The Elephant in the Room.

On Twitter about two weeks ago, Max Roser tweeted the following graphic:

From Health and the Economy in the United States from 1750 to the Present

The plots of low & stable BMI's until ~1945 made me think.

1. Over-refined sugars & starches entered the US food supply in ~1880. Ref: How the Mid-Victorians Worked, Ate and Died. ∴ Over-refined sugars & starches don't cause obesity.

2. Americans ate more carbohydrate per day from 1909 to 1929 than they do now. Ref: 3rd Fig. from More Thoughts on Macronutrient Trends. ∴ Carbohydrates don't cause obesity.

3. The "low-fat" dietary guidelines were issued in 1980. The two dates at which BMI began to increase significantly are ~1945 (slow rate of increase) and ~1990 (rapid rate of increase). ∴ The 1980 "low-fat" dietary guidelines didn't cause obesity.

So, what happened in the US in ~1945? From my comment HERE:
"After World War 2, the economy was in a slump and something had to be done to get people to buy more stuff, to stimulate economic growth. Corporations changed the way that they marketed to people. Instead of appealing to people’s logic, they began to appeal to people’s emotions. It worked.

Edward Bernays pioneered all of the dirty tricks used by the Food Product Industry to get people to over-consume. Ref: http://www.dailymotion.com/video/x2d29tf_the-century-of-the-self-part-1-of-4-happiness-machines_school

One of Bernays' dirty tricks is confusing the public by promulgating conflicting information. The Tobacco Industry paid health professionals to advertise cigarettes. On the one hand, you had researchers telling people that smoking was bad for them and on the other hand you had a doctor on TV saying that he preferred to smoke Camel cigarettes. This confused the public and made them mistrust researchers & science. Another dirty trick was setting-up organisations with scientific-sounding names to promulgate conflicting reports which the press published as “science”, saying that “X” was good for you, then some time later “X” was bad for you, then some time later “X” was good for you again and so on. The public mistrusted researchers & science even more.

The recent NOF report from Malhotra et al telling people to eat more fat is conflicting information, resulting in even more public confusion and even more mistrust of researchers & science. This is exactly what the Food Product Industry wants."

The Tobacco Industry used Bernays' dirty tricks to encourage women to smoke in public by making smoking a women's rights issue. Cigarettes were marketed to women as "Torches of Freedom". From the 1920's, women became as free as men to greatly increase their risk of getting Emphysema a.k.a. Chronic Obstructive Pulmonary Disease, Lung Cancer & Coronary Heart Disease, while the Tobacco Industry's profits increased.

By focusing on foods/macronutrients/micronutrients etc, people like Taubes, Teicholz, Malhotra et al are helping the Food Product Industry to manipulate the masses to over-consume their products.


So, what happened in the US in ~1990? Which dirty trick used by the Food Product Industry caused the rapid rate of increase in BMI from ~1990?

See also The cause of America's rising obesity rate is irrelevant. The cure for it is what's important.

The cause of America's rising obesity rate is irrelevant. The cure for it is what's important.

NuSi go home. You're not needed!

From http://dietdatabase.com/causes-of-obesity/

On a blog comments section somewhere, a argument discussion took place about what caused America's rising obesity rate. Certain people have a hypothesis that there's one cause. Here's a rough list, in no particular order:-
Carbohydrates (Taubes)
Refined Sugar (Yudkin. Lustig)
Refined Fructose (Lustig)
Wheat/Gluten Grains (Davis)
Fat (Ornish, Esseltyn etc)
Saturated Fat (Ornish, Esseltyn etc)
Animal Protein (Vegans)
Mineral Imbalances (Karlsson, "Duck Dodgers")
The Government (Nikoley)
Dietary Guidelines (Teicholz et al)

It's not Refined Sugar. Sorry, John Yudkin & Robert Lustig. See below...

Refined Sugar intake (kcal/capita/day) is higher in France than in the USA, but in France there's a lower obesity rate. ∴ Hypothesis disproved*.

*As the Refined Sugar intake data may be unreliable (it's also associational data), the hypothesis is not necessarily disproved. If only there's an interventional study (which proves causation) which results in lower weight on a higher sugar/fructose intake. There is! See The effect of two energy-restricted diets, a low-fructose diet versus a moderate natural fructose diet, on weight loss and metabolic syndrome parameters: a randomized controlled trial. ∴ Hypothesis disproved.

I asked Duck Dodgers what he wanted to happen. He said:-
"My feeling is that if people recognize that enriched foods are the antithesis of whole foods, then the demand for enriched/refined foods may diminish, forcing the industry to change."

I want people to eschew refined foods for whole foods, too. So all the arguing about what caused America's rising obesity rate was a complete waste of time. This gave me an idea. I decided to run my idea past someone who deals with obese people with T2DM and who just happened to be in the U.K, attending the Health Unplugged Conference, I PM'ed Dr. Jeffrey Gerber on Facebook, inviting him to meet me at Cafe Class in Woking (a location roughly half-way between my home and London).

So this happened...

Ivor Cummins came, too!

Suffice it to say, the afternoon was a blast!

Cont'd on Public Service Announcement: Calling all Low-carb, Low-fat and Veg*n advocates.

Why using macronutrient percentages is so wrong.

From http://sciencelearn.org.nz/Contexts/Food-Function-and-Structure/Sci-Media/Images/Macronutrient-percentages

1. Deception

Consider Lies, damned lies and statistics, part n+1. Riera-Crichton et al.  

Relative fat intake in %E decreased and obesity increased.

The conclusion:- "Carbohydrates are fattening and fat is slimming." Yeah, right!

Absolute fat intake in grams/kcals increased after healthy eating guidelines (which weren't low-fat guidelines) came out in 1980, according to More Thoughts on Macronutrient Trends.

Gary Taubes & Nina Teicholz use this deliberate misrepresentation of data to create the false narrative that low-fat healthy eating guidelines caused the obesity epidemic in the US. It's a pack of lies.

2. The terms "Low Fat" and "High Fat" are meaningless

Take 55g of fat (500kcals), 125g of protein (500kcals) and 375g of carbohydrate (1,500kcals). It adds up to 2,500kcals, with a percentage C/F/P split of 60/20/20. It's a High Carb, Low Fat diet.

Now remove 125g of carbohydrate to leave 250g of carbohydrate (1000kcals). It now adds up to 2,000kcals, with a percentage C/F/P split of 50/25/25. It's still a High Carb, Low Fat diet.

Now remove another 125g of carbohydrate to leave 125g of carbohydrate (500kcals). It now adds up to 1,500kcals, with a percentage C/F/P split of 33/33/33. It's now a Medium Carb, Medium Fat Zone diet.

Now remove another 62.5g of carbohydrate to leave 62.5g of carbohydrate (250kcals). It now adds up to 1,250kcals, with a percentage C/F/P split of 20/40/40. It's now a Low Carb, Highish Fat diet.

Now remove another 62.5g of carbohydrate to leave 0g of carbohydrate (0kcals). It now adds up to 1,000kcals, with a percentage C/F/P split of 0/50/50. It's now a Very Low Carb, High Fat diet.

So, 55g/day of fat can be Low Fat, Medium Fat, Highish Fat or High Fat. Which leads to...

3. Confusion

When someone sees the term LCHF (Low Carb, High Fat), they think it means "Eat less carbohydrate and eat more fat". As changes in bodily stores are determined by Energy Balance, eating more fat leads to a slower rate of weight-loss (or even weight-gain), not a faster rate of weight-loss.

By all means cut the consumption of "bad" carbs, like burgers in buns, chips/fries, crisps/chips, pizza, cake, biscuits/cookies, chocolate and sugar sweetened beverages.

However, if you believe that "good" carbs like vegetable produce, legumes, whole grains and whole fruits make you fat and sick, you need to have your head examined, unless you're in the tiny percentage of the population who have genetic carbohydrate intolerance.

See also Insulin Resistance: Solutions to problems.

Nutritional Ketosis: What is it good for?

I have a video in mind...


Having previously shown you what I look like on a diet of ~125g/day low-GL carbohydrates, here are a couple of recent pictures of Jimmy Moore, who's on a very-low-carb, very-high-fat diet (~85%E from fats), a.k.a. Nutritional Ketosis. It involves adding Kerrygold butter to just about everything, even eating sticks of it from a block. I'm not kidding.

I told you I wasn't kidding.

From Google Image Search on "Jimmy Moore" OR "Livin la Vida low carb", images in the last 7 days:-

On 6.7.14.

On 8.7.14.

The only recent footage of Fredrick Hahn, is the following video from the Low Carb Cruise...


To my eyes, Nutritional Ketosis is good for absolutely nothing. Dietary fat can be stored as body fat, in the absence of dietary carbohydrates. Gary Taubes' claim "You can basically exercise as much gluttony as you want, as long as you're eating (only) fat and protein." is pure fantasy, not supported by evidence.

The low protein intake in Nutritional Ketosis, combined with the high serum cortisol that's almost inevitable on this way of eating, results in a loss of muscle mass. I give Nutritional Ketosis a thumbs-down.
 

Summary:-

1) No Energy Deficit → No Weight Loss. There is no Metabolic Advantage to Nutritional Ketosis. See http://www.jbc.org/content/92/3/679.full.pdf

2) Insufficient carbohydrate intake and insufficient protein intake starves the liver & kidneys of gluconeogenic pre-cursors, which raises cortisol, which converts muscle mass into gluconeogenic pre-cursors e.g. Glutamine, Alanine etc. This is standard Biochemistry. No links required.

3) While excess carbohydrates are converted into triglycerides by the liver, excess fats are converted into cholesterol by the liver, which is exported to tissues as LDL-C.

LDL-P ∝ LDL-C. High LDL-P is strongly associated with increased risk factor for CHD. See http://www.lecturepad.org/dayspring/lipidaholics/pdf/LipidaholicsCase291.pdf

CHD is not an inflammation-mediated phenomenon. It's an LDL-P and neovascularisation-mediated phenomenon. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492120/

Postprandial lipaemia is atherogenic. See Ultra-high-fat (~80%) diets: The good, the bad and the ugly.

4) Read Page 10 of https://www.drmcdougall.com/misc/2013nl/feb/pritikinpdf3.pdf, starting from "Could such a cream meal precipitate an angina attack because the oxygen-carrying capacity of the blood is lowered?" It's an actual trial on humans with clogged coronary arteries. It's not a hypothesis.

5) Chronically-raised cortisol causes aggressive behaviour (cortisol is a stress hormone) and adversely affects short-term memory storage in the Hippocampus. See http://evolutionarypsychiatry.blogspot.co.uk/search?q=cortisol

6) Eskimos, Sami, Masai, Samburu, Tokelauans etc, get ~50% of their total energy from fats. There are zero populations that get ≥80%E from fats.


Update 25th July 2014: I appear to have rustled Fredrick Hahn's Jimmies. See https://www.facebook.com/FredrickHahn/posts/10152227780827864

I can safely state that Fredrick Hahn is a liar (I am not poking fun at anybody and I have only blocked him (not his followers) from posting here, for a flagrant breach of my Moderation Policy on his first attempt at commenting), and intellectually-dishonest (for repeatedly mis-quoting me, and using other logical fallacies). He posted the above post knowing that, as I had blocked him on Facebook, I wouldn't see it. I only learned of its existence after a friend PM'ed me on Facebook Messenger. He instructed his "followers" to leave comments here and then accuse me of lying about white-listing, back on his page, because their comments didn't appear immediately. He's a real piece of work! From ABOUT ME:-

Moderation Policy: Comments from first-time & untrusted commenters are moderated ← (click for details). Please be patient. Now that I have a Smart Phone, I can publish your comments during the day when I'm away from my lap-top, but I prefer to type replies on my lap-top. Comments from anonymous commenters, containing links in any form, are deleted.

This is a function of Disqus, as it's impossible to retrospectively white-list a commenter who's never commented here before. There appears to be a severe lack of cognitive function in these people. I really can't think why that is ;-)

Why am I being so hard on Jimmy Moore and Fredrick Hahn? I don't know these people personally.

1) These people are making money out of peddling pseudoscience.

2) These people meet all the criteria in Guest post: Science versus Pseudoscience and have created an alternative science, where sky-high LDL cholesterol, sky-high LDL-P and sky-high postprandial TG's are not risk factors for CHD, but are either harmless or beneficial.

How low-carbohydrate diets are (incorrectly) explained to work.

Having explained how low-carbohydrate diets work, here are a few ways in which they don't work.

Uh, nope!

1. Hormonal clogs: This is a term used by Jonathan Bailor. I don't think he's referring to wooden shoes! The "clog", I'm guessing, is supposedly caused by that dastardly hormone insulin. Uh, nope!

See the following plots of RER vs exercise intensity after being on high-fat diet or low-fat diet.

RER = 0.7 ≡ 100%E from fat. RER ≥ 1.0 ≡ 100%E from carb.

The low-fat diet results in higher RER, so the body is burning a higher %E from carb and a lower %E from fat.

However, this doesn't make any difference to weight loss, as it's merely a substrate utilisation issue. In addition, when the body is burning a higher %E from carb, this depletes muscle glycogen stores faster, which lowers RER during the course of the exercise. So, it's not a problem.


2. Insulin: This is Gary Taubes' hypothesis. Insulin makes your body store carbohydrates as body fat. Uh, nope!

The only time that there's significant hepatic DNL is when there's chronic carbohydrate over-feeding. If you eat sensibly, there's no significant hepatic DNL.


3. A Calorie isn't a Calorie, where weight change is concerned: This is Richard D Feinman's hypothesis. "A calorie is a calorie" violates the second law of thermodynamics, therefore there's a metabolic advantage with low-carbohydrate diets. Uh, nope!

Where to start? Evelyn Kocur knows her Physics, so I'll start there. See The first law of thermodynamics (Part 1) and The first law of thermodynamics (Part 2).

From Second Law of Thermodynamics:-
"Living organisms are often mistakenly believed to defy the Second Law because they are able to increase their level of organization. To correct this misinterpretation, one must refer simply to the definition of systems and boundaries. A living organism is an open system, able to exchange both matter and energy with its environment."

People on ketogenic diets excrete very few kcals as ketone bodies. See STUDIES IN KETONE BODY EXCRETION. There is no significant Metabolic Advantage with low-carbohydrate diets.

How low-carbohydrate diets result in more weight loss than high-carbohydrate diets for people with Insulin Resistance or Type 2 Diabetes.

See The Battle of the Diets: Is Anyone Winning (At Losing?) for trials where insulin resistant people get more weight loss on low-carbohydrate diets than on high-carbohydrate diets, and insulin sensitive people get more weight loss on high-carbohydrate diets than on low-carbohydrate diets.

If Gary Taubes' carbohydrate/insulin hypothesis of obesity was correct, everyone would get more weight loss on low-carbohydrate diets. This isn't the case, therefore Gary Taubes' hypothesis is not correct.

Although insulin is involved, it has nothing to do with "Hormonal clogs" or "Insulin fairies"!

The Aragon Insulin Fairy

The Energy Balance Equation

Change in Bodily Stores = Energy in - Energy out, where... 

Energy in = Energy entering mouth - Energy exiting anus, and... 

Energy out = BMR/RMR + TEF + TEA + SPA/NEAT

See The Energy Balance Equation to find out what the above terms mean.

People with Insulin Resistance (IR), Impaired Glucose Tolerance (IGT) & Type 2 Diabetes (T2DM) have excessive insulin secretion in response to meals (postprandial hyperinsulinaemia). See Hyperinsulinaemia and Insulin Resistance - An Engineer's Perspective.

People with Insulin Resistance (IR), Impaired Glucose Tolerance (IGT) & Type 2 Diabetes (T2DM) also have impaired/no 1st phase insulin response to a sudden rise in blood glucose level. This introduces a time-lag into the negative feed-back (NFB) loop that regulates blood glucose level. If the input rise-time is less than the time-lag in a NFB loop, the output of the NFB loop overshoots. This is standard NFB loop behaviour. Trust me, I'm a retired Electronic Engineer. I've observed this (too) many times!

1. On a high-refined-carbohydrate or high-GL diet, blood glucose level rises rapidly, with a rise-time that's less than the time-lag in the blood glucose regulation NFB loop. Insulin secretion from the pancreas overshoots in a positive direction. The resulting massive postprandial hyperinsulinaemia results in down-regulation of insulin receptors in the brain, which reduces insulin action in the brain. When the insulin level eventually falls to normal a few hours later, the brain interprets a normal insulin level as hypoinsulinaemia. Hypoinsulinaemia results in ravenous hunger, as insulin is a short-term satiety/satiation hormone in the brain (leptin is a long-term satiety/satiation hormone in the brain). Ravenous hunger results in over-eating. Energy in increases. Postprandial hyperinsulinaemia also results in postprandial sleepiness. Energy out decreases. ∴ Bodily stores increase. There are also accusations of sloth & gluttony!

2. On a low-carbohydrate or low-GL diet, there are small fluctuations in blood glucose & insulin levels. There is no ravenous hunger. There is much less/no over-eating. Energy in decreases. There is no massive postprandial hyperinsulinaemia. There is much less/no postprandial sleepiness. Energy out increases. ∴ Bodily stores decrease.

In addition, there is a loss of water weight due to a loss of liver & muscle glycogen. This can be ~2kg in one day (it varies from person to person). Kidneys can increase their output of urine for hormonal reasons. This can increase water weight loss to ~5kg. See Why counting Calories and weighing yourself regularly can be a waste of time.

There are also other hormones involved. For a Facebook discussion with James Krieger that led to the updating of this post, see https://www.facebook.com/james.krieger1/posts/10153228943648587

P.S. In Metabolic Ward studies, food intake is tightly controlled, so postprandial hunger doesn't result in over-eating. Energy expenditure is also controlled, so postprandial sleepiness doesn't significantly affect energy expenditure. This is why varying Fat:Carb ratios (with Protein held constant) makes no significant difference to weight in a Metabolic Ward. See Energy intake required to maintain body weight is not affected by wide variation in diet composition.

P.P.S. Inter-personal variations in postprandial hyperinsulinaemia, postprandial sleepiness & energy out explain the inter-personal variations in weight gain seen under hypercaloric conditions.

P.P.P.S. Insulin Resistance can be fixed in the long-term. See Insulin Resistance: Solutions to problems.

Type 2 Diabetes can be fixed in the long-term. See Reversing type 2 diabetes, the lecture explaining T2D progression, and how to treat it.

Aim to fix the problem in the long-term. If a long-term fix isn't possible (due to excessive destruction of pancreatic beta cells), use a low-carbohydrate diet as an adjunct to medication.

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

Here's another "video" (it has sound and static images only). As I haven't learned how to embed a YouTube video that starts at a specific time, here's a link to it and a picture of it:- Gary Taubes' "Why We Get Fat" IMS Lecture On August 12, 2010 (Part 8 of 8), starting at 8 minutes and 13 seconds in.

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

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

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

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

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

I therefore conclude that itsthewoo is hearing (and seeing) the world through "cognitive bias" Weird Filters , resulting in her hearing what she wants to hear. Sorry!