Synthesis: Guyenet, Colpo, Calories Count, Food Quality Matters, Macronutrient Ratios are Qualitative

This is actually my favorite sort of post to do; more so, even, than the rants here and there. I find it interesting to get two or more perspectives on some issue or controversy, then synthesize them into what I always hope will be a broader context of understanding and in particular, highly accessible to those less interested in the nitty-gritty of the science.

It's a dialectic of sorts, but in this case, doesn't involve any material antithesis. Here, it's actually two pretty compatible theses: one put forth by Anthony Colpo (quantitative); the other by Dr. Stephan Guyenet (quantitative and qualitative). This is a follow-on to my post of yesterday, JAMA: Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance (access the full text of the study here).

I do find this study highly fascinating. I suppose because it has a number of elements that are ripe for debate, and open debate tends to get more people more closer to more truth. I read the thing from start to finish a couple of times, including all the figures and tables. Something just didn't add up for me. I quote from the Comment section (emphasis mine):

The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective. During isocaloric feeding following weight loss, REE was 67 kcal/d higher with the very low-carbohydrate diet compared with the low-fat diet. TEE differed by approximately 300 kcal/d between these 2 diets, an effect corresponding with the amount of energy typically expended in 1 hour of moderate-intensity physical activity.

OK, but then there's this from the Results section (emphasis mine):

Body weight did not differ significantly among the 3 diets.

So I popped off an email to David Ludwig, MD, PhD, one of the researchers. Here's the relevant part:

I was interested in the study just published yesterday [...]

However, I have a glaring question I have been unable to answer after reading the study and looking at the figures and tables:

Where did the 300 calories go LC vs. LF? As I understand it, participants ate isocalorically in crossover fashion, so the only change was the macro ratios. It's also stated that physical activity did not change. So if they ate the same calories, had the same physical activity, maintained the same weight loss throughout, then how are the 300 daily calories accounted for if not in additional weight loss beyond the initial loss?

Perhaps I could learn more from the eMethods supplement as cited in the article. However, the link to the PDF is broken. If you have that PDF I'd appreciate it, and of course any light you could shed on my question so I can pass it on to my readers and commenters.

Anticipating that the answer might be something like: increased bodily metabolism (higher heart rate, respiration, etc, etc), then my follow on question might be what's the point, the advantage?

I got back a very quick response.

The point is that 4 weeks isn't long enough to translate a 300 kcal/d difference into statistically significant weight change, especially when one considers that body weight normally fluctuates by a kilogram or two through the course of a week, based on differences in hydration status, the time of the last bowel movement, etc. We'd need 6 months to reliably see this effect. Nevertheless, there was a slight, and not statistically significant difference in the hypothesized direction, with body weight highest on the low fat diet (data included in the results section).

I've informed the journal about the web site problem with the eMethods. Hopefully they will correct that soon.

OK, now here's the two posts by Guyenet and Colpo.

Hmmm...now comes the hard part, which is where to begin, what to highlight, what to say about it (actually, I worked that latter part all out in the shower this morning). Suffice to say that I like both of these posts for their mutual injection of sanity into what seemed initially to be a lot of attaboys, high-fives, etc., amongst ardent fans of carbohydrate restriction (I count myself a circumspect fan of LC) leading to metabolic advantage (eat as much as you want LC, no problem—I'm not a fan).

Let's begin with what I'd characterize as a strictly quantitative analysis from Anthony. In the first part of his post, Anthony takes time to review the fact that every single metabolic ward study going back to 1935—every single one—fails to find a statistically significant difference in weight loss amongst different sorts of diet compositions (including LC). In other words, weight loss always comes from caloric restriction. He goes into great detail on every single one of these studies in his book, The Fat Loss Bible. He then goes on to address this particular study; kinda doing so with one arm tied behind his back, because he doesn't make a lot of fuss about it not being a metabolic ward study, and thus tightly controlled (for my take, the team did appear to use an impressive array of state of art methods and incentives to motivate decent compliance and record data). An excerpt from the post.

Bodyweight was virtually identical during all three isocaloric diet phases which to me, as a rational indvidual whose head has never been embedded in his culo, quickly refutes the famous low-carb claim that greater weight loss will occur on a low-carb diet at a given caloric intake. At the caloric level calculated by the researchers to maintain weight, the low-carb diet did exactly what the other diets did – it maintained weight. It did not magically produce further weight loss while the other diets simply maintained the status quo.

I could by all rights end the discussion there, but the interesting thing about this study is that the lack of difference in weight status during the 3 diets is being roundly ignored by the very same low-carb advocates who are parading this study as proof of a metabolic weight loss advantage.

Instead, they are wanking on and on about an allegedly greater increase in resting energy expenditure and total energy expenditure experienced by the participants during the low-carb phase. This increase in REE and TEE, they are claiming, is proof that low-carb diets produce greater weight loss – even though the low-carb diet didn’t produce any weight loss at all.

Got that?

Let me attempt a different way of conveying the essential point Anthony is making in hopes of getting just one or two more otherwise breathless LC metabolic advantage fans to take a breath.

Here goes, y'ready? ...

All 21 participants did lose a significant 13% average body weight over 12 weeks on a calorie restricted diet equal to 60% of daily energy requirements.

Did that escape everyone's attention, or only the fact that everybody didn't lose any weight regardless of dietary composition over a separate 12 weeks? And just as the first 12 weeks was designed to lose weight (via caloric/energy imbalance), the second 12 weeks was designed to maintain weight (via caloric/energy balance). Everything went according to plan, so is there really any meaningful news here beyond a curiosity that may merit further investigation?

Let me put it a different way, hopefully getting a few more breathless to take a breath:

Researchers gave 12 people free food, prepared it for them, and promised to pay them $500 if they could stand a 40% caloric deficit for 12 weeks. Additionally, they gave them another 12 weeks of free, prepared food, and promised to pay them another $2,000 if they would eat it and come to the hospital for 9 days of tests.

Again, everything went according to plan.

Another thing Anthony points out is important especially on the basis of what has already happened in the media and some blogs: '300 calorie per day metabolic advantage for low carb; step right up and get your metabolic advantage.'

On the TEE graph, 8 of 21 subjects experienced greater declines in TEE on the low-carb diet when compared to the low-GI diet, and four of these folks experienced similar or greater declines in TEE than they did on the low-fat diet.

So you can see that the true story is a little more complicated and somewhat different to the one low-carb shills are trying to portray. Rather than a clear-cut case of reduced drops in REE and TEE during a low-carb diet, the indvidual results are in fact much more haphazard, with some subjects in fact showing markedly greater drops in REE and TEE during the low-carb diet.

Meaning that if you adopt a low-carb diet expecting an increase in metabolism, based on the results of this study, there’s a very strong possibility you’ll be sorely disappointed.

Colpo goes on to address some of the hormonal markers and such, but I'll set that aside and focus just on the weight loss.

So let's move on to Stephan Guyenet who, while addressing some of these quantitative weight loss issues, also includes a qualitative angle, and it's just this sort of thing that makes for a good synthesis. Stephan summarizes the entire dispute in three points.

1. Calories don’t matter at all, only diet composition matters.
2. Calories are the only thing that matters, and diet composition is irrelevant.
3. Calories matter, but diet composition may also play a role.

The first one is an odd position that is not very well populated. The second one has a lot of adherents in the research world, and there’s enough evidence to make a good case for it. It’s represented by the phrase ‘a calorie is a calorie’, i.e. all calories are equally fattening. #1 and #2 are both extreme positions, and as such they get a lot of attention. But the third group, although less vocal, may be closest to the truth.

Sounds like he might be talking about real food, eh? He continues. You can check the post for his references.

Some people have suggested that the type of food we eat, not just the amount, influences energy expenditure, and in particular that this is related to the diet's carbohydrate content. In people who are not trying to lose weight (4, 5), or who are being overfed (6, 7), the carbohydrate:fat ratio in the diet has little or no detectable impact on energy expenditure, and if anything it favors carbohydrate, but could this be different during fat loss in people who start off overweight? This idea has been called the ‘metabolic advantage’, most notably attributed to the low-carbohydrate diet. The idea here is that you can lose fat eating the same number of calories if carbohydrate is kept low.

I’ve never really weighed in on this because it’s a topic of heated debate, and in any case it’s a fairly academic question. Why is it academic? Because previous weight loss studies have shown that if a metabolic advantage exists at all, it’s quite small, because the effect is undetectable in most studies (8, 9, 10). People who are not associated with the low-carbohydrate community tend to conclude that there's no metabolic advantage when they review the literature (11), although I haven't reviewed it closely myself. It’s clear that where fat loss is concerned, calorie intake is much more important than the amount of fat or carbohydrate in the diet. What previous studies have suggested is that low-carbohydrate diets suppress appetite — often resulting in lower calorie intake (12, 13). The reason for this remains a topic of speculation.

So we begin to come full circle with what Anthony said. To put my take on it, Anthony says it's dumb to believe in any metabolic advantage, while Stephan says it's pointless, because either it doesn't exist or is too small to matter.

At which point, I remind you:

All 21 participants did lose a significant 13% average body weight over 12 weeks on a calorie restricted diet equal to 60% of daily energy requirements.

Now enter the qualitative angle. Stephan again.

That being said, I’m actually quite open to the idea that food quality in addition to quantity can influence body fatness, and I would encourage people to think outside the macronutrient box: there are probably many different dietary factors that can have such an effect. Although this idea hasn’t received much support in the human literature so far, there’s quite a bit of evidence for it in the animal literature.

...Like, real food: meat, fish, fowl, vegetables and fruit, like we evolved to eat? Animals? You mean like all those animals in the wild that maintain body compositions exactly as they're supposed to, when able to eat what they're supposed to eat? And we're not even talking about health, yet. Is an animal going to generally fair healthier on a diet provided by nature, or industrial crap in a bag/box?

OK, so if there's anything that could be termed an antithesis from Guyenet contra Colpo's thesis in this regard, here it is—but it's certainly on no such level that all you have to do is eat zero carbs and you'll lose weight:

Does this support the idea that there is a ‘metabolic advantage’ to low-carbohydrate diets? Well, sort of. It doesn’t change the previous findings that the carbohydrate:fat ratio has little or no impact on energy expenditure during overfeeding, in weight stable people, or during weight loss, but it does suggest that a VLC dietary pattern has a metabolic advantage over a LF diet specifically in the context of weight maintenance after weight loss. It also suggests that a LGI diet has a smaller but still meaningful metabolic advantage in this setting, and that a LF diet are not very effective in this regard. It also opens a whole new can of worms for the research world, investigating the effects of diet quality on energy expenditure.

...It's that last phrase I'm most interested in: "investigating the effects of diet quality on energy expenditure." If that were actually to happen, what would that mean for fans of Paleo and WAPF, allied most specifically because of their advocacy of real, whole foods from all the available sources (sorry, veg*ns, no soup for you!)?

Here's an idea: eat real food first. If I can play loose with the term "metabolic advantage," I'd say that in the end, I think calories count, but that food quality matters. Low to moderate carbohydrate diets—when done right—tend to push out crap food for much better food. Much better food means improved satisfaction, satiation...a greater chance of being in control of appetite, cravings, and so on. Inasmuch as appetite, hunger and satiation are related to metabolism, loosely stated, there's your metabolic advantage, right there.

If this was recognized above all, perhaps we could get off macronutrient ratios and focus on real, quality food. In so doing—unless you're just going to eat tubers all day—you're likely going to be eating a pretty moderate carbohydrate load anyway, and even if that includes potatoes, a pretty low glycemic load (that's index, with over time thrown in because, y'know, time passes by).

The takeaway: Eat. Real. Food. Move. Around. If you need to lose weight: Eat. Less. Real. Food. Move. Around. More.

[As an endnote, I was already well into this post when I learned that Evelyn at Carb Sane also weighed in. We've had our differences, but fair is fair and she raises some of the same questions and issues: A Modest Proposal for Peer Review Research. Check it out.]

Comments

  1. EatLessMoveMoore says:

    Jimmy Moore: “Colpo became irrelevant a long time ago.”

    Funny, a lot of us never got the memo.

    • I’d rather look good naked than be relevant.

      “Metabolic advantage” is interesting because in most settings the diet where you expend more energy while you are resting actually offers a disadvantage. The last thing someone in the Sudan wants is to use more energy while resting.

    • Elenor says:

      But, as someone living in the land of plenty (America), I DO want to use more energy when resting! No disadvantage to me — or to a couple million other Americans who need to waste that energy!

  2. Scott Miller says:

    I’m sure you remember this:
    http://www.proteinpower.com/drmike/weight-loss/ac-metabolic-advantage-dismemberment/

    There is definitely a thermogenic advantage when eating the right foods. And it makes total evolutionary sense for animals to have self-corrective weight management systems (within a reasonable range — 300 cals plus or minus is probably the right ballpark) because no animal in the wild can count calories.

    • Scott

      Yes, good identification. If your going to count calories, then count them and the whole LC thing becomes irrelevant and if you keep the deficit to 300-500 per day average, you lose no matter what, but probably have a easier time of it on real food.

      Or just eat real food and see if nature takes its course naturally.

      Long time no hear from you. Always glad to see you pop in.

  3. Joseph Fetz says:

    I do some of my best thinking in the shower. Unfortunately, the other time that I do my best thinking is when I am trying to go to sleep.

  4. Peggy Holloway says:

    What about insulin?

    • I dunno, Peggy. What about it? My mom, and relatives I know need to take it supplementally. This suggests two things to me.

      1 it’s highly individualistic

      2 it’s a pretty necessary thing

      Do you think that insulin resistance or insulin insufficiency is a big problem for people who are not obese, not diabetic, have never had issues with weight gain, inability to lose fat, etc? Should everyone be wringing their hands and be up in arms over the fact that some minority of the population does have issues with insulin?

    • Paul Bowers says:

      Looks like insulin sensitivity increased across the board in this study, with VLC improving the most and LF improving the least.

      • So Paul, what does that mean to you in your day to day life?

        Do you measure your Insulinz sensitivity regularly?

      • Paul Bowers says:

        Nope, never have measured insulin sensitivity; probably would do regularly – out of curosity more than anything – if I had the resources (equipment, health insurance, $$). I do think increased insulin sensitivity is an indicator of improving overall health. Ideally my body would be diverting energy towards my muscle rather than my fat, which I believe improving insulin sensitivity marks for.

    • ChocoTaco369 says:

      Insulin does not make you fat. Overconsumption of energy makes you fat. I’ve been screaming this for a long time: there is no advantage to a low carbohydrate diet, it’s simply that high protein/fattier foods keep you fuller longer, so you naturally eat less. If you are trying to drop those last 10-15 lbs, you’re going to learn how counterproductive dietary fat REALLY is to weight loss, and you’re going to have to start dropping your fat intake for carbohydrate. That’s the only way to get a similar food volume with less calories: replace high caloric density with lower caloric density.

      You can blame “insulin” all you want, but the fact is insulin is necessary to store carbs as fat because carbohydrate is NOT directly stored as fat. To store carbs as fat, you first have to overeat your TDEE. Then, you have to overfill your glycogen stores. Then, some of the carbs will be stored as fat (while some get stored as muscle, bone, etc). For fat to be stored as dietary fat, all you have to do is overeat. Dietary fat doesn’t need insulin to be stored as adipose tissue because fat is already fat. The ONLY difference is it’s more difficult to overeat fattier foods. Of course, if you eliminate processed foods, the game changes. Anyone try to binge on boiled white potatoes? I can pack in a lot more calories of ribeye than of potato. But, alas, deep fry them in oil and salt them? Now my hunger mechanism becomes faulty, and we’re back to the “food quality” argument.

      Full circle! Cheers!

    • AndrewS says:

      Seriously? Caloric density? How specious. When I’m hungry, I don’t feel the urge to eat 500ml of food. If that was true, I could down a glass of water and be perfectly sated.

      8 ounces of ribeye and I’m full. Back when I ate pasta, I could eat two cups of pasta with lean chicken and I’d still feel hungry — yet be sick of the flavorless crap.

      We’re both in agreement (perhaps?) that the combination of fat and carbs (ice cream, fried potatoes, cake) is more fattening and far more addictive than either alone.

  5. Paul Bowers says:

    Richard, have you scrutinized Colpo’s “tightly-contolled metabolic ward” studies? I did a few years ago and remember them being unimpressed with their “tightness”. For instance, in one of them participants left the ward every day to go to work, returning in the evenings. I think in this case “tightness” is determined by how well the study aligned with Colpo’s view. Even then, many of those studies did show greater weight loss for the LC groups, but because metabolic ward studies tend to have so few participants, gaining statistical significance was difficult.

    And I don’t think you necessarily should to expect greater weight loss in the group with increased energy expenditure if body composition is improved (i.e. less fat/more muscle/increased bone density).

    • I’m not sure about earier revisions but in the latest, he addressed a lot or all of that. In some cases, as I recall, those allowed to leave we’re actually helpers on the lab, invested in results.

      Bit I tend to dismiss all of that anyway, I don’t think there’s much of a reason to hold onto a metabolic advantage since caloric restriction is totally proven, easy to do. If eating real food doesn’t work (and it works for a lot with no counting), then count.

      I’m coming to the conclusion that while LC is a valid method, it’s is being peddled as a scam, a promise of being able to just eat, so long as low carb. I’m becoming convinced we’ve reached diminishing returns.

      • gallier2 says:

        Here I will cite someone you don’t like (and she doesn’t like you in return) but I think it is the best characterization of Colpo to date:


        I’m trying to read Colpo’s interpretation, but he is so aggressive and abrasive it’s hard to even make it through. TO LAFF, the same people criticize me for being hard to tolerate, ha I am a box of kittens compared to this guy. I sort of want to give him some liquid VPA or an emergency haldol shot. Calm down buddie it’s not that serious! Your going to end up in the quiet room!!

        A summary of Colpo’s analysis :

        1) GRRRAAAAAH I KICKED EADES ASS IN 2010!!!!
        2) OKAY, SOMETIMES BUT NOT ALWAYS LOW CARB DIETS LEAD TO A GREATER EE. BUT THEY DON’T WEIGH ANY LESS! [my note: maybe they are just less fat and more muscular, dummie, sort of like you have replaced your brain with muscle apparently.]
        3) I AM RANDOMLY GOING TO MAKE UP NONSENSE AND SAY THAT THE GREATER VLC EE IS BECAUSE OF HYPERCORTISOLISM IN SPITE OF ZERO EVIDENCE THIS IS THE CASE. I WIN.

        4) AND MORE OF A REITERATION THAT A CALORIE IS A CALORIE BECAUSE I AM A BOSS AND I LIFT HEAVY OBJECTS IN AUSTRALIA ALL DAY FUCKER.

      • Gallier2

        Well, I have a couple of posts making fun of Anthony, but as you may know I came back around a few months back. I look past his ranting because it’s always either directed at Eades, or someone who went after him first. He doesn’t—at least it seems to me—go around looking to pick fights with people.

        Have you read TFLB? It’s good, and in the most recent version he has a chapter on Paleo. He’s solidly for it, except for the LC part and he allows for drinking sugar (such as fruit juice) post workout.

        So, I wonder what book this her has written, and I also wonder how many thousands of people she’s helped to shed fat. Moreover, how many thousands have been steered in the right direction concerning saturated fat and cholesterol. Colpo has been around for a long time, has helped thousands, perhaps tens f thousands and his two published works are top notch. Even when I was making fun of him, I still always praised TGCC.

      • I think the difference is between

        low carb as a diet

        and

        low carb as a lifestyle

        I still think it’s great as a diet, worked wonders for me, but I don’t buy it as a lifestyle. When you need to lose fat, expending energy while resting is a positive, if you don’t need to lose fat, on the other hand, that extra energy could have been used to

        hunt food
        gather food
        spread your seed far and wide
        kill your enemies

        rather than being used while you are resting.

  6. I like to think of low carb paleo (LCP) as the first stage in obesity triage. I don’t think there can ever be agreement on the cause of obesity because there isn’t just one cause.

    LCP addresses all of them except eating out of boredom/depression and those relatives who love to force feed everyone. So start there and once you feel good experiment with adding things back in.

    If you have severe reactive hypoglycaemia a calorie is still a calorie but it’s inevitably chased by more of them to overpower your insulin response.. In that case eating high carb/ low fat is a recipe for disaster. It’s like the Chinese take-out problem on steroids.

    I think paleo has so many low carb adherents because the only people trying it are (for the most part) those for whom the conventional approach failed miserably. Does that mean everyone should eat LCP? No. Does it mean you should try it if you’re overweight and nothing seems to work? Definitely!

  7. Teddy P says:

    The deeper underlying question I have is why would anyone want to follow a diet that has a metabolic advantage in the first place? Your body is simply wasting calories if this were the case. Its assumed that
    LC’ers are all in favor of this. Why not eat fiber, metal, tires, bricks, etc… if you truly want a metabolic advantage?

    • Elenor says:

      And you think there is something wrong with wasting calories? “[F]iber, metal, tires, and bricks” do NOT assuage hunger. (For a living being….) The problem with food is –unlike a recovering alkie and his booze — you cannot stop forever eating food. If, as a metabolically deranged person, I HAVE to eat food, but I also need to use as many calories as possible to try to lose weight… then “wasting” energy while sitting or sleeping is a consummation devoutly to be desired!

      Cutting my intake down to 400 calories a day is pretty much guaranteed to screw up my metabolism further, no matter how many pounds melt off (and, as has been shown multiple times, never the same number of pounds as ‘should’ occur on the basis of a calorie is a calorie). So, I have to eat a ‘living wage’ of calories to prevent starvation effects, and thus any “excess” calorie wasting (metabolic advantage) is a good thing!

  8. Hey Richard, have you see this article about American Gorillas ..”Gorillas Go Green: Apes Shed Pounds While Doubling Calories On Leafy Diet, Researcher Finds”

    http://www.sciencedaily.com/releases/2011/02/110217091130.htm

    “In fact, heart disease is the number one killer of male Western lowland gorillas — the only species of gorillas in North American zoos.”

    “Although they take in twice as many calories on the new diet, after a year, the big boys of the primate house have dropped nearly 65 pounds each and weigh in the range of their wild relatives.”

    “Gone is the bucketful of vitamin-rich, high-sugar and high-starch foods that zoos used for decades to ensure gorillas received enough nutrients.”

    We have here animals that are eating twice as many calories as they used to (Essentially, a high fat fermenting diet) and they are losing weight. That seems like a helluv a metabolic advantage to me. What do you take of this?

    • Hey Steve

      I had heard somewhere about this, but not the detail of the additional calories.

      I suspect it’s an issue of nutritional density combined with the way their gut functions contra ours. Pellets are so far off their evolutionary scale that they are able to achieve highly efficient energy absorption, whereas their evolutionary diet of very nutritionally sparse fiber is so inefficient that they have to “overheat” just to get enough and still might not be able to.

      Another way to look at it is that pellets are dense enough to sustain a gorilla weight 65 pounds over normal, but not a diet of greens, so they drop weight to the point where it can.

      So, metabolic advantage? I suppose, but if it can be said to be an advantage, it seems to me it runs the other way: dense, non evolutionary food is highly efficient. They no longer have to spend every waking hour eating.

  9. gallier2 says:

    The fundamental misconception is not that LC has a metabolic advantage, it’s that HCLF shuts your metabolism down (at least for a non negligeable part of the population). The thing is, what is called low-carb nowadays was baseline in older times, only after decades of pushing from big ag, government agencies and misguided experts could this absolutely unnatural and unpalatable rabbit food be considered normal.
    TL;DR it’s HCLF that has metabolic disadvantage. Probably due to the missing cofactores necessary to its correct assimilation.

  10. Paul Bowers says:

    The “tightly-controlled” study I was referring to is the “Metabolic Effects of Very Low Calorie Weight Reduction Diets”. I dug it up and can’t find anywhere in the methods where the author reveal the jobs that the study participants held. It just says the ate their lunches as the job, not in the hospital cafeteria. I don’t know, judge for yourselves: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC425077/pdf/jcinvest00131-0160.pdf.

    Notice that compliance was established indirectly through interviews, urine testing, etc., not through observation. Leads me to believe Colpo’s definition of “tight” is pretty loose; and selectively so.

    Also of note is that the diets really weren’t truly isocaloric: the carb-free diet (both were lc) participants ate an average of 58 kcal more/day. For diets of less than 600kcal’/day, that’s substantial (~10% > for the carbless) and weight loss wasn’t statistically significant. Did Colpo mention this?

  11. dr. gabriella kadar says:

    If it’s weight loss that is desired, then from my own experience a diet that is high in carbs and restrictive in caloric intake is a suffering type diet: chronic feelings of hunger.

    Like you, Richard, I am not an advocate of the low carb diet. And there are carbs, like from potatoes, sweet potatoes and yams, that do not induce hunger pangs which cereal carbs and sugars do.

    According to information from archeological digs in Central Asia and the southern Ural region, people about 4500 BC at the corms or bulbs of water plants. No grain though. No dental caries either. They were not Paleo and they were not Neolithic either since they didn’t farm. They did herd and hunt. I think that their dietary was probably setting a better balance than assuming that Paleo was extremely low carb. The Native people of the west coast of what is now Canada consumed a diet that contained a wealth of starchy food sources and many, many plants and berries. These people were not grain farmers and to all intents and purposes they were Paleo.

  12. I’m not sure, Paul, but Colpo does cover every single metabolic ward study in English that had been performed at the time of writing TFLB. There were a number of them (about 30 comes to mind) and for several as I recall, he dutifully reported any of these sorts of issues he was aware of.

  13. Gabriella:

    To clarify, I am a “circumspect” fan of LC, meaning: if it works for you, you get good results, etc. I’m not a fan of the idea that it has some magical property in terms of metabolic advantage. And even if it did, it would be a pretty small one and far outweighed by the proven effectiveness of caloric restriction. Just an average 300 kcal per day restriction adds up to 30 pounds per year.

    Otherwise, yea, there are lots of different dietary compositions and those who claim Paleo is all about meat and fat, never about starch are ignoring huge swaths of the earth that primitive ancestors migrated too and thrived.

  14. I’m a 60-20-20 guy and with 8% bf and I’m happy with my diet. However, I wanted to mention that the CRP levels did not really rise with the low carb diet. They were just reduced less than with the other diets, but were still lower than the pre-weight loss baseline. These are the numbers provided by the study:

    Pre-weight loss baseline CRP: 1.75 (0.44 to 4.61)
    Low fat diet CRP: 0.78 (0.38 to 1.92)
    Low glycemic CRP: 0. 76 (0.50 to 2.20)
    Low carb: 0.87 (0.57 to 2.69)

    Normal range, by the way, is less than one.

    Low carb cortisol, however, did increase slightly. These are the numbers:
    Pre-weight loss baseline: 58 (47-73)
    Low fat: 50 (41-60)
    Low glycemic: 60 (49-73)
    Low carb: 71 (58-85)

    Normal range, by the way, is between 10 and 100.

    Bottom line: the variation shown within the diets’ subjects, albeit it is a small sample, clearly indicate that not all diets are good for all people and some diets are best for some people.

    I find it insulting that certain people want to force others to eat certain way based on these studies, that in reality do not include a truly representative sample of the world’s population. besides, who the fuck are you to tell me what to eat.

    LC metabolic advantage? For some people? Who cares? You can always get off your butt and burn more calories!

  15. Hi Richard,

    Sadly the reason low carbs are thermogenic seems pretty obvious to me.

    As an avid snow shoe and trail runner, descended from Canadian Indians and Norther Europeans, it seems to me the more North you go, the more “low carb high fat” the average year round diet becomes.

    So given a higher carb safe starch diet enjoyed in the paleolithic near the equator runs us cooler, and a low carb paleolitch diet in the arctic circle runs us warmer, yet neither causing additional loss of energy storage, it makes sense from a survival point of view.

    Being low carb in the winter, and snow shoeing all over, I greatly enjoy the thermogenic effect, it keeps my skin warm and makes the day more enjoyable. I love the fact that the starchers are huddling into their coats and complaining about the cold.

    Just personal experience and a thought to share.

    And only my opinion.

  16. To add to that, there are no accidents in nature. Nature’s design is perfect. If we run hotter while low carb then there is a good reason and I am going to bet its a thing called “winter”

  17. dr. gabriella kadar says:

    I think the primitive ancestors were probably as interested in finding bulbs, roots and corms as they were in finding animals to hunt or seafood to collect. Traditionally, archeological digs weren’t all that focused on the midden heaps or pits. Fossil bones were always easier to find and identify. These days the focus has changed and hence the remains of plant fibres, seeds etc. are being dissected from the various sedimentary layers around ancient habitation sites.

  18. Come on up to my neck of the woods this winter and show me those abundant bulbs and roots, nobody has pulled it off yet.

    In the winter in North Bay, the bush gives meat and not much else.

  19. Let’s be careful of confirmation bias here.

    If a study of this quality had been published and revealed a 300 kcal metabolic advantage of unknown origin for a paleo diet, we’d all be exchanging high fives and yelling “WOOOOOOOOOO”. 300 kcal is a significant number — and the attempts to explain it away have so far been very unsatisfying:

    * “300 kcal isn’t that significant anyway” (Yes, it is…that’s 12-15% of daily intake. To burn 300 kcal with exercise, you’d need to run about 2.5 miles or walk about 3.5 miles.)
    * “There was substantial individual variation” (Of course there was. But that doesn’t change the fact that, on average, 300 kcal is significant.)
    * “OMG CRP went up on LC!” (No, it went down by 50%, vs. 57% for LG and 55% for LF. Feel free to argue that this is a highly significant difference.)
    * “OMG cortisol!” (This is to be expected. Cortisol triggers gluconeogenesis, which is necessary to some extent on a diet of 10% CHO. The 22% increase (vs. +3% for LG and -15% for LF) left it well within normal physiological range. If this worries you, eat 15-20% CHO.)
    * “OMG thyroid!” (T3 is a necessary part of glucose metabolism AFAIK. Again, an expected result. Note that TSH was essentially unchanged.)

    And, of course, we have to neglect all the other positives for the LC group:
    * 20% greater HDL than the LF group
    * 39% lower TG than the LF group (Together these correlate with a greatly reduced risk of heart disease)
    * Increased insulin sensitivity

    It should be clear by the fact that I recommend the Jaminets’ “Perfect Health Diet” (among other sources) that I am not an inveterate low-carber. However, it’s always important to double-check study results with observed reality. As I noted in my interview with Richard, a great many people see initial success on low-carb, especially those who have failed repeatedly on other diets — and though low-carb often doesn’t get them all the way to their goal weight (because it’s not the only factor in fat gain), I see religion creeping back in here. “CICO! Eat less, move more!” (With the unspoken implication always being “you’re fat because you’re lazy, unlike me.”)

    Unlike the recent red meat scare, this isn’t a population study based on self-reported data known to be inaccurate. If we want to make progress, we need to accept, understand, and explain results like these — not explain them away with claims that they’re not significant.

    JS

  20. Of course, the gluttony and lazy implication is often packaged with eat real food, not garbage, as it is with ELMM.

  21. dr. gabriella kadar says:

    Various water plants have bulbs. They can be roasted, dried and pounded into a powder to be used later. Northern peoples didn’t just eat fresh meat all the time. They made things like pemmican. Not all pemmican contained only dried powdered meat and fat. Besides dried berries, pemmican could also contain the starches from water plants.

  22. Danny J Albers says:

    Pemmican contained none of that until the voyageurs started purchasing it. The complained of the lack of taste.

    And even then it barely blips on the calorie radar as far as carb percent. Pemmican with blue berries is still low carb high fat. You are warping reality to fit your theory.

    You do not generally add plants to pemmican and its rarely done even now.

    You come and eat those water bulbs. They suck to harvest, taste like crap, are miniscule in yield and unavailable 65% of the year. Nobody here would bother to preserve one. Ive never even seen the at traditional feasts.

    As far as Northern Ontario and what my ancestors eat Im gonna go with reality here. There is really no natural highly abundant wild source of carbs here for the majority of the year. And yes, meat only was often a reality for Jan-April when all the stored plants had mostly been consumed. The further North you get the more true it is.

    Even the sainted wild rice is tourist fodder. Its not consumed much and certainly not in quantity to push the diet into a carb based one.

  23. What happened to them when they bumped into a bunch of guys who had spent a couple of thousand years fueling themselves with glucose?

  24. Paul Bowers says:

    they adopted their diet (not necessarily by choice) and got fat and diabetic.

  25. Richard,
    Excellent “dialectic” and great post in general.
    With regard to the hugely-popular-in-the-blogosphere REE discussion, I have one comment. Most of the change in REE likely occurred during weight loss, when everyone was eating the same thing. Any subsequent changes in REE, and thus anything that could be attributable to differences between the three “weight-loss maintenance” diets, would’ve paled in comparison. In other words, I think the diet-induced differences in REE are being overestimated.
    Bill

  26. Richard,
    What has always bothered me about calories is people treat them as actual things and not a unit of measurement like miles per hour. Asking here the extra calories go is like asking where your airline miles are stored. Maybe the enough fats in the LC were pissed away as ketones?

  27. Anna K. says:

    I think it’s important to note that LC diet is easier to do then HC because of the appetite suppression.

  28. Re: Jeff’s comment above about pissing out fat as ketones: There is one thing I wonder about but have never seen addressed in these types of discussions concerning calories in/calories out, etc.

    We think of calories out as used for living: maintaining temperature, movement, etc. But has anyone studied whether our bodies can regulate ‘calories out’ more literally, by NOT absorbing all the caloric content of foods and instead disposing of unneeded calories the same way we dispose of other waste products? Has anyone studied (gulp) the residual caloric content of feces under various conditions?

    If such a mechanism exists, then there is a major variable to these discussions that needs to be considered. Perhaps eating “…Like, real food: meat, fish, fowl, vegetables and fruit, like we evolved to eat? Animals?” conditions us to better maintain appropriate body fat levels by simply dumping (i.e. not absorbing) unneeded calories.

    Seems like a much simpler weight control mechanism, if it exists. Anyone aware of any research on this?

    • John, that’s a significant question, especially if you are ignoring the answer and you are following a conventional “calories in minus calories burned = calories stored as body fat. There is not a lot I could find readily on the web, so please indulge me if I post a couple of relevant items here:

      Wikipedia 21 March 2012:
      [This article is about faeces in general, not about human faeces.]

      … After an animal has digested eaten material, the remains of that material are expelled from its body as waste. Though it is lower in energy than the food it came from, faeces may still contain a large amount of energy, often 50% of that of the original food.[3] This means that of all food eaten, a significant amount of energy remains for the decomposers of ecosystems. …
      =========
      “Energy content of stools in normal healthy controls and patients with cystic fibrosis”
      Arch Dis Child. 1991 April; 66(4): 495–500.
      J L Murphy, S A Wootton, S A Bond, and A A Jackson
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793018/
      Abstract
      Stool energy losses and the sources of energy within the stool were determined in 20 healthy controls and 20 patients with cystic fibrosis while on their habitual pancreatic enzyme replacement treatment. Stool energy losses were equivalent to 3.5% of gross energy intake in healthy children (range 1.3-5.8%). … Stool lipid could account for only 29% and 41% of the energy within the stool in controls …. Approximately 30% of the energy within the stool could be attributable to colonic bacteria …. the energy content per gram wet weight remains relatively constant (8 kJ/g),…
      [KT: … 1 kJ = 0.239 kilocalories. So 100g of faecal matter would contain 191 kilocalories. By way of comparison, USDA tells us:
      • Chicken meat and skin has 216 kcal/100g
      • Sardines in tomato sauce has 185
      • Avocados have 160
      • Eggs (raw) have 143]
      =============
      On this basis I make a point of tossing into conversations about avocados the ‘little known fact’ that its calorie content is about the same as sh-t. However, I am surprised at this figure – I would have expected something closer to 100 kcal/100g.

  29. Is there any data in these studies on body composition besides body weight? I’ve been on LCHF for 3+ years. I now weigh about the same as when I first started, but my body fat percentage has gone down and my waist circumference is two inches smaller. It strikes me that studies that only focus on changes in “body weight” may be overlooking subtle changes in body composition, e.g. in muscle mass vs. fat mass.

  30. I used to really not like Colpo but have grown to really appreciate his insights. As much as he rails against MAD and LC he eats a paleo diet of whole foods but consumes natural carb sources. He is really an easy going guy and will happily discuss diet and exercise. I have traded quite a few emails with him to my surprise.

    Evelyn can blast him all she wants. I doubt he even knows who she is. He pulls me back to reality when I get wrapped up in these internet scuffles and reminds me that interacting with real people is much more fulfilling.

    • Rodeo says:

      Chris tamme: carbsane is on colpo’s blogroll and Evelyn hasn’t blasted him.

  31. Isabel says:

    Have you seen Peter Attia´s post on this study? The best and most rigorous interpretation I have seen so far:

    http://eatingacademy.com/

  32. Anna K. says:

    Isabel, great article.
    “While it is mathematically true that someone who has gained weight has consumed more energy than they have expended, using the First Law to explain why someone gains weight is of little help. The First Law is descriptive but not explanative.”

    It’s similar to the main point Gary Tubes brought up. Fat people are sick of hearing – just eat less and exercise more. It’s not that simple.

    • “It’s not that simple.”

      It actually is, in absolute, practical terms.

      The problem is that LCers have to have magic. They just can’t be content with the fact that they likely have a psychological advantage, but still need to go into caloric deficit one way or another.

      Perhaps that’s why so many of them are so sickeningly religious. ….always looking for magicical kingdoms. It’s endemic.

    • FrankG says:

      Just who are these LCers of which you speak in such generalized terms? Do you mean all, some, many a few? Do you find it productive or conducive to reasonable discussion to tar everyone with the same brush? People you have never met nor know anything about?

      I guess I might be described as an LCer based on the way I choose to eat; although it certainly does not define me as a person.

      Speaking just for myself, I need NO magic and (despite a strict Roman Catholic upbringing) I consciously shy away from ANY religious leanings… preferring to base my decisions on rational thought instead.

      For my part, the fact that eating LCHF – real, whole food including dairy but avoiding grains and most starches – the fact that this leaves me satisfied and not continually hungry between meals, is ALL the metabolic advantage I need.

    • Anna K. says:

      I agree with Frank, this is very unlike you Richard to make such broad generalized statements about LCers. I also eat LC, but not because it’s magic but because it works for me. I used to eat every 3-4 hours or I get very hungry, now I can go for a day without food and I’m fine. And I’m not fat or diabetic and have no major issues with health ,don’t need to loose weight. But LC greatly improved my energy levels, stamina, appetite control, mood swings, pms, etc. and I like it, I don’t need more carbs. But I’m not religious about it, some days I eat more (100), some less (30), some days I fast, some days I even eat bread! (not very often).

      And what is LC anyway??? under 30? 50? 100?

    • “Just who are these LCers of which you speak in such generalized terms? ”

      The ones who hit a road block with it yet keep doing the same thing over and over, expecting a different result. There’s tons of them. Finally, it looks like Jimmy Moore at least has changed things up and looks like it’s working so far.

  33. Anna K. says:

    Richard, didn’t LC work for you? why did you do it if it’s only about calories in and out??? You could try limiting protein and fat, not carbs to reduce your caloric intake.

    Also, I do maintain that it’s not just calories, it’s about appetite control, feeling more satiated, feeling more energized, etc.

    did you read the study? it clearly points to the fact that not all calories are created equal.

    “The group consuming a very low carbohydrate diet had a higher REE and TEE than the low GI group, which had a higher REE and TEE than the low fat group. In other words, the fewer carbohydrates in the diet, the higher the resting and overall expenditure. This is actually the sine qua non of the alternative hypothesis: something beyond the actual number of calories is playing a role in how the body expends energy.”

    • Steve says:

      Ultimately, I think what Richard is saying is that when your go low carb, you end up feeling satiated at a lower caloric count, which then allows you to lose weight down to your bodies natural set point. Processed foods and various non paleo foods for some people disregulate their metabolic systems and force their bodies into a higher unnatural set point.

    • “did you read the study?”

      Did you read my post?

  34. Anna K. says:

    And it’s not about magic or religion of LC, but about practical reality. Most people in reality do better on LC to lose weight then on LF or calorie counting. Sure there are exceptions, but for most people LC just works.

    • You would also lose weight by replacing that pre-packaged crap in a box and that can of coke with your 6″ subway sandwich with fruit and potatoes and still noticed the same weight lose without calorie counting – that’s the point. It’s not low carb – its real food. I dare the religious LC’er here replace some fat with fruit and potatoes.

  35. Steve says:

    Instead of worrying about caloric density, focus on nutrient density, and that means focusing on meats, dairy for some, veggies, and fruits. If you can handle organ meats then that’s a big plus. I think some people focus on calories making you full, when our body craves other things as well, not just energy

  36. lorraine says:

    I don’t read all the LC blogs, but I do read a lot, and I’ve yet to read the Ludwig study being championed by the LC’ers as proof that metabolic advantage is defined as the ability to lose more weight per same caloric intake. The finding has more relevance as it relates to maintenance of weight loss, immunity against weight regain, which is how I think most are actually defining metabolic advantage. That’s the even bigger nut to crack. The study authors even state this as the purpose of their investigation, although they didn’t actually test this idea by overfeeding after weight loss. And in that infamous dust-up between Colpo and Eades over metabolic advantage, many of the details of which are forgotten to me because it just got so out of hand, Eades reiterated that as a clinician he sees people way overeat LC and not gain weight, and that’s what he was calling metabolic advantage. Can 300 kcals a day over a serious amount of time add up to a weight loss advantage? Who knows, but you can’t project that out from a 30 day result. NuSI, the group formed by Gary Taubes and Peter Attia appear to be working on doing a follow-up study to this Ludwig study, and doing it as an over-feeding study; again, defining metabolic advantage as protection against weight regain.

    I’m unaware of the LC crowd that claims that all you have to do is reduce CHO to lose weight by magic. Taubes/Eades/Volek/Phinney/Westman have always taken the position that caloric deficit is absolutely necessary for fat loss, but that low carb suppresses hunger which makes caloric deficit possible, and it better maintains lean mass during weight loss, improving composition. I’m sure there are many people who’ve interpreted what these experts say as meaning that you don’t have to worry about calories, but none of those experts have ever said that. Not all calories are equal, doesn’t equate to don’t worry about them. That people are not executing sufficient caloric deficit on LC could account for many of the failures.

    And maybe in some worlds it does only take 300-500 calorie deficit to lose weight on real food and move more, irrespective of macronutrient. But in my working world of menopausal women, thyroid patients and diabetics, a superhuman compliance to a 300-500 kcal deficit over many months and years gets nowhere.

  37. george henderson says:

    The question to test: is losing 300kcal/day through metabolic “advantage” as slimming as losing the same through a) eating less or b) exercising more?
    In other words, will it make one as hungry to eat 300kcal more?
    If not, why not?
    Are we instead looking at a pharmacological effect of ketosis on appetite and activity when VLC works, of which the “advantage” is merely a marker?

  38. For me the issue with carbs goes beyond weight. Yes, going LCHF/EatRealFood/Paleo has enabled me to lose over 50 pounds from my processed food vegetarian days, but more importantly it improved several other aspects of my health even when barely a few pounds had started to come off. Deciding to stick with low carb has as much to do with weight to me as it does many of the toxic effects that sugar is being linked to, including diseases that are not typically thought of as being obesity related. So while the metabolic advantage, if any, is one interesting avenue of investigation for the merits of being low carb, it’s hardly the only one.

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