved eating a vegetarian diet. Every primative culture discovered has relied mainly on meat for nutrition.

    >>>>Third, evolution did not stop once we became hunter-gatherers (lactose tolerance being one, and I’ve seen mention of evolution in response to farming).

    Never said it did, but evolution is a very slow process and something as fundamental as metabolism is not going to change in just a few thousand years.

    >>>Fourth, the amount of exercise you get chasing down your dinner versus buying it is tremendous.

    Primative that is not relevant.

    >>>Fifth, I believe studies of current hunter-gatherer tribes show more calories from non-meat sources than meat sources.

    No. There was a bias used in calculating sources of calories that was prevalent for a number of years. The thinking was that since a proportion of dietary carbs are required for health, they must have been eating lots of plants. This has been debunked.

    >>>>Sixth, even hugely obese people usually live past child-bearing ages, and once you’ve bred the evolutionary pressures are quite different. Evolution only wants you to live long enough to pass on genes, we certainly aren’t designed to live into our 60s, 70s, 80s and 90s.

    That’s a very simplistic view of what influences evolution. A parent may stop having kids at 40, for example, but could continue for a number of years making contributions to the family that help ensure other family members live long enough to reproduce. That herd effect becomes a part of evolutionary seclection.

    >>>I may change my mind if more evidence rolls in supporting Atkins as a magic bullet.

    Not magic. Metabolic.

    >>>Until then, I’ll rest on my stubborn opinion that it’s unsupported handwaving. I like eating potatoes, and the USDA says it’s just fine.

    OK, something to think about. The primary mission of the USDA is to promote the US agricultural industry.

    Is it any surprise that their advice is to eat grains and other US agricultural products?

  73. tanha says:

    SBM has jumped the shark. Who gives a shit if people want to “eat clean”? While you are at it, why don’t you spend an afternoon writing about how there are no studies demontrating that “Words With Friends” is fun and therefore it’s quackery.

  74. WilliamLawrenceUtridge says:

    I should have been clearer. When I said belts don’t stretch, I was actually admitting they do and that fact was a serious flaw in my use of belts to monitor my body fat. My bad :( My simple and elegant theory was in fact wrong, thanks for correcting me :)

    Maybe. But here’s the thing. Zoos have found that if they feed animals the food they evolved eating the animals do better. Why would that not be true for humans? [snip to unrelated section barely thematically linked, somewhat disingenuous] Never said it did, but evolution is a very slow process and something as fundamental as metabolism is not going to change in just a few thousand years.

    Because the best comparison there would be animals who ate zoo chow, rather than their regular diet, for thousands of years over multiple generations. Those animals have experienced no selective pressure to survive on a modified diet. Humans have. Sweet Flying Monkey Jebus, if nothing else the differences in skin tones between those whose ancestors never left Africa and those whose ancestors inhabited Norway for 1,000 years is pretty undeniable. For you to claim that aspect of environment exerted evolutionary pressure, but food from farming did not, seems quite questionable to me (you may not be doing so, I’m stitching together a couple comments so please correct me if I’m wrong). Evolution is not always slow, 10 human generations can be as little as 130 years and that’s enough generations to create whole new species if selection pressure is hard enough (within a given definition of species, I’m thinking more size disparities in nature that prevent sexual activity but could be enabled by petri dishes). Single-gene mutations (like, say, lactose tolerance) would (and have) accumulated and spread pretty quickly, particularly in times of famine.

    Every primative culture discovered has relied mainly on meat for nutrition.

    Hm…questionable hypothesis. My understanding was that hunting was prestigious and rare, while gathering was “women’s work”, disdained, but provided food more regularly (and I believe more calories overall). Though this will vary by society and habitat I’m sure. And related…

    No. There was a bias used in calculating sources of calories that was prevalent for a number of years. The thinking was that since a proportion of dietary carbs are required for health, they must have been eating lots of plants. This has been debunked.

    My digging turned up mutual and contradictory analyses, it doesn’t look like there is a conclusive answer, not one that I could find. If you could provide the citations, I might be persuaded.

    That’s a very simplistic view of what influences evolution. A parent may stop having kids at 40, for example, but could continue for a number of years making contributions to the family that help ensure other family members live long enough to reproduce. That herd effect becomes a part of evolutionary seclection.

    Sure, kin selection favours certain genes. I realize this, and it’s simplistic to treat evolution as just occurring on an individual level. But that doesn’t mean it’s wrong – having a gene that makes it more likely to share with family members is still far less heritable than being able to extract more calories from milk (to pick a fairly classic example).

    Not magic. Metabolic.

    Magic metabolic, or metabolic magic. Either way, questionable. And getting back to evolution, it seems odd to base a diet on what we allegedly evolved eating. In early days of food insecurity, a form of metabolism that fostered eating less and burning more calories would seem to be selected against. By saying “I can eat meat and fat and lose weight”, you’re basically arguing against evolution which seems to strongly favour fat storage as a long-term survival strategy.

    OK, something to think about. The primary mission of the USDA is to promote the US agricultural industry. Is it any surprise that their advice is to eat grains and other US agricultural products?

    Nope, conspiracy theories lose you the argument. Not to mention meat is a product of the US agricultural system.

  75. evilrobotxoxo says:

    @Harriet Hall: I partially disagree with you on this. People aren’t really trying to lose weight, they’re trying to lose fat, i.e. decrease adiposity. The fact that body mass isn’t all that great of a marker for adiposity is one of the major problems with “weight loss” as a concept, as well as a confounding variable in epidemiological studies. How many times have you heard a person say “I lost half a pound this week!” Or “I ate too much this weekend, and I gained three pounds!” Given that weight fluctuates by several pounds on a daily basis with changes in fluid status, these statements are completely meaningless. I always have to remind my wife that when I was a medicine intern, we used daily weights as a marker for fluid status, not adiposity. I agree that it’s useful for people to plot their weight over time, but the problem is that that’s not how people actually do it.

  76. lizz says:

    @WilliamLawrence Hey, to be fair, if you invented a completely non-stretchy belt it might be a huge success – it has the potential to become the new weighing scale. (As in, black/blue/orange is “the new” black… Sorry, I don’t think my popular culture references work online :P ) My apologies that I interpreted your original reply differently to what you intended. :)

  77. estockly says:

    >>>Because the best comparison there would be animals who ate zoo chow, rather than their regular diet, for thousands of years over multiple generations. Those animals have experienced no selective pressure to survive on a modified diet. Humans have.

    Zoo chow for thousands of years? Seriously? You think animals in today’s zoos are descendants of animals in Roman zoos?

    What’s this selective pressure humans have been experiencing related to diet?

    >>>Sweet Flying Monkey Jebus, if nothing else the differences in skin tones between those whose ancestors never left Africa and those whose ancestors inhabited Norway for 1,000 years is pretty undeniable.

    And irrelevant. No one is arguing that the human metabolic response to macro or micro nutrients has evolved. And certainly not since the advent of agriculture.

    >>>Evolution is not always slow, 10 human generations can be as little as 130 years and that’s enough generations to create whole new species

    Citation for a new species in 10 generations?

    Again, no evidence, whatsoever, that human’s metabolism has evolved one iota since the advent of agriculture.

    >>>Single-gene mutations (like, say, lactose tolerance) would (and have) accumulated and spread pretty quickly, particularly in times of famine.

    If lactose intolerance were fatal, then it could exert evolutionary pressure. It doesn’t.

    >>>Not magic. Metabolic.
    Magic metabolic, or metabolic magic.

    We’re talking about the science of metabolism. It seems like you’re reducing it to magic, either to make it easier to dismiss out of hand or because you’re not aware of the details of the biochemical processes involved and the science behind them.

    >>>OK, something to think about. The primary mission of the USDA is to promote the US agricultural industry. Is it any surprise that their advice is to eat grains and other US agricultural products?

    >>>Nope, conspiracy theories lose you the argument.

    Here’s an irony for you. It was Sen. George McGovern who’s committee did the work on establishing the USDA guidelines and putting them into place, over the objections of the FDA and the scientific community. McGovern knows something about conspiracies!

    In this case, it’s not a conspiracy. It’s well meaning people doing what they think is right, but they did not follow the science and the results have been a disaster.

    >>>Not to mention meat is a product of the US agricultural system.

    Last I checked the USDA guidelines include meat. And the meat industry is doing just fine, too.

    ES

  78. WilliamLawrenceUtridge says:

    @WilliamLawrence Hey, to be fair, if you invented a completely non-stretchy belt it might be a huge success

    They already have it, in the form of counter-cultures that use chains as belts :(

    What’s this selective pressure humans have been experiencing related to diet?

    Consuming milk allows you to eat, over the lifetime, several cow’s worth of protein, sugar and fat out of a single cow, who in turn consumes plants that are non-nutritious to humans. Enhanced ability to eat wheat is a tremendous advantage in cultures where wheat is a significant contributor to the diet.

    The problem with evolutionary biology is that one can spin a multitude of scenarios, proving them is another thing. Claiming evolutionary history is a supporter for any particular diet, particularly when humans are very strongly omnivorous with few specialized adaptations to specific diets, is questionable.

    Again, no evidence, whatsoever, that human’s metabolism has evolved one iota since the advent of agriculture…If lactose intolerance were fatal, then it could exert evolutionary pressure. It doesn’t.

    And again, lactose tolerance is an example. Note I am saying tolerance, not intolerance; coming out of Africa, humans were unable to consume milk beyond childhood. Lactose tolerance is what evolved. In places where milk-producing animals were domesticated, there was selection pressure for lactose tolerance (not intolerance) to spread.

    Citation for a new species in 10 generations?
    Again, no evidence, whatsoever, that human’s metabolism has evolved one iota since the advent of agriculture.

    Dogs are an example of a single species that can quite quickly be selected into novel forms that can’t interbreed. Jerry Coyne’s book Why Evolution is True discusses the ability of new species to evolve in single generations, though he was talking about plants. He also used as examples of rapid evolution Darwin’s finches, which showed trends towards new beak shapes over the course of a multi-year drought. Geckos introduced to uninhabited (by other reptiles) islands showed elongated limbs to better allow climbing of palm trees to catch insects. It’s possible to produce a new species (again, in terms of unable to interbreed due to size and shape, not due to biochemical changes) in the face of severe selection pressure, I’m not saying it’s common.

    And again, adult lactose tolerance is pretty clearly an example of human evolutionary change to take advantage of a new food source.

    The broader consensus is that fat loss is due to calorie restriction and Atkins is not special in this regard. I’m more inclined to believe genuine experts than someone from the comments section of a blog, and I’m certainly not going to put in the time to build up the kind of expertise to debate fine points of evolution and biochemistry. Instead, I’m going to eat small servings of meat on most days of the week, lots of fruits and vegetables, and enjoy regular servings of baked potatoes, rice and bread. They’re yummy.

  79. estockly says:

    >>>>What’s this selective pressure humans have been experiencing related to diet?

    >>Consuming milk allows you to eat, over the lifetime, several cow’s worth of protein, sugar and fat out of a single cow, who in turn consumes plants that are non-nutritious to humans.

    But there is no selection involved. Unless you have a specific allergy anyone can drink milk. Even if you don’t have the enzyme to digest lactose. It just means that one single component in milk gets digested by microbes in your gut and you fart more. It doesn’t kill you. It doesn’t prevent you from becoming an adult and having kids.

    >>Enhanced ability to eat wheat is a tremendous advantage in cultures where wheat is a significant contributor to the diet.

    Again, there is no evidence that any humans have evolved to eat more wheat than pre-agricultural man

    >>>>And again, lactose tolerance is an example. Note I am saying tolerance, not intolerance; coming out of Africa, humans were unable to consume milk beyond childhood. Lactose tolerance is what evolved. In places where milk-producing animals were domesticated, there was selection pressure for lactose tolerance (not intolerance) to spread.

    Lactose tolerance and intolerance are a dichotomy. If you have the enzyme to digest lactose, you’re lactose tolerant. If you don’t you’re not. There is no selective pressure for lactose tolerance or intolerance.

    >>>>Citation for a new species in 10 generations?
    >>>>Again, no evidence, whatsoever, that human’s metabolism has evolved one iota since the advent of agriculture.

    >>Dogs are an example of a single species that can quite quickly be selected into novel forms that can’t interbreed.

    Ok, so not a new species, and not 10 generations. Plus, if you take any dog breeds and let them freely breed with other dogs, within a few generations the breed variations disappear. Mutts are basically mutss.

    That said there is new science that shows that over the history of dogs living with man, the dog’s metabolism has evolved to better digest carbs. So it is possible.

    The point is, though, there is no evidence that man has evolved to better digest grain or sugar in the amounts we do in this century

    >>> Instead, I’m going to eat small servings of meat on most days of the week, lots of fruits and vegetables, and enjoy regular servings of baked potatoes, rice and bread. They’re yummy.

    Is it unreasonable to suggest that the yummiest foods happen to be the ones that drive the obesity epidemic?

    If spinach and liver were the foods that caused obesity, we’d live in the land of the thin and fit.

    It’s starch, sugar and flour that cause obesity, and they just happen to be our favorite foods.

    Go figure.

    ES

  80. Narad says:

    >>> Instead, I’m going to eat small servings of meat on most days of the week, lots of fruits and vegetables, and enjoy regular servings of baked potatoes, rice and bread. They’re yummy.

    Is it unreasonable to suggest that the yummiest foods happen to be the ones that drive the obesity epidemic?

    If you’re going to try to pin “the obesity epidemic” on potatoes, perhaps you’d like to assign some dates to it.

  81. SEC says:

    Nutrition is one of my favourite topics, perhaps because of its complexity (I am a social scientist, so maybe I like the challenge of teasing out causality in complex systems?). I am always happy to see it covered on SBM.

    I would love to see posts on SBM about cholesterol and saturated fat. The paleo/ancestral health/Weston A. Price communities contend that saturated fats are among the healthiest (if not THE healthiest) fats humans can consume. Many are also cholesterol deniers, saying that HDL/LDL are meaningless as are the markers of particle size, leaving them to basically conclude that cholesterol means nothing so long as you’re eating “like our ancestors”. One prominent advocate of the low carb paleo-type diet has been publishing his cholesterol numbers lately, and his total cholesterol was 419. He contends it’s not a problem because he has low triglycerides and c-reactive protein. This is not an uncommon view in the blogworld, so it would be nice to see an objective summary on SBM of the present understanding on the effect of saturated fat and cholesterol on health and its relationship to diet. I know that’s a big ask for an article, but it’s becoming an increasingly dominent view among those who want to “eat clean” and optimise their health. Because as far as they are concerned, bacon is health food and grains are the devil because saturated fat is so ‘nourishing’.

    All the dodgy evidence aside, I think the term “clean eating” has got to go. For people that struggle to eat right, tend to emotionally eat, or have an eating disorder, the last thing they need is for someone to tell them that some foods are “clean” thus implying others are “dirty”. So much implicit value judgment in the term, made worse by the fact that it is a nebulous concept that means different things to different people.

  82. Alia says:

    estockly “Is it unreasonable to suggest that the yummiest foods happen to be the ones that drive the obesity epidemic?”

    But of course. The yummiest foods are the ones we tend to overeat, so they drive the obesity epidemic. BTW, when I was much fatter, I tended to overeat not on starches, grains and sweets but on cheese. Cheese with everything, basically. What do you make of that?

  83. WilliamLawrenceUtridge says:

    But there is no selection involved. Unless you have a specific allergy anyone can drink milk. Even if you don’t have the enzyme to digest lactose. It just means that one single component in milk gets digested by microbes in your gut and you fart more. It doesn’t kill you. It doesn’t prevent you from becoming an adult and having kids.

    That’s a narrow and inaccurate depiction of evolution, it’s not solely a matter of killing you before you have children, it may also allow your children to survive and thrive more, attract more mates, grow larger, get fatter (valuable when famine was common) and so on. The idea that selection pressure only acts when it immediately kills a child is simply wrong (and you in fact alluded to this in an earlier post when you mentioned kin selection).

    Lactose tolerance and intolerance are a dichotomy. If you have the enzyme to digest lactose, you’re lactose tolerant. If you don’t you’re not. There is no selective pressure for lactose tolerance or intolerance.

    You may think this, but you would be quite wrong.

    Ok, so not a new species, and not 10 generations. Plus, if you take any dog breeds and let them freely breed with other dogs, within a few generations the breed variations disappear. Mutts are basically mutss.

    There is no universally agreed-upon definition of species that suits all situations, but a common one is when a male and a female with the same common ancestor can no longer breed together. A great dane and a chihuahua can’t breed without outside assistance, so under that definition, they are different species. Size is one of the ways in which new species can appear.

    The point is, though, there is no evidence that man has evolved to better digest grain or sugar in the amounts we do in this century

    There’s evidence to the contrary in fact, the appearance of significant gluten intolerance is no longer a barrier to reproduction.

    Also, for there to be evolution within a century or two, there would have to be massive selection pressure, and there’s been rather the opposite since 1900 – new technologies that allow human survival and reproduction for people who would have been unable to have children in the past. My comments about evolution in the face of dietary changes have been aimed at changes since the last common ancestor of all humans, perhaps 100,000 years ago since you have been claiming a) that the best diet is the one eaten by our ancestors and b) that diet is one based primarily on protein and fat at the expense of carbohydrates.

    But obviously I’m not going to convince you, and now I’m going to stop trying.

  84. Harriet Hall says:

    @SEC,

    I’ve written twice about cholesterol skeptics.
    http://www.sciencebasedmedicine.org/index.php/the-international-network-of-cholesterol-skeptics/
    http://www.sciencebasedmedicine.org/index.php/cholesterol-skeptics-strike-again/
    More recently, there is evidence that statins are also useful in primary prevention.
    The consensus today is that trans-fats are bad, but limiting total fat intake is not as important and saturated fats are not as bad as we thought.

  85. estockly says:

    @ SEC and Harriet Hall

    I view the term Cholesterol Skeptics as a pejorative. Yes there are those who offer blanket denials of the health problems with cholesterol, but they are just as wrong as those who argue that all cholesterol is bad and that we should limit dietary cholesterol and keep total cholesterol low.

    Dietary cholesterol is no longer considered unhealthy. It’s okay to eat eggs again.

    Total cholesterol is meaningless. To understand the risk factors you need to look at the details.

    HDL cholesterol is good in that high HDL indicates a reduced risk for CVD

    While LDL is considered bad, high LDL generally indicates an increased risk, it’s not that simple.

    LDL particle size matters. Large LDL particles do not add to CVD risks and may be protective. Small LDL particles aradd to CVD risks.

    High serum triglycerides also add to CVD risks.

    Statins lower all cholesterol, good and bad, and for most that decreases risks.

    But, if there were a pill that could change one’s cholesterol profile the way a LCHF diet does, it would be the preferred treatment.

    ES

    1. Harriet Hall says:

      @estockly

      “I view the term Cholesterol Skeptics as a pejorative.”
      Apparently they don’t. They banded together to call themselves the International Network of Cholesterol Skeptics.

      “Total cholesterol is meaningless. ”
      No, total cholesterol is a risk factor. You are correct to point out that it’s more complicated than that alone, but no good doctor looks at total cholesterol in isolation.

      “Statins lower all cholesterol, good and bad”
      Statins increase HDL.

  86. estockly says:

    @WilliamLawrenceUtridgeon

    >>>But there is no selection involved. Unless you have a specific allergy anyone can drink milk. Even if you don’t have the enzyme to digest lactose. It just means that one single component in milk gets digested by microbes in your gut and you fart more. It doesn’t kill you. It doesn’t prevent you from becoming an adult and having kids.

    >>>That’s a narrow and inaccurate depiction of evolution, it’s not solely a matter of killing you before you have children, it may also allow your children to survive and thrive more, attract more mates, grow larger, get fatter (valuable when famine was common) and so on.

    Not if you’re suggesting an evolutionary change in humans since the advent of agriculture. There would need to be a significant pressure for that to occur.
    >>>The idea that selection pressure only acts when it immediately kills a child is simply wrong (and you in fact alluded to this in an earlier post when you mentioned kin selection).

    I never mentioned kin selection that was your misinterpretation of the the herd effect.

    >>>>There is no universally agreed-upon definition of species that suits all situations,

    Really? How about classifications that biologists agree on. Species are well defined.

    >>>>but a common one is when a male and a female with the same common ancestor can no longer breed together. A great dane and a chihuahua can’t breed without outside assistance, so under that definition, they are different species.

    That’s silly. After a generation or of interbreeding with other breeds or with mutts the descendants of both can easily interbreed.

    All dogs are the same species. Wolves are a different species. Wolves and dogs can interbreed.

    >>>My comments about evolution in the face of dietary changes have been aimed at changes since the last common ancestor of all humans, perhaps 100,000 years ago

    I think you’ve got that wrong too.

    >>>a) that the best diet is the one eaten by our ancestors

    The diet that the human species evolved eating.

    >>>b) that diet is one based primarily on protein and fat at the expense of carbohydrates.

    A diet high in fat, moderate in protein and limited in carbs.

    >>>But obviously I’m not going to convince you, and now I’m going to stop trying.

    Not without better arguments supported by good evidence.

    ES

  87. mousethatroared says:

    Alia “But of course. The yummiest foods are the ones we tend to overeat, so they drive the obesity epidemic. BTW, when I was much fatter, I tended to overeat not on starches, grains and sweets but on cheese. Cheese with everything, basically. What do you make of that?”

    I’m picking out this quote, although my comment is intended to be addressed generally to the obesity epidemic topic.

    I suspect the “obesity epidemic” is caused by the increased availability of “yummy” foods in general and a tendency for higher calorie (yummy) but lower nutrition processed foods to be more readily available and cheaper than fresh lower calorie (not so yummy) nutrition dense foods. I have heard that from “experts” but it was on the radio, so I’m not sure how expert those experts really are.

    Personally, starches and sweets are my weakness, although cheese(!) is awfully yummy and surprisingly high calorie per serving. At least I’m always surprised. I have found since I started using less cheese in my cooking (due to my husband’s lactose intolerance) that my based (set) weight seems to be about 5lbs lower than before. I don’t think this is anything magical or chemical, just less cheese = less calories.

  88. estockly says:

    >>>But of course. The yummiest foods are the ones we tend to overeat, so they drive the obesity epidemic. BTW, when I was much fatter, I tended to overeat not on starches, grains and sweets but on cheese. Cheese with everything, basically. What do you make of that?

    Impossible to say. It’s actually very difficult to identify all sources of carbs in the diet, and can be challenging to limit them. Some cheeses have carbs, some don’t

    Plus, my argument is that you don’t need to “overeat” carbs to add fat. You eat the recommended amount of carbs in your diet and you can add fat.

    You could fill out a survey indicating how much of what kinds of foods you ate when you were getting fat and we could analyze the carb, fat and protein components. How accurate do you think you could be?

    ES

  89. Alia says:

    I come from a former communist country. And for us here is one more reason for increasing rate of obesity. For almost 50 years we lived in perpetual crisis, and while people generally did not go hungry, there wasn’t much chance to overeat on anything. And if some luxury products (like chocolate) did appear in the shops, you had to hoard them. The result is – people from my parents’ generation tend to buy too much, overstock their pantries and their fridges and eat too much. To make up for all those “lost years”. These may be different products, meat on the one hand (in the former communist countries meat and meat products were rationed), sweets and chocolate on the other.

  90. Calli Arcale says:

    estockly:

    But there is no selection involved. Unless you have a specific allergy anyone can drink milk. Even if you don’t have the enzyme to digest lactose. It just means that one single component in milk gets digested by microbes in your gut and you fart more. It doesn’t kill you. It doesn’t prevent you from becoming an adult and having kids.

    Seriously? You’re arguing for the evolutionary betterness of the Atkins diet and *simultaneously* poo-pooing the evolutionary advantages of drinking milk? People who could drink milk into adulthood had much better chances of surviving to adulthood, and they were bigger as well. They would have had more children, and the children would’ve been stronger, and more of the children would’ve survived to adulthood. In those populations where the gene appeared, it became dominant very quickly. It exists in the overwhelming majority of Europeans; Asians, however, rarely have it, because by chance, the mutation did not occur in that population. They did, however, invent ways of processing milk so it would be okay to drink. That’s why yogurt, certain types of cheese, and fermented milk were born. Milk drinking is clearly a substantial advantage; enough so that if the ability doesn’t evolve, human ingenuity will step in.

  91. estockly says:

    @Calli Arcale
    >>>>But there is no selection involved. Unless you have a specific allergy anyone can drink milk. Even if you don’t have the enzyme to digest lactose. It just means that one single component in milk gets digested by microbes in your gut and you fart more. It doesn’t kill you. It doesn’t prevent you from becoming an adult and having kids.

    >>Seriously? You’re arguing for the evolutionary betterness of the Atkins diet and *simultaneously* poo-pooing the evolutionary advantages of drinking milk?

    No… I’m saying that lactose intolerance doesn’t prevent people from drinking milk to the degree that it would foster a relatively short-term evolutionary advantage.

    >>>People who could drink milk into adulthood had much better chances of surviving to adulthood, and they were bigger as well. They would have had more children, and the children would’ve been stronger, and more of the children would’ve survived to adulthood.

    And, given enough time, lactose intolerance would die out and our species would evolve into a lactose tolerant species. Hasn’t happened yet. Also, lactose intolerance does not prevent consumption of milk.

    >>They did, however, invent ways of processing milk so it would be okay to drink. That’s why yogurt, certain types of cheese, and fermented milk were born. Milk drinking is clearly a substantial advantage; enough so that if the ability doesn’t evolve, human ingenuity will step in.

    Right, human ingenuity is not an evolutionary change.

    At the same time humans developed ways of processing inedible grains so to make them okay to eat. But, the while the processed form of grain is OK to eat, in the long term it leads to obesity and increased risks for chronic disease.

    ES

  92. estockly says:

    @Harriet Hall

    >>>“I view the term Cholesterol Skeptics as a pejorative.”

    >>Apparently they don’t. They banded together to call themselves the International Network of Cholesterol Skeptics.

    Yea, but I’m not a member of that club. I don’t know anyone who is. That said, they do have a website where they say this:

    “Members of this group represent different views about the causation of atherosclerosis and cardiovascular disease, some of them are in conflict with others, but this is a normal part of science. What we all oppose is that animal fat and high cholesterol play a role.”

    I can’t agree with that. High cholesterol, on a diet high in carbs, does play a role in CVD and atherosclerosis.

    >>>“Total cholesterol is meaningless. ”
    No, total cholesterol is a risk factor. You are correct to point out that it’s more complicated than that alone, but no good doctor looks at total cholesterol in isolation.

    I agree to the extent that if a patient has high total cholesterol, the good doctor should look more carefully at HDL and LDL particle size.

    >>>“Statins lower all cholesterol, good and bad”
    >>Statins increase HDL.

    That’s correct.

    ES

  93. estockly says:

    @Alia

    >>>I come from a former communist country. And for us here is one more reason for increasing rate of obesity. For almost 50 years we lived in perpetual crisis, and while people generally did not go hungry, there wasn’t much chance to overeat on anything. And if some luxury products (like chocolate) did appear in the shops, you had to hoard them. The result is – people from my parents’ generation tend to buy too much, overstock their pantries and their fridges and eat too much. To make up for all those “lost years”. These may be different products, meat on the one hand (in the former communist countries meat and meat products were rationed), sweets and chocolate on the other.

    That may explain a tiny fraction of the obesity epidemic. I’ve heard similar arguments about the depression generation in this country, and the post war generation in Europe. But there are so many obese in this country never exposed to those kinds of shortages or scarcity that something else is at work.

    Also, it’s important to note that most of the foods that can be successfully stored for long periods (hoarded) are processed foods and high carb foods.

    ES

  94. Alia says:

    @estockly
    Sorry, but you don’t live here. You haven’t seen my mother-in-law and her friends on a cooking (and feeding) spree, you haven’t seen our shops around Christmas period (which in the previous era was the time when the food shortages were the most visible). You weren’t around here in the early 1990s, when suddenly everything was available. And you know what – my mother-in-law, father-in-law and their friends were all very lean, almost thin people. Up to until 1990s.
    BTW, our traditional cooking is high in fat on the one hand (lard as the basic fat, almost everything fried) and carbohydrates on the other (potatoes and bread, and all kinds of starch-based poor men’s dishes). The epitome of this are our meat sauces, very heavy, made with a lot of flour and bread. And yet, before 1990s there were much fewer obese people. Simply because there wasn’t enough food to overeat, unless of course you were a communist party bonzo.

  95. WilliamLawrenceUtridge says:

    When conclusion preceeds conclusion, it doesn’t really matter what the real facts are.

  96. WilliamLawrenceUtridge says:

    WTF is wrong with me? Should read:

    When conclusion preceeds premise, it doesn’t really matter what the real facts are.

  97. estockly says:

    @Alia
    >>>Sorry, but you don’t live here.

    No, but I do live here! (I’m curious where you are) I’ll just bet we have a bigger problem with obesity here in the US than you do in your country.

    >>>You haven’t seen my mother-in-law and her friends on a cooking (and feeding) spree, you haven’t seen our shops around Christmas period (which in the previous era was the time when the food shortages were the most visible). You weren’t around here in the early 1990s, when suddenly everything was available. And you know what – my mother-in-law, father-in-law and their friends were all very lean, almost thin people. Up to until 1990s.

    That coincides pretty well with the obesity epidemic in the US. You may be a few years behind us.

    >>>BTW, our traditional cooking is high in fat on the one hand (lard as the basic fat, almost everything fried) and carbohydrates on the other (potatoes and bread, and all kinds of starch-based poor men’s dishes).

    There are carbs and there are carbs. If your breads were not made from highly processed flour, they wouldn’t have been as obesigenic. If your diet had sufficient fiber, the starches would enter your blood stream at a slower rate, and again, would not be as obesigenic.

    >>>The epitome of this are our meat sauces, very heavy, made with a lot of flour and bread. And yet, before 1990s there were much fewer obese people. Simply because there wasn’t enough food to overeat, unless of course you were a communist party bonzo.

    What’s I find interesting is that there has been a spike in obesity in the west, where we are not rebounding from chronic food shortages, and, apparently, an increase in obesity in former communist countries.

    You may be right, it may be binge eating. I think it’s more about what people are eating.

    ES

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