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The Diet Fix

Diets fail. Not just often, but almost always—90% of the time. If diets worked we wouldn’t have a worldwide obesity problem. And obesity is a problem that needs to be solved. The prevalence of obesity has doubled since 1980. As a public health issue, there are few determinants of illness that are more destructive, as obesity contributes to the growing rates of diabetes, heart disease, and even cancer. There’s no “one true cause” of all illness, but obesity comes pretty close. When people ask me for the single most important thing they can do for their health, my advice (after quitting smoking) is to (1) ensure you keep your weight under control and (2) exercise in any way possible.

Despite its tremendous impact on health, I’ve only blogged about obesity in an indirect way—by pointing out what doesn’t work. Dr. Oz is my perpetual source of bad health information with his regular promotion of bogus “weight loss” supplements like the green coffee bean “miracle”. I’ve also criticized eating programs like the fads of “Eating Clean”, gluten “intolerance”, or harmful diet delusions like “detox”. It’s the typical skeptical science blogger approach—spot pseudoscience, debunk it, and hope you did something good. But none of my posts have focused on what one should do—just what you shouldn’t. Weekly SBM contributor Dr. Mark Crislip recently commented that what we (SBM) support manifests in what we oppose. He’s right, because that’s the easy approach. Using the principles of science-based medicine, there’s an awful lot to oppose in the current writing and popular opinion on how to treat obesity. And my professional advice in the role of a pharmacist has been limited to steering people away from supplements, and then giving some basic advice about dietary planning. Anecdotes and platitudes. I admit that I’ve told patients to “eat less and exercise more”.

I surmised several years ago that if I could be a more effective advocate and coach on obesity, I could deliver some meaningful health benefits to my patients—likely far greater than any medication. I started following obesity and nutrition experts who blog and tweet, and began to read the literature they cited. What I learned left me a bit chastened. My basic advice about eating less and exercising wasn’t wrong—but it was simplistic, incomplete, and almost certainly ineffective. I didn’t recognize the drivers of obesity in the population—and how people can identify and change them. Sure, “Eat food, not too much, mostly plants” has a kernel of truth. But alone, that type of recommendation isn’t helpful for weight loss. It isn’t a lack of willpower that has almost tripled childhood and adolescent obesity rates since 1980, and made one third of adults obese. Exercise as the sole strategy for weight loss is actually a terrible strategy. And while I knew most of the popular diet plans rarely succeed in the long run, I didn’t know what the evidence actually said about effective interventions. Other than recommending blogs and articles, I didn’t have any resource I could recommend without reservation, especially for those that prefer books over blogs. Until I read The Diet Fix [Amazon]—the first “diet” book I’ve read that is science-based and pseudoscience-free.

The Diet Fix

I’ve been a fan of Dr. Yoni Freedhoff’s blog Weighty Matters for years—it’s deservedly one of the most popular blogs about obesity. Freedhoff is a fierce critic of obesity pseudoscience and also an outspoken critic of the products and policies that contribute to today’s obesogenic environment. As a family physician with his own obesity practice, Freedhoff brings to the blog a knowledge of the medical literature, combined with extensive experience working directly with obese patients.

The healthiest life you can enjoy

This is an unconventional diet book because it doesn’t recommend what many will think of as a “diet” at all. If you’re looking for a strict meal plan with foods that are either celebrated or demonized, you’ll be disappointed. There are no traumatic sacrifices required. No starvation, no cleanses, and no miracle supplements.

Freedhoff opens the book describing “Dieting’s Seven Deadly Sins”, which are commonly held, but dangerous, beliefs about dieting. Hunger is the first myth to go. Freedhoff argues that any diet plan that leaves you hungry won’t be sustainable. Sacrifice is next—perpetual sacrifice of anything you enjoy will make any diet fail. Willpower is important, but permanent resistance is almost certainly futile. Blind food restrictions are the next to go, and Freedhoff is adamant we need to manage, but not banish, certain food groups. Sweating is the next myth, with The Biggest Loser epitomizing the belief that exercise can contribute to significant weight loss. You can’t outrun your fork—not in the long run. Anticipating perfection is also a myth, so real diets must be flexible enough to accommodate setbacks. Denial is the last myth. “The diet was great—I just couldn’t stick with it” is a common refrain. As weight loss progresses, any suffering gets harder to sustain, and harder to deny.

Given almost all typical “diets” don’t deliver long-term results, few who read The Diet Fix will be dieting newbies. Negative emotions and expectations from dieting are to be expected and Freedhoff reviews the most common traumas, and how to address them. These include guilt, shame, failure, depression, despair, binge eating, and weight cycling/metabolic slowdown.

The core of the book is focused on what Freedhoff calls the “Ten Day Reset” that is designed to “reset” behaviors and recalibrate expectation about what a “diet” really should be. Each day describes how to develop a new set of skills to support permanent behavior change. One of the points that Freedhoff repeatedly emphasizes is in order to make permanent changes in your weight, you must be prepared to make permanent changes in your life. And the more weight you want to lose, the more of your life you must be prepared to permanently change. Any intervention that is too difficult to sustain will eventually be abandoned, so Freedhoff emphasizes that one’s target weight must be based on a “best weight”. The “best weight” is the point at which you’ve found a balance between your weight and your own satisfaction and willingness to stick to a plan. There are no promises of magical (and unsustainable) weight loss. This is an approach for a lifetime.

The ten days of the reset are as follows:

  1. Gearing up: Scales, for you and for your kitchen, to measure and weigh food (and yourself) accurately. A journal (for a food diary) is essential. And buy food. Freedhoff emphasizes healthier choices and thoughtful selections, and recommends minimizing refined carbs (including juice) while promoting whole foods. He doesn’t demonize any food group, except (justifiably) artificially-created trans fats.
  2. The food diary: All food has a metabolic cost, and it’s measured in calories. It’s promoted as a tool to guide eating, and make eating more conscientious. Freedhoff not only encourages logging what was eaten, but also the calories, when it was eaten, and any hunger cravings. There are a number of online sites and phone apps that make logging take only minutes per day.
  3. Banishing hunger: Keep hunger pains at bay by eating regularly: Don’t skip breakfast, eat every 2-3 hours (set reminders if necessary), and include adequate protein (for satiety) every time you eat. Your daily calorie “budget” needs to be allocated across your meals.
  4. Cook: Regularly eating purchased and prepared meals make it more difficult to control portions and calories. Cook real foods focusing on healthy ingredients. Minimize using refined and processed foods as much as possible, but not so much that you’ll give up.
  5. Think: Describe your best weight—one in which you’re living the healthiest life you can honestly enjoy.
  6. Exercise: You can’t out-exercise a bad diet, but regular exercise helps keep weight off, and changes your attitude for the better. And exercise has enormous health benefits beyond any impact on weight. What exercise? Something. Anything. “Some is good, more is better, everything counts” Freedhoff suggests.
  7. Indulge: There are no forbidden foods. Real life includes indulgences, and permanently denying yourself pleasurable foods (whatever they may be) makes any diet plan unsustainable. So one must learn to manage indulges in a calorically-responsible way. Freedhoff suggests asking yourself two questions: “Is it worth the calories?” and “How much of it do I need to be happy?”
  8. Eat out: Cooking is crucial, but eating out is part of life for many—so navigating a restaurant successfully is an essential weight management skill. Freedhoff suggests knowing your calories, pre-eating, moderating alcohol, and making thoughtful choices between calories and food you’ll actually enjoy.
  9. Goal setting: Behavior change is accelerated when goals are achieved. The two most important goals are (1) to eat the smallest number of calories possible (while still liking your life) and (2) to exercise as much as you can enjoy.
  10. Troubleshoot: Making permanent change can inevitably lead to roadblocks, and Freedhoff looks at the commonly encountered roadblocks to sustainability.

Freedhoff is adamant that there is no one perfect “diet” for everyone, so The Diet Fix doesn’t prescribe one beyond his general guidelines. The behaviors and skills are relevant to any approach to weight loss—as long as you’re enjoying the approach and see it as sustainable for the long-term, then it will work. Freedhoff repeatedly emphasizes that healthy living is a lifelong approach—not something you can repair with a “quick fix” diet or detox.

In this book we obey the laws of thermodynamics

Freedhoff tackles a number of diet and obesity issues throughout the book, blowing up cherished myths throughout:

  • Calories do matter (Yes, Taubes is still wrong). Calories are the fundamental unit of energy and counting calories is the intervention that Freedhoff ranks more important than anything else in the book.
  • Low carb/Low fat/Paleo/Vegan are all acceptable—if you can sustain it, and as long as you watch caloric balance. Freedhoff argues against demonizing any food (even chocolate has its place, he says) and cautions that your diet must be sustainable.
  • The enemy isn’t carbs/fat/glucose/gluten. Cutting out food groups can sometimes deliver short term results (like low-carb) but they’re difficult to maintain over the long term.
  • Dietary fats are not the enemy. Saturated fat is not the health risk it was once believed to be. Unsaturated fats may offer health benefits, so ensuring these are part of your diet is probably a good idea.
  • There are no magical supplements. There is no persuasive evidence to support the long-term effectiveness of any supplement.
  • Artificial sweeteners are safe, and can be beneficial as part of a weight loss strategy. The same cannot be said for sugar.

Conclusion

The Diet Fix is an oddity among the diet books you’ll find in bookstores. There are no outlandish promises, no strict dietary rules, no excessive exercise, and no recommendations for supplements and potions. I doubt we’ll see Dr. Freedhoff’s book profiled on Dr. Oz. And that’s a shame because this book deserves a wide audience, especially to those that have struggled and failed on the types of weight loss strategies that Dr. Oz loves to tout. I wouldn’t hesitate to recommend The Diet Fix as a science-based guide for anyone that seeking credible and sustainable advice on permanent weight loss.

Full disclosure: I received a free copy of The Diet Fix from the publisher, but I was not asked (nor did I offer) to write a review of the book.

Posted in: Book & movie reviews, Nutrition

Leave a Comment (259) ↓

259 thoughts on “The Diet Fix

  1. Andrew says:

    This sounds an awful lot like “The Hacker’s Diet” which I read a number of years ago. One of the things I liked most about “The Hacker’s Diet” which I think is unique is a discussion on (and tools for) analyzing your data. Daily weight measurements, like many variables in science, are noisy. So plotting and tracking to a trend-line is much more beneficial as it gives a better idea of “what’s going on.”

    I think too many people just look at the number on the scale and feel as though that somehow defines them rather than seeing it as a simple ‘data point’ that needs to be analyzed before it can be understood.

  2. DanG says:

    While I agree that the content is sound, it is frustrating when legit experts slip into pseudoscience and marketing buzz terms like ’10 day reset’.

    If this was someone else saying this, Freedhoff would be all over them.

    A relentless self promoter, Freedhoff has a habit of holding others to much higher standards than himself.

    1. windriven says:

      “marketing buzz terms like ’10 day reset’”

      A book sitting unopened on a shelf loses no weight.

  3. Joanna says:

    I’ve maintained a 30 pound weight loss for over ten years now, with one break during pregnancy and breast feeding. These guidelines are exactly the “plan” I’ve followed. I’m so happy to see them all brought together in such a comprehensive book. It’s taken me a lot of reading and experimentation to work all that out. I’m going to add this to my reading list to see what else I can learn.

  4. Amit says:

    I agree with you that there are no magical weight loss supplements. I agree that thermodynamics can be applied for weight loss. If you burn more calories than you consume, you will surely end up losing weight. But unfortunately it is not so easy because our metabolic process is very complicated.
    http://freehealthadvice.blog.com

  5. Peter Andersson says:

    Eat every 2-3 hours? So, 8-12 meals per day? And I’m guessing we can kiss that good 5-7 uninterrupted sleep goodnight since if we don’t eat every 2-3 hours we will die?

    1. Scott Gavura says:

      Eat every 2-3 hours while awake. Freedhoff notes that some do have success with the Intermittent Fasting (IF) model (16 hours fasting/8 hours eating), but those that struggle with hunger may not find that approach sustainable. Whatever strategy works as long as you’re successfully able to sustainably manage your calorie intake and be satisfied while you do it.

      1. Jim Glass says:

        “Eat every 2-3 hours while awake. ..”

        An otherwise excellent list of advice — but this I’m not buying for 5 seconds, as the best theory and the data IMHO, plus my personal experience, are all against it.

        When I was in the middle of losing 75 pounds I was eating twice a day at most, often only once. I was netting 800-1000 calories a day over exercise, and losing 2.0 to 2.5 pounds per week. And I was *not* hungry, I felt great.

        But i I was eating every 2-3 hours to head off hunger I could never have succeeded at losing the weight, I would have failed for sure. I’ve already expounded on the the reasons why below, so I won’t repeat them here.

        Whatever strategy works as long as you’re successfully able to sustainably manage your calorie intake and be satisfied while you do it.

        Ah, yes, exactly. Whatever works for you is best — for you. Just like 1.5 meals a day was best for me, easiest, what worked.

        1. Lacri says:

          Eat as often as you must to avoid getting ravenous and losing control of your hunger. For most people this would be a small meal or snack every 2-3 hours.

      2. russel says:

        I haven’t heard anyone mention portion sizes. I lost113 pound 10 yrs ago and not only kept it off, but I’m even lighter today. Portions have slowly
        increased in restaurants, grocery stores and just about everywhere else.
        This is a key to how I kept my weight off; small portions.

      3. Marga says:

        Science in the nutrigenomics domain has shown that some people have variations in the genetic make up that would lead to constant eating and have a repressed “switch” (if you want to call it that) that does not lead to satiety and a feeling of being constantly hungry. That is why I would not suggest constant eating for all patients.
        Every time you eat, you will have oxidative stress in the body and the body has to handle what is coming to it.

        DNA analysis and variations also shown that some people should really limit saturated fats and other should really increase vegetables – more so than other population groups without the variant genotype.

        The main point that I am trying to make, is that your genetic make-up plays a big role in what a person should or shouldn’t eat and suggested lifestyle changes.
        There is a whole new world to be discovered still – especially to break the epidemic of obesity and non communicable diseases.
        That is why you would find that a low carb diet would work for one, but not for the other. That is why you would find that low fat diets do not work for everyone.

        The way your body processes oestrogen, for instance, have an effect on phase I and phase II (biochemistry 101 at varsity level) of liver function (yes, we call it detoxification), also plays a major role in how the body stores fat, deals with toxins (xenobiotics), etc.

        There is no golden standard to dieting – that is why individualized treatment plans and a multidisciplinary approach is so important.

        My experience is that most lifestyle changes have a positive effect, but you still get a patient that exercises and eat healthy without the results that you would like to see…reason? Because our own genetic make-up, environmental factors and epigenitcs, play a HUGE role in how our body would respond to certain interventions….

        1. Harriet Hall says:

          Nutrigenomics makes claims that go beyond the currently available evidence. The potential is there, but it’s not ready for prime time, and the companies that want to sell you supplements and individualized diet plans based on your DNA are not reliable.

        2. WilliamLawrenceUtridge says:

          Geez. Eat a diet rich in fruits, vegetables, whole grains and beans. Exercise. Get enough sleep. Don’t waste time chasing down immortality and the false promises of companies trying to sell you genetic tests, supplements and unrealistic diets. Enjoy life. Eat pizza and cheesecake. Sleep. Love your family and friends. Don’t smoke.

        3. Angora Rabbit says:

          Ditto what Dr. Hall said. Yes, someday we will be at this point where allelisms can be used to make meaningful modifications to individual dietary practices. The reality is that we are not there yet, despite the mega-hyping of those having vested financial interest. Reality is that the advice one typically gets from these vendors* is fairly generic and is what we’d be recommending to most folks anyway – eat in moderation, limit excess calories and fats, reduce simple sugars, etc. At this writing it’s still quite like cold reading. There are few exceptions starting to pop up (I recall reading Craig Ventor had one of those). But let’s put it this way – I’m a nutrition professional and am not spending my pennies this way yet (heck, I could even sequence myself for free!). But I’d like to think it will be really cool when it finally happens.

          *Vendors who are highly variable. One recent study sent off dog DNA, which the vendor completely missed – probably never even sequenced.

  6. Bruce says:

    Thank you for this review Scott.

    I have lost over 30kgs in the last year and I have basically been following exactly what this book seems to describe. The two bits of advice I always give people who want to know my “secret” is… know what you are eating ie log calories accurately… and then my golden rule “Is it worth the calories?”

    Had to chuckle when I read it above.

  7. Liz says:

    I successfully lost weight by reducing the size of my protein portion to 1/4 lb and doubling and or adding a second portion of veg. Gave myself small goals of 2 lbs and slowly over a year lost weight. Now I just need to maintain that loss. I exercise everyday and have for years. If it creeps up it can creep down. Good post. Thank you.

  8. Adora Tsang says:

    I think that any diet requiring a permanent journaling is just taking advantage of the hawthorne effect. It works, but it is no way to live, constantly reporting the food.
    Just eat less and exercise. Take responsibility for yourself. No excuses.

    1. Nashira says:

      Logging what you eat makes it significantly easier to “eat less”. If you don’t quantify, how exactly are you to make sure you really *are* eating fewer calories? Not that many folks are capable of accurately estimating their intake at every single meal. Not even the perfect ones who think they are.

      Plus, most people tend to eat similar meals each day for breakfast or lunch. Most food journaling tools include ways to save favorite meals, which makes it take far less time than you think it does.

      1. TwistBarbie says:

        Without recording people really tend to underestimate the caloric value of the foods they eat and overestimate the losses through exercise. I use an app called MyFitnessPal, I’ve been using it for around three years and it’s quick, easy and certainly a sustainable practise. The meal saving feature is great, as is the recipe creating feature. You can make a big pot of soup or whatever and punch in all the ingredients and it will tell you how many calories per serving.

      2. Alyssa says:

        I use the loseit app, but there are several other good ones out there too. It really isn’t burdensome to poke your meals into an app throughout the day.

        A kitchen scale is a great tool too. American cooking is volume rather than weight based so we often don’t have one, but it’s a good $30 investment.

    2. Greg says:

      A diary also makes people very aware of the choices they make. IMO more people would be more successful with weight loss if they kept a journal and not necessarily one that tracks calories – just the time of day, food and beverages except for water and clear tea & coffee. That’s how my wife was able to lose over 100lbs – she just started writing everything down and made small changes for the better – 4 years later and she has kept most of it off. Her weight crept up by about 10lbs from where she’d like to be, so she has now added an exercise component that is slowly bringing it back down.

  9. Daniel says:

    How is this book “science-based and pseudoscience-free”?

    The author has christened his own disorder. “Post-Traumatic Dieting Disorder”

    The references are sparse. For instance, the chapter on “Banishing Hunger” has only one reference from nearly a decade ago. Based on the title of the article, it is unlikely to cover what is known about the effects of hormones and GI-motility on hunger.

    There are a lot of steps (“days”). Have these steps been validated in any clinical trials?

    Many of the steps are great for people with OCD tendencies, but not (more) “normal” people. For instance, who has the time or desire to weigh everything, keep a detailed food diary, and eat 8-12 meals a day?

    Appeals to the “laws of thermodynamics” are fairly common in pseudoscience circles. Thermodynamics laws apply to closed systems. Humans are not closed systems. We take in sources of energy and have outputs. Different sources of energy are metabolized differently and conserved differently (ie, not all “calories” are “equal”)… If it’s not a physics text, and thermodynamics are mentioned, turn around and walk away.

    1. Andrey Pavlov says:

      The references are sparse.

      References =/= science based. Yes, there should exist references and data somewhere but just because a particular text or comment isn’t referenced doesn’t make it not science based. If I say that proteinaceous chyme induces the release of somatostatin once it hits the duodenum, but don’t include a reference does that mean it is not a science based statement?

      The worst you can say is that you wish there were more references for you to look up. But that is not a direct indictment that the content is not science based. Nor is text replete with references science based. Just look at all the articles on homeopathy with a huge references cited section.

      There are a lot of steps (“days”). Have these steps been validated in any clinical trials?

      Methodolatry much? There are more types of evidence than clinical trials and you needn’t have one in order to be science based. It merely adds more weight to your conclusions. There have also been no clinical trials of smoking causing lung cancer. Is the fact that we assert it confidently now not science based?

      Many of the steps are great for people with OCD tendencies, but not (more) “normal” people. For instance, who has the time or desire to weigh everything, keep a detailed food diary, and eat 8-12 meals a day?

      Now here I could be wrong, but my take is that it is suggested as a possible strategy and is only one facet of many. Plus, it would not be 8-12 meals per day. It is obvious (despite apparently not being so, since Scott had to clarify it to someone else in the comment thread) that it is a recommendation to eat every 2-3 hours while awake. It is also not advice to eat a full meal that often and it works out to 5-8 “eatings” a day, which is not far off from the 5-6 that we recommend to our diabetic patients. 3 larger “meals” and a few smaller, healthful snacks in between.

      As for keeping a detailed food diary… duh. Of course it is not for everyone. And not necessary to be sustained in the long term. I’ve commented about that in this thread as well.

      Appeals to the “laws of thermodynamics” are fairly common in pseudoscience circles. Thermodynamics laws apply to closed systems

      Ummm… no. The laws of thermodynamics apply to all systems. It is just much more difficult to account for them in open systems which is why we tend to simplify the modeling and math of it in undergrad physics to closed systems (and pretend a system is closed). Yes the appeals to thermodynamics is common in pseudoscience, but in the opposite way to which you are implying.

      Different sources of energy are metabolized differently and conserved differently (ie, not all “calories” are “equal”)…

      And again…. no. A calorie is a calorie. Different foods have different caloric contents based on the way they are they are digested but by in large the difference is negligible. Metabolism of food stuffs is always going to be identical and yield the same caloric input. A glucose molecule will yield 36 ATP molecules regardless of where it came from.

      1. WilliamLawrenceUtridge says:

        If I say that proteinaceous chyme induces the release of somatostatin once it hits the duodenum, but don’t include a reference does that mean it is not a science based statement?

        Not to mention, do you need to go into that level of detail to substantiate a point? Protein slows stomach emptying, the specific molecules involved don’t really matter from a practical standpoint. Do you need to know the hormones involved? Unless you have a specific diet or biochemical defect in which weight loss is predicated on manipulating that hormone (and if a diet is predicated on this – I would suspect quackery as the food would then be acting as a drug, which is questionable) then who cares about the biochemistry? Tricking the body doesn’t work over the long term, calorie control does. That seems to be the overall thrust of the book.

        Also, thermodynamics apply to humans, we are considered closed systems.

        I have been curious about the differential effect of protein, carbs and fat as inputs. I learned years ago that to convert 100 calories of dietary fat to stored fat takes about 3 calories (97% conversion rate, assuming conversion is maximized). Because of the biochemical steps involved, that figure is 90% for carbohydrates, and something like 70% for proteins (again, conversion of macronutrient into body fat). I wonder if this is true, and the implications for diet. I wonder about these facts, if true, and their relationship to high protein diets. Would eating a 2,000 calorie diet of pure protein (aside from killing you over the long term) result in less stored fat?

        1. Andrey Pavlov says:

          Not to mention, do you need to go into that level of detail to substantiate a point?

          No, not at all. But it is nice to have the mechanism known so that you can more reliably manipulate whatever outcomes/physiology you are looking to manipulate.

          Tricking the body doesn’t work over the long term, calorie control does. That seems to be the overall thrust of the book.

          Correct, but if we acknowledge that hunger is a driver of overeating and that fullness of the stomach significantly (though not exclusively) mediates hunger, it would follow that delaying gastric emptying would decrease hunger, decrease food consumption, decrease caloric intake, and (all other things being equal) lead to weight loss.

          This isn’t a way to “trick the body” but a way to craft a diet such that it becomes more sustainable by avoiding hunger whilst simultaneously decreasing caloric intake. Another “trick” I used to use was to have certain meals where I just loaded up on very bulky foods that were not calorically dense; things like cabbage, broccoli, etc. This way I would have that “very full” feeling without it comprising as many calories (which is why juice of any kind is not as “good” in that sense since you can fit a lot more carrot into your stomach as a juice than as an actual whole carrot). By adding in some lean protein (like tofu, grilled chicken, or even lean steak) that delays gastric emptying and makes me feel fuller longer with much fewer calories ingested.

          I think of this as a strategy rather than a way to “trick” the body. And as a strategy it is reasonably sustainable.

          I learned years ago that to convert 100 calories of dietary fat to stored fat takes about 3 calories (97% conversion rate, assuming conversion is maximized). Because of the biochemical steps involved, that figure is 90% for carbohydrates, and something like 70% for proteins (again, conversion of macronutrient into body fat).

          I did a very quick search and couldn’t find anything rigorous to back up those exact numbers, though I did find this which has similar numbers but no references. I also found a study on fish growth that indirectly addresses the question.

          It is an interesting question indeed and from a purely biochemical standpoint in a vacuum makes sense and is, in fact, the basis of the Atkins diet. The idea being that there are extra biochemical steps required to convert protein into fat (true) and that burning fat tends to lead to ketosis since the beta oxidation process produces acetyl-CoA which is funneled into the TCA cycle but cannot be used in gluconeogenesis (also true).

          I think in the long term having a purely protein diet will indeed lead to fat loss and ultimately weight loss, but it will also lead to kwashiorkor. Of course, I think it is arguable that any extreme diet which eliminates most other food groups/stuffs will lead to the same.

          The confounding occurs from the fact that while in a vacuum that sort of biochemistry holds up, in the system of our biology it gets compensated for. Since protein will require more “energy” to convert it to fat, it simply will be used for other purposes while the fat that would normally be used for daily cellular energetics will get shuffled over to fat cells. In other words, lets say you are overweight and ingest 3,000 kcal/day with equal parts fat, carb, protein (33% each). Now you switch your diet so it is 80% protein, but the same calories/day. What will happen is that remaining 10% of your diet that is fat will be preferentially absorbed by fat cells and the remaining carbs/protein will be preferentially metabolized for daily cellular energetics. Thus, you will still retain the same adiposity. Complex systems tend to have “inertia” and are resistant to change.

          Obviously there will be parameters that fall outside the ability for the system to compensate, so if you are morbidly obese and try the same “trick” it will likely not be able to compensate quite as much and you may lose some adiposity. But also remember that maintaining adipose cells is much less energetic than maintaining other types of tissue. And once you really push the system out of parameters you will get other negative health effects that are either before or outweigh the adiposity loss (like kwashiorkor).

          Would eating a 2,000 calorie diet of pure protein (aside from killing you over the long term) result in less stored fat?

          That is the interesting question. In a tightly controlled experiment will an isocaloric diet of pure protein lead to decreased adiposity? Perhaps. But that depends on how much adiposity you are starting with and how many calories there are to work with. I think that as you take the system down to “running lean” there is less wiggle room for compensation and it could indeed decrease adiposity in the short term. Run it “rich” and you have a lot more wiggle room in that system and perturbations would have to be larger to produce an effect.

          What I think is even more interesting is the idea of caloric availability. One thing that is at least somewhat true in the “not all calories are equal” argument is that we are not bomb calorimeters. Calculating the caloric content of foods is typically done by burning them and seeing how much heat is released. By that measure plastics are very calorically dense. But we can’t digest plastic so it won’t make us fat despite having a lot of calories. So it could be argued that what the label says is the caloric content of something is not what is actually available to us metabolically. But that is not the argument being made by the likes of Taubes or the “not all calories are equal” crowd and once the molecule is digested then yes, all calories become equal. In any case, I think that the margin of error on such considerations is well within experimental parameters, so it is unlikely to be anything but a very marginal effect if it exists at all.

          1. WilliamLawrenceUtridge says:

            But it is nice to have the mechanism known so that you can more reliably manipulate whatever outcomes/physiology you are looking to manipulate.

            That’s a pretty big “IF” in this case. I question whether we’ll ever be able to safely manipulate appetite given how important food is to survival.

            I did a very quick search and couldn’t find anything rigorous to back up those exact numbers, though I did find this which has similar numbers but no references. I also found a study on fish growth that indirectly addresses the question.

            Aw :( And humans aren’t fish :( :(

            One thing that is at least somewhat true in the “not all calories are equal” argument is that we are not bomb calorimeters.

            So true, and also involves the most awesomely-named scientific tool ever invented :) That’s why I always glance askance at the calorie information on the nutrition label, as I wonder – how many of those calories are coming from the indigestible fiber?

            Though I could always do the math :)

            And ultimately it all comes down to – eat food with protein, fiber and vitamins, but not too much. Get exercise and adequate sleep. Don’t smoke. Pretty much everything else is details.

            And Olestra is the funniest thing they ever put in food, by far.

      2. Thor says:

        Andrey, just (tried) to read the following article (not a scientist, so quite challenging), but it seems to look at the CICO paradigm in a different light.
        Alert: long and detailed. What say thee?

        http://www.nutritionj.com/content/3/1/9#

        1. Thor says:

          Andrey—I missed your response to WLU, which contains thoughts related to my query about CICO, so no need to repeat. Any additional thoughts will be appreciated, though.

          1. Andrey Pavlov says:

            Thor – they make some good points and are indeed correct in noting that it would be improper to assume that all metabolic processes are a state function with identical Gibbs free energies. This is essentially what I eluded to in my response to WLU.

            From a very strict perspective, yes, one would expect that different macronutrients would have slightly different “effective calorie counts” based on the path through which they must travel. That, as I said, is the underlying premise of the Atkins diet. And it is supported by the fact that we can determine what macronutrient is predominately being metabolized in critically ill patients by looking at their RQ (respiratory quotient). And, of course, kwashiorkor which is the extreme example. And indeed I was reasonably convinced that it must be the case and that isocaloric low carb, high protein, fat neutral diets should lead to weight loss.

            The problem – which they briefly touch on – is the complex milieu of physiology. The body will attempt to re-rout pathways to maintain the current setpoint. You could force that out of whack. The question is can you do so in such a manner as to predicate weight loss without leading to serious physiological issues first and will that loss be clinically significant?

            They cite a couple of studies which seem to indicate that this is possible, but they are small and pilot studies only. They argue that despite being small they were very well controlled. Agreed, but that doesn’t negate that they are small. Nor that the prime example study they cite is one actually funded by Atkins and presented only in abstract form with no follow up. And it doesn’t negate the voluminous other data, meta analyses, and larger trials that demonstrate no significant effect.

            So while it may be very technically incorrect to say “a calorie is a calorie” it seems to be a close enough approximation to reality to be a reasonable statement. The same way we still use classical Newtonian physics to launch vehicles into space even though very technically Newtonian mechanics are wrong and quantum mechanics are actually what rule the day.

            Within the typical parameters of physiology and “normal” diets, a calorie is a calorie. At least, that what the evidence seems to tell us.

            I also take issue with their comment that small changes shouldn’t amount to weight loss because of the tendency for the body to stay at a setpoint. They argue that by definition the system would be hard to perturb, therefore the small calorie changes advocated by dieticians shouldn’t work. And they are right, but only if those small changes are also over a short timeframe. If you try and change the course of a cruise ship by swimming against it, you won’t get far. But given enough time and a consistent force, you will change the course.

            1. Thor says:

              Thanks, Andrey, for taking the time to respond in such detail not only to my question, but to the post and other comments as well. I’m sure many are eagerly lapping it up. Like I mentioned, it can be quite difficult for the average person to understand—due diligence and study is certainly required. You lend an ‘extra’ degree of authority to the issue by personally having gone through the weight loss conundrum (and in such dramatic fashion).

              Of all the issues SBM addresses, there is probably not a more contentious (and confusing) issue than diet and nutrition, especially amongst laypersons, but also in medicine and the scientifically literate/minded. Food is simply one of the closest, most basic issues to us as humans.

              1. Andrey Pavlov says:

                Glad to be of help Thor. I hope it is helpful.

                I want to be clear that what I have written is not gospel and is my best interpretation. I could be wrong, but I’d at least like to think that where I am it is in relatively trivial aspects and/or where the data is simply incomplete.

                You are right that it is a confusing and contentious issue and that is because it is a complicated issue. One mustn’t forget that the background of it all is changing as well – we are still continually evolving (despite what the Paleo diet people think).

                It shouldn’t be necessary to have lost a bunch of weight in order to have authority on the topic, but I understand it does bring me some added credibility.

                Ultimately these ideas about a calorie not being just a calorie and other sorts of diet “tricks” and whatnot probably have at least some truth to them (not all, but some). But then it becomes a question of “does that really matter”? And from what I can tell the answer is no. It is like arguing which paint job will be best for the aerodynamics of plane. Undoubtedly some will produce less drag and more lift. But to such a small extent that trying to focus on that is just a waste of time. So perhaps if you switch to an isocaloric low carb/high protein diet you could nudge your metabolism towards decreased fat accumulation. But for all practical purposes it is most likely such a small effect that it isn’t worthwhile.

            2. WilliamLawrenceUtridge says:

              From a very strict perspective, yes, one would expect that different macronutrients would have slightly different “effective calorie counts” based on the path through which they must travel. [snip] The problem – which they briefly touch on – is the complex milieu of physiology.

              The real problem in my mind is that if you are basing your weight loss strategy on those “slightly different effective calorie counts”, it will be incredibly easy to wipe them out. If you’re basing your assumptions on say, a 1% difference between calorie processing results, that’s 20 calories for a mythical average adult male. That’s a mint. Or 10 Tic-Tacs. 13 Tic-Tacs? There was a whole thing about how Tic-Tacs don’t have many calories. Mrs. Utridge likes the orange ones. I like peeling the label off of the boxes.

              Ahem.

              So to extend your cruise ship analogy, it’s akin to a single swimmer trying to divert a cruise ship, while someone else routinely sets off fireworks against the hull. Or something.

              If you are relying on tiny differences, whether they be metabolic or calorie count, that would seem to underscore even more strongly at least some of Dr. Freedhoff’s points, particularly about tracking food intake.

              1. Andrey Pavlov says:

                The real problem in my mind is that if you are basing your weight loss strategy on those “slightly different effective calorie counts”, it will be incredibly easy to wipe them out.

                Precisely. Which is why if there is a metabolic advantage to low carb high protein diets (the “a calorie is not just a calorie” argument) it would most likely be small enough that sneaking in an extra cookie or two a week could obliterate it.

                But if you consistently have a 10% reduction (or even 5%) it will add up. The larger the reduction the harder to obliterate it. There is also a practicality issue. Even if you are 100% rigorous on your 1% reduction, it may prove to take too long for practical purposes (even if you didn’t obliterate it with a cookie).

      3. Calli Arcale says:

        I think that’s mainly because we don’t eat many foods where the calories are largely inaccessible (celery and iceberg lettuce being notable exceptions). But the old yarn about the cereal box being more nutritious than the cereal? The box actually does have a higher calorie count, but it’s indigestible by humans. A goat might benefit from it, though. ;-)

        Random memory: I once dropped my sketchbook over a railing in a park near Banff, Canada. A pair of bighorn sheep started fighting over it, actually cracking noggins over the right to devour it. Luckily, they decided they didn’t like it anymore once it got to the first chalk drawing, which probably tasted pretty bad (but does have tooth marks on it).

      4. Daniel says:

        References =/= science based.

        The *single* reference provided for the chapter I mentioned (banishing hunger) is, as far as I can tell, survey based. Surveys are among the weakest research tools, perhaps a step above “I just made it up.” At least throw in a review article or two about the physiology of hunger, unless physiology is largely ignored — which it seems to be.

        Methodolatry much? There are more types of evidence than clinical trials and you needn’t have one in order to be science based.

        Have the steps/days been validated in any manner whatsoever?

        A calorie is a calorie… Metabolism of food stuffs is always going to be identical and yield the same caloric input.

        Each molecule of [glucose, fat, protein] goes through multiple steps in the conversion to ATP and other energy-containing molecules. At any stage of the process, the metabolites can be diverted elsewhere to be used for structure, signaling, or simply discarded as waste. That is, they do not become ATP.

    2. George Locke says:

      “Appeals to the “laws of thermodynamics” are fairly common in pseudoscience circles. Thermodynamics laws apply to closed systems. Humans are not closed systems. We take in sources of energy and have outputs. Different sources of energy are metabolized differently and conserved differently (ie, not all “calories” are “equal”)… If it’s not a physics text, and thermodynamics are mentioned, turn around and walk away.”

      I am not a doctor but I am a physicist, and I can tell you that thermodynamics applies far beyond the “closed system”; of particular note is the physics of a heat engine, which A is essentially about exchange of energy, and B is closely analogous to the human body (replace heat input with chemical energy from digesting food). The first law of thermodynamics explicitly describes the exchange of energy through a system, and this is the “thermodynamics” involved in this particular issue (CICO). Thermodynamics has a huge variety of applications outside its originally intended subject matter.

      The major danger of applying physics concepts to non-physics questions is the spherical cow. In the case of the analogy of the human body as heat engine, the difficulty comes from the fact that the “efficiency” of the engine is a complicated function of the state of your body/health, whereas the model considers this to be a fixed property of the engine. CICO is true insofar as energy is conserved and false insofar as the “calories in” are not uniquely determined by the food you eat, but depend in your metabolism, which is complicated.

  10. Andrey Pavlov says:

    This is very much in concordance with my own experiences and my own evolving understanding of the literature. I’ve made it a point here and amongst friends and family who ask that yes it all will always boil down to thermodynamics. It just so happens that there are many ways to skin a cat (and thankfully mine who is currently nuzzled up against my computer can’t read).

    Ultimately the thing that all diets that “work” have in common is that they make you more cognizant of what you are putting into your mouth (depending on the literature you can find that people underestimate their caloric intake by as much as 500 calories per day, simply by not realizing or remembering that they snacked on little things throughout the day), making it more difficult to ingest as many calories as you once did, and in some cases physiological “tricks” to make you feel fuller longer (like making sure each meal has some lean protein in it to delay gastric emptying).

    I’ve mentioned it many times before but I was always obese until 2007. At that time I did not have as sophisticated an understanding of dieting and weight loss and I went for the really hardcore Atkins style diet and insane amounts of exercise. Both of which were completely unsustainable in the long term, but ended up with me losing in excess of 70 pounds in ~5 months. At one point I needed ~5,000 cal/day just to maintain weight… but I was also working out an average of 40 hours per week. Yes, literally, 40 hours per week. I also worked full time and did lab work. My days were consumed with just those things. Work 12 hours (nights), go to the lab directly from work, crank on my experiments for a couple of hours, sleep for 6 hours, workout for 3 hours, back to work, repeat. On my nights off I would work out for anywhere from 5-10 hours (I did distance cycling – 400 miles/week at least – plus running, lifting, swimming, surfing, and other random things). So yeah, that works, but is completely unsustainable.

    Thinking about things as a system makes much more sense. I have given a few talks at high schools about eating and living healthy and make that point. I show a picture of a big bacon cheeseburger and ask “is that healthy?” Everyone answers “no.” I then say “how do you know?” And teach them that you need context to determine if it is healthy. I remember once I was ordering my dinner at the hospital before starting my shift. I asked for extra bacon. A woman next to me chided me for eating so unhealthily. The irony was that at the time I had “6-pack” abs and she had a few extra kilos on her. When I told her I just just 30 minutes prior finished an 80 mile bike ride where I burned 3,000 calories she was stunned.

    The point being that this book seems to systematically codify such things. We shouldn’t give up our favorite foods, splurges, and luxuries. But we must evaluate them in the context of what we are doing. Nowadays I can’t order that extra bacon and eat greasy burgers 4 times a week because I am not working out 40 hours per week. It is all about balancing the ins and outs to create a stable system. And if you are currently obese it is unquestionable that the setpoint of your current system is one which will make and keep you fat. There are many ways to tweak the setpoint that will produce results, but each person’s “system” is different, which is why no one-size-fits-all plan works.

    Case in point – eating every 2-3 hours. That simply does not work well for me. I just don’t get hungry that often and if I do eat a larger meal I don’t feel hungry for a long time. If I splurge and overindulge at dinner I won’t feel hungry again until dinner the next day. But I also won’t get “hangry” as my fiance does, which is why eating every 2-3 hours is a good plan for her.

    Of course we should also recognize that context can be highly subjective and that people overestimate the “good” things they’ve done and underestimate the “bad” things, so that is important to bear in mind.

    Thanks for the post and the reference! I’ll pass this along to some friends and family.

    1. Joanna says:

      I get “hangry” That’s why I work really hard to make sure I eat in a way that prevents it from happening.

      The problem with just reducing calories and increasing exercise is that and not tracking your weight or calories is that you have no way of knowing if what you are doing is working. I do project management and we always track metrics to see if things are working, and tweak things if they aren’t. This goes for weight loss and maintenance. You need to know your numbers so you can tell if it’s working or not.

      I admit, tracking calories gets old pretty quickly. But I’ve found that by doing this for over a decade, I have a very good idea of the calories in most of the foods I eat. I no longer need to keep a written record, but I do keep a mental tally every day.

      1. Andrey Pavlov says:

        The problem with just reducing calories and increasing exercise is that and not tracking your weight or calories is that you have no way of knowing if what you are doing is working.

        Hmmm…. yes and no. No because you can tell if it is working without tracking because your clothes will fit differently (or not). But yes, because that is a crude tool to use and doesn’t actually help you achieve the goal. Many people don’t realize how many calories things actually have in them. I believe there is data on this but my own anecdotal experiences demonstrate that people are very poor judges of caloric content of things. Journaling and looking it up will provide you a reference point so you can later on make rough guesses that are more accurate. And after a while of having your diet changed (primarily portion control, secondarily content) you will get used to that and find it easier to maintain. But I agree that at first it is very helpful to have an objective measure in order to “reset” your “yardstick” if you will. Also because it may provide you concrete reasons to cut certain things out of your diet. Maybe that thing you kinda-sorta like turns out to have way more calories than you had imagined. That could make it very easy to just nix it entirely and could make a significant difference over the long term.

        I admit, tracking calories gets old pretty quickly. But I’ve found that by doing this for over a decade, I have a very good idea of the calories in most of the foods I eat. I no longer need to keep a written record, but I do keep a mental tally every day.

        Precisely.

        1. Joanna says:

          You’re right, a waistband will work as well as a scale. I guess a better way to say it is that you should have some tool that will help you determine if your efforts are paying off, be it a scale, a tape measure, or a waistband. Just don’t use yoga pants, they are too stretchy. : )

          1. Andrey Pavlov says:

            I guess a better way to say it is that you should have some tool that will help you determine if your efforts are paying off

            Agreed.

            Just don’t use yoga pants, they are too stretchy. : )

            My jeans and slacks are a good indicator that I am currently above my preferred weight. ;-)

    2. Greg says:

      I know it was some time ago, but congratulations on your weight loss!!

      1. Andrey Pavlov says:

        Thanks!

  11. violetd says:

    The best advice I can give to people who want to loose and keep off weight is ask yourself regularly “does the taste justify the calories.” An example plain eggs are low in calories but for me the taste doesn’t justify eating them. However cheese is high in calories and for me very tasty, so I justify it by eating small amounts (weighing) of the most tasty–real swiss as opposed to colby. Know your taste and your calories. Frosting–high in calories low in taste for me so it’s out.

  12. Sullivanthepoop says:

    I don’t know why this article made me think of this, but I have a friends who used to own an estate company and did manual labor at all of her houses. She once had an exceptionally large house she was working on and it had a deadline she was working there all the time. We ran into this girl we hadn’t seen in a while and she said to my friend, “You look great, what have you been doing [to lose weight]?
    My friends went into the whole thing about the house and she was so busy she didn’t have time to snack or whatever and the girl said, “Oh, so calorie reduction and increased activity. Isn’t that always the way no matter how much you wish for a different answer.”
    I thought that was great.

  13. Dorothy says:

    Taubes does not deny thermodynamics. He simply points out that it is a tautology. An equation without direction and the old “eat less exercise more” implies a directionality that is not supported by science.

  14. Sawyer says:

    Two book reviews in one week? How am I supposed to keep up with all this reading? You guys are clearly shills for Big Library.

    Just a reminder to bibliophiles – I’ve put all the SBM book recommendations into a list on Goodreads if anyone wants a handy source of book recommendations. Anyone is free to add their own favorite medical books, but if you look at my votes you’ll only see stuff that received positive reviews on this site (mostly by Harriet).

    https://www.goodreads.com/list/show/52624.Science_Based_Medicine_Recommends

    1. George Locke says:

      You guys are clearly shills for Big Library.

      Lol

  15. steney01 says:

    An interesting paper was out a couple years ago comparing risk of death with bmi in asian populations. Turned out the low risk range was found to be 22.6 to 27.5. (27.5 would be considered overweight in the US btw). Elevated risk of death was seen for both very low bmi groups and very high (over 35), but only for certain subpopulations. Others (Indians and bangladeshis) had no increased risk of death with high bmi.
    http://www.nejm.org/doi/full/10.1056/NEJMoa1010679

    Another interesting paper from the look ahead group studying overweight and obese populations with type 2 diabetes who underwent intensive lifestyle intervention (calorie reduction and exercise) showed no benefit to frequency of cardiovascular events. Sure they lose weight, and show improvements in some cardiovascular risk factors, but improving risk factors doesn’t always mean improving the final outcomes.
    http://www.nejm.org/doi/full/10.1056/NEJMoa1212914

    So weight and diabetes and cardiovascular events and mortality is not as cut and dry as people seem to suggest…it’s very complicated…and much more needs to be done to tease this out..

    1. WilliamLawrenceUtridge says:

      That NEJM article is stunning. I would love to see an analysis of it. Long follow-up, hard outcome measures, no benefits to weight loss? Bizarre.

      1. Dr Robert Peers MBBS [UniMelb] says:

        Sir William,

        The Look AHEAD paper is free, so you can read their own analysis–they reduced calories, but did not attempt to alter diet composition much. “Fat” was reduced to below 30% of calories, but that’s nowhere near enough to reduce vascular risk, and they don’t distinguish sat fats from polyunsaturates, so we can’t get any idea of the P/S ratio, which if much below 1.00 will cause insulin resistance, oxidation and inflammation–despite weight loss. Protein was increased to over 15% of cals, which might at east promote satiety.

        Their conclusion was that they maybe should have used a Mediterranean diet instead, which actually gets vascular risk down properly, as in PREDIMED, and as in the 1994 Lyon Diet Heart Study [2.5 times better protection than statins].

        Or just whole-grain cereals, which are very protective against heart attack [Prof Jerry Morris, 1977, Heart and Diet: A Postscript]. Medi diet and cereal fibre both provide an anti platelet factor, hexahydroxycyclohexane, that seems as good as aspirin, at stopping arterial clots.

        Another study that failed to stop heart attacks or strokes in diabetics was the UK/Denmark/Holland ADDITION Study, which used intensive drug therapy, but failed to implement the planned dietary intervention.

        Compare that with Dr Dean Ornish’s old Diet Heart Study, that showed real benefits with very low fat, high-grain and legume diet, in high-risk subjects.

        The Look AHEAD investigators obviously don’t read the older literature.

        1. WilliamLawrenceUtridge says:

          Any comment you make about any topic renders it immediately uninteresting to me. Childish, but I’m pretty annoyed at your “I can’t believe Burzynski is selling that kid quackery, he should stop so I can give him some of my quackery” approach to life.

  16. Adam says:

    I understand the swipe at Taubes.

    His main point is that sugar and carbs affect your insulin levels and subsequent hunger.

    Seems like he was ahead of the curve on the problems with “low fat” diets.

    1. Harriet Hall says:

      But he himself admits that his diet recommendations have not been properly tested in clinical trials. His enthusiasm goes beyond his data.

      1. ThorntonHall says:

        As opposed to the recommendations against cholesterol? Salt?

        Eggs? They have been saying eggs are bad for you for 30 years? Guess how much data there is for that!

        1. WilliamLawrenceUtridge says:

          Oh, yeah, the statements about the health risks of eggs are way off . There’s definitely no nuance to be found. It’s not like the recommendations changed 14 years ago.

  17. JasonL says:

    Excellent report. I look forward to reading the book.

    n=1 will forever be a powerful tool in nutrition (and fitness). I don’t see any way around the fact that “what works for me” is more powerful than any science for many people.

    That, and I always enjoy a report that says I can keep eating Bacon!

  18. Harriet Hall says:

    I weigh myself every day and when my weight is up a pound or two above my goal, I eat fewer calories until it goes back down. I realize the day-to-day fluctuations are not really significant, but the motivation to see that magic number on the scale helps me eat more sensibly.

    Then there’s “scale denial” – one of my patients who had lost weight successfully was surprised to have gained 10 pounds. He claimed he hadn’t weighed himself since reaching his goal because “he wanted to see what would happen.” He found out. :-)

    1. goodnightirene says:

      I follow the same practice most of the time. Whenever I stop nearly daily weighing, I find that I rapidly gain three or four pounds, which then takes me a month or so to get rid of–yet I never seem to learn! I think it’s a type of denial. People say (including doctors) that three or four pounds is insignificant, but I’m just 5’ 2”, and I disagree–three will become six nearly overnight and on it goes. I will remain vigilant and my scale will remain my best friend, the one in the bathroom AND the little one in the kitchen.

    2. Greg says:

      Weighing daily can become obsessive. And if you’re doing any resistance training, it may not be an accurate reflection of fat loss as any gains in muscle mass will offset overall weigh loss. The mirror and your clothes can also be a guide for your weight loss efforts.

      1. Stella B says:

        It’s unlikely that a post-menopausal woman will gain much muscle mass without a very, very aggressive weight training regimen. “I’m gaining muscle from exercising” is often another one of those little acts of denial.

        Exercise is still good!

    3. Lytrigian says:

      On the other hand, sometimes different “scales” yield different results. When I was exercising regularly a few years ago I started out with just running. This brought my weight down from its all-time high of 215 to about 175. When I added weight training on alternate days, I began gaining until I was about 190, but my waistband told me I was still losing what I wanted to lose.

    4. Dr Robert Peers MBBS [UniMelb] says:

      Most of my patients who weigh themselves regularly have anxiety disorder, a well-known driver of comfort-eating [including binge-eating , snacking and night-grazing]. Elissa Epel has described the problem, which seems to be due to the effects of cortisol on the reward centre. See her on PubMed.

      I detect anxiety by asking about childhood shyness or sensitivity, and lifelong worrying nature. I treat all my anxious patients with the anxiolytic glucose isomer myo-Inositol, 5 gm/day. This reverses anxiety by inhibiting serotonin 2A receptors [C Brink, 2004]–an action that reverses HPA stress axis activation, so lowers cortisol [J Levine, 2001].

      My many anxious fatties–many of whom are chocoholics–rapidly lose their food cravings, take to salads and fruit spontaneously, and lose 4-10 kg within 2 months. Several have lost 15-20 kg, and one huge guy, addicted to cheese sandwiches and sugary drinks, lost 99 kg in 18 months [and got a job!].

      Diets rich in inositol–like grain’n'bean diet or grapefruit–get 2-3 kg off, which is something; but full anxiety reversal, sadly, takes more inositol than the 2 gm or so/day provided by diet. I recommend high-inositol diet [grains, nuts, legumes, citrus], plus I add 5 gm/day of inositol powder.

      Other benefits reported by my inositol-treated anxious patients include newfound calmness, better concentration and memory, no more “brain-fog” on waking up, a big rise in energy and stamina, faster growth of hair and nails, and far better libido and immunity.

      And they stop using their scales!!

      1. Harriet Hall says:

        “I treat all my anxious patients with the anxiolytic glucose isomer myo-Inositol, 5 gm/day. ”

        Not just the anxious ones. You treat your patients with inositol for pretty much whatever ails them. You seem to think it is a panacea. Maybe it is, but it will take a lot more than your assertions to convince us. Until controlled clinical studies are done, bombarding us with these repetitive claims is a waste of your time and just makes you sound like a crank. Patients get better for lots of reasons, and confirmation bias can be a very powerful thing when one is enthusiastic about an untested hypothesis. You have no way of knowing whether your approach wouldn’t work just as well with a placebo.

        1. Dr Robert Peers MBBS [UniMelb] says:

          Dear Anxiety Sufferer,

          I make observations, not assertions. I was trained at Melbourne University and the Royal Melbourne Hospital; our Professor of Medicine, Richard Lovell, instilled into us his English love of rigorous and honest observation, from which new discoveries may sometimes come.

          I also read widely, and keep research files, as should be obvious from the frequent references that I post in my comments, that American-trained medicos–perhaps lacking rigour and honesty–can’t be bothered reading.

          I only use supplementary inositol where dietary sources aren’t enough, that is, moderate to severe anxiety in teens and adults. I am lately testing high-inositol diet alone [estim. 2.0-2.5 gm/day] for mild adult anxiety. Anxious kids, to age 10 or 12, get full anxiety reversal with diet alone, preferably with citrus added to grains, nuts and legumes.

          I also recommend the high-inositol diet [but not the supplement] to non-anxious patients, since inositol has significant anti-platelet effects [shamsuddin a and platelet] for vascular protection, and also has promising anti-cancer and anti-ageing potential, by inhibiting IGF-1 signalling [falasca m and pentaphosphate]; [igf-1 and longevity].

          My colleagues in regional clinical schools may be the first to do a trial of inositol in anxiety-driven obesity, that I hope will confirm my own observations, of 4-10 km wt loss in my own anxious fatties.

          I am also hoping to confirm the promising results of an old Israeli study on inositol and Alzheimer’s [levine j and alzheimer], with the help of Finnish neuroscientists in Kuopio, and Deakin University preventive health researchers, in Western Victoria, who have an active collaboration with Finnish preventive experts.

          A further project involves the Monash Institute of Pharmaceutical Sciences, possibly with funding from drug giant GSK, to develop a drug that will cause the kidney to retain inositol, to save us trucking 100s of tons of magic white powder across the nation, to satisfy the demand.

          In the US, 5 million Alzheimer cases needing 10 gm/day would mean supplying 50 tonnes a day!! Maybe your MidWest inositol production, from corn, could try to produce this much, but it still needs to be distributed, in very large quantities.

          If we can develop the inositol-sparing wonder drug, we would call it Panacea–naturally.

          1. WilliamLawrenceUtridge says:

            Where are your tests published?

            1. Dr Robert Peers MBBS [UniMelb] says:

              Keep an eye on the Australian Journal of Rural Health, and also the New Zealand Medical Journal. But be patient, as the trials I mention are only in the planning stage at present.

              Regarding my clinical observations using inositol supplement in anxiety disorder, my rationale can be found in the 1990s studies, in Beer-Sheeva, of inositol in depression, panic disorder, OCD, and eating disorders. The lead investigators on these RCTs were Profs Joe Levine and Robert Belmaker.

              I was surprised that they did not test inositol in plain anxiety, since this is well known to be the preceding and underlying basis of the above disorders. I see many anxious patients, but mostly without depression, so in 1999 I began testing inositol in plain anxiety.

              I soon realised that I was onto something big–not just calmness and refreshing sleep, but many other surprising effects, including a big lift in energy, anti-craving effects [food, cigs, alcohol, pot], better libido [as in a Roman clinic for men with ED], far better immunity, and an intriguingly faster growth of hair and nails, that when fully grown appear silky, shiny and strong. Some day, I will persuade an academic psychiatrist to confirm these effects in a publishable formal study, but that will take money.

              I have now treated over 2000 cases, and have carefully recorded the above results. As for controls, Levine et al were able to use them in an academic trial setting, but in general practice we are usually restricted to open label or n=1 trials.

              However, some of my many inositol-treated cases inadvertently act as their own controls, when they run out of powder, or think they don’t need it anymore. They then turn up, looking obviously stressed, compared with how I last saw them, and they quickly respond on resuming inositol.

              Just today, I had a very anxious young woman come in, complaining of bad insomnia and recurring panic attacks, both of which had abated when on high-dose inositol [10 gm/day]. Inquiry revealed that she had run out of her powder 2 weeks earlier, while the symptoms had returned about 2 days later.

              I also recall an anxious man, who took a trip to Europe: I told him not to take white powder with him [customs risk], but to drink lots of citrus juice, to get 2-3 gm of inositol/day. He forgot to do this, proceeded to eat most of the cheese in Holland, and the chocolate in Switzerland, came home a month later, slumped in the surgery chair, and moaned that he felt “absolutely flat and crap”. His depression soon cleared up, and he remains well.

              My first priority, being country-born and bred–and as a former bush doctor–is to improve the physical and mental health of rural people, first in Australia, then later in the US and Canada. Hence my decision to publish only in the above journals, and to reach country folks via their local press and farming magazines etc., and via rural health lecture tours, and a national network of National Institutes of Health–one for each town–staffed by locally-recruited ex-nurses etc., trained to use low-fat, high-inositol diet to implement nutrition, prevention and anti-ageing.

              1. WilliamLawrenceUtridge says:

                But be patient, as the trials I mention are only in the planning stage at present.

                …and that’s why I’m not taking you seriously. Because right now, all you have are anecdotes. Hypothesis-generating, not hypothesis-testing.

                Regarding my clinical observations using inositol supplement in anxiety disorder, my rationale can be found in the 1990s studies, in Beer-Sheeva, of inositol in depression, panic disorder, OCD, and eating disorders

                Meta-analysis for depression: no benefit. The rest of the conditions don’t seem to have sufficient literature to conduct such a meta-analysis.

                However, some of my many inositol-treated cases inadvertently act as their own controls, when they run out of powder, or think they don’t need it anymore. They then turn up, looking obviously stressed, compared with how I last saw them, and they quickly respond on resuming inositol.

                Do I need to explain why this is not the same thing as acting as one’s own control in any way, shape or form?

                Also – mentioning anti-aging doesn’t help your credibility. You’re at best a hair’s breadth above most of the quacks who show up here proclaiming miracles, but I bump your grade down a notch because you tried to shill this to a kid with cancer.

              2. Harriet Hall says:

                People who are convinced a bogus treatment is helping them will often experience a recurrence of symptoms when the treatment is stopped. It’s called conditioning. It’s one of the many reasons we have to do double blind trials. I challenge Dr. Peers to do an informal experiment that will cost practically nothing. He could tell patients he was trying to find out “if” inositol worked (not prove “that” it worked) and they would get either the real thing or a placebo, he could document informed consent in the medical record, and his office nurse or assistant could dispense powders made up by a pharmacist and labelled A or B. If the inositol works as well as he believes, that would justify a formal study. But he might be surprised to discover that he couldn’t tell from the patients’ responses which ones had gotten the inositol, and it just might persuade him to question his beliefs. I predict that he will not be willing to try this; a convenient cop-out would be “I know it works and it wouldn’t be ethical to deny patients effective treatment.”

              3. MadisonMD says:

                better libido [as in a Roman clinic for men with ED], far better immunity, and an intriguingly faster growth of hair and nails, that when fully grown appear silky, shiny and strong.

                I have now treated over 2000 cases, and have carefully recorded the above results.

                Great. Since you haven’t published yet, but carefully recorded hair and nail length, please provide the data here. I’m also interested in how you quantified and carefully recorded hair and nail silkiness, shininess, and strength.

                WLU says: “Also – mentioning anti-aging doesn’t help your credibility.”
                Libido also skirts dangerously close. But, hey for Peers inositol is panacea!

              4. Dr Robert Peers MBBS [UniMelb] says:

                To William Lawrence Outrage: I say this:

                You are an extremely unpleasant person, whose obvious high intelligence is spoiled by a foul temper. And you know it–whence cometh your recent dark moods? A touch of bipolar anger, switching to depression of late?

                I demand that you learn to correct your own mistakes, and refrain from making further comments on this site, until you apologise to a conscientious and respected Aussie GP, regarding your vile attacks on me for being a [shill] trying to flog my [adjunctive] cancer treatment, to help a poor Jewish child dying from a brain tumour.

                I urge you to look back at those posts–in one of David Gorski’s Burzynski articles a month or so ago–and find there my detailed justification for offering my help to this child. I point out there, that inositol is known to synergize with the anti-medulloblastoma drug cisplatin [Dr Marco Falasca, 2004 paper on inositol pentaphosphate]; and so may restore the drug’s response, if it had been tried and lost its effect.

                I also state my personal and family reasons for wanting to help Jewish people, in particular, in health matters. I think that David may have accepted my explanation, but you completely ignored my attempt to placate your uncontrollable knee-jerk hostility, by means of a couple of detailed posts, written with a generous spirit.

                You responded to my conciliatory remarks with unbelievable abuse and further insulting comments, which show no sign of abating. My wish is that regular SBM contributors, who read this protest, will have a word with you, warning you to moderate your tone, make a manly apology, and begin to show some respect for an independent researcher and family physician whose over-riding purpose is to add scientific nutrition to the doctor’s armamentarium, to improve public health and diminish the appeal of CAM.

                Now as for those studies on inositol, it may not be clear to you –since you do not pay attention–that I only began my general practice studies on anxiety AFTER first spotting Joe Levine’s big 1997 abstract [Controlled Trials of Inositol in Psychiatry], back in 1999.

                Although these were small trials, they were proper RCTs, that showed efficacy of inositol in depression, panic disorder, obsessional disorders, and eating disorders. The reason they have not been recognised by academic psychiatry, and widely repeated, may be the well-known dependence of psychiatry researchers on drug company funding.

                Why don’t you get angry about THAT?

                Had Levine not published this work, I might have tested inositol eventually, on the basis that it inhibits serotonin 2A receptors better than Prozac [C B Brink, 2004]; and Irish psychopharmacologist Brian Leonard has predicted antidepressant effects from either inhibiting those receptors [to block CRF action], or activating serotonin 1A receptors.

                I learnt about Leonard’s prediction, from local psychopharmacologist Prof Trevor Norman, who tips me off about latest developments.

                Your spot check of meta-analyses on inositol backfires badly in this particular case. The lack of sufficient follow-up studies on panic, OCD and eating disorders is probably due to our drug company-corrupted academic researchers, while the 4 depression studies selected by the Cochrane reviewers are woefully inadequate.

                Of these, only one tested inositol alone, vs. placebo–the Levine study cited in his 1997 abstract. Although small, with wide confidence intervals, the benefit was significant.

                The other three studies are pathetic: they tested inositol in treatment resistant depression, where standard SSRI drugs had already failed; and one trial was in bipolar depression, and gave mixed results, with poor results in scruffy, violent, unkempt patients [who may have been missed cases of Adult ADHD--easily confused with bipolar rage and mood swings].

                Those Cochrane reviewers in Oxford bungled this one–and one of them is, to my knowledge, involved with a UK biotech in developing new chemical-based antidepressants [hardly one to enthuse over a natural treatment].

                What causes treatment-resistant depression is a bit of a mystery. I have seen a slower response than usual to inositol, in a few patients who ignored my advice to reduce saturated fat [inflames the brain: CULVER B AND FAT, 2005].

                SSRIs work partly by raising synaptic serotonin levels, partly by inhibiting the above 2A receptors–and also by promoting new nerve membrane synthesis, with high inositol content, that may restore BDNF neurotrophin level and hippocampal neurogenesis [Dr Marwan Aboukhatwa, Philadelphia].

                Therefore, treatment-resistant cases who get no better on an SSRI will also not respond by adding inositol.

                The least that psychiatrists could do in such cases, is call in a dietitian, to institute a healthy low-fat diet. Prof Michael Berk, in Geelong, is considering this strategy, which is beyond the wits of the NIMH–even given the evidence that depression is a pre-diabetic inflammatory state, that may represent basal anxiety, aggravated by fatty diet.

                Another possible cause of treatment resistance may be the consumption of refined salad and cooking oils [vitamin E-depleted omega-6 seed oils]. I have seen a number of anxious patients, who became highly irritable on starting to eat such oils–which, in calmer folks, cause mild amnesia, glare sensitivity and impaired dark adaptation.

                Indeed, such oils are linked with late-life Alzheimer’s disease, due to the synaptic lipid peroxidation toxicity they induce , via the fatty acid fragment 4-hydroxy nonenal–known to inhibit not only AD-relevant proteins, but also synaptic release of mood-affecting neurotransmitters [dopamine, noradrenaline], plus direct inactivation of serotonin receptors. See LOPACHIN R AND SYNAPTIC, re 4-HNE toxicity.

                About 30% of US citizens show AD pathology in late life–consistent with lifelong seed oil exposure–and about the same proportion of depressed cases are treatment resistant.

                So to see the true effects of inositol in depression, dietary confounders should be addressed first, by instituting a low-fat diet that also excludes brain-peroxidizing refined seed oils.

                Those cases exposed to the latter should also have a short course of vitamin E and fish oil, to correct low brain levels of these nutrients, before testing either SSRIs or inositol.

                Then Cochrane might have something reliable to say about inositol.

              5. Sawyer says:

                @ Dr. Rob

                A touch of bipolar anger, switching to depression of late?

                WOW. Just …. wow. Even the normal crackpots we have floating around here have the sense not to make this mistake. Which prestigious institution did you earn your degree from that told you it’s a good idea to try to diagnose mental health problems based on a handful of internet comments? L Ron Hubbard U? Isn’t this one of the first things you’re taught not to do, ever, by any medical school, anywhere? I’ve noticed WLU’s style doesn’t always mesh with everyone else, but the main reason is because so many other people here have an inhuman level of tolerance for quacks.

                I’ve been enjoying watching old re-runs of Community where one of the characters pursuing an Associate’s Degree in Psychology keeps hilariously misdiagnosing her fellow students with mental disorders. Too bad she doesn’t prescribe inositol or she’d be your soul mate.

              6. mousethatroared says:

                Dr Robert Peers MBBS [UniMelb] says: to WLU ‘You are an extremely unpleasant person, whose obvious high intelligence is spoiled by a foul temper. And you know it–whence cometh your recent dark moods? A touch of bipolar anger, switching to depression of late?’

                @Dr Robert Peers MBBS – I haven’t been following this thread, but your above statement go a long way to undermining your credibility.

                I am deeply concerned that you would use an impromptu diagnoses of mental illness to insult a commenter online. When we use a psychiatric diagnoses to define someone as unpleasant, wrong or immoral we reinforce the incredibly harmful negative stereotypes that people with mental illnesses and there family have fought so hard to overcome.

                These sort of tactics only serve to increase the stigma that endangers people with psychiatric illnesses.

                As a doctor you should be doubly concerned with the negative consequences of this kind of stigmatization. Instead, you choose to misuse your position of trust in a petty attempt to put down your detractor.

                I for one, will NOT request WLU “moderate his tone” Why?
                because this isn’t the 1940′s when doctors were allowed to labeled “difficult” patients who asked too many questions or were too assertive as mentally ill, just to shut them up and do as they’re told.

                It’s the internet and if you can’t take the heat I suggest you spend more time watching this. https://www.youtube.com/watch?v=StTqXEQ2l-Y
                and less time on this site.

              7. MadisonMD says:

                …refrain from making further comments on this site, until you apologise to a conscientious and respected Aussie GP

                Peers: I’m willing to have a word with WLU about this. But can you first help me identify the GP you are referring to?

              8. mousethatroared says:

                sawyer “I’ve noticed WLU’s style doesn’t always mesh with everyone else, but the main reason is because so many other people here have an inhuman level of tolerance for quacks.”

                ahh – nope. Personally, I don’t think that any of my ‘lack of meshing’ with WLU’s style has ever been because I think he should be more tolerant of quacks – and I’ll leave it that.

                But, maybe you’re thinking of somebody else.

              9. Sawyer says:

                @MTR

                I should have used the word “patience” instead of tolerance. I’m happy that very few people here are tolerant of outright falsities.

              10. mousethatroared says:

                Sawyer “I should have used the word “patience” instead of tolerance.”

                I get it now. Thanks for clarifying.

              11. WilliamLawrenceUtridge says:

                You are an extremely unpleasant person, whose obvious high intelligence is spoiled by a foul temper.

                Actually, I’m usually pretty easy to get along with in person. The internet brings out the worst in people – for instance, quacks who want to sell cure-alls to desperate cancer patients. I’m talking about you here.

                Also, is your assessment of me perhaps informed by the fact that you can’t really address my points except by anecdotes?

                My ill temper on this webpage comes from having to deal with repetitive idiots.

                I demand that you learn to correct your own mistakes, and refrain from making further comments on this site, until you apologise to a conscientious and respected Aussie GP, regarding your vile attacks on me for being a [shill] trying to flog my [adjunctive] cancer treatment, to help a poor Jewish child dying from a brain tumour.

                YOU are the one whose first post expressed outrage that Burzynski would sell his untested treatment to desperate cancer patients and then demanded contact information so the desperate cancer patients could get in touch with you. I can only see you as a blind, deluded hypocrite. Your very first post demonstrated a startling lack of insight, and your subsequent posts reinforced this. Your detailed posts, all of them, failed to address my core point – your confidence is unjustified, and your evidence is shoddy. Your panacea is unlikely to be a panacea, and your flogging of it, even for the best of intentions, does a disservice to basically everyone, and I can’t believe you have the gall, the gall to keep doing it. Go start a clinical trial if you want some respect from me, and make sure you double-blind it. My knee-jerk hostility is informed by your self-righteous demands that I take your word for it and the complete lack of adequate evidence for your opinions. I see it a lot, and it annoys me. All the more so when it’s slathered in the inability to see how you are very close to the man you are so disgusted with.

                make a manly apology

                So…what…I take a picture of my genitals saying I’m sorry?

                Are you not used to people calling you on stuff like this or something? Because you seem to be taking it very, very personally.

                over-riding purpose is to add scientific nutrition to the doctor’s armamentarium, to improve public health and diminish the appeal of CAM.

                You do realize that your efforts on this webpage are indistinguishable from those very CAMsters you hold in such contempt, don’t you? Small studies, anecdotes, in vitro work, old studies, “for the children”, and so forth. Do you know what Poe’s law is? I mean Jebus, you even invoke “Big Bad Pharma”. Big Pharma is assholes and whatnot, but at least they actually test their drugs and don’t wimp out with “wah, competition is hard”. The fact that you have to reach for and explain away failure to find significant results means that you are not justified in handing out inositol as if it were a treatment. Do you know what special pleading is?

                But hey, keep arguing with me. That’s productive. Want to prove me wrong? Prove me wrong. If inositol is as cheap as you say it is, what is preventing you from running a clinical trial? That’ll show Pfizer!

                @Mouse

                I haven’t been following this thread, but your above statement go a long way to undermining your credibility.

                That’s not what undermines his credibility. Not by a long shot.

                And though I probably haven’t shown it, particularly recently, I do appreciate your acting as a leash on my excesses. I apologize that you have to keep reminding me of the humanity of others on the internet.

              12. mousethatroared says:

                WLU “That’s not what undermines his credibility. Not by a long shot.”

                Yeah, I can see from reading this thread, it’s only a drop in the bucket. But, like I said I hadn’t been following and I don’t read the cancer articles unless I’m feeling particularily resilient that day.

                And thank you. I would add, I also don’t say enough that I appreciate your efforts with many of the practioners of pseudoscience like this doctor and SSR. I do not have the time, background or intellect to dispute many of their claims, but I am glad to see it done.

            2. WilliamLawrenceUtridge says:

              And thank you. I would add, I also don’t say enough that I appreciate your efforts with many of the practioners of pseudoscience like this doctor and SSR. I do not have the time, background or intellect to dispute many of their claims, but I am glad to see it done.

              It’s obvious that you appreciate my factual statements, and don’t appreciate my often-profane delivery. Tone, civility, spelling, grammar and word choice on the internet are like the clothes you wear on in real life, and they are important. I’m just as likely as any other human to dig in my heels when challenged on my civility, but that doesn’t mean I’m right.

              1. mousethatroared says:

                Oh well, I AM awfully stubborn.

                WLU “It’s obvious that you appreciate my factual statements, and don’t appreciate my often-profane delivery.”

                It’s not so much that. I like your personality and profanity (profaneness?) is part of your persona. I guess we just come at things from different angles. It’s bound to happen, different backgrounds, education, social circles, life experience, etc.

                No doubt we will butt head in the future, but I do appreciate that sometimes strong words are needed and appropriate.

          2. Harriet Hall says:

            “Dear Anxiety Sufferer”
            Why are you calling me an anxiety sufferer? I am not and never have been.

            “I make observations, not assertions”
            You make uncontrolled observations. Uncontrolled observations have value, but only as a starting point to justify controlled studies. Uncontrolled observations are very unreliable and misleading; they commonly lead to false conclusions. Medieval bloodletters observed their patients recovering; more recently, surgeons who did mammary artery ligations observed their patients improving. Controlled studies showed they were wrong. You could be wrong too; if you don’t accept that possibility, you are no scientist. True scientists try to disprove their own hypotheses to see if they are bulletproof; they ask “if” their ideas are true rather than trying to accumulate poor quality evidence to show that they “are” true.

            You have indeed made assertions about the value of inositol, assertions that are not backed by evidence from controlled clinical studies.

            “the frequent references that I post in my comments, that American-trained medicos–perhaps lacking rigour and honesty–can’t be bothered reading.”
            Levine? do you mean this study? http://www.ncbi.nlm.nih.gov/pubmed/8843494
            It was a small pilot study with only 11 patients and although it found improvements in language and orientation, it found that “Overall CAMCOG scores showed a TREND for greater improvement with inositol that was NOT SIGNIFICANT.” Or perhaps this one? http://www.ncbi.nlm.nih.gov/pubmed/9169302 where he says that “inositol… is not beneficial in schizophrenia, Alzheimer’s ADDH, autism or ECT-induced cognitive impairment.” No, we can’t be bothered to read every small pilot study or basic science study that you think “might” support your hypotheses. If we read everything that every “true believer” wanted us to, we wouldn’t have time to keep up with the medical literature in our own fields.

            You go beyond the evidence in treating your patients. I can understand why Medieval bloodletters treated patients on the basis of uncontrolled observations and hypothetical mechanisms of action; I find it difficult to understand why a scientifically trained medical doctor would be just as willing to do the same in the 21st century.

            1. Dr Robert Peers MBBS [UniMelb] says:

              Hooray! Harriet finally gets to read–or perhaps glance at–a couple of inositol studies: those relating to Alzheimer’s.

              Yes, Joe Levine did see, in his very small 1996 study, only an upward trend in cognitive score–but no such positive change is seen with palliative AD drugs [which merely slow cog decline], so actually suggests a disease-modifying action.

              This small but promising benefit was seen within only four weeks–faster, I suspect, than one sees in AD vaccine trials [when they work]. Harriet’s obvious personal animosity towards me proves the truth of the old dictum : Stress over-rides higher reasoning. A frontal lobe taken off-line by anger and resentment is quite unable to ask, in a cool and reflective way:

              1] Would the upward cog trend have eventually reached significance with a longer trial than 4 weeks?

              2] Even with no further up-trend beyond the first 4 weeks, what if the small improvement were to PERSIST, say for 1-2 years? Would that not mean disease stabilization–a sip from The Holy Grail?

              3] Would a better cog effect perhaps be seen in PRE-AD cases, with positive bio-markers, or with amnestic MCI? Which is where most treatments are now aimed–before it gets too far advanced.

              4] Why does Harriet acknowledge that inositol caused benefits on language and orientation, but carefully avoids Levine’s use of the word SIGNIFICANTLY, to describe those valuable benefits? The FDA is encouraging new treatments that improve cognition OR that afford global benefits of a non-cognitive nature.

              5] Similarly, SBM readers who bother to click on her link to the study, and read what is actually said there, may be disconcerted to see that she omits to mention the authors’ conclusion, in point 4: that a higher dose should be tried, for a longer period.

              Now why would they say that? Could it be that they see real promise in inositol for AD, and do not suffer from chronic negative thinking, that deflects Harriet from cool science, into an ad hominem pursuit of an independent thinker she calls a CRANK?

              I note that Harriet deplores cherry-picking–by other folks.

              The Levine study, although not based on any theoretical effect of inositol in AD, is highly significant to anyone who actually studies the disease. A few years later, in 2000, Canadian scientists discovered that three isomers of inositol–including the above myo-inositol–bind and neutralize toxic soluble beta-amyloid.

              And an even more promising mechanism has emerged since, from the ground-breaking work of Andy Dillin and Ehud Cohen, at the Salk in 2009. Andy once worked with Cynthia Kenyon, at UCSF, on the longevity effects of IGF1 pathway suppression, so they inhibited the pathway in transgenic AD mice, with impressive results.

              Cohen, now back in Jerusalem, has developed a hot new AD drug, called NT219, designed to inhibit the above signalling pathway, with the specific aim of exploiting longevity-associated proteostasis chaperones, proteases etc., to treat AD.

              Along with the crenezumab vaccine and two new Australian drugs, these may be the only AD drugs left standing in the race to find disease-modifying treatments for this huge neuroepidemic facing the world.

              In a previous post–Harriet’s vitamin E story, in January–I warded off one of her specious personal attacks, by citing Cohen’s work, and pointing out that inositol [via its pentaphosphate IP5] inhibits the exact same IGF1 signal pathway targeted by NT219.

              She made no response–and has clearly forgotten what I said, in the present context. Stress over-rides higher reasoning, and memory too?

              Finally, who does Harriet think she is fooling, when she cites a second abstract by Levine, that states that inositol has no effect in AD [or words similar]. Does she imagine, in her unseemly haste, that this later [1997] study finally showed inositol to be useless in AD, perhaps in a longer trial with higher dose?

              She neglects to mention that this large abstract is not a new study, but a summary of inositol’s effects in a number of brain disorders–in which, in concluding, Levine briefly dismisses his own 1996 AD study, perhaps over the small cog effect seen.

              In other words, like Harriet, even the wily Joe himself had ignored the potential of inositol in AD, and neglected to implement his own conclusion from that study–to use a higher dose for a longer period. Which is what I hope to do, in a much larger trial, with the help of Finnish and local researchers.

              1. WilliamLawrenceUtridge says:

                Yes, Joe Levine did see, in his very small 1996 study, only an upward trend in cognitive score–but no such positive change is seen with palliative AD drugs [which merely slow cog decline], so actually suggests a disease-modifying action.

                …or problems with blinding.

                I don’t think anyone here will be impressed until there is a large trial as a starting point, and is unlikely to change any practice or recommendations until there is enough for a meta-analysis, and in particular, until actual experts produce a consensus statement.

              2. Harriet Hall says:

                “the authors’ conclusion, in point 4: that a higher dose should be tried, for a longer period.”

                That was not a conclusion, but speculation based on a NON-significant trend in only 11 subjects. Not only did the author fail to pursue his own suggestion for further research with higher doses, but in the second cited article, he summarized all research findings (including his own) as showing no benefit for Alzheimer’s.

                It’s not relevant to talk about pathways that might explain “how” inositol works in Alzheimer’s when it has not yet been shown “that” it works in AD.

                I don’t think I’m guilty of cherry-picking; I think you are guilty of reading too much into preliminary trials and of confirmation bias.

          3. gewisn says:

            ” I treat all my anxious patients with…”
            It really makes no difference how you end that sentence.
            Treating all patients, even those with the same disorder, in precisely the same way, is almost Never good medical practice. People are different and their responses to treatments will vary.
            It is either lazy or self-serving to “treat all my patients” with anything.

            Okay I lied.
            It is entirely acceptable to “treat all my patients” with respect for their differences in biology and philosophy and with the dignitity they deserve by their existence.

  19. goodnightirene says:

    Hey, he wrote MY book! Or perhaps it should be that, “I learned all this on my own, but I’m glad someone has put it all in a real book”.

    One personal note: I have found out the hard way that chocolate cannot be even a part of my diet. I’m an addict in that sense. One bite on my birthday and I’m hooked on large amounts until I “kick it” again for the umpteenth time. Nothing else does this to me. :-(

    1. Greg says:

      Real chocolate or sugary junk they call milk chocolate? My wife is a chocoholic – she won’t give it up so I convinced her to eat only dark chocolate (70% cocoa or higher). A couple of squares per day (33 calories each) satisfies her craving.

  20. Frederick says:

    Diet and the obsession of weight loss create a lot of eating disorders, the obsession of calories counting and thing like will not help the problem, it will increase it. Peoples creating themselves “forbidden” kind of food, make them want it more. My Wife have a eating disorder she has been living with for years,( wich it finally recognize in the new DSM5, of course some denier think it is stupid) she dieted many times, obsesses herself with exercise, and created a list of forbidden food ( ice only once a month, etc). it never worked. for 3 years now she consulting a nutritionist clinic in Montreal, there have a different approach. First throw your bathroom scale in the garbage ( we still have it, under a pile of other thing, i use it to weight my the propane tank, so i know when to get more for the BBQ lol) and they work on freeing her from her obsession, the learn how listen to her body signal, when she is hungry, when is had enough. the goal is to have a right to eat everything you want. but if you do it the right way, you lose weight, naturally, it is a long process but it work. unfortunate the way we take action right now against obesity, making people obsesse with exercise, making them count calories, Are in reality part of the problem.
    It seem that a lot of people ( a lot more than we think) have eating disorder, and a lot of people consulting this clinic realize they have one. There’s some medical reason the some diet, but for ost people, there is none.

    Like peoples on those Weight loss shows, you can see some of those people have emotional problems, and that make them eat, and become overweight. But instead of helping them get past those problem, they just make them train non-stop. the reason why they become overweight is still there, so the day the stop training and dieting like crazy, it will just start again.

    My mother also dieted many many times without any real success, She used to joke about that when she was in the finally stage of her ALS disease, she went from 220 pound to 95. “it took a disease to make me lose weight”, yeah she always wanted to make the bad thing funny.

    1. cheshireb says:

      I am like your wife, I think it would be dangerous for me to diet again. Suggestions that go with me weighting myself everyday are about as safe as suggesting that an dry alcoholic just has one pint.

      NHS has a program for weight control. Their success was losing more than 5% of body weight (5% is not a lot, and not going to move anyone from obese to normal.) One in 6 people managed it, and 10-20 percent of the whole program (it isn’t stated how many of those who successfully lost weight) were prescribed diet drugs. I skeptically anticipate the RCT based on the “diet fix” and will stick to trying to eat well, exercise and not get myself hospitalized with anorexia.

  21. Kyle says:

    In all seriousness, very few people will sustain a religious journal of what they ate, when they had cravings, etc. It’s just not a practical thing to expect of anyone. So the ‘reset’ is good in that it’s only ten days, but will that same behavior carry over after the journal keeping has ended? Adora Tsang sites the Hawthorne Effect which is exactly what the ten day reset would likely do.

    The key to weight loss has never been sexy or glamorous, and never will be. ‘Calories out > Calories in’ doesn’t sell books or commercials. So how do we market self discipline in a society that sells pseudoscience and miracles? It’s starts with children. Target the children because that’s when most successful behaviors are established.

  22. Keating Willcox says:

    Some points of disagreement.

    1. No mention of setpoint. As we saw with the letpin experiments on rats, and is often observed when obese folks lose weight, their entire metabolism changes in an instant. The cells send messages that they are starving, the metabolism slows, the body thinks it is starving to death. A four hundred pound man diets and loses 100 pounds, so he is still obese, but his cells resemble those of a person starving to death. That is the essential reason diets fail. It is why trying to control caloric intake is not so useful. It is very discouraging that the books seems to ignore this fact, and you seem not to mention it. Oh well.

    2. We do have an idea that setpoints, once raised, tend to stay higher, and this may be the key to why obesity is so common. That is why the excitement over Leptin was so extensive, because Leptin seemed to control the setpoint. In rats, yes. In humans, no.

    3. There are large populations on earth, such as Okinawans or some Chinese whose simple diet permits a universal level of longevity, good health, and slim bodies.

    4. We know that the whites, sugar, white bread, candy feed the setpoint with bad information, and cause health problems.

    5. Exercise may not be useful to lose weight, but it helps. I didn’t see a lot of fat people at the Sochi Olympics.

    6. The big crisis in nutrition is not obesity as much as ultra low fat diets to prevent heart disease, vs high fat diets to prevent dementia. I saw no mention of this in your review.

    1. Sawyer says:

      5. Exercise may not be useful to lose weight, but it helps. I didn’t see a lot of fat people at the Sochi Olympics.

      Was this supposed to be sarcasm, or do you really not understand that 99.9999% of the population are not Olympic athletes? And it isn’t even a point of disagreement. Where did Scott say exercise didn’t help?

      1. Phil Koop says:

        “Where did Scott say exercise didn’t help?”

        1. “Sweating is the next myth, with The Biggest Loser epitomizing the belief that exercise can contribute to significant weight loss. You can’t outrun your fork—not in the long run.”

        If you claim that it is a “myth” that exercise can contribute to significant weight loss, then you are claiming that exercise cannot contribute to significant weight loss.

        2. “Exercise: You can’t out-exercise a bad diet, but regular exercise helps keep weight off …”

        Although not very clearly stated, this seems to be a claim that exercise cannot contribute to reducing weight but can contribute to maintaining it.

        If you believe that diet has a causal influence on exercise, then you must condition on diet when looking for relationships in data because diet would be a confounding factor. In this case, I think that Scott’s claims would be supported.

        If you believe that exercise has a causal influence on diet, then you must not condition on diet because it is not a confounder and conditioning is certain to give you a wrong answer. In this case, my reading is that Scott’s claims are not supported.

        If you don’t believe either of these causal models then it will be difficult to draw any conclusions from the data.

        1. Jim Glass says:

          “Although not very clearly stated, this seems to be a claim that exercise cannot contribute to reducing weight but can contribute to maintaining it.”

          1) You can’t lose weight by exercise per se, because too few calories are burned. Running a full 26.2 mile marathon burns only about .75 of a pound — and after doing so you are going to have a big dinner!

          2) Exercise is *essential* to creating the behavioral changes that enable one to lose weight while feeling actually good about it, avoiding all the “dieting suffering and want” that defeats 90% of people who try to lose weight.

          Thus, exercise does help you lose weight by enabling you to more easily diet and control the food you eat. (Having been through this, I can tell you I don’t even have to bother controlling what I eat now — well, not much.)

          The evidence of both facts is very clear in the data of the National Weight Control Registry, where among people who have lost and kept off 30+ pounds effectively nobody has done it through exercise alone, while almost everybody has done it through diet plus *serious* exercise averaging over 2,500 calories a week for women and 3,000 calories for men — equivalent to rather more than running a marathon a week for the average woman/man.

          See details in the larger comment I just made at the bottom here.

          1. WilliamLawrenceUtridge says:

            My now-very-old undergraduate education suggested that exercise was bad for losing weight, but very, very good for preventing the gradual-inching-up of body fat that tends to accompany middle age. That 1-2 pounds per year that most people start experiencing in their 20s. And also good for helping those who have lost weight to keep it off.

            And that was over a decade ago.

    2. Angora Rabbit says:

      The big crisis in “nutrition” are outsiders who think they have the One True Answer. Real nutritionists know it is multifactorial and complex. Even setpoint doesn’t explain it all. The strategies the reviewed book suggests would actually help address set point through modification of behavior and self-awareness that there is a set point out there. And interesting work going on to look at how set point might be altered in brain, for example, in bariatric surgeries.

      1. WilliamLawrenceUtridge says:

        I wonder how long it will be before this topic links to Dr. Novella’s post from last week, and we begin to use brain stimulation to promote weight loss. Eat a small dinner, then pulse some current through a wire in your head. Stop eating. That’d be a neat Orwellian (Wachowskian? Almost certainly not Orwellian, but it’s such an easy adjective to drop) non-solution with horrible outcomes.

      2. Dr Robert Peers MBBS [UniMelb] says:

        Dear Ms Rabbit,

        Why should not the causes of complex phenomena be simple? Like scurvy, or beri-beri, or pellagra? I am researching what may be the most common cause of a pathologically raised appetite set-point, and it is simple: fatty maternal diet.

        Such a diet causes offspring anxiety [Dr Elinor Sullivan--monkeys; Dr Staci Bilbo--mice], and also causes offspring binge-eating [Dr Paul Taylor--mice; Dr Sarah Leibowitz--mice].

        Most dieticians and family physicians are painfully aware that anxiety drives over-eating in their clients and patients, yet few obesity researchers seem interested in the psychiatric aspects of the problem.

        I use dietary and supplementary myo-Inositol with great success, to get weight off my anxious fatties–see my post further back, in this thread, for details. A simple treatment for a common disorder with a simple cause.

        And the big guy who lost 99 kg in 18 months did not need bariatric surgery.

        I am planning to use this high-inositol regimen to treat anxiety and obesity in regional Australia, by creating an Australian College of Health Practitioners, whose Fellows [trained ex-nurses, and dieticians, psychologists etc.] will be recruited in country towns and cities, where we hope to set up a network of National Institutes of Health, each with a HealthyCare Clinic.

        1. MadisonMD says:

          I’ve told you this before, Peers. Inositol is not a panacea. Your ‘proof’ is a series of inferences and anecdotes without critical tests of the hypothesis. You need to rigorously test your hypothesis before you announce, recommend, and expose people to it.

          You have even proposed using it on a child with cancer.

          As I’ve told you, a your inductive reasoning is nothing but a series of tenuous logical leaps. It ignores other ramifications in an infinite web of potential and equally weak inferences that could lead to contradictory conclusions. You need to be quiet and earnest, to rigorously test your hypothesis, and announce them to the world only when done–in short you should behave like a scientist. If you did so, you could do some good with your life. It does potential harm–and no good–to prematurely announce unlikely and unproven hypotheses to the world in youtube videos. Do you learn nothing from Pons and Fleischmann?

          Experienced scientists know that you will often need to vigorously test 10′s or 100′s of hypotheses before you find one to be true.

        2. Angora Rabbit says:

          Dr Peers, it’s Dr. Rabbit and in fact scurvy, pellagra and beri-beri (especially beri-beri) are quite complex diseases, as any of the students in my graduate vitamins seminar would tell you. I stand by my statement.

          I did, btw, go into PubMed and do some reading. Even the work using inositol variants for PCOS are clearly acknowledging the limitations and caveats. What troubles me about you (on behalf of your patients) is that you apparently don’t see the caveats. Truly, if this was really working as well as you claim, then why on earth are you not publishing this in the peer-reviewed literature. The first thing we learn at our mentor’s knee is that Unpublished Data Don’t Exist. In the U.S. there is a saying, “put up or shut up.” I can talk about my nifty hypotheses, but they are merely that if I can’t back it up with data that withstands peer review. So, if you findings are that strong, for the sake of patients everywhere, get it into the primary literature. You owe it to them. And NOT as a data-free article in Medical Hypothesis, for goodness sake. PLOS One is a good place to start.

    3. WilliamLawrenceUtridge says:

      Setpoints are interesting, but humans aren’t rats, and humans are capable of losing weight. I often wonder how well-validated that whole “dieting slows down your metabolism” claim is, and I also wonder how much role leptin and related satiety molecules play in weight loss.

      The Okinawans are also incredibly genetically isolated and insular. Claiming that their diet is the sole or even primary factor in their longevity is an open question.

      1. Angora Rabbit says:

        Hi WLU,

        Setpoints in humans are very real. The interesting thing about bariatric surgery is that they seem to reset them, which is why they “work”, although some forms are better at resetting it than others (have to look at notes to recall which ones).

        I think leptin today is mostly important because it was the first and set the paradigm for the concept of orexigenic hormones. Turned out very few people had true mutations for leptin or its receptor. But thanks to it, we then identified a whole family of these, like NPY, ghrelin, GLP1, melanocortin, and adiponectin. In other words, it’s complicated. :)

        A reduction in energy expenditure is a classic response to a reduction in calories, and BMI can shift downward to compensate. This is why people are recommended to exercise when dieting, to keep the BMI from adapting. But then the problem with exercising is that it increases appetite over the long term (suppresses in the short term), so that one is in danger of overeating to compensate for the increased calorie expenditure. That pesky set point again! But if you’re aware of both issues, then you can compensate and watch for them.

        Hope this is helpful!

        1. araikwao says:

          The Roux en Y procedure works because it involves excision of part of the stomach, so less ghrelin can be produced, therefore less hunger. Significant complications though. Lap band doesn’t work so well.

          1. Angora Rabbit says:

            Yeah, the effects of the various bariatric surgeries are really interesting and complex. I heard a seminar last week comparing banding and R-e-Y with gastric sleeve/VSG. In addition to some of the hormonal changes on appetite, they are also finding significant gut adaptations that may be driving some of the metabolic changes. For example, suggestions of increased energy utilization by intestinal populations as they adapt to the surgery. The microbial population and their products may be shifting also. It’s definitely about more than just a smaller stomach making someone feel fuller. Neat stuff!

        2. WilliamLawrenceUtridge says:

          I love it when you tell me I’m wrong AR, keep it up!

          Also – guest post. On leptins and setpoints!! Or shoes!!! Three-legged races, I don’t care!!!!

          At least my point about Okinawans stands (he says, watching for a refutation. Eagerly).

  23. Greg says:

    I’ve done a fair amount of reading about nutrition, particularly in the context of bodybuilding which means clean eating. I could be way off base here, but one of the things I eschew, when asked, is that people’s diets should be as free of processed foods as is humanly possible. The other thing is that it should mainly consist of foods that can be eaten in their raw state, which is not to say I advocate a raw diet, just a restriction of foods such as grains and beans, which require significant processing to make them edible. IDK if this is at all true but I read that from a genetic standpoint it takes about 50,000 years for us to adapt to new foods, so we really are not well suited to eating grains or beans. And we couldn’t be more different from animals that are able to digest those foods.

    1. Andrey Pavlov says:

      IDK if this is at all true but I read that from a genetic standpoint it takes about 50,000 years for us to adapt to new foods, so we really are not well suited to eating grains or beans.

      There is no reason to believe this is true. Bacteria have evolved completely novel protein folds in order to digest nylon in just a few decades. And that is evolutionarily stunning. Making relatively minor adjustments without needing to create new protein domains is trivial in comparison. So I don’t see any reason why it would take 50,000 years to adjust to eating legumes. Plus, even if that were the case, what it would mean is that you simply wouldn’t be able to absorb it. It would merely make for more feces and more gas. Which does, to an extent, happen with legumes. But to say that we haven’t “adapted” to the new foods means that if you ate nothing but grains or beans you would rapidly starve to death and that is simply not the case.

      The concept of “clean eating” also doesn’t quite make sense. Clean from what? The same with this idea of “we aren’t evolutionarily adapted” to a foodstuff – it is nebulous and ill defined. It just sounds good as a just-so story with nothing to really back it up and plenty to argue against it.

      Avoiding processed foods is good, but not because they are somehow inherently magically worse for you, but simply because they tend to be artificially calorically dense and at times micronutrient deficient. The former makes it easier to overeat, the latter doesn’t matter unless you are truly an elite athlete.

      As for raw state eating… that also makes no sense. Why would that somehow make things better? We can come up with specific examples where micronutrient or caloric content is reduced by certain cooking methods (water soluble vitamins leech out of boiled veg for example) but it is widely accepted that the invention of fire and cooking (e.g. processing food) is what allowed us to come to dominate the earth. The caloric advantage (along with the infectious advantage) of cooked food allowed us to thrive in our ecological niche. So I don’t see any reason to think that more “natural state” means “better” in any tangible way.

      1. Greg says:

        Bacteria have evolved completely novel protein folds in order to digest nylon in just a few decades. Is that a fair comparison? The human digestive system is much more complex than the metabolic processes of bacteria, isn’t it?

        But to say that we haven’t “adapted” to the new foods means that if you ate nothing but grains or beans you would rapidly starve to death and that is simply not the case. Adapted as in being able to efficiently digest and assimilate the nutrients provided by a given food in it’s raw state. If you were to eat beans and grains in a raw state you’d likely die before too long – from starvation and toxins, then again, I could be wrong about that.

        As for raw state eating… that also makes no sense. I meant that people’s diets should consist mainly of foods that can be eaten in their raw state, not that they have to be eaten that way or that I am advocating a raw diet.

        PS sorry for the double-post

        1. Andrey Pavlov says:

          <blockquote. Is that a fair comparison? The human digestive system is much more complex than the metabolic processes of bacteria, isn’t it?

          I don’t think you are appreciating how much more incredibly vastly more complicated an entirely new protein fold is vs a re-jiggering of a complex but already existing system. So yes, it is a very fair comparison. The crux of the argument is that we cannot have evolved to be better suited to our “novel” diet in such a short amount of time. If a bacteria can evolve a completely new protein fold in a matter of decades, then yes, we absolutely and most certainly can adapt to our food in very short times spans as well.

          By analogy a new protein fold would be like traveling from DC to LA via teleportation instead of by covered wagon, whereas adapting our existing digestive tract would be like doing the same trip via automobile instead of covered wagon.

          My point was to illustrate that molecular evolution – even of a stunningly difficult nature – can occur rapidly and so there is absolutely no reason to believe we couldn’t have adapted to our food or that it would take 50,000 years to do so. Even the idea of setting a number to how long it would take is utterly arbitrary and cannot possibly have any sort of reasonable justification.

          Adapted as in being able to efficiently digest and assimilate the nutrients provided by a given food in it’s raw state. If you were to eat beans and grains in a raw state you’d likely die before too long – from starvation and toxins, then again, I could be wrong about that.

          Well, as WLU pointed out, then cook your food. There isn’t something magical that happens when you cook beans – it makes more of the nutritive content available. And there is nothing inherently magically negative about cooking things either. I simply see no scientific justification for trying to stick to things “closer to their raw state.” If your argument is that we are not adapted to eat raw beans and grains, sure. But then your argument is completely moot if you just cooked the dang things.

          But maybe I am missing something. Can you provide some actual concrete reasons why “people’s diets should consist mainly of foods that can be eaten in their raw state”? What is the benefit of that? And what is the detriment of eating cooked or otherwise prepared foods?

          1. Greg says:

            Can you provide some actual concrete reasons why “people’s diets should consist mainly of foods that can be eaten in their raw state”?

            that’s a good question – I’ll have to get back to you on that, but my school of thought leans towards the paleo/hunter gatherer diet of human ancestry. And again, I’m not advocating eating a raw diet, just using it as a basis for choosing your foods, which you can prepare (or not) any way you like.

            1. Andrey Pavlov says:

              but my school of thought leans towards the paleo/hunter gatherer diet of human ancestry

              I get that is where your school of thought is and it is oft touted by sciencey sounding people as an “evolutionarily sound diet.” But in order to make that argument they have to make claims which you are (reasonably) parroting: that we cannot have evolved to eat the foods we currently do in [x] amount of time and that this lack of adaptation has some sort of intrinsically negative effects should we eat said foods.

              The problem is that the first premise is not based on sound evolutionary biology (I do hold an undergrad degree in the field and keep up with it somewhat). There is no reason to think we couldn’t have adapted and plenty of evidence to demonstrate quite clearly that we are, indeed, still evolving. Particularly on a molecular level.

              The second premise is not only not established, but is essentially already moot. There is literally almost nothing that we eat or even could eat that existed 50,000 years ago. Or even 20 or 10 thousand.

              I’m open to evidence otherwise, but there simply isn’t any to support this particular school of thought. It is just a “sounds good” just-so story.

              And again, I’m not advocating eating a raw diet, just using it as a basis for choosing your foods, which you can prepare (or not) any way you like.

              There is nothing wrong with that. And it is probably a reasonably healthy diet. And most ways of choosing what foods to eat is arbitrary anyways. As long as you are OK with that, that’s fine. But if you are trying to make the assertion that there is some actual intrinsic benefit unique to such a school of thought, then that needs to be backed up with evidence.

              If you want to say “Yep, just as good as any other, I just happen to like it” and leave it at that, then fine. But you are making concrete assertions about evolution and molecular biology that are not correct.

            2. WilliamLawrenceUtridge says:

              Most humans descend from hundreds of generations of farmers, not hunter-gatherers, eating diets many thousands of generations removed from wild plants. And if the theories about cooking driving human evolution are correct, even before we adopted farming we were already strongly and powerfully shaped by applying heat to meat and plants. Raw food may not merely be less-than-optimal diet, it may be actively harmful and contrary to a primary driver of human evolution.

              And it’s just so stupid – where do people even get the idea that raw food is magic?

              1. Greg says:

                Most humans descend from hundreds of generations of farmers, not hunter-gatherers, eating diets many thousands of generations removed from wild plants

                Isn’t this what you would call a logical fallacy? We have all descended from hunter-gatherers.

              2. WilliamLawrenceUtridge says:

                I would say it’s more hair-splitting than a logical fallacy. We are mostly descended from farmers, those farmers are descended from hunter-gatherers, farming exerted a real, pronounced, and much more recent evolutionary pressure on humans versus HG. Plus, there are humans that are currently HG or “directly” descended from HG (i.e. the Australian Aborigines AFAIK didn’t really farm before the arrival of Europeans, and I think many of the !Kung/San are currently HG). The idea that the HG lifestyle was the last and most relevant source of evolutionary pressure upon modern humans is basically wrong, it ignores the significant evidence that farming exerted a not-inconsiderable pressure on the human gene pool. Evolution did not stop once we stopped chasing our meat and diggin up roots in the forest or grasslands. Adult lactose tolerance and improved ability to digest gluten alone are obvious examples and there are more. The idea that HG is the critical period that we should aspire to eat like is speculative, and not particularly well-grounded.

              3. Andrey Pavlov says:

                Adult lactose tolerance and improved ability to digest gluten alone are obvious examples and there are more

                Actually there is some evidence to support the idea that lactose tolerance arose specifically because of the invention of cheese. Once we went ag and farmed animals as well, dairy products became a boon for sustenance. But in the pre-refrigeration days you couldn’t exactly export milk very far and so the consumption of dairy became a boon for just a small part of the population. Then cheese. Now we could transport calorically dense, macro and micro nutrient rich dairy products long distances and feed more people. So it became more advantageous to have lactose tolerance and the trait proliferated.

                The Asian cultures never had a huge dairy and cheese boon like the Europeans though so they tend to have much higher rates of lactose intolerance.

        2. Andrey Pavlov says:

          I should also add that all this means is that you just eat more beans (or whatever) and have the same outcomes (within the limits of practicality, of course). The advantage for us hominids in cooking and preparing food is that we were able to extract more of the nutritive content of it therefore needing less to sustain a given population (in other words, allowing for population growth). But in principle, you could also just have a boatload of beans and eat more or eat less and cook them. There’s no particular difference between the two strategies except that early in our evolution cooking was much more pragmatic than scrounging up more food.

          (obviously in certain contrived situations you could posit that you physically cannot eat enough raw beans to sustain yourself, which may be true, but doesn’t invalidate the core premise)

      2. WilliamLawrenceUtridge says:

        The concept of “clean eating” also doesn’t quite make sense.

        It makes sense from a marketing perspective, it takes advantage of our contamination fears, that in the absence of ritual purity laws and ceremonies appear to have gone hog-wild on our fear of bacteria.

        Also, in many cases cooking makes nutrients more available, lycopene in tomatoes being a significant example.

        1. Greg says:

          As I understand it, the concept of eating clean means free of chemical additives (excluding agro-chemicals).

          1. Andrey Pavlov says:

            Which sort of chemical additives? How do you define that? Is it confined to inorganic chemicals or are organic compounds included as well? Salt is a chemical additive. So is smoke in anything smoke-cured (nitrosamines). MSG would be a chemical additive (which has been shown to have no harmful effects, despite claims otherwise). How about tartrazine? That’s also known as “yellow #5″ and is an organic molecule added to foods. Agar-agar is also an organic molecule added to foods. How about sodium benzoate?

            The point I am trying to make is that “free of chemical additives” is just as nebulous and ill defined as “eating clean.” And that the distinction between “natural” and “not natural” is certainly not a bright line. Everything has some sort of additive to it, unless you really do go for a raw foodist type diet (and even then I might get pedantic and argue there is still some kind of additive).

            Why exclude agro-chems? And what would the negative effects of eating “chemical additives”? Is there any evidence that they build up in the body? Cause metabolic changes? Cause end organ damage?

            It is easy to make a superficially good sounding claim like “eating clean” and “no chemical additives.” But when you actually try to define and implement what that means it suddenly becomes very messy and the cutoffs inevitably become arbitrary.

            Perhaps if you gave a few examples of what you deem to be “clean” and “not clean” foods?

            1. Greg says:

              No offense intended, all your questions amuse me. Fresh foods such as vegetables and fruits, as far as I know, don’t have chemical additives, other than the chemicals used in agriculture.

              1. WilliamLawrenceUtridge says:

                Fresh foods, all foods, are made up of chemicals. Whether they are added or not is irrelevant, it is the individual effects of each chemical on specific species that matters. Bt for instance, is deadly to insects, but has zero impact on humans. The question isn’t even “is this chemical safe”, it is “at what does does this chemcial become harmful?” Water has an LD50 that is far, far worse than many banned chemicals; if you increase your fluoride intake by 10 times what the FDA recommends, you’ll get stained teeth that can bite through rock. If you increase your water intake by an equivalent amount, you’ll die. Quickly.

                The idea that “adding chemicals” is an inherent risk is stupid, and really annoys me. It’s a marketing ploy that organic farmers use to sell their products. Food additives are tested for safety at well beyond the doses found in actual foods. The people who make the recommendations aren’t morons, and they eat food. They are far, far, far better informed than the people who object to the presence of dihydrogen monoxide in their apples, yet policy makers and reporters ignore, minimize and belittle them because it plays to the prejudices of upper-class, google-educated suburban humanities graduates.

                To grossly stereotype.

                I’ve given up tracking down the data and sources individual food additives because every time I did so, it turned out the concerns were overblown if not outright wrong. I trust the experts because, it turns out, they are experts.

              2. Andrey Pavlov says:

                I’m glad they amuse you. It is also obvious you can’t actually answer them. All you are left with is implying that we should have a raw food diet, despite claiming you aren’t trying to say that. All you can come up with is that “fresh veg and fruits” don’t have “chemical additives” which you can’t (or won’t) define.

                That’s fine, if you aren’t interested in engaging in an actual science based and intellectual conversation on the matter you don’t have to. But don’t expect to come over to a place like this and make really nebulous arguments with a smattering of specious claims and have it be accepted.

              3. Greg says:

                Whatever dude, I didn’t post here to be interrogated and ripped apart by intellectually arrogant people such as you and William. If you can’t understand that eating fresh foods cooked or otherwise are better for you, then obviously you are not as intelligent as you seem to think you are.

              4. Chris says:

                Depends on the fresh veg and fruit you are talking about.

                There are a few variety of apricots, and some of those varieties are the ones that produce almonds. The seeds of most apricots do look like almonds, but taste quite bitter.

                Do you know what is special about “bitter almonds”? It is also why you should not burn apricot wood, and some others in a barbecue.

                By the way, a carrot plant close resembles a hemlock plant. And there have been deaths by those making that mistake when they harvested “wild carrots.”

              5. Andrey Pavlov says:

                If you can’t understand that eating fresh foods cooked or otherwise are better for you, then obviously you are not as intelligent as you seem to think you are.

                And if you can’t explain why they are then you are intellectually dishonest. On top of making verifiably false claims and obviously not knowing what you are talking about. You make an evolutionary claim and then obviously have no idea what a protein fold is, but rebut by making a simplistically stupid argument that we are more complicated than bacteria.

                I – and others here – who actually do know a lot more science, medicine, and physiology are arguing that a there is nothing intrinsically better about “eating fresh foods.” Prove me wrong. I’m totally open to it. But you haven’t presented anything except your vague and nebulous assertions with a smattering of factoids that are simply wrong.

                <blockquote.BTW it’s not that I can’t answer them,, it’s that I refuse to be dragged into your little game of intellectual bullying.

                Intellectual bullying? I am asking you questions to challenge your assertions. We call that “science” and it is precisely how ideas are refined, honed, improved, and – when necessary – abandoned.

                If you had an answer it would be trivially easy to just write it out. The reality is you don’t. All you have is some vague notion about evolution which is wrong and a vague notion of “some chemicals are bad” and “fresh is better” without the ability to even define what that means let alone demonstrate the claim to be true.

                So no, the fact that I do not “obviously see” that “fresh is better” does not mean I am not as “smart” as I think I am. It means that there is no evidence to persuade me of that claim and you haven’t provided anything.

                So go flounce off and avoid the “intellectual bullying” of having your ideas challenged. You can at least pretend that they stand up to the challenge that way.

              6. Andrey Pavlov says:

                Funny enough, Steve Novella has a blog post that touches on exactly this topic over at Neurologica.

              7. WilliamLawrenceUtridge says:

                Whatever dude, I didn’t post here to be interrogated and ripped apart by intellectually arrogant people such as you and William. If you can’t understand that eating fresh foods cooked or otherwise are better for you, then obviously you are not as intelligent as you seem to think you are.

                Is pointing out you are wrong in general and specific details “arrogant”? I’ve spent a not-insubstantial amount of time learning about stuff like diet, exercise and human history. Andrey’s learning surpasses mine by an order of magnitude. If you’re not interested in finding out if your preconceptions and assumptions are true, then I agree – your time is better spent elsewhere. If you can’t see that claiming “eating fresh foods cooked or otherwise are better for you” is an assertion (not to mention an inaccurate summary of many points made here by myself and Andrey), then perhaps your time is better spent elsewhere.

                I don’t think anyone claimed that processed, refined and cooked foods are, in all case a priori better for you. I certainly think that in general foods cooked from fresh and unprocessed ingredients are better for you than many that come sealed in plastic (though mostly because before they are sealed in plastic, a substantial amount of sugar, salt and fat is added to offset the lack of flavour). But not always, not in all circumstances, and in many cases processing enhances foods in many was (increased bioavailability is a big one, reduced toxicity is another and the novel molecules that arise through fermentation, a form of processing, is a third).

                Having your preconceptions challenged is discomforting, but if your reaction is to call someone with superior knowledge “arrogant”, that says more about you than anything else. I like being told I am wrong, with evidence or reasoning to back this up. It forces me to change my beliefs, which is uncomfortable, but ultimately beneficial.

              8. Andrey Pavlov says:

                Andrey’s learning surpasses mine by an order of magnitude.

                Much too kind. Just my particular field of interest and expertise is all.

                I don’t think anyone claimed that processed, refined and cooked foods are, in all case a priori better for you.

                Precisely. I am not trying to claim that cooked processed food is better. I am saying that any blanket statement of what food is “good” or “bad” and any uniform basis for picking such foods applied across the board will fail. There are simply too numerous exceptions to any “rule” you may devise and it is entirely context dependent, which varies from person to person and within an individual’s lifespan.

                Having your preconceptions challenged is discomforting, but if your reaction is to call someone with superior knowledge “arrogant”, that says more about you than anything else. I like being told I am wrong, with evidence or reasoning to back this up. It forces me to change my beliefs, which is uncomfortable, but ultimately beneficial.

                Yep. And I have told you when you are wrong. And you the same for me. The people I respect the most and are my closest friends are the ones most willing to challenge my ideas and make me work to demonstrate them correct. The harder I have to work for it, the more I like ‘em. Because then I invariably get better and better and learn more.

                Anyone who just tells me “whatever dude, I don’t need to challenge your ideas. Believe whatever you want” is not someone I care to spend too much time associating with.

              9. WilliamLawrenceUtridge says:

                I have no doubt that there are areas where I could run laps around you in knowledge, they’re just of absolutely zero interest to someone who is not in my professional field (or otaku niche, for instance using the word “otaku”).

              10. Greg says:

                Having your preconceptions challenged is discomforting,

                Actually that doesn’t bother me. The supercritical analysis of my statements does.

                If I’m wrong, then I am wrong. You don’t need to challenge me – just give me the facts as you know them.

                As I understand it, one of the overriding concerns of many posters on this blog, is that people are too easily woo-ed, so to speak. If you want to win people over to your way of thinking you need to convince them they are wrong, however being confrontational does not work – it only puts people on the defensive. Isn’t it better to state to someone “that may be your view” but this is what is known about it…

              11. WilliamLawrenceUtridge says:

                If I’m wrong, then I am wrong. You don’t need to challenge me – just give me the facts as you know them.

                That’s what I was doing, and you gave every appearance of freaking the fuck out over it.

                As I understand it, one of the overriding concerns of many posters on this blog, is that people are too easily woo-ed, so to speak. If you want to win people over to your way of thinking you need to convince them they are wrong, however being confrontational does not work – it only puts people on the defensive. Isn’t it better to state to someone “that may be your view” but this is what is known about it…

                Your assumption here is that I’m trying to win you over. I really don’t care, and it is an extreme rarity that anyone willing to post, and repeat, such dogmatic statements as you have will ever admit they didn’t know something, let alone that they made a factual error, let alone that they made an assumption, let alone a stupid assumption. Generally my comments have the following aim, in rank order:
                1) To amuse myself
                2) To inform lurkers
                3) To correct a factual error on the part of another

                #3 is far, far below even #2, which is far, far, far below #1.

            2. Greg says:

              BTW it’s not that I can’t answer them,, it’s that I refuse to be dragged into your little game of intellectual bullying.

              1. weing says:

                “Whatever dude, I didn’t post here to be interrogated and ripped apart by intellectually arrogant people such as you and William.”

                That’s exactly why I post here. Otherwise, I might end up thinking I’m a f*cking genius.

                “BTW it’s not that I can’t answer them,, it’s that I refuse to be dragged into your little game of intellectual bullying”

                Of course you can answer them. But to whose satisfaction? Your own? Others, who are trying to really understand the world around them? Or just plain idiots, like me?

              2. WilliamLawrenceUtridge says:

                From our perspective, we can’t tell the difference between “I refuse to prove you are wrong” and “I can’t prove you are wrong”, but Occam’s razor suggests the latter is more likely to be correct.

            3. Andrey Pavlov says:

              If I’m wrong, then I am wrong. You don’t need to challenge me – just give me the facts as you know them.

              Funny that Greg, that’s precisely what WLU and I did! I told you that you were wrong about evolution and told you why. Your rebuttal demonstrated a lack of knowledge on the topic and I again explained why. The rest of what you wrote isn’t wrong until you clarify what you mean. We weren’t saying “eating clean” is wrong, because we need to know what “eating clean” means – it is an ill defined term. So I asked. Or would you prefer if I had just said “Eating clean is a nonsensical term and you are obviously wrong for even using it?”

              And the rest of it is called the Socratic method. Because I am not about to engage in a single question back-and-forth style which is better in person, I just listed them all out. And yes, it is also a rhetorical device to demonstrate why “eating clean” is a nonsensical term, same with the idea of “chemical additives”.

              1. Greg says:

                Ok – that’s the way you view it. You keep harping on about the way I view evolution, when I didn’t state my views on evolution: I told you what I had read. I did not say I believed it. As for clarification of the terminology I used with respect to eating clean, I apologize for not precisely defining what I meant – I don’t always have the time to answer as fully as I’d like. You’ve given me much to consider. Why don’t we just leave it at that?

              2. Andrey Pavlov says:

                Sorry Greg, but you used evolution to justify the rational of your diet choices. When I explained why that was wrong, you tried to discount it by saying that comparing a bacteria to human digestion isn’t a fair comparison. Whether you realize it or not, you made claims based in evolution as your rationale.

                You’ve given me much to consider. Why don’t we just leave it at that?

                Sure. Fair enough. But I can’t read your mind. You never indicated that you realize you were wrong on the evolution bit (whether you were just quoting “what you read” or whether you actually believed it yourself doesn’t really matter), you never said anything except a few counterarguments and finally that you could answer but won’t.

                What else am I supposed to go on?

                I’m glad I’ve given you much to consider. That was the goal. You just can’t expect me to read your mind as you continue to argue points and then say you just don’t wanna even though you could.

              3. WilliamLawrenceUtridge says:

                You keep harping on about the way I view evolution, when I didn’t state my views on evolution

                Your statements conveyed quite clearly a lack of understanding and some incorrect assumptions about certain points of human evolution. If these weren’t “your real views”, then I’m curious why you bothered mentioning them.

                You’re welcome for helping you to clarify your thinking on the matter.

              4. Greg says:

                In future, I will make a point of being more detailed and specific. And thanks to both of you for your input.

              5. WilliamLawrenceUtridge says:

                Well now I feel like a douche. I hate it when seemingly-unreasonable people become reasonable, it takes the righteous out of my indignation.

                Greg, I hope you stick around. In the future, a great way to help both your learning and ours is to ask where we heard it. Even skeptics are human, and often fall prey to source confusion and simple memory error (Mistakes were Made (but not by me) by Carol Tavris and another guy I always forget).

                Source for human evolution being driven by cooking – Catching Fire by Richard Wrangham

                Sources for the novelty of certain foods, and their impact on human civilization/farming:
                - Guns, Germs and Steel by Jared Diamond, which is quite an amazing book
                - 1493 by Charles Mann, also an amazing book (and I would also recommend 1491 by the same author)

              6. Greg says:

                I hate it when seemingly-unreasonable people become reasonable, it takes the righteous out of my indignation.

                No worries – I’m still acclimatizing to the environment here. I guess I over-reacted a little…

    2. WilliamLawrenceUtridge says:

      Greg, when do you think humans started eating tomatoes, potatoes, corn, squash, turkey, guinea pig and capsicum (peppers)? All of these foods have their origins in the Americas, which even the most ardent supporters of early migration theories don’t push back much further than 25,000 years ago. They are now ubiquitous. Beyond that – they are now staples in nearly every culture that has encountered them. In fact, potatoes and corn alone revolutionized food production to such a degree that their use has torn down mountains.*

      Meat takes pretty significant processing for it to be safe and palatable for most folks, as well as to free up huge amounts of the energy through cooking. In fact, there are paleoanthropologists who believe that “significant processing” is the driver that led to the divergence of Homo sapiens from the other hominids. In their minds, “significant processing” is what made, and makes us human. I agree, we couldn’t be more different from animals that can digest grains and beans in their uncooked forms (particularly in the absence of breeding to make them more edible) mostly because we use applied chemistry to make these grains and beans digestible.

      And I will note that raw foodists are very, very far from pictures of health. They are thin, yes, but they also tend to be anemic (and in purely evolutionary terms, the absence of menstrual periods for a siginificant portion of the women suggests rather strongly that raw food is an evolutionary dead end, or at minimum substantial barrier, for humans).

      *Sort-of. In China.

  24. Catherine says:

    I a bit suspicious of any book on weight management that doesn’t seriously address exercise. As I understand it, the problem of obesity is not that people are overweight, it is that they are over-fat. If curtailing calories causes you to lose weight and that lost weight is water and lean body mass, the new number on the scale isn’t much of a success and it might be a step in the wrong direction.

    I’ve lost a lot of fat (and kept it off) with weight training. Cardio is important, too; but building muscle, maintaining muscle tone and building/maintaining bone density just doesn’t happen from all types of exercise.

  25. Angora Rabbit says:

    Sounds like a terrific book! You’ve summarized exactly the same advice our students receive in class. The bottom line is that one must be willing to change behavior, and then to sustain that change.

    Regarding the eating every few hours, I keep a bag of peanuts at my desk. If a minor hunger pain, I drink some tea. If a big hunger pain (between meals) I pour out about a tablespoon, put the bag away, and nibble on those. Nuts have a great satiety factor.

    I don’t use a bathroom scale. I use the waistband/pant approach. Works great when you have seasonal clothing to pick up shifts in weight.

    And I’m writing this from a standing desk, $250 total from Ikea. Nothing fancy. My computer’s on it. I may use it 3-4hr/day, but that’s 3-4hr/day more standing than I used to do.

    I think the author’s point is that a lot of small changes can add up to big change. Add them one at a time, until they become a habit. Then add your next one. Repeat.

  26. Kevin Moore says:

    “Unsaturated fats may offer health benefits” or the opposite according to some studies. U.S. per capita consumption of polyunsaturated fats has doubled in the last 50 years. Perhaps more investigation in to the effect of this dietary change is warranted.

  27. Fat Bob says:

    Some of these recommendations are one-size fits all but may not fit a large percentage of people.

    The one that jumps out at me personally is “Indulge” – the idea is that “permanently denying yourself pleasurable foods makes any diet plan unsustainable”. I think Gretchen Rubin explained the phenomenon well here. Some people find it easier to abstain completely rather than moderate their consumption of particular things.

    For example, I find it easy to completely abstain from chocolate (I forget about it) but if I start to eat it I end up eating a lot. Other people are the other way round.

  28. Alex says:

    It’s a success story. I exercised for many years to get in shape and loose weight. I achieved first goal to be in shape but weight management was challenging. I read article in SBM on diets. Calorie counting is very important stated in Steven Novella’s article. It’s a simple rule for weight control as well. I started counting calories, lost weight. Food calories are in; exercise calories are out. I’m now in maintenance stage. I’m happier, healthier and have normal BMI.
    I appreciate a good job SBM doing to educate people. Thank you.

  29. Stella B says:

    Dr. David Kessler’s book, “The End of Overeating”, is a good source of information, too. He reviews the studies that look at reasons for bingeing and overeating. The fat-salt-sugar combination is a potent one for driving repeated consumption as the food industry well knows.

    I’ve been doing Weight Watchers for 6 weeks. I never had to diet or even think about it before menopause, but hormone changes and aging joints have done me in despite daily exercise. I’ve found that the only way to get a handle on those silly WW points is to plan all of my meals in advance whether I’m eating out or eating in. If I make choices on the fly, I screw up. 7.4 lbs in 6 weeks, 7.6 left to go….

  30. Greg says:

    Bacteria have evolved completely novel protein folds in order to digest nylon in just a few decades. Is that a fair comparison? The human digestive system is much more complex than the metabolic processes of bacteria, isn’t it?

    But to say that we haven’t “adapted” to the new foods means that if you ate nothing but grains or beans you would rapidly starve to death and that is simply not the case. Adapted as in being able to efficiently digest and assimilate the nutrients provided by a given food in it’s raw state. If you were to eat beans and grains in a raw state you’d likely die before too long – from starvation and toxins, then again, I could be wrong about that.

    As for raw state eating… that also makes no sense. I meant that people’s diets should consist mainly of foods that can be eaten in their raw state, not that they have to be eaten that way or that I am advocating a raw diet.

  31. I’ve struggled with eating disorders more of my life than I probably realize. I encourage you to read some of the literature (especially the NIDA-funded research) on eating disorders and other addictions. No, most people don’t have eating disorders, but there is a lot of disordered eating going on. At least, there is intriguing neuroimaging research that makes it worthwhile to look at potential neurochemical pathways.

    As a medical reporter, I’ve covered enough endocrinology research to be flummoxed by the complexity of the biochemistry of fat — the largest endocrine organ in the body. I recommend starting with the work of Dr. F. Xavier Pi-Sunyer.

    Obligatory self-promotion: you can also check out a blog post of mine from a few years back at a hypertension meeting.

    Obesity: A Bigger Problem Than We Think

  32. dick cummings says:

    nickelback sucks

    1. WilliamLawrenceUtridge says:

      Irrelevant but true.

  33. Marion says:

    It would not surprise me at all if the plethora of bullshit diet plans & advice hawked by scam artists like Dr Oz and thousands others have turned people off to the idea that obesity and lack of exercise are even problems at all. They have certainly turned me off to the idea. Well, maybe obesity is a problem, but every other problem in the world comes before it.

  34. Marion says:

    The Low-Calorie Starvation Diet

    Could somebody please tell me whether the studies that assert that organisms living under some certain minimal level of continuous starvation actually live significantly longer than organisms not on this diet, independent of level of exercise, independent of practically all other variables, and independent of species?

    I’ve heard these studies have been around since the early 1900s.

    No, in no way do I suggest anyone go on such a diet (unless you want to, then knock yourself out). I just want to know if this hearsay I hear on the internet is pseudoscience or if its valid reproducible-in-the-lab science.

    1. Chris says:

      None for “VLCD” which is extreme, but there is evidence that calorie restriction with adequate nutrition extends lifespan in many organisms (it’s usually considered to be 20% under a “normal” caloric load, to my understanding).

      But it has never been proven in humans, no.

    2. Andrey Pavlov says:

      There is animal data to show that all things being equal being on a starvation diet increases longevity. In humans this was thought to be the same since the same biomarkers become elevated in response to starvation diet. The problem is those are all surrogate markers and it is obviously very hard to have a cohort of people live their entire lives under starvation diet conditions unless they are in a developing nation and are then likely to suffer other confounding comorbid states.

      However, I recall an episode of the SGU where they talked about how it was actually recently shown that despite these biomarker elevations, it turns out that a starvation diet – while it does “work” in invertebrates and many vertebrate animals – doesn’t seem to actually have the same outcome in primates, including us. I can’t recall the episode off the top of my head, but it is there somewhere and they discussed the data for a few minutes.

    3. Angora Rabbit says:

      Marion, I sat on the thesis committees for students running those studies back in the late 1990s, especially the primate work. The monkeys were consuming 100% of their micronutrients (vitamins, minerals, essential fatty acids, 100% protein requirement) but 70% of their calories. They look terrific compared to their siblings eating free-range. They have lower serum insulin, less liver glucose production (which contributes to NIDDM), lower fat mass, better serum glucose clearance, better BP, etc.

      However, the study about 20yrs in found no different in mortality to date. I haven’t checked on the update to see if that’s starting to change. Or not. I can tell you that some of the folks running those studies are actually practicing the diet on themselves. They look good and they’re still with us. :-)

      Then there’s this new fasting cycle diet running around, but frankly, I like food but I know some folks trying it. I’m not sure it works apart from the “buzz” they get from the mild metabolic acidosis when they’re fasting.

  35. Chris says:

    I’ve struggled for life with weight. Primarily because I don’t like exercise and like food. (Go figure). You can choose one or the other, I figured, not both.

    In any event the problem I always had with dieting was hunger and cravings for food. How do people do this, I thought? When you’re always hungry (and also *like* to eat), you’re kind of screwed.

    What ended up being successful was a prescription for Dexedrine. It eliminated the cravings and that combined with counting calories has allowed me to lose around 65 lbs over the past 6-8 months. Along the way I think I’ve learned to think better about food in general. I still eat “poorly”, but I watch the portions and have a good idea about what each food’s metabolic “cost” is.

    n=1 is not how science works, I know, but this has led me to wonder if, in general, we have moved too far away from one of the few things that seems to actually have some benefit – stimulant drugs.

    I suppose phentermine is still prescribed, and Belviq was approved a year or two ago, but people seem reluctant these days to go for stimulants.

    If patients understand (as I do) that the drug is not a “cure”, is not “exercise in a bottle”, and will not allow you to do whatever you want, but rather a tool and an aide, I tend to think more would have success losing weight.

    Unfortunately most of the studies on straight pharmaceutical amphetamine for weight loss seem to be 60+ years old.

    I realize this is an unconventional view, perhaps, but it’s not like we aren’t handing these drugs out to kids with ADD like candy. For a lot of folks the risk of a stimulant is going to be trumped by the risk of continued obesity.

    1. Andrey Pavlov says:

      I realize this is an unconventional view, perhaps, but it’s not like we aren’t handing these drugs out to kids with ADD like candy. For a lot of folks the risk of a stimulant is going to be trumped by the risk of continued obesity.

      Definitely an interesting point. I would argue that just because we are over prescribing them to one group doesn’t mean we should compound the problem by prescribing it to another.

      Plus, you can’t really translate the safety data of ADD use to that of obese patients. They simply don’t have the same comorbidities. Plus there is a huge opportunity for abuse and dependence, particularly in people who have struggled with weight and find this helps them lose some. If some helped, more would be better, right?

      It is not at all implausible that the risks of stimulants may be outweighed by the risks of continued obesity. I just don’t know that to be the case and it would be very different for each individual with no particularly good way to weigh those risks and benefits since the evidence base is lacking. Personally, I think that bariatric surgery is probably a better option than stimulants. And of course the best would be to change the sociocultural milieu and food industry infrastructure to engender better health choices but obviously that is not an easy task! However if you look at other countries like Denmark you’ll find that they are on the whole a lot less obese than we are. But they are becoming more so. Why exactly? Hard to say, but obviously shifting cultural ideals play a role somehow.

      But it is thought provoking to consider.

    2. Chris says:

      I think I’ll stick to diet and exercise. Today, a lovely sunny day, will include a walk to the bank, to the library and home. It is a way to get errands done with five to six miles of walking thrown in (depending how I meander through my hilly neighborhood).

      When I took Sudafed for a cold in college I ended up with elevated blood pressure. I really don’t think I want to take amphetamines. Coffee is about as strong a heart stimulant I will indulge in… black, no sugar and not a latte.

    3. angora rabbit says:

      Chris, congratulations on the weight loss! It is very hard, and your progress is fantastic.

      About stimulants, the general problem is they can be dangerous and it can be hard to figure out who is at risk. They are also cardiac stimulants and since 0.7% of the population has a congenital heart problem, many of them undiagnosed, those folks will be at risk. We are not at the routine echocardiography screening stage, so hence the non-diagnosis.

      The second problem is fen-fen. This was the combo drug in the 1990s that was popular for weight lost. Alas, one of the components was associated with a high risk for cardiac valve thickening, so it was pulled off the market, and rightly so because it was likely causative. That experience pretty much killed any future market for amphetamines and other stimulants for weight loss.

      Again, I’m so glad this is working for you!

      1. Andrey Pavlov says:

        About stimulants, the general problem is they can be dangerous and it can be hard to figure out who is at risk. They are also cardiac stimulants and since 0.7% of the population has a congenital heart problem, many of them undiagnosed, those folks will be at risk.

        Very good point Angora. Sort of what I was trying to get across – we just don’t know how to gauge the risk on a population level. I hadn’t explicitly considered the undiagnosed congential heart defects but most certainly that is a strong consideration.

        Interestingly it is conceivable that, on a population level, the harms from exposing those individuals to stimulants could still be outweighed by the benefits of weight loss. But that would be a purely Machiavellian outlook. It would, I think, still be arguably unethical to simply give stimulants out knowing that while it may benefit the population at large there is a distinctly non-zero chance you could precipitate death in the person in front of you. Which means we would have to do echo’s on everyone we prescribe it to. And what if you screen someone who doesn’t pass the screen but still wants the stimulants?

        And that would only address that one specific concern. It can become unwieldy rather quickly.

    4. Jim Glass says:

      In any event the problem I always had with dieting was hunger and cravings for food. How do people do this, I thought? When you’re always hungry (and also *like* to eat), you’re kind of screwed.

      The simple starting point — and a much safer one than drugs — is to recognize the difference between feeling “hunger” and feeling “cravings”, they are two very different things.

      Hunger comes from lack of nutrition, and significantly over-weight people very rarely feel it, if they ever do. I mean, consider it.

      Cravings come from *habits*. Food cravings are very powerful, and habits related to eating have deep evolutionary roots, so once they are established they are very very difficult if not impossible to break. “Fighting” them is always near-surely doomed to failure, which is why near all deprivation (“just east less”) diets fail in the end.

      But it is relatively easy to instead work around old, established habits by creating new ones that enable you to avoid the “triggers” of the old ones — and then the cravings are never triggered … and your hunger just disappears!

      I speak from experience on this — 75 pounds down and never hungry — see my other posts I’ve just put in this thread. When I first learned to recognize the difference between the feelings of hunger and craving, it was a very enlightening thing.

      IMHO “diet plans” focus far far too much on the chemical components of dieting — carbs and such — and not nearly enough on the behavioral psychology of it, which is what actually determines the outcome.

      See Daniel Kahneman, Roy Baumeister, and their fellows, who are *not* diet gurus pushing weight loss ideas, but the leading experts on behavioral psychology and how it applies to you, whether you are over-weight or not. They gave me what I needed to know.

  36. Lucario says:

    I personally think that if a diet/weight loss program doen’t look like a traditional foodway or way of life, it’s nonsense. Hence, I’m partial to, say, the Mediterranean diet (if only I could find a way to do that on the cheap!).

    I’ve been trying to lose some weight (doctor’s orders), with some success. However, I’ve been wondering: are there any cultures that traditionally eat multiple small meals as opposed to 3 square meals as is done in the West?

    Also re: fasting. How exactly does one do that and keep one’s mind off of hunger? I’d really like to try alternat fasting (if for nothing else to save money on eating out after work), but I really don’t like hunger pangs.

    1. WilliamLawrenceUtridge says:

      You may think that as a personal belief, but that doesn’t make it true. It may be true for you, but it is unlikely to be true for everyone. A professor of nutrition from Kansas State University lost 27 pounds by eating Twinkies.* Traditional foodways do have a lot of advantages (they tend to be delicious and nutritionally complete, if prepared appropriately, and generally have a fair bit of fiber) but they aren’t panaceas. Nigerian traditional foodways includes enough meat to make a Texan blush. Traditional Mongolian foodways (and I believe some African herders) involve mostly milk and drinking blood fresh from the cow or horse’s veins. Traditional French cuisine is pretty calorie-intense, rich, and easily obesogenic. The main thing is – if it reduces your calorie intake, it doesn’t matter where it comes from. The Mediterranean diet is a great way to eat in a lot of ways, even if it doesn’t alter your weight one whit.

      The idea that multiple small meals is better than even a single large one has been tested, and my recall is that it didn’t make a difference – metabolisms were not “supercharged” and I think even free-ranging calorie intakes were identical (single meal days have an advantage, there’s a fixed limit to the amount you can stuff into your stomach in a single sitting). Can’t find the reference on Pubmed though.

      *Goldacre inside joke. You know what I’m saying.

    2. MadisonMD says:

      re: fasting. How exactly does one do that and keep one’s mind off of hunger?

      Activity, exercise, non-calorie self rewards, zero-calorie beverages, caffeine or theophylline. Not fasting, but effective: low caloric-density foods (e.g. some fresh vegetables), and eating strictly by clock can help. A Ulysses contract can also be useful– you would implement this by preventing easy access to calorie-dense foods (i.e. don’t buy it on Sunday and you won’t eat it on Tuesday).

      I personally think that if a diet/weight loss program doen’t look like a traditional foodway or way of life, it’s nonsense.

      This blog is more about science than belief, as pointed out by WLU. But your idea of weight loss by changing lifestyle rather than by a temporary crash diet is well established.

      1. Jim Glass says:

        “The idea that multiple small meals is better than even a single large one has been tested, and my recall is that it didn’t make a difference “

        Right. This is the one idea reported in the Freedhoff book that is old cliche wives’-tale quality.

        When I was in the middle of losing 75 pounds I was eating twice a day at most, often only once. I was netting 800-1000 calories a day over exercise, and losing 2.0 to 2.5 pounds per week. And I was *not* hungry.

        If I was eating 5 or 6 small meals a day “to ameliorate hunger” I could never have succeeded at losing the weight, I would have failed for sure. Why:

        Seriously overweight people do not eat because they are hungry, I mean think about it. They eat because of *habit* — what they take for hunger is actually a craving, which is a very different thing. Habits are terrible to try to break by willpower, but *easy* to work around once you identify them. And if you avoid the trigger of the habit, you avoid the craving, and your hunger disappears. (What you thought was hunger).

        That’s what I did — identified my triggers, changed my routines to avoid them, exercised a lot to get positive feedback from another direction. The feedback from the exercise was so good that absent my food cravings I really *didn’t want* to eat more than I was. I wanted to get the exercise benefits coming as fast as I could and eating got in the way. (Then when I really was hungry I ate: true hunger is very different from a craving, it makes one crabby and short-tempered [blood glucose]. Learning the difference was a big part of my weight control success.)

        Now IF I had eaten five or six times a day *that* would have invoked my craving triggers, I have no doubt. For me, starting to eat triggers craving for more. (And I can still eat a whole pepperoni & sausage pizza if it is set down before me.) Minimizing my encounters with food avoided my triggers. I still limit my food to 2.5 meals a day, even though I’ve moved to a whole new 75-pound lower, exercise expenditure much higher equilibrium. ( One slice of pepperoni pizza can set me off on a food bender that will set me back a month, even while I’m not hungry at all while gorging on it.)

    3. mousethatroared says:

      I have never even considered fasting as a diet. When I get overly hungry, I get shaky, break out into a cold sweat, get nauseous and eventually feel like I’m going to faint…and people don’t want to be around me because I’m really, really surly. I’ve never tried to just wait it out and see if the symptoms go away, because that doesn’t seem healthy (Like I might fall over and hit my head on the floor kinda unhealthy).

      I will say for normal hunger, like oh the afternoon munchies, sometimes a cup of tea or a large glass of water does the trick. I’m partial to hot tea as it somehow seem more satisfying than a cold drink.

      “I personally think that if a diet/weight loss program doen’t look like a traditional foodway or way of life, it’s nonsense. ”

      Well, it certainly makes sense that if it’s food you can find in your grocery store, you won’t be tempted to “cheat” because you don’t have time to go get the special food from the store an hour away.

      The book sound like the kinda plans that have worked for me. It seems like the pounds only drift on when I don’t journal my food. I also find keeping sweets and junk food out of sight is very helpful. My husband is a cookie monster, but I have finally got him to start putting away the cookies.

      1. Kathy says:

        Seems the reaction to fasting is also pretty individual. I don’t get any of these symptoms except to get shaky and also irritable. But I do have to go pee every half-hour. No idea why … I never read anything about this in any book on the subject.

        1. mousethatroared says:

          You pee a lot only when fasting? Even if you aren’t drinking more fluid? No – I don’t get that. Biology is weird, eh? Fun with the autonomic nervous system.

          I go through other times when I have to pee lots – Sometimes – when I’m working outside in the heat, I drink a lot, but then pee even more…to the point where my hands and around my eyes start to crease up from dehydration. It’s kinda frustrating because my blood pressure is on the low/normal side, so when I get kinda dehydrated I have to be careful standing up from sitting or stooping, because I get dizzy. Same thing sometimes when I have a cold or asthma. I’ve taken to keeping those powder packets of sugar free sport rehydration powder.

          No idea why, my (previous) doctor said it might be some sort of hormonal shifting. But it doesn’t happen enough and isn’t severe enough to be dangerous, so I just work around it.

          1. Lacri says:

            Don’t you burn through your glycogen stores when fasting? Glycogen in the muscles and liver is bound to 4x its weight in water, I’m told, and this water is released when the glycogen is used – which is why they always tell you that rapid weight loss is water loss, something I didn’t previously understand.

            1. WilliamLawrenceUtridge says:

              I’d thought the total amount of glycogen stored in the body would be quite low, but a study from 1992 estimated it at 400 g, which would put associated water weight at 1.6 kg (total weight of 2 kg). That would actually pretty neatly account for a lot of the water weight lost with initial changes in diet. Neat! Wonder if the study has been replicated, a quick google search turned up very little reliable to answer the question “how much glycogen is there in the body”.

            2. Angora Rabbit says:

              Yup! This is why you have to drink water when glycogen loading. Burning fat also releases water – it’s that camel storing water in the hump, thing.

              The trick is that the (water) weight loss is the psychological reinforcement that causes the person to stick a bit longer to the diet. It’s a trick but obviously an effective one at least in the short term. Also, if the diet is ketogenic (aka Atkins / high protein) the same high water weight losses occur, this time from peeing out the ketones. Again, it’s a reinforcement.

              1. WilliamLawrenceUtridge says:

                The down side being, once you run out of glycogen you feel like absolute shit. I remember taking a course on exercise physiology, and when we got to the glycogen loading part, the “best practice” was two days of exercise with zero carbs. Day one was OK, just like regular exercise. The prof emphasized, repeatedly, just how much day two would suck utter balls because exercising without glycogen stores is awful. Leaden, exhausting, slogging, painful, every adjective implying difficult and slow.

                Now, while people on a diet who don’t exercise might not notice this, I still doubt this makes the activities of daily life any easier, and possibly harder in many ways. It may even reinforce (or exaggerate), for those who try a whole-lifestyle change of diet + exercise, just how difficult it can be. It would be interesting to see how glycogen depletion affects adherence to diet and/or exercise regimes, but man – that would be a hard study to do.

        2. MadisonMD says:

          Simple explanation for peeing while fasting– assuming you are drinking water or other liquids. If you drink water, you will bring your serum osmolarity lower, and antidiuretic hormone(ADH) will decrease, leading to diuresis. If you also eat (or drink salty liquid–eg gatorade), your serum osmolarity will be maintained, ADH will remain high, and you will pee less.

          My classmates and I actually did this experiment on ourselves during med school, with three groups drinking water, salt water, or water + ADH injection. The water group urinated the most liquid within the first hour.

          1. mousethatroared says:

            Cool!

  37. Liz says:

    I guess we’ve all heard people complain “BMI measuring doesn’t work for me; it says I’m fat but I’m definitely pure muscle”… but does anyone know whether BMI healthy/overweight/obese ranges remain accurate if you’re taller or shorter than average? I’m under 5′ and the weight-range which I’m supposed to be in according to the BMI looks too big on me. But similarly I’ve tried looking at the BMI healthy range used for children (since most kids are under 5′ :P ) and they come up waay to small.

    Just me?

    1. Angora Rabbit says:

      BMI is fantastic for public health purposes when we are trying to characterize body composition on a large population. For the individual, BMI is only one aspect and no respectable researcher considers it inviolate. One has to look at overall body composition, bone mass, fat mass, etc. I am also petite and small boned, so lower BMIs are better for me, too. On a big boned person, they are healthier with the larger BMI.

      The reason we use BMI for populations is that it is just too danged expensive to do BodPods or DEXA or even skinfolds on 1000s of people. But having said that, it is not common these days to find a western population with a huge muscle relative to fat mass, hence higher BMIs generally correlate with increased fat mass. But because people don’t understand how BMI should be used, there’s a lot of misunderstanding and inappropriate BMI bashing.

      Hope this helps!

  38. Dave says:

    I just read an interesting article on Medscape about grains vs meats in our diets and whether grains are truly as bad as some people seem to think. The article referenced an article in Am J Clin Nutr 2010: 91 p 1530-1536 entitled Trends in Food Availability 1909-2007. The average American per capita yearly consumption of meat in 1909 was 123.9 lbs. In 2004 it was 201.5 lbs. The average cheese consumption in 1909 was 4 lbs, 34 lbs in 2004. Grain consumption however has decreased in that time. Of course, the average lifespan in 1909 was less than now but the nutritional advice back then was geared to making sure people got enough to eat, not directed to avoiding eating too much.

    I also know that portion sizes have increased quite a bit in my lifetime. When I was a kid a soft drink was 6 oz and a hamburger would fit in your palm. The portion sizes were what the dieticians refer to as portion sizes – i.e. a serving of meat is the size of a deck of cards and a serving of potatoes is the size of an egg. Defintiely not what the average Joe thinks of as a “serving”.

    1. Greg says:

      From the abstract:
      Flour and cereal availability decreased from 1909 until the late 1960s but rebounded thereafter.

      Can someone clarify this statement? Did grain consumption rebound to the same level or is it still below the level observed in 1909?

      1. Andrey Pavlov says:

        Can someone clarify this statement? Did grain consumption rebound to the same level or is it still below the level observed in 1909?

        It is helpful to read beyond the abstract. This graph in the section on grains shows quite clearly that it did not. In 1909 136kg of grain vs 89kg in 2007.

        1. Harriet Hall says:

          Possible confounder: lots of people lived on farms in 1909, and they didn’t have the modern labor-saving conveniences we have today. I would guess they were more physically active in 1909 and burned more calories. They may have needed more meat and grain to cover their calorie requirements.

          At any rate, these numbers argue against the idea that people are healthier when they eat less meat and the idea that grains are responsible for the obesity epidemic (“wheat belly”).

          1. Andrey Pavlov says:

            Another thought occurred to me from your comment Dr. Hall – the study notes that they use availability as a proxy for consumption. The idea being that if it was produced that means it was eaten. This does not take into account spoilage, which the authors note, and why the USDA ended up creating coefficients of spoilage for different food groups to adjust available food down to more closely approximate consumed food. However, this is not possible from before 1970. So another confounder in the 1909 data on grains is that since people did live on farms, they most likely consumed their own farmed goods rather than buy it from others, so it would likely be that those unadjusted values from 1909 could be low, depending on what spoilage may actually have been.

            I think in any case that it can be safe to say that grain consumption has decreased to some significant degree while meat, cheese, oil, and fat consumption has clearly skyrocketed.

          2. Stella B. says:

            In the 60s a McDonald’s hamburger patty was 1.6 oz of raw meat. A “double” burger like the Big Mac was 3.2 oz and then sometime in the 70s a larger burger, “the Quarterpounder” was added. Think about that. A meal for an adult would include a 1.6 oz burger with a proportionally sized bun and a modest serving of French fries with, perhaps, 8-12 oz of soda. That would look like a Happy Meal today.

            Obesity rates were actually pretty stable in the US until they started to shoot up in the 80s. I think they reflect behavioral changes (more families with two working parents, more public eating, etc.), increased sedentary recreational choices (57 channels and nothing on) and food costs amounting to an increasingly lower percentage of income. Wheat didn’t suddenly become “toxic” in the 80s.

    2. Andrey Pavlov says:

      Excellent reference Dave. Thanks for that.

      Seems to add another bit of evidence that it is not grain consumption that is the primary driver of obesity, but increased caloric intake from increased consumption of calorically dense foods.

    3. Greg says:

      The abstract was all I could view, when I searched on it yesterday – today I can see the full article – weird.

  39. The problem is that no one wants to take the time or energy to measure and weight food! So why not learn to eat correctly and not worry about portion control? Here is a general guide: If it is man-made food or drink, avoid it, if it is natural, feel free to eat it.

    In other words, consume plenty or organic fruits and vegetables. As far as meat, ensure you eat the free grazing type. Avoid cattle that aren’t grass fed and chickens from processing plants. Do this and become healthy while reaching an ideal weight, guaranteed!

    1. Thor says:

      Red lights must go up when a guarantee is pronounced.
      Here again, the seemingly unending tendency for the appeal to nature fallacy.
      It just sounds so enticing, so philosophically correct (from a CAM perspective). As if there aren’t countless substances in nature that aren’t harmful when ingested. Avoid man-made food? I guess you mean almost all the food available today. As has been elucidated numerous times on this blog, modern-day fruits, vegetables and, yes, even animals are ‘man-made’, the result of generations of genetic modification.
      One wouldn’t even recognize the original, ‘natural’ foods, let alone desire to eat them unless there was nothing else available.
      Also, the pseudo-scientific myth of organic foods being superior to conventional foods has been thoroughly investigated—no evidence for this claim thus far.
      And they even fail the taste test, as Penn and Teller amusingly displayed in an episode of Bullshit.

    2. WilliamLawrenceUtridge says:

      If it is man-made food or drink, avoid it, if it is natural, feel free to eat it.

      What a stupid thing to say. Do fava beans are natural, do you know what favism is? Death’s cap mushrooms are natural. Caffeine is natural and deadly in surprisingly small doses, easily achievable through something like no-doze (harder in coffee beans). Mandrake root – natural. Sarsaparilla – natural. Kava-kava, natural. All are natural, all can be deadly. River water is often filled with natural viruses and bacteria like polio, and we unnaturally filter or bleach them out – very unnatural, but means fewer children die of diarrhea.

      Also, I make my own lasagna noodles with egg and flour. Should I avoid it? After all, I am a man. The number of “man made” (by which I assume you mean “processed”) foods has increased dramatically in the last century, and lifespan continues to climb. One can very easily become obese eating “natural” lard fresh from the pig’s belly, and you’ll just as “naturally” die of that obesity. Plus, processed foods have the advantage of preservatives – meaning your food is less likely to be infected, spoiled, rotten or moldy when you eat it. And need I point out that infectious organisms, spoiled and moldy food are not exactly good for you?

      In other words, consume plenty or organic fruits and vegetables.

      Why organic? Organic food is more expensive but it’s not more nutritious. It might have fewer pesticides and herbicides (but not necessarily since the definition of what is a “natural” pesticide or herbicide allows for some incredibly toxic substances to be used). But it also probably uses feces as fertilizer. Where did that outbreak of E. coli that killed a bunch of people come from again? Oh yeah – an organic farm.

      Do this and become healthy while reaching an ideal weight, guaranteed!

      So let me get this straight. In the days before food processing, nobody was obese? Do you know who Howard Taft was? Do you know how much he weighed?

      “Natural” is not the same thing as “better”. In fact, “natural” often means “inedible, dangerous and poisonous”. The precursors to modern tomatoes, potatoes and capsicum were deadly nightshade plants.* Your “solution” is a gross oversimplification of a truly complex reality, one that you’ve probably been spoonfed by your chiropractic college, a haven of uncritical ideas and spurious rhetoric.

      *I think all of them are from the same family. At least one is.

    3. Chris says:

      “If it is man-made food or drink, avoid it, if it is natural, feel free to eat it.”

      I’m sorry, but that eliminates almost all grains, fruit, vegetable and meat that is commercially grown anywhere. It just leaves you with hunting for game, fishing and foraging what grows wild.

      Because most of the food you eat has been selectively bred for tens of thousands of years. Bananas, carrots, celery, popcorn, chickens, potatoes, and on and on are man-made. Do you really think seedless grapes and oranges developed without human intervention? How do you think they propagate without seeds?

      One big part of agriculture is trying to find new hybrids through crossbreeding. You should really read up on folks like Norman Borlaug, Luther Burbank, George Mendel, and on and on. And since it is coming close to spring in the Northern Hemisphere, pick up a garden catalog. In it you will see sections of new varieties, often listed with the breeder (who has a patent on the plant).

      Note: we are redoing our backyard, and some of the things I plan to get are small berry plants that have been introduced by a plant breeding nursery, Fall Creek Farm & Nursery, Inc, owned by the Brazeltons:
      http://www.brazelberries.com/breeders

      Though will say one thing, having an edible garden does teach you about the plants, the food and how difficult it is to get nice looking fruit/veg. You then stop making simplistic pronouncements on what is or is not good food.

    4. mousethatroared says:

      ““If it is man-made food or drink, avoid it, if it is natural, feel free to eat it.”

      You can have my* ice cream when you pry it from my cold dead hands.

      *1/2 cup of Ben and Jerry ‘s Chubby Hubby-

      1. mousethatroared says:

        And, no alcohol, or coffee? God, Why would you even want to have a long life if you had to resort to that?

    5. Jim Glass says:

      “The problem is that no one wants to take the time or energy to measure and weight food! “

      It’s really not so hard to read the calories on the label. Anyone who’s not willing to do that isn’t even trying, so forget about ‘em.

      “So why not learn to eat correctly and not worry about portion control? Here is a general guide: If it is man-made food or drink, avoid it, if it is natural, feel free to eat it. “

      The naturalistic fallacy. Almonds and peach and pear pits contain cyanide.

      To lose weight, reduce the calories you consume relative to the calories you expend. Whatever their source, it doesn’t matter. (So whatever works best for you is the best — for you). It’s thermodynamics.

      Even as to “natural” foods that actually are healthy, if you ignore portion control so your calorie consumption goes up relative to expenditure, you’ll get even fatter. Thermodynamics.

      1. Chris says:

        “Almonds and peach and pear pits contain cyanide.”

        I think you meant to say “Apricot and peach ….”

        Almonds are from a variety of apricot/peach which have been selectively bred to not contain cyanide. Though “bitter almonds”, another name for apricot pits, have plenty. By the way, the flesh around the almond resembles an apricot, but is often not very tasty. There are a few varieties that give both fruit and nut:
        http://www.raintreenursery.com/Chinese_Montgamet_Sweet_Pit_Apricot_Mar2624.html

        Also the cyanide is in the leaves and wood. This is why it is not wise to barbecue with apricot/almond wood. Nor to give small pet rodents any apricot branches/leaves to gnaw on (which I did once, then thought about it, looked it up, and ran up and took it out of the cages… I did not want to be the parent who killed my kids’ pets).

        My dad has an unverified story from over fifty years ago of going to a gathering on a beach. They decided to build a bonfire with some wood from an almond tree. But it turns the smoke from fire caused some eye damage. So he always warned against burning almond wood. I don’t know if it is true, but some wood smokes are nasty. While mesquite wood can make tasty burgers, don’t get it in your eyes, because it really is caustic.

  40. Bonnie says:

    I do hope there is a disclaimer in the book that some of these ideas would be deadly for a diabetic. Eating every 2-3 hours would guarantee high blood glucose levels, and so would the advice to indulge. For the diabetic there are forbidden foods. No way around that. I know that the ADA says to go ahead and eat some sugar, but that would be a big mistake for most of us. Between the high BG and the onset of hard-to-resist cravings, I’d end up insulin-dependent in no time. And still fat.

    By restricting the carbs I eat (both amount & type) I’ve lost weight and am beginning to get my blood glucose under control.

    1. Mie says:

      Dose and context. That applies to people with diabetes, too. Of course somewhat differently than to people who don’t have diabetes, but still.

      And to my knowledge the ADA doesn’t encourage diabetics to “eat sugar” in the sense you put it, but they too acknowledge the fact that you’re not going to die if you have a piece of cake once in a blue moon.

  41. Jim Glass says:

    Hi: I self-designed a diet program that 90% corresponds with what you write above after researching the psycho-biology of the subject, most notably as per Kahneman (Nobelist) and Baumeister plus some others. With it I’ve lost 75 pounds, my doctor says I’ve improved my health more than any other patient he’s ever had in is career who didn’t have surgery, I feel 20 years younger both physically and mentally, confirmed by my friends saying I act that way — and I am never hungry. Keeping the weight off is easy, no challenge at all, eating all I want.

    As much as I agree with most all you write above, a couple of thoughts and one significant objection:

    [] You appear self-contradictory on exercise: “Sweating is the next myth, with The Biggest Loser epitomizing the belief that exercise can contribute to significant weight loss. You can’t outrun your fork”, versus “Exercise … Something. Anything. ‘Some is good, more is better, everything counts’ Freedhoff suggests.”

    There is a resolution to this apparent contradiction, well documented in the data at the National Weight Control Registry which tracks people who have lost and successfully kept off 30+ pounds.

    1) One can’t burn off enough calories via exercise to lose weight. Even running a 26-mile marathon burns off only about 0.75 pounds — and then you are going to be hungry and eat more. In the NWCR data base, virtually *nobody* lost weight by exercise alone. BUT….

    2) Exercise is *vital* to successful weight loss. Essential. Because it is the key to obtaining the positive feedback that changes behavior. Reams of data show it provides psychological, physical and social benefits — pleasures! — that drive behavioral change.

    Kahneman and Baumeister emphasize that overeating is a conditioned habit, and eating habits have deep evolutionary roots which make them impossible to break — the reason why diets fail is that the constant fight against unbreakable habit can’t be won. But new habits can be created to “bypass” the old habits, so “hunger disappears” when they are no longer activated — and exercise is the self-conditioning that creates the new habits.

    The NWCR data confirms this: Almost everybody in the data, 90+%, exercises seriously, average 2,500+ k/cal per week for women and 3,000+ for men — equivalent to rather *more* than running a marathon every week!

    So the claim that “the belief that exercise can contribute to significant weight loss” is a “myth” is flat wrong — not only can it contribute, it is essential.

    [] The NWCR data shows no particular diet being better than any other as long as total calories are limited (as per the Laws of Thermodynamics), just as per Freedhoff — but with one major exception. Almost everybody in the data uses a high-carbs diet. (Sorry, Atkins). Why? See how much they exercise.

    [] The “reset your life in just 10 days” title claim and idea is just totally wrong, and a great plan for failure. Again as per Kahneman and Baumeister, the #1 reason why “resolutions” like this fail is trying too much too fast, expecting too much too soon.

    Once more, the key to success is creating new habits that “bypass” old habits. Creating new habits takes willpower to maintain new behavior until it becomes a habit. We all have finite, limited willpower, and it is needed to deal with all our challenges in life (work, family, etc.) There’s just not enough available to reset a life in 10 days. When you run out it is, “oh, c**p, failed again”, back to the old ways.

    What works is, to the contrary, to use limited willpower to build new habits slowly, incrementally, so if one slips one day it doesn’t matter, take the long view and pick things up the next. My personal experience is a testament to this. I tried the “new life starting today” thing a score of times and never lasted a week. It was just too hard to start keeping a diet log and all the rest at once. But when I decided “I’m just going to switch to no-cal soda, no more for now”, then a year later I had a full spreadsheet of diet log/exercise data. After going slowly, step-by-step.

    Freedhoff seems to know this when he talks about limited willpower and how change must be perpetual, forever — but his headline “10 day” claim/agenda flatly contradicts it. I worked in publishing for a dozen years, so I know how such headline claims can be a necessity to get published (and often come from the publisher rather than the author) … but still.

    On the whole though, very good, agree 90%.

  42. ThorntonHall says:

    Saying “Taubes is still wrong” in the context of “Calories still matter” is really pretty far beneath what I would expect from “science based” analysis. Clicking through tells me that a “law of thermodynamics” means that “a calorie is a calorie”.

    Any scientist who looks at the literature knows that there are important pathways of communication between the gut and the brain. The entire history of diabetes science is learning how different foods cause vastly different hormones to be released.

    It doesn’t take a rocket scientist (or maybe it does) to realize that gut plus hormones plus brain can equal behavior, for example, through satiation. And hormones affect metabolism as well.

    So yes, the calories you eat are “still important”, and low-carb advocates would of course agree, but it is certainly possible that different foods cause different reactions in the body, some of which might lead to more or less calorie consumption, more or less weight gain, more or less energy expended, etc.

    1. Jim Glass says:

      Any scientist who looks at the literature knows that there are important pathways of communication between the gut and the brain.

      Absolutely! Which is why cognitive behavior and self-conditioning is so vitally important to successful weight loss, as per cognitive scientists such as Kahneman and Baumeister — while near totally ignored by the nutrient component-obsessed diet community in general, and Taubes in particular.

      it is certainly possible that different foods cause different reactions in the body, some of which might lead to more or less calorie consumption, more or less weight gain, more or less energy expended, etc.

      It is not only possible but doubtless true — as second order and third order effects.

      But a real-world dieter trying to lose serious weight must change ingrained behavior, habits with deep evolutionary roots, and has only limited, finite, willpower available to do so — and thus must concentrate on obtaining the first-order effects that produce 90% of real-world results.

      Absent unusual specific medical conditions, those first-order effects come from calorie limitation and exercise (the latter much more for behavior modification than calorie burning), the direct calories in-calories burned equation. Squandering effort pursuing third-order effects while ignoring first-order effects is the sure road to weight-loss failure “yet again”.

      After one has mastered behavioral control of one’s health regime (through new habits that run themselves, at no willpower cost) and largely won the health battle, then one can move on to invest one’s efforts in pursuing lower-order effects to become a master athlete or whatever one wants.

      That’s what I’ve done in going from being a clinically obese couch potato, who had pain simply standing up out of a chair, to a marathon runner.

      From the “Taubes is still wrong” link:

      “Taubes’ demonization of the calories-in/calories-out principle strikes me as a bit of a straw man argument. He says exercising and reducing total calorie intake don’t work; moreover, he says they can’t work.”

      They “can’t”?

      And yet at the National Weight Control Registry fully 90%+ of successful weight losers report using calorie limitation, plus 2500+ kcal worth of exercise per week, on a high-carbs diet (needed to fuel the exercise). I’m one of them, 75 pounds down on a high-carbs diet.

      When what one thinks “can’t” work is the dominating model of what *does* work, it is time to check one’s priors.

      1. I can’t believe that comments about the National Weight Control Registry go unchallenged. They only keep track of success stories. That’s just plain bizarre if the goal is to learn something about nutrition.

        I mean, I could limit my study of AIDS to the prostitutes who seem to be immune. I would quickly conclude that sexual contact does not transmit HIV. And I’d be wrong and crazy.

  43. ThorntonHall says:

    Thermodynamics? But this isn’t physics, it’s biology!

    Here’s how Taubes puts it:
    “All those who have insisted (and still do) that overeating and/or sedentary behavior must be the cause of obesity have done so on the basis of this same fundamental error: they will observe correctly that positive caloric balance must be associated with weight gain, but then they will assume without justification that positive caloric balance is the cause of weight gain. This simple misconception has led to a century of misguided obesity research.”

    Excerpt From: Gary Taubes. “Good Calories, Bad Calories.” iBooks. https://itun.es/us/T5ccz.l”

    Excerpt From: Gary Taubes. “Good Calories, Bad Calories.” iBooks. https://itun.es/us/T5ccz.l

    1. Harriet Hall says:

      Whatever the cause of overweight, there is no doubt that a negative calorie balance results in weight loss. My daughter adopted a dog that was overweight by about 50 pounds; he lost weight slowly and steadily on a calorie controlled diet and went back down to his ideal weight. The same thing would work for humans if you could control their intake. The problem is that they are in control of what goes in their mouth and their behavior patterns and psychology get in the way.

      And exercise is not absolutely essential for weight loss. It does help a lot of people, but my husband lost 60 pounds in 5 months without any exercise at all.

      1. Andrey Pavlov says:

        When I lost weight it was spurred by a ski jumping accident where I dislocated both my knees and was left with Grade 3 MCL and LCL sprains making it almost impossible for me to walk for a week or two and I couldn’t walk around at a somewhat normal level for close to a month. I couldn’t exercise for about 6 weeks (save mild PT).

        I lost 15 lbs in a month being mostly immobile purely through diet.

        Yes, exercise is important. But when you realize that a reasonably strenuous exercise will burn off 500 calories and something as seemingly innocuous as a single can of regular soda has 160 calories, a regular sized candy bar easily has over 200 calories, and a medium order of french fries is 375 one should realize how incredibly easy to completely obviate the calories lost by exercise. The other thing to realize that is for most people a ~2,000 kcal diet is what is needed to maintain a healthy weight, but this can be less for women, older individuals, and smaller individuals and less for weight loss it becomes simple numbers to realize that while exercise will certainly help, it will not get you there without a change in your diet. People are commonly overeating by 500-1000 calories a day and if you manage to actually exercise to the tune of 500 cal per day I’d be impressed. That is minimum of 45-60 minutes of reasonably strenuous exercise per day. That is what I understand by the phrase “You can’t out exercise your fork” and why it is reasonable to say that for people looking to lose weight, what you eat is by far the most important factor. Everything else is just lagniappe.

        There are many other advantages to exercise that occur independently of weight loss and it should be encouraged. The only one direct advantage is that if you exercise regularly you can boost your basal metabolic rate such that even on days off of exercise you are still getting a little bit of carry over advantage.

        1. mousethatroared says:

          That’s a great point Andrey – I can’t count the number of time I’ve read some movie star quoted in a fitness magazine as saying. I don’t diet – I run X miles a day (or do spinning or some trendy exercise) so I can eat anything I want.

          But the reality is that the average person can’t take up jogging and then eat anything they want (or at least, not everything I want. :) ) and expect to be the size of Jennifer Aniston. It all depends upon what you want, I guess.

    2. WilliamLawrenceUtridge says:

      Thermodynamics? But this isn’t physics, it’s biology!

      Biology is predicated and builds from physics in astonishingly complicated ways. Doesn’t change the fact that thermodynamics still applies. Energy consumed has to go somewhere. It may be excreted (all the energy in the indigestible fiber) or burned (everything used as part of metabolism, that is ultimately radiated as heat) or stored (and that’s where the fat comes from). Attempting to excrete any energy that is not in the form of indigestible fiber is pretty catastrophic for your digestive tract – if it’s sugar, have fun with all the new, interesting and flammable gasses that your gut bacteria produce, in massive quantities, in your lower intestine. Fats? Ditto, plus it’ll strip fat-soluble vitamins right out of you (how do you feel about rickets?). The human body is pretty efficient, it basically absorbs everything it can and anything that comes out of the lengthy tube starting at your lips is probably non-nutrative for anything with language. That basically leaves trying to up metabolism, which can occur through exercise. A lot of diets try to use metabolic tricks to essentially reduce the efficiency of the body. As Andrey discusses above, this is problematic, mostly speculative, and probably doesn’t work. That leaves basically the only real reason most diets work, and ultimately fail – reduce intake. Which is possible, but for a variety of reasons, hard to maintain. People like to eat, and do so for many reasons beyond mere hunger – and we live in an environment that supports this to an unhealthy degree.

      Taubes is basically assuming some sort of metabolic trick to reduce the efficiency of the body (i.e. increase thermogenesis without increasing any other meaningful aspects of metabolism). Though he might be theorizing some sort of satiety mechanism, I don’t know as I haven’t read any of his books beyond Bad Science which was delightful. Either way, strongly speculative, and it’s unlikely that a science reporter picked up on something missed by thousands of active researchers.

      I could be wrong, he could be right. I just doubt it.

    3. Jim Glass says:

      As to Taubes, I’ll just note again that at the National Weight Control Registry, of all those who report successfully losing 30+ pounds and keeping it off (average 66 pounds, 5.5 years) the dominating majority report using a high-carbohydrates diet.

      In fact, “high carbohydrates” is the one and only consistent factor found across the successful diets, apart from calories limitation. (The rest is whatever works for you is best for you.)

      1. Angora Rabbit says:

        But you know, carbohydrates are not all alike. Taubes promotes complex carbs, which are digested slowly by pancreatic amylases, so that the glucose enters the bloodstream more slowly, so that one has a lower insulin spike and thereby has a lower anabolic response that could include reduced conversion of fatty acids to glucose. But that’s not some mystical Taubes trick; it;s the same thing we tell diabetics and the same we tell everyone to help lose weight.

        Now, if it was simple carbohydrates (mono and disaccharides), then you have fast digestion, fast absorption, high glucose spike, and increased propensity to convert the glucose into triglycerides.

        This is just biochem 101 and not earth shattering.

        So, be careful in saying “high carbs” because what you really mean to say is “complex carbs.”

      2. Mie says:

        “In fact, “high carbohydrates” is the one and only consistent factor found across the successful diets, apart from calories limitation”

        Since low carb diets seem to be as efficient as many other options, including very high carb diets such as Ornish, I beg to differ.

        The one and only consistent factor is calorie restriction, which seems to be best guaranteed by adherence to the diet (and not the varying proportions of different macronutrients in the diet itself).

  44. gewisn says:

    I’m interested in the evidence for/against the “cheat day” involving periodic intentional splurging with dramatically higher calorie content. My minimal understanding of the concept is that you keep your average calorie intake (including the cheat day) to a reasonable goal, but that having the occasional cheat day can help prevent the starvation metabolism that becomes so efficient at saving calories. Of course, the cheat day provides a relief from the sense of deprivation, and a reward for efforts in between. But I’m asking whether there is evidence for a physiologic benefit.

  45. Lacri says:

    “Thermodynamics” questions:

    In simplistic terms –

    1. You ingest food which contains a certain calorie value.
    2. You digest it, using some calories, but releasing more than are consumed.
    3. Calories in excess of what is immediately required are stored first in glycogen, and then in fat.

    How efficient and predictable are these processes? How much variation is possible in the proportion of calories used or released in digestion, or in the proportion of excess calories stored vs “lost”?

    The assumption always seems to be energy stored (ultimately as fat) equals energy taken in (food eaten) minus energy used (calories burned), and that the entire surplus is automatically stored. But this storage process is something that your body must actively do, not something that just “happens”. I’m assuming that if I were to sit down and guzzle say 10,000 calories in one go that my body would not perfectly efficiently store each and every one of those 10,000 calories. One also hears of extremely thin people who are adamant that they are unable to gain weight no matter how many calories they consume.

    Hunger is also a process of the body, of course, and there seems no reason to assume that it is perfectly aligned with the body’s actual energy requirements. How much variation is there between people in the accuracy of hunger signalling? Hungry people, no matter how much self-control they have, will eventually eat, regardless of whether they need those calories or whether they are just going to end up as fat.

    1. Calli Arcale says:

      “One also hears of extremely thin people who are adamant that they are unable to gain weight no matter how many calories they consume. ”

      My brother is one of those people. He lost about fifteen pounds during a bout of pneumonia a year or so ago and has been very frustrated at his inability to get it back. He weighs around 145 pounds and is over six feet tall, and he’s been actively *trying* to gain weight. He’s one of those rare people who works out in an attempt to *gain* weight (since what he lost during the pneumonia was muscle mass).

    2. Jane says:

      A calorie may be a calorie, but what a calorie means to an individual differs. How many calories is takes to turn into a gain or loss of, say, a pound, is not universal, and actually has a wide variance, which appears to be genetic in origin ( See “The response to long-term overfeeding in identical twins”) and I think is one of the places a lot of current diet plans set people up to fail from the outset when they try to tell you how much you “should” be eating, and how much you should cut back to get the desired results.

      I am still not clear, however, on how they have determined obesity to be causative to all these disease rather than a ride-along; perhaps I am biased because everyone I know who is obese (which is probably half of my acquaintance, and yes, I know anecdata is not real data, but I would love to see real data) got sick first, and then put on the weight. (And of course, once you have gained the weight, not only is it harder to lose it than it is to prevent the initial gain, but the quality of medical care you get has a decent chance of going seriously downhill.)

      1. Angora Rabbit says:

        Jane, caution on the article you cite as it’s 24yrs old and the science has progressed a little since then. :-) Consider that identical twins aren’t really identical due to mutations during embryogenesis, their differential microbiome, epigenetic differences, and just differences in things like chewing and digestion. Biology is stochastic.

        Regarding obesity, the word isn’t causative but risk-modifying. In biology, it is a case of mass action and multiple processes, the net sum of which affect disease risk. Obesity might not affect disease X as strongly, for example, if you’ve fortunately inherited an allele that, say, enhances HDL serum lifetime. No one really doing the research thinks causation per se; it’s all about relative risk being increased or decreased over the mean risk.

        It’s like smoking – if you’re lucky and have the allele that doesn’t activate some of the smoke carcinogens (I’ve forgotten the gene name, probably a P450) then you have a good chance of smoking like a chimney till your 80 (like my aunt). But if you’ve got the other variant, then look out. But since the latter is far more common than the former, it would be very prudent to stop smoking rather than play Russian roulette.

        Plus there are human mutations in disease who are the “natural experiments” in understanding disease risk. For example, children who can’t clear LDL from the blood due to impaired LDL receptors die of CVD before the age of 10yrs and thus need liver transplant for clearing their LDL. Pretty good natural evidence that high LDL increases CVD risk.

        Hope this helps!

  46. Nuvet says:

    Whatever the cause of overweight, there is no doubt that a negative calorie balance results in weight loss. My daughter adopted a dog that was overweight by about 50 pounds; he lost weight slowly and steadily on a calorie controlled diet and went back down to his ideal weight.

  47. Andy says:

    I saw many resentful comments here. Not sure why there are so many of those. I believe that documenting all the meals and all the exercise is very realistic. And not only it is realistic it is very helpful. It makes you feel accountable for your actions and by that makes you stronger.

  48. Jason says:

    For those knowledgeable on nutrition, I found this statement, albeit with no citations, but I have never seen this before which makes me think it might be propaganda by a certain faction to reduce animal product consumption.

    “The pancreas produces a limited amount of protective enzymes used to break down the protein linings that hide cancer cells in the body. Everyone has free floating cancer cells in their blood. They have to use some of these enzymes to break down animal protein leaving less and less to find the cancer cells and then the hunter T-Cells cannot multiple and attack the exposed cancer cells allowing them to multiply and form tumors. This however is not the case with veg based proteins only animal proteins. So basically the less animal protein you ingest the more of these pancreatic enzymes are available to find and identify free cancer cells to allow them to be killed. ”

    I have yet to find a medical source that says everyone has free floating cancer cells in their blood or that enzymes used to breakdown dietary proteins takes away from the immune systems ability to identify and destroy abnormal cells.

    Is this a bunch of bollocks?

    1. Andrey Pavlov says:

      @Jason:

      It is 100% complete bollocks. On every imagineable level. So much so that I would have to write a few paragraphs to explain it all, but I’ll opt for a few salient bullet points:

      - The pancreas can produce as much protein as necessary, barring some sort of specific damage to the pancreas. Even then, it has a lot of reserve. For example, you don’t start manifesting diabetes until 90% of your pancreatic islet cells are destroyed.

      - Protein linings that hide cancer cells is nonsensical

      - It is true that most people will have cancer at some point that is dealt with by the immune system. But certainly not all the time and certainly not always free floating in the blood. Besides, how does that comport with the protein linings bit?

      - Whether veg based or animal based a protein is a protein. They are amino acids linked by peptide bonds. The enzymes released by the pancreas are different classes of enzymes that work on different types of bonds, not of different types of proteins (e.g. serine proteases which have different subtypes that will cleave specific amino acid combinations). So it cannot differentiate between animal and veg protein.

      So yeah, utter bollocks.

      1. Jason says:

        No sooner did I respond to this, I opened science daily and this
        http://www.sciencedaily.com/releases/2014/03/140304125639.htm

        “Not only is excessive protein consumption linked to a dramatic rise in cancer mortality, but middle-aged people who eat lots of proteins from animal sources — including meat, milk and cheese — are also more susceptible to early death in general, reveals the study to be published March 4 in Cell Metabolism. Protein-lovers were 74 percent more likely to die of any cause within the study period than their more low-protein counterparts. They were also several times more likely to die of diabetes.”

        People really have it in for animal protein these days.

    2. Angora Rabbit says:

      Hi Jason! It’s so many bollocks that you could fry ‘em up and serve ‘em as Rocky Mountain oysters.

      So, the pancreas actually has two major parts that have a yin-yang relationship in their origin and function. The quote has completely mixed them up. Probably slept through high school physiology.

      The endocrine pancreas is the part that makes stuff that enters the bloodstream (endo = interior). Stuff like insulin and glucagon. I’m not aware of any protease originating from the endocrine pancreas but feel free to correct me, Andrey or someone.

      The exocrine pancreas (exo = exterior) makes the digestive enzymes that operate in the small intestine. That includes proteases needed to digest dietary protein, plant or animal in origin. Also the dead cells your gut sloughs off, the digestive enzymes themselves, all efficiently recycled and reused.

      Bottom line: your digestive exocrine proteases ain’t gonna reach the cancer cells, even if they were protected by a protein layer (which they aren’t). If your digestive proteases entered your bloodstream, they would also digest you and your pancreas and it would be horrible. In fact, it is horrible, and the disease is called “pancreatitis.”

      Someone apparently dozed off in class and then tried to crib half-remembered bits into an unconvincing tale lacking even verisimilitude. (too lazy to hunt the quote)

      1. Andrey Pavlov says:

        @Angora:

        Yes, quite spot on. And also equally damning to the idea. I just didn’t bother getting into those details because, well, there was just so much wrong with that paragraph I could have written a book chapter to explain why. Or the original author could have just read a chapter on the pancreas and digestive physiology. It would indeed be very bad if digestive enzymes entered the bloodstream and yes, spot on that pancreatitis is a manifestation of that. It usually is from a blockage of the ducts of the exocrine pancreas that cause a backup and then auto-digestion of the pancreas leading to extreme pain. In severe cases it can even lead to hypocalcemia from a saponification reaction when the lipases autodigest the fat surrounding the pancreas. And in cases like that, mortality can actually be very high – we use Ranson’s criteria to calculate mortality and it goes up to 100%, but typically severe cases top out at around 40% mortality unless you are basically knocking on death’s door.

    3. MadisonMD says:

      @Jason
      Mechanism is highly specious as pointed out by Andrey and AR. Moreover, if the model were true, we could make a very simple prediction. Viz: cancer rates should be much lower in vegetarians. Well, guess what? Cancer rates are not lower in vegetarians*

      *Without, of course, cherrypicking single studies. Individual studies can show both higher or lower rates in vegetarians, as expected by statistical noise.

  49. Jason says:

    I thought it seemed a little specious. People who don’t know metabolism would have no idea. I just had a hunch there was a vegan agenda behind it.
    Thanks for responding.

    1. Jason says:

      This was supposed to be a reply to Andrey, but didn’t get linked to the original topic.

    2. Andrey Pavlov says:

      No worries, glad to be of help.

      It is really hard to parse wether a claim is total BS if it is well outside your realm of expertise. If someone tells me they have a flying hoverboard, I can’t just confidently say it is bollocks, even though I am highly suspicious of it.

      The key is to develop a BS sensor such that your spidey sense tingles when a claim doesn’t make sense. That shouldn’t prompt you to just dismiss it out of hand, but to reserve judgment one way or another until you can further evaluate the claim. So good on ya for that.

      Funny thing is that I have noticed people actually have a better developed BS detector than we may think. This is anecdotal, of course, but I have noticed over the years as people come to me with questions about stuff they are immediately enthusiastic about, when they actually ask me the question they already know it is likely bollocks. More often than not I just have to ask “What do you think?” and they reluctantly answer that they know it is probably BS but that they just don’t know why. Left without a resource like me (after all, not everyone knows a physician and researcher that they can just shoot a text or email to or talk to over a beer) they likely would have gone on choosing to believe it is likely true and ignore the spidey sense tingling. Because otherwise it becomes much more effort to try and find out the answer since they don’t have someone like me to quickly give it to them and explain in a few sentences why. Which is part of why I take the time to answer such questions like yours. I value the same when I have questions outside my expertise, so I figure someone like you would value it as well.

      (and especially since it is obvious that you are asking genuine questions and not just JAQing off)

      1. WilliamLawrenceUtridge says:

        Plus, a dogmatic promoter will usually insist on the truth of their claim. There will be no recognition of nuance, no explanation of the flaws in the theory or possible alternative explanations.

  50. Jason says:

    Thanks everyone. I couldn’t have asked for clearer and easy to understand responses.

  51. Jill says:

    Based on the statement Artificial sweeteners are safe, and can be beneficial as part of a weight loss strategy, I would NEVER buy this guys book or trust anything that came out of his mouth. Sounds like he doesn’t have a clue about things and is making it up. He also sounds like he is taking bits from Beyond Diet which is the BEST plan ever and The Cruise Control diet, which is far superior to his inept book. What a joke.

    1. WilliamLawrenceUtridge says:

      Solely because he recognizes that artificial sweeteners are a safe way of getting a pleasing sensory experience without attached calories, that means the entire book is invalid? Your reasoning seems specious. Artificial sweeteners have been tested for decades, on dozens of animal species including humans. One of them, aspartame I believe, caused bladder cancer in rats, the sole safety concern I am aware of. However, rat urine is drastically different from human urine, it is far, far more concentrated (among other differences), so there is good reason to believe that the findings don’t necessarily apply to us.

      Meanwhile the Cruise Control diet emphasizes whole foods (good), but promises tricks (which generally don’t work), recommends supplements (specifically L-glutamine), when supplements have no safety or efficacy testing, and promises fruits that “burn fat” (thermodynamics doesn’t work that way). It demonizes high-fructose corn syrup (when fruit is higher in fructose than in corn syrup, and table sugar is basically the same thing with slightly different proportions of glucose and fructose) and favourably cites studies with 12 participants (meanwhile ignoring the enormous volume of studies that find HFCS no better or worse than any other sugar). It also recommends apple cider vinegar, raw honey and charcoal (yum, briquettes!) as a treatment for heartburn (you know who else does this? Convicted felon Kevin Trudeau). It demonizes canola oil, praises red meat and promotes “the truth about cholesterol”, in fact, I wonder if there’s any natural-is-better tropes it doesn’t promote?

      The Beyond Diet is more of the same. FOODS THAT BURN FAT!! GLUTEN IS EVIL!!! I can’t see much beyond the first page, but it basically seems to be a gluten-free diet. In other words, it tricks you into calorie-restricting by avoiding grains.

      Meanwhile, The Diet Fix promotes accepting a lifestyle change and self that you can maintain while staying happy, regular exercise, and basically a lifelong lifestyle that you can maintain. No miracles, just hard work and a different way of thinking about food.

      Basing your opinion of the book solely on one factor, that it recommends artificial sweeteners as a way of getting something sweet, seems specious.

  52. Greg says:

    Interestingly Dr. Freedhoff was on a local TV station just this morning promoting his book. I’ve also been recommending it to people at work who are looking to lose weight – no feedback so far…

  53. Dave says:

    I just got the latest issue of the journal Science. Their News & Analysis section has an article on nutrition, citing a couple of studies, one on mice and another using self-reported diet surveys on humans (6381 people). The article doesn’t go into great detail but those people under 65 who reported a diet where > 20% of the calories were from protein were 4 times as likely to die from cancer over the 18 years after they were surveyed and 75% more likely to die of any cause compared to high carbohydrate low protein individuals. In the mouse study high protein mice were leaner but shorter-lived than high carbohydrate fed mice. The researchers caution that “It’s probably overly simplistic to say that everyone should go on a low protein diet at this point.” The article is on page1068 of the March 7 2014 edition of the journal for those interested. Disappointingly, the journals the studies were published in was not mentioned, nor were the raw data. Just FYI.

    1. Calories do matter, with one important exception:

      Dietary fiber.

      Dietary fiber is counted in the calorie count on product labels — at least in the U.S. — but is absolutely, positively, unquestionably, undeniably not absorbed into your bloodstream. It does not contribute to your body’s energy budget.

      1. Angora Rabbit says:

        Umm…not correct,I’m sad to say. The typical human western diet provides about 10% of daily calories from microbial fermentation of fiber. The volatile fatty acids generally are utilized for the energy by colonic cells. Higher fiber intakes can provide appreciable VFAs to liver as well. If you are an Angora Rabbit, you get ~30% of your calories from cecal fiber fermentation. A foregut ruminant like a cow, 80%-plus.

        I’m not convinced that food labels reflect this but I really need to check that.

        Honestly, don’t worry about those calories per se. At the same time, the Specific Thermogenic Effect can burn calories during digestion that we generally don’t count as well. This is the warmth that some folks feel shortly after they start eating.

        I am hoping that hot flashes are a significant source of burning calories, but so far this doesn’t seem to pan out.

        1. WilliamLawrenceUtridge says:

          Awesome. Angora Rabbit, a question for your expertise. What are the implications of a low-fiber diet for the colon cells? Particularly, say, an ultra-low fiber diet composed mostly of meat (i.e. fat and protein, minimal glucose)? Absorption of fats from the meat instead? What about a pure protein diet, say over the long term? I doubt any human has ever tried it for long and survived it.

          I love having real experts around, I learn the most amazing things.

          1. Harriet Hall says:

            There was an experiment where subjects ate nothing but raw meat for a year, with no adverse consequences. (Meat even contains vitamin C before it is cooked.)

            1. WilliamLawrenceUtridge says:

              Ah, but raw meat wouldn’t be pure protein, there’s fat as well.

              Also, who were these subjects and how were they induced to do this? Was it in the glory days of WWII when they got to do horrible things to conscientious objectors?

              1. Harriet Hall says:

                No, it was a polar explorer trying to make a point about the Eskimo diet.

            2. Dave says:

              I’m not a dietician but I read somewhere that the Eskimo diet contained a lot of of fish in a fairly ripe state, and that the bacteria in the fish contributed some essential vitamins.

              1. Harriet Hall says:

                As I remember the experiment, the subjects subsisted on raw meat, not fish.

            3. Angora Rabbit says:

              I wasn’t certain about this myself. Quick google search reveals this:
              http://en.wikipedia.org/wiki/Vilhjalmur_Stefansson#Low-carbohydrate_diet_of_meat_and_fish

              I will read the AJCN paper of the actual study when I’m back at work. But I noticed that it wasn’t just a “raw meat” diet, but also included entrails. Entrails are myofibril (=meat) poor and rich in diverse molecules used in metabolism, including glycoproteins. If this is the study, I also note the study subject was an Arctic explorer, someone who would be in remarkable health at the onset. He was big on the Inuits, but recall the Inuit energy expenditure would have been well beyond people today.

              Having said this, and it could be correct, I have to also consider that this type of diet, metabolically, is not dissimilar from the metabolism of an uncontrolled, type 1 diabetic. That is, no incoming glucose to stimulate insulin, and thus glucagon activity dominates. Gluconeogenesis of amino acids could supply carbon skeleton for TCA cycle, which would be key.

              In the mid-90s, when Atkins was yet again a fad, emergency rooms were seeing people near-death who decided that, since less carbo was good, then no-carb was even better. They were giving themselves heart attacks and some of them diet. MInd, these people were probably not on the health level of the Arctic explorer.

              So without having read the actual study (which I look forward to!), I’d say it is possible (I’m less worried about micronutrients because they are eating kidney and liver), but I’d be watching their health and metabolism carefully.

              Oh, and I’d be very interested to know if they had significant constipation – my $$ says yes.

              1. Harriet Hall says:

                Thanks for finding the study. I had remembered wrong: I thought they ate raw meat, but it says it was lightly cooked. I’m puzzled, because I thought that scurvy would develop without vitamin C and that meat contains vitamin C that is destroyed with cooking. Your lose the bet about constipation: they had no more constipation than on a regular diet, and too high a proportion of lean meat resulted in diarrhea.

              2. Angora Rabbit says:

                That’s interesting about the constipation. I guess they had hearty colons! I will buy you a drink when we finally meet. Actually, they probably had colons already adapted to that diet, which is what the wiki tag suggests, so maybe not such a wide dietary swing for them.

                Re: vit C, you are right that muscle isn’t a great source but does contain 3-5 mg/g (values for rat and human, shrug). Organ meats are much richer – adrenals are chock-full maybe from all the P450 reactions, and liver & kidney have decent content as well.

                Interesting topic! Thanks for posting that about the explorer’s study – forgotten nutrition.

              3. WilliamLawrenceUtridge says:

                What were they pooping out without fiber? I remember AR saying a while back that poop is made up of a surprising amount (to me) of dead bacteria, did more grow because of all the meat?

                Science is awesome.

              4. Angora Rabbit says:

                Oh, sure. Lots of microbial growth. If you feed them, they will grow. Different ones grow depending on the input. Take a look at some of Jeff Gordon’s or Rob Knight’s papers in PubMed. Interesting reading! (Though I haven’t looked for any focusing on the meat / high protein side of things, but it’s probably out there.)

            4. Andrés says:

              First a personal disclosure. I think that most days I am below the 150g of non-fiber carbohydrates. Some I am below the 50g and it has checked positive on ketostix next day (I was curious). So I like having a flexible metabolism and I am not interested in staying in ketosis permanently.

              Angora Rabbit said:

              I have to also consider that this type of diet, metabolically, is not dissimilar from the metabolism of an uncontrolled, type 1 diabetic. That is, no incoming glucose to stimulate insulin, and thus glucagon activity dominates.

              From the paper by Holt et alter (via wikipedia) it seems that there is going to be enough insulin to avoid ketoacidosis (I would link any other source but I can’t find any just now), that’s what an uncontrolled type 1 diabetic gets.

              In the mid-90s, when Atkins was yet again a fad, emergency rooms were seeing people near-death who decided that, since less carbo was good, then no-carb was even better. They were giving themselves heart attacks and some of them diet.

              Citation? All I can find is mostly positive results such as those papers pointed out by Dr. Eenfeldt.

              1. Angora Rabbit says:

                Insulin from what? Something has to stimulate its release.

                The ‘reference’ is from a former student who worked in the Las Vegas ER during that period. It happened enough times that the attendings and nutritional staff took notice.

            5. Andrés says:

              Angora Rabbit said:

              Insulin from what? Something has to stimulate its release.

              Are you sure?

              First, protein drives insulin release. From the paper by Holt et alter (that I have already linked) the insulin score for beef was measured as 50±14 (reference value 100 for white bread).

              Second, from Dr. Genuth’s paper it seems (Table 1) that prolonged fasting doesn’t bring neither insulin secretion to zero nor butyrate concentration to ketoacidosis levels:

              Basal levels of plasma insulin were 11 microunits per ml. before and 10 microunits per ml. after fasting.

              Angora Rabbit said:

              The ‘reference’ is from a former student who worked in the Las Vegas ER during that period. It happened enough times that the attendings and nutritional staff took notice.

              The plural of anecdote is not data.

              1. WilliamLawrenceUtridge says:

                The plural of anecdote is not data.

                The “science-based” part of “science-based” medicine puts emphasis on the fact that we can use basic science to predict and evaluate. Basic science predicts that no-carb diet is problematic (it’s why the Inuit consume not only the meat of a caribou, but also the contents of their GI tract for partially-digested plants). Or one can also point to rabbit starvation.

            6. Andrés says:

              WLU said:

              Basic science predicts that no-carb diet is problematic (it’s why the Inuit consume not only the meat of a caribou, but also the contents of their GI tract for partially-digested plants).

              Perhaps they get some glucose if they have eaten lichens. Perhaps it gets fermented (caribou are ruminants) and only thing left are volatile fatty acids.

              WLU said:

              Or one can also point to rabbit starvation.

              Have you read the paper Dr. Hall pointed out? Have you read the rabbit starvation entry you have linked? Our liver size predicts that we can’t survive on a mainly protein diet. It doesn’t predict we can’t survive* on a mainly fat plus protein diet.

              *There are those that think (opinion) that too low carbohydrate consumption may have detrimental effects to our health on the long run. WLU said:

              What were they pooping out without fiber?

              One of these would be a deficit of substrate (the carbohydrate part) for mucin production. Mucin seems to be used by our gut commensal bacteria.

              1. WilliamLawrenceUtridge says:

                Perhaps they get some glucose if they have eaten lichens. Perhaps it gets fermented (caribou are ruminants) and only thing left are volatile fatty acids.

                Perhaps. Does this actually happen? Because if you have no proof, you’re just chaining speculation, which is pretty close to special pleading.

                Have you read the paper Dr. Hall pointed out? Have you read the rabbit starvation entry you have linked? Our liver size predicts that we can’t survive on a mainly protein diet. It doesn’t predict we can’t survive* on a mainly fat plus protein diet.

                One will note that rabbit fever specifies extremely lean meats. One will also note the fat content of a skinless, boneless chicken breast and can of tuna packed in water. One will finally note that Angora Rabbit’s original discussion referenced first world people coming to emergency rooms due to high protein, low carbohydrate diets, the kinds of people who might try losing weight by also avoiding fat, and have access to things like canned tuna and skinless, boneless chicken breasts. Chains of speculation can be fun. They solve nothing, but can be emotionally satisfying.

            7. Andrés says:

              I said:

              Perhaps they get some glucose if they have eaten lichens. Perhaps it gets fermented (caribou are ruminants) and only thing left are volatile fatty acids.

              WLU said:

              Perhaps. Does this actually happen? Because if you have no proof, you’re just chaining speculation, which is pretty close to special pleading.

              Well, glucose from lichens is from wikipedia (I failed to add that link in my previous post). We have that ruminants feed mainly on fat and protein. From Gluconeogenesis in Cattle: Significance and Methodology:

              Gluconeogenesis is a continual process that is of great importance in ruminants because almost all dietary carbohydrates are fermented to volatile fatty acids in the rumen. In turn, propionate is the only major volatile fatty acid that contributes to gluconeogenesis.

              It is not clear to me if the gut contents eaten by Inuit had a significant amount of human-digestible carbohydrates or not. It was your point that they had.

              WLU said:

              One will finally note that Angora Rabbit’s original discussion referenced first world people coming to emergency rooms due to high protein, low carbohydrate diets, the kinds of people who might try losing weight by also avoiding fat, and have access to things like canned tuna and skinless, boneless chicken breasts.

              Yes, that may be a very real problem. Nevertheless late Dr. Atkins’ diet certainly was not low in fat. Actually a diet so described would be more similar to that promoted by Dr. Dukan (I haven’t read his book nor I am going to).

              WLU said:

              Chains of speculation can be fun. They solve nothing, but can be emotionally satisfying.

              Of course. It is one of our inherent characteristics to look for patterns.

              1. WilliamLawrenceUtridge says:

                No, I was asking do caribou (or Inuit, your initial post was unclear) actually eat lichen in meaningful amounts? Particularly considering how slow lichen grows.

                Yes, that may be a very real problem. Nevertheless late Dr. Atkins’ diet certainly was not low in fat.

                The context of AR’s original comment was not “people following the Atkins diet”, it was people following ultra-low carbohydrate diets that went beyond the actual recommendations of the diet. Not specifically Atkins, and realistically not specifically any actual “diet”.

            8. Andrés says:

              WLU said:

              your initial post was unclear

              Without the link certainly it wasn’t clear.

  54. Krisandra Rafa says:

    I agree with most of what Scott has written and what he has posted from the Diet Fix.Except detoxes…I have enjoyed the benefits of detoxes for over 30 years. My favourites, The Seven Day Cleanse,the Wild Rose cleanse,and The lemonade cleanse.what can be harmfully in cleansing and supporting your organs,eating only healthy,alkaline food groups and getting you back on track for making better choices? I also experience more clarity in mind,more energy, lighter of course from weight loss,no cravings for sugar and not hungry. My experience with detoxes has been very positive and I believe can compliment a life style change for better health and weight loss.

    1. WilliamLawrenceUtridge says:

      So…what you’re saying is…you believe in everything Scott says about dieting, except the parts I really want to believe in, in which case I will ignore science completely and continue practicing my quackery.

      Science. You’re doing it wrong. And you’re putting money into the pockets of Big Detox for their worthless, sometimes harmful scams?

      What can be harmful – well, you’re wasting time and money. A lot of the detoxes are pretty unhealthy over the long-term, they’re completely useuless, they actually give you less energy (because they are basically fasts), they are a terrible idea for anyone with diabetes or other blood sugar issues, and I could go on.

      What “toxins” are you “detoxing” by the way?

      How do you “support the organs”? What, like a girdle?

  55. wikipedia pi says:

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    1. WilliamLawrenceUtridge says:

      Spam. For Cafe Press oddly enough.

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