What gives is that I’m stuck in the airport in Seattle – my flight to Chicago is delayed for almost four hours because of bad weather in the Windy City.  I figured I would use this time to stick up a quick post about thermodynamics and provide a long quote from Robert McLeod, who writes Entropy Production, a physics (sort of) blog.  As you can see below, he pretty much trashes Bray and other nutritional researchers who blithely use the 1st Law of Thermodynamics to prove the old a-calorie-is-a-calorie notion.  To show the way the average nutritional writer looks at this law, I needed to find a quote.  As it works out, the only thing I have with me is Anthony’s book The Fat Loss Bible, which just happens to have the perfect quote.  So, sorry AC, I’m not really trying to pick on you.  And you certainly aren’t the only nutritional writer who thinks this way – you’re just the only one who has a quote handy I can use.

The First Law of Thermodynamics states that energy can neither be created nor destroyed. It can only be converted from one form to another. In other words, energy just doesn’t just magically disappear; it must be converted to something else. In the case of any excess calories you ingest, they will be stored as fat, used to accommodate an increase in lean tissue mass, or dissipated as heat through thermogenesis. Manipulating the proportion of protein, fat and carbohydrate you eat each day will not excuse you from the Law of Thermodynamics.

This is the way just about all nutritional scientists and writers look at the First Law.  Let’s take a look at how a physicist sees it.  Robert McLeod wrote a long post a while back reviewing Gary Taubes’ Good Calories, Bad Calories.  Near the end of the post, he discusses the energy balance equation and one of our old friends, Dr. George Bray, who gave Gary’s book a bad review in an obesity journal.  (I posted on this same review a couple of times here and here.)

Here’s what he says:

I was somewhat confused to see this [a nutritional description of the energy balance equation] Surely the nutritional scientists did not not really believe this, right? I mean, any idiot undergraduate students knows that the 1st Law is only useful in a closed system, and humans live on the planet Earth, not in an insulated box. Right?

Enter a rebuttal by G. Bray in the journal Obesity Reviews. Bray is a to be a major obesity researcher and one of the 2nd tier villains in the book. Taubes relates a story of Bray excising a section of a British report on obesity, where Bray removed the material pertaining to the relationship between insulin and obesity. He clearly has editorial support to make his case. Bray is one of the second-tier villains in Taubes’ book. Taubes has a footnote (p. 421), which suggests that Bray actively suppressed the carbohydrate-insulin hypothesis.

“According to Novin, when he wrote up his presentation for the conference proceedings Bray removed the last four pages, all of which were on the link between carbohydrates, insulin, hunger, and weight gain. “I couldn’t believe he would make that kind of arbitrary decision,” Novin said.”

Unfortunately, to a physicist this energy balance hypothesis looks like a silly hand-waving exercise, not a serious argument. Frankly I was flabbergasted when I first read this article. This conservation of energy argument is on the same scientific level as the ridiculous “drink cold water to lose weight” idiocy. A human organism is:

1. Not in thermal equilibrium with their environment. Last time I checked I have a body temperature around 38 °C and spend most of my time in 21 °C rooms.
2. Capable of significant mass flows (e.g. respiration).
3. Capable of sequestering entropy (e.g. protein synthesis).

Is wearing a sweater fattening (by insulating you from your environment)? Here’s a quote from the rebuttal,

“Let me make my position very clear. Obesity is the result of a prolonged small positive energy surplus with fat storage as the result. An energy deficit produces weight loss and tips the balance in the opposite direction from overeating.”

According Bray’s thermodynamics argument, wearing sweaters makes you fat. This illustrates the greatest fallacy of trying to apply the 1st Law to a human: it makes the implication that living organisms consume kilocalories for the purpose of generating heat rather than perform useful work (i.e. breathing, contracting cardio and skeletal muscle, generating nervous action pulses, etc.). In reality heat is the waste product of basal metabolism. The first law does not distinguish between different types of energy. Heat, work are all equal under the First Law of Thermodynamics.

Applying the 1st Law to living organisms is Proof by Tautology. Yes, 1 + 1 = 2, but this tells us absolutely nothing about the underlying mechanics. The 1st Law does not (I repeat N-O-T) tell us whether you store excess energy in the form of fat, or bleed it off into the atmosphere by dilating blood vessels next to the skin, sweating, etc. To do so would require an accounting of entropy.

What would a semi-rigorous description of the thermodynamics of a human organism look like? Look at the title strip on the top of the page. See that equation in the background?

[The above is the background of the header of Robert McLeod's blog]

This type of equation would be a bare starting point for energy balance in a complex system like a living organism. Good luck actually accounting for all the terms. Those Σs are sums.

The media is alive today with advanced reports that the January issue of O magazine contains an interview with its namesake Oprah Winfrey in which she divulges that she has once again become obese. (here, here and here)

Apparently the queen of daytime TV (and my neighbor down the street) has ballooned up to 200 pounds.  And, if her statement on the cover of her magazine can be believed, she wonders how it happened. I’ve read a few of the articles, most of which quoted her from the advance copy of her January magazine.  As I read her quotes I realize that despite all her fame and wealth, she is basically just like any other middle-aged woman prone to obesity.  Let’s let her talk.

I’m mad at myself…

I’m embarrassed. I can’t believe that after all these years, all the things I know how to do, I’m still talking about my weight. I look at my thinner self and think, ‘How did I let this happen again?’

I was so frustrated I started eating whatever I wanted — and that’s never good.

I felt like a fat cow. I wanted to disappear.

I definitely wasn’t setting an example. I was talking the talk, but I wasn’t walking the walk. And that was very disappointing to me.

When it comes to maintaining my health I didn’t just fall off the wagon. I let the wagon fall on me. I didn’t follow my own fundamental rule of taking care of self first.

Sound familiar?

During my recent Photo food diary blog, a number of people commented that I had it easy because MD prepares all my food, as if the only reason I can stay thin is that someone waits on me hand and foot.  Well, Oprah has an entire staff to prepare whatever she wants whenever she wants it, and it hasn’t helped her.  Apparently all the money in the world and all the ability to hand pick any expert or consultant she might want to hire have not done the trick.  What’s the deal?

Why does Oprah have such a problem?

As you might imagine, I have a few thoughts on the matter.

According to Oprah’s biography, she was born to a poor single mother in rural Mississippi.  I would assume that her mother, like most poor rural people, consumed primarily a carb-based diet.  Why?  Carbs are cheap.  One of the reason poor people are fatter in general than well-off people, is that poor people eat a lot more carbs for budget reasons.  Another reason poor people are fatter is a little less known, but surely applies to Oprah.

When pregnant women load up on refined carbohydrates during pregnancy, especially during the first trimester, they end up damaging the developing pancreas of the fetus.  The pancreas is pretty much developed during the first trimester, so a chronic high load of glucose in the mother’s blood that crosses the placenta ends up programming the fetal pancreas in much the same way that a huge chronic glucose load over a long time in adults creates insulin resistance.  This situation has been published about extensively in the medical literature.  The phenomenon is called fetal programming.  Babies born are basically  programed to become insulin resistant and obese.  These kids tend to develop obesity and insulin resistance more easily than others and have a tougher time dealing with it.  I’m sure that Oprah falls into this category.

Just like any adults who have glucose intolerance, insulin resistance, and/or diabetes, these fetally-programmed people tend to do better on low-carbohydrate diets than on low-fat/high-carb diets.

The only diet Oprah really did well on was the Optifast diet, the one on which she lost 67 pounds and looked great.  The Optifast diet is the high-protein, low-fat, low-calorie diet that Oprah followed for four months.  She then appeared on her show in a pair of size 10 jeans.  The problem with the Optifast diet is that people who finish the program are encouraged to begin following a low-fat maintenance diet.  Many people lose a lot of weight on the diet, then turn around and go face down in all the food they’ve been denying themselves while they lost.  Oprah is no exception. She speaks of her experience after the show with the size 10 Calvin Kleins.

I had literally starved myself for four months — not a morsel of food. Two hours after that show, I started eating to celebrate — of course, within two days those jeans no longer fit!

The only Oprah Winfrey show I’ve ever seen is this very show.  She looked fabulous, which is usually the situation when people lose weight while getting plenty of protein.  Her face didn’t look gaunt.  She didn’t lose her muscular tone – she looked tight and healthy.  She obviously does well on a low-carb, high-protein diet.  She just needed to be on a different one, one for the long term.

For whatever reason, Oprah fought the idea of a low-carb diet for years.  Then, when she decided to go on a low-carb diet, she ended up selecting probably the worst low-carb diet she could have chosen: the Carbohydrate Addicts Diet (CAD).  For those who don’t know, the CAD recommends that people follow a strict low-carb diet all day, then allow themselves to eat all they want of anything they want for an hour – the so-called Reward Meal.  I didn’t see the show, but I was told by those who did that Oprah said that she liked macaroni and cheese and wondered if she could eat that on the diet.  The authors of the CAD responded that not only could she eat all the macaroni and cheese she wanted during her Reward Meal hour, but that she should throw in some apple pie for dessert. (If any readers of this blog saw that show and have a different remembrance, set me straight in the comments.) This kind of eating is the worst possible way of eating for those with insulin resistance.  And those people who try it usually fail because what appeals to them is the idea that they can eat all they want of whatever they want for an hour a day.

Many obese people do this same thing without calling it the CAD.  They wake up in the morning, skip breakfast and head to work.  Then they eat a salad for lunch.  By the time they get home, they are starving, so they eat everything that’s not red hot or nailed down, then promise themselves that they will do much better tomorrow.  Then repeat.

It’s no wonder Oprah failed on the CAD.  She probably ate 300 gm of carb per day along with everything else.  Problem is, she thought she was on a low-carb diet when she really wasn’t.  She then made the pronouncement that she had tried a low-carb diet and it hadn’t worked.  She tarred every low-carb diet with the CAD brush when she really didn’t try a low-carb diet at all.  In fact, the only time she tried anything approximating a low-carb diet was when she did the Optifast program, and those results spoke for themselves.  She could do the same thing now with a good quality, whole-food low-carb diet.  It may take a little longer than the four months it took her on Optifast, but she could stay on the program forever.  Just like I do.  You saw my food diary.  Did it look like I was denying myself a lot?

The second major problem that Oprah has is directly related to her fame and position.  Because she is who she is, she can have access to anyone she wants to have access to.  And she makes the same mistake all people in her position seem to make.  When she has a health problem, she turns to Harvard or some other big-name institution to get advice.  The problem with that is that all the people at Harvard and other big-name institutions are as mainstream as mainstream can get.  They are also far removed from patients care.  They haven’t had an original thought in years.  I would be willing to bet that yours truly has more first hand experience taking care of overweight middle-aged females than the entire faculty of Harvard and Yale put together.  But when Oprah (or any other celeb) has a problem, where does she turn?  To Mehmet Oz, Harvard grad, and a low-fatter of the deepest dye.

She tries low-fat, stays hungry, and as a consequence binges or at the very least eats a lot of stuff she shouldn’t be eating.  She is never going to win the battle against hunger because it can’t be won.  Sooner or later, she (and anyone else) will give in to hunger.  Fighting it is a losing battle.  On a true low-carb diet she a) wouldn’t be as hungry, and b) could eat something filling if she were.

But, unfortunately, she’s tied into all these low-fatters with the big school reputations and she’ll never gain control.  And, sadly, she’s taken the tack of the chronically overweight.  She’s ‘accepting’ her obesity. According to the reports

Winfrey also writes that her goal is no longer to be thin; instead, she wants to be strong, healthy and fit.

Uh huh.  I’m not trying to be sarcastic because I think the situation is pitiful.  Here is a beautiful, intelligent, creative, talented woman who is giving up on a relatively easy quest.  All her other accomplishments were much more difficult than losing weight, but she knew what she was doing.  For weight loss, however, she is listening to idiots.  And their advice is wrong.  And she hasn’t lost.  So she’s giving up.  It’s really sad.  Especially since one can’t really be fat and be healthy.  She’s fooling herself.  If she’s overweight, she’s got a metabolic problem that isn’t being dealt with.

Like many unsuccessful dieters, she is blaming her glands.

during the spring of 2007, Winfrey reported that she developed an underactive thyroid problem.

Controversially, Winfrey suggested that she had chosen diet and stress reduction as her thyroid treatment approach, and emphasized that her dietary regimen relied heavily on soy products, antithyroid goitrogens which are known to aggravate and worsen thyroid conditions in some people. Winfrey did an episode of her show with Dr. Christiane Northrup, during which she again controversially signed on to Northrup’s belief that thyroid problems develop in women who suffer an energy blockage in the throat region, and result from a lifetime of a woman’s ’swallowing’ words she wants to express. [Jesus wept.  God help us all.] More recently, Winfrey reported that she was going on a several week vegan dietary “cleanse,” but the diet included tofu, tempeh, soy sausage, soy milk, soy yogurt, and soy products on the menu nearly every day, sometimes more than once.  Oprah did not report any weight loss on this diet. To date, Winfrey has not reported receiving any medical treatment, or taking any prescription medication, for her thyroid.

She may well have an underactive thyroid, which may mean that she needs nothing more than a little iodine.  Or she may need some thyroid hormone.  What she doesn’t need is soy and a vegan cleansing diet.  Her thyroid problem, if she has one, can be easily dealt with.  What may be more problematic are her sex hormones.  She will be 55 in late January of next year, so she’s either menopausal or peri-menopausal, and as such probably needs to have a hormonal workup and bioidentical hormones.

Oprah may have to work a little harder to overcome her fetal programming than others who may not have had her in utero experience, but it can be done.  She needs to have a hormonal workup, get things balanced hormonally, get her thyroid dealt with, and go on a quality whole food, low-carb diet.  If she were to do this, she could lose the weight she wants to lose and become healthy.  There’s really nothing much to it, but if keeps on relying on the people she’s relying on…  Well, she’ll keep getting the same results.  For her sake, I hate to see it happening.

Oprah is viewing her situation as a hopeless condition and is obviously despairing.  I view it as the same problem presented to me by thousands of overweight middle-aged women in my own office. As I explained to them, it’s like any other problem.  It’s easy to solve if you have the knowledge and the right tools.  And as these patients proved again and again, with the right knowledge and the right tools it can be done.

Think again.

A story appeared in the online version of Time Magazine last year that I read when it came out, put aside to blog about later, then got sidetracked.  A reader sent me a link to it a few days ago, which brought it back to the front of my mind.

The article discusses a study being done in Germany using a carb-restricted diet to fight cancer.  In pre-WWII days, a German scientist, Otto Warburg, received a Nobel Prize for his work in sussing out the fact that cancer cells don’t generate energy the same way that normal cells do.  Cancer cells get their energy, not like normal cells, from the mitochondrial oxidation of fat, but from glycolysis, the breakdown of glucose withing the cytoplasm (the liquid part of the cell).  This different metabolism of cancer cells that sets them apart from normal cells is called the Warburg effect.  Warburg thought until his dying day that this difference is what causes cancer, and although it is true that people with elevated levels of insulin and glucose do develop more cancers, most scientists in the field don’t believe that the Warburg effect is the driving force behind the development of cancer.

But it stands to reason that it can be used to treat cancer that is already growing.  Since cancers can’t really get nourishment from anything but glucose, it stands to reason that cutting off this supply would, at the very least, slow down tumor growth, especially in aggressive, fast-growing cancers requiring a lot of glucose to fuel their rapid growth.

Thomas Seyfried (the same Thomas Seyfried mentioned in the article) has shown that ketogenic diets in animals and humans can stop malignant brain tumors.  There is no reason to believe they wouldn’t work in humans as well.

A group in Germany is looking at such diets in a small pilot study.  Patients are only admitted to the study when all standard therapies – chemotherapy, radiation, surgery, etc. – have failed and they have basically been sent home to die.  In fact, a few were so far gone that they died within the first week of starting the study. You couldn’t ask for a study group more destined for failure, but, according to the Times article

The good news is that for five patients who were able to endure three months of carb-free eating, the results were positive: the patients stayed alive, their physical condition stabilized or improved and their tumors slowed or stopped growing, or shrunk.

If you understand the Warburg effect and the metabolism of cancer cells, it’s easy to see why this therapy works, even in patients who at at death’s door.  Since the cancers can use only glucose, and since glucose is made in the cancer cells slowly and inefficiently, the cancer cells have to rely on outside glucose to provide nourishment for their rapid growth and replication.  People on very-low-carb diets produce ketones, which take the place of glucose in other cells that can use these ketones for fuel.  But cancer cells can’t use the ketones since ketones have to be burned in the mitochondria, which are dysfunctional in cancer cells.  If you can keep blood sugar low, then growth of the cancer cells may be held in check long enough for the body’s own previously overwhelmed immune system to rally and beat the vulnerable cancer back.

Now, given all this, if you had a big cancer eating you alive and you were offered a chance for salvation by doing nothing more than following a low-carb diet, would you take it?  I certainly would.  But, not everyone does. I was stunned to read the comments of Dr. Melanie Schmidt, one of the researchers, about people dropping out of the study.

[Some] dropped out because they found it hard to stick to the no-sweets diet: “We didn’t expect this to be such a big problem, but a considerable number of patients left the study because they were unable or unwilling to renounce soft drinks, chocolate and so on.”

Let me see if I’ve got this right.  A lifesaving therapy is offered to patients who have undergone the misery of radiation therapy, chemotherapy, and surgery, and who are beyond hope, and this therapy requires nothing more than eating a lot of butter, meat, cream, cheese, etc. while avoiding most carbohydrates.  And a considerable number” drop out because they can’t give up carbs?

I say it again.  And you don’t think carbs are addictive?

As a coda to this post, I’ve got to tell you that MD at this very moment is rolling out a fondant that she made a couple of days ago.  She was dragooned into making the birthday cake for our granddaughter whose party is tomorrow.  The kid doesn’t want a store-bought birthday cake, she wants a custom-made cake by her Nanny, which has become a tradition.  She wants a Razor (a Swat Kat) cake, so MD is having to free-hand it.  Although she’s never made a fondant before, she figured that would be the easiest way to frost and decorate the cake she has in mind.  I wandered over to get a cup of coffee and pulled off a tiny piece of the stuff and popped in my mouth just to see what it tasted like.  Her fondant is made with powdered sugar, corn syrup, and lard (not the vegetable shortening called for in the recipe), and it is good beyond belief.  I’m sitting here writing this post, and after a tiny, tiny piece (maybe 3/4 inch by 1/2 inch by 1/8 inch) of fondant, I am obsessing over how easy it would be to walk the 10 feet to where it is and start throwing it down by the handfuls.  So, yes, carbs are addictive.  Especially the carb-fat combo.

Lest you get the wrong idea, our granddaughter’s parents keep her on a kid’s version of the low-carb diet most of the time.  The cake is a once a year deal.  Thank God.

Hodgson Mill, near Gainesville, MO. Built in 1884 Photo by Hemant (click to enlarge)

Someone I know gave me a look at a book by a guy named Dr. Gregory Ellis, who is a Ph.D. body builder and an ex-pro footballer, and asked me to take a look at it. The book suffers from being self published and not having the helping hand of a professional editor. It is way overwritten and about three or four times as long as it needs to be (it’s about the size of the Little Rock, AR telephone directory) to make the case Dr. Ellis is trying to make.

Dr. Ellis, like my good friend from Down Under, is a firm believer in the calorie is a calorie is a calorie theory. In fact, he is such a firm believer that it seems to have reached the point of almost being a religion to him. His book contains 26 chapters, and starting with Chapter 3 (I don’t know why he didn’t start with Chapter 1, but he didn’t) and going all the way through the rest of the 26 chapters, he puts this statement at the top of the chapter page:

Calories Count! The Energy Balance Equation is weight control’s Golden Rule: it’s Ultimate, Irrefutable, and Holy Law. Calories consumed cannot exceed those burned off without gaining weight. The myth of the “fast” and “slow” metabolism that varies widely from person to person – is just that, a myth. It’s a myth that Uncle Harry “eats everything in sight and remains slim.” It’s a myth that Aunt Alice “gains weight at the whiff of a hot muffin.” Resting metabolism depends on body size and we can predict it by a formula; we aren’t that different. And large differences in the amounts eaten only come because one person is far more physically active than another. The Law is always obeyed. It’s unbreakable. All are accountable. No one escapes; no one is above the Law. This is the First Principal, failure to learn the Law will lead you to failure in bodyweight regulation. “But,’ you say… there are no Buts! [all bold text in the original]

This same statement – word for word, bold text for bold text – is how 21 chapters out of 23 start, so it’s got to be assumed that Dr. Ellis finds this important. Extremely important.

(It is obvious that he is unfamiliar with or oblivious to the multitude of overfeeding studies that give the lie to this notion, but we won’t go in to that now.)

The reality is that our bodies have the capacity to deal with calories by changing the rate at which we burn them. Calories in and calories out are dependent variables, not independent variables: the one depends upon the other. Let me show you what I mean and explain why it’s often so difficult to lose weigh while dieting.

It always drives me nuts when people use a car or another piece of machinery as an analogy to the human body. Why? Because in a car the gasoline in/gasoline out equation (the energy balance equation for a car) works the way Dr. Ellis thinks it does in the human body. You put gas in the tank, and if you run the engine harder (exercise for the car), you burn more gas. And it can be easily calculated how much you’ll burn at a given engine speed on level ground. And it can be replicated. As the gas runs low in the tank, the car can’t help itself get better mileage to conserve.

If a car is going to be used as an analogy to the human body, we need to include the driver to make the system perform more human-body-like. We have a body and a brain – the car has a body and a brain (the driver).

A few years back MD and I were driving through the Ozarks in southwest Missouri where I grew up. We had just been to visit Hodson’s Mill, pictured above, the mill where my maternal grandfather used to take corn on muleback to be milled when he was a kid circa the turn of the 20th century. The countryside is beautifully picturesque with loads of hardwood trees, rolling hills and large bluffs, the Ozark Mountains. We were riding in an SUV, and as we motored along, I suddenly noticed that the gas gauge was banging on empty. Then it dawned on me that it was a Sunday, and it was likely that in rural America there weren’t going to be a lot of service stations open. Especially not out where we were. And I didn’t even know exactly where we were relative to any towns because I hadn’t been paying close attention to the road signs. I went into gas conserve mode. As we approached hills, I timed my speed so that we would barely make it to the top, then be able to coast down and halfway up the next hill before I had to hit the gas pedal. I let my coast speed build up to way more than I felt comfortable with given the winding roads and blind curves, all the while trying to ignore MD’s sharp intakes of breath, her legs and feet pushed against the floorboard braced for collision, and her death grip on the handhold. Even though I was driving a gas-guzzling SUV, I’ll bet I milked 40 miles to the gallon out of that sucker until we finally found an open service station, and the day was saved. Once we were filled up, and I was back at the wheel driving normally, we probably dropped back down to the 18 mpg range.

If I’m running late and in a hurry, I get a lot less gas mileage than normal. I race up to stoplights, slam on the breaks, floor the accelerator when the light changes – all activities that minimize gas mileage, but get me wherever I’m going a little sooner.

In both of the cases described above, it’s the car/driver combo that makes the difference. It’s the same with our bodies. Numerous overfeeding studies have shown that when weight-stable people are overfed huge numbers of calories over varying periods of time, their body weights change minimally, at best, just a fraction of what would be estimated based on their increased caloric intake. Why? Because their body/brain combination is performing much like my driver/car example when I’m trying to get somewhere in a hurry. I waste gas in exchange for speed; these overfeeding subjects waste calories in exchange for stable body weight.

Underfeeding or starvation studies show just the opposite. When people are fed calorically-restricted diets, they go into kind of a metabolic slow down process to conserve fuel just as I did with the vehicle when we were running out of gas. These calorically-restricted subjects become lethargic – they move less and they sleep more. Their reduced calories in induces their bodies to reduce the calories going out.

This phenomenon is called adaptive thermogenesis, which is defined as increase or decrease in energy expenditure in response to overfeeding or underfeeding (or even temperature change).

Adaptive thermogenesis is the reason that my friend from Down Under, who is so taken with his metabolic ward studies showing no difference in weight loss irrespective of dietary macronutrient composition, doesn’t understand or believe in the metabolic advantage. In his book he has assembled a number of studies done in metabolic wards (sort of; but that’s a topic for another post) showing that subjects fed primarily fat or primarily protein or primarily carbohydrate all lose the same amount of weight. These papers show that it doesn’t really matter what the protein/fat/carbohydrate composition of these restricted diets are, the subjects all lose the same amount of weight. Which to our friend, who hasn’t really bothered to think it all through, proves that dietary composition doesn’t matter. He, like Dr. Gregory Ellis, believes it is simply a matter of calories, not macronutrient composition. And most of the studies he lists seem to corroborate his belief. But there is a problem. A big one.

Virtually all of these studies are ones in which the subjects are severely restricted in calories. In some the caloric restriction is so great (500 kcal total intake per day) as to be truly starvation diets. When the body is severely calorically restricted, it uses every scrap of food that comes in. It burns protein; it burns fat; and it burns carbs. And it burns them efficiently. During starvation it doesn’t matter what the composition is, the body simply consumes the calories. And, under those circumstances, it makes perfect sense that there would be no difference in weight loss regardless of what the ratio of macronutrients happens to be.

As the caloric intake increases, a point is finally reached at which the body can afford to be a little more discriminating as to what it does with the calories coming in, and at that point the macronutrient composition begins to matter. As the caloric intake increases, as it does in the overfeeding studies, there comes a time at which the body again doesn’t particularly care what the macronutrient composition is – there is simply too much of everything, and so the body blows it all off.

In between these two points, in the caloric range where most of us operate most of the time, macronutrient composition does matter. In fact, in our friend’s book, he actually lists a couple of studies in which there does appear to be a metabolic advantage. And guess what? Those are studies in which the caloric intake is up more in the range one would expect while dieting, not starving. And those studies do indeed show that a low-carb diet brings about more weight loss than an equal number of calories given as a high carb diet. These studies were done in Germany under metabolic ward conditions by a researcher named Udo Rabast. Dr. Rabast did the studies mentioned in this book plus a few that weren’t mentioned because, although they were done under metabolic ward conditions, they didn’t fit the selection criteria of our friend, i.e., they didn’t show what he wanted them to show to substantiate his argument. The Rabast studies do indeed show a fairly robust metabolic advantage to the low-carb diet. The two studies that were mentioned were sort of included in the book chapter as oddities, I suppose. So how did our friend deal with these studies. He blew them off. He simply stated that since all the other studies he presented don’t show a metabolic advantage, then these have to be aberrations and should be ignored. Don’t believe me? Here he is in his own words:

Regardless of whether Rabast el al’s findings were the result of water loss from glycogen depletion, pure chance, or some other unidentified factor, they should be regarded for what they are: An anomaly that has never been replicated by any other group of researchers. For a research finding to be considered valid, it must be consistently reproducible when tested by other researchers. As proof of the alleged weight-loss advantage of low-carbohydrate diets, the findings by Rabast and colleagues fail dismally on this key requirement.

Could the “some other unidentified factor” possibly be a metabolic advantage? Methinks so.

There is another study in his list showing a large metabolic advantage that he totally misinterprets, but we’ll leave that one for another day. I want to write on it in more detail because it shows all the problems inherent in these kinds of studies. And in the interpretation of them by people with little experience and/or an axe to grind.

Following a low-carbohydrate diet that is in the calorie range where the metabolic advantage exists makes one able to lose weight without the weight-retaining effects of adaptive thermogenesis kicking in. You can, so to speak, have your cake and eat it to. The body is getting enough calories to keep it from going into starvation mode yet the macronutrient composition of the diet leads to enough of a caloric deficit to ensure weight loss. The best of all worlds.

The phenomenon of adaptive thermogenesis is getting a lot of play currently in the scientific literature. There are a number of researchers who feel that certain factors have changed in our environment making it more difficult for us to lose weight once we’ve gained it. And making it easier to gain in the first place.

I’ll address these factors in a later post and show how you can overcome them.

About a month ago I posted on a Swedish overfeeding study and how the results were misreported in the press. This study showed that increased carbohydrate intake can cause an increase in certain liver enzymes associated with the metabolic syndrome. Along with this liver enzyme data the authors reported on metabolic rate changes that are instructive in our quest to determine the existence (or lack thereof) of the metabolic advantage.

I would imagine that most people reading this blog have had problems with excess weight sometime in their pasts. Those of you who have struggled with overweight probably have little sympathy for those who have the opposite problem – that of inability to gain. Despite how easy it seems for those with weight problems to gain weight and especially to regain lost weight, it is extremely difficult for many people to gain weight almost irrespective of how much they try.

The medical literature is full of overfeeding studies in which subjects are encouraged to eat substantially greater amounts of food than they typically eat in an effort to get them to gain weight. Probably the most famous of these are the Vermont prison overfeeding studies conducted by Ethan Sims back in the 1970s. These studies, like the starvation studies of Keys, would probably never make it past the ethics review today, and will likely never be repeated.

Sims and his team overfed prisoners and found that despite being overfed the same number of calories there were large differences in the rate of weight gain between individuals. And he discovered that when the overfeeding stopped, there were differences in the rates at which inmates lost the weight they had gained. One of the lessons from these studies is that individuals have different predispositions to gain and lose weight independent of caloric intake.

Another lesson is that overfeeding tends to increase metabolic rate, allowing a dissipation of many of the excess calories consumed. As I’ve pointed out before, the calories in/calories out part of the energy balance equation are not independent variables. In other words just because you decrease (or increase) calories in doesn’t mean that calories out stays the same. Virtually all overfeeding studies show that there is much less weight gain than the increased caloric intake would predict. This effect is so common that German researchers in the early 20th century gave it the name luxusconsumption, meaning the wastage of calories by increasing metabolic rate during overfeeding.

We can see luxusconsumption at work in the Swedish fast food overfeeding study. The authors were a little hazy about the actual caloric consumption of the subjects, reporting it differently in two places, so we really can’t use their figures for our own calculations. The table below shows the increases in weight and metabolic rate during the 28 day study. We can make some calculations from these numbers.

Since the data isn’t broken out by male/female I did my calculations based on all the subjects being male since two thirds of them were. I worked backward from the BMI and calculated the average height of the subjects as being 176 cm.

I used the Harris-Benedict equation to determine starting and ending resting metabolic rates (RMR). The Harris-Benedict equations were developed in 1919 and have been used extensively since then. A few researchers have come along and improved on them since, but most of the online RMR calculators use the Harris-Benedict equations, so that’s what I used. These equations assume that given a sex, height, and age that the RMR correlates with weight, which is one of the reasons many people who should know better state categorically that RMR is simply a function of weight.

My calculations show that prior to starting the overfeeding, the average subject should have had an RMR of 2064 kcal/day. After 28 days of overfeeding and a 6.4 kg ( 14 lb) weight gain, the RMR calculates to 2152 kcal/day, about a 4% increase.

When the Swedish researchers measured the RMR directly using the ventilated hood technique they found a starting RMR of 1615 kcal/day that increased to 1813 kcal/day, a little over a 12 % increase.

Weight increased from 67.6 kg to 74 kg, a little over a 9% increase, while the RMR increased by 12% as compared to the 4% predicted by the Harris-Benedict equation. This measured increase in RMR that is greater than the weight gain would predict is luxusconsumption in action.

Another name for luxusconsumption is metabolic advantage. Metabolic advantage is defined as a lesser weight gain than a given number of extra calories consumed would predict, and is brought about by an increase in metabolic rate driven by the diet. In other words, calories in increase calories out to a greater extent than the calories in. The subjects in this study were definitely experiencing a metabolic advantage.

As more calories are consumed, luxusconsumption increases. And this effect takes place irrespective of the type of calories – macronutrients – consumed. The metabolic advantage is firmly established in the medical literature dating back over 100 years and was once again confirmed in this study. The debate we’ve been having is whether there is a different metabolic advantage for differing macronutrient consumption, i.e., does restricting carbs produce more of a metabolic advantage than restricting fat in diets of the same number of calories. We will address this in a future post, but for now I want everyone to realize that a metabolic advantage does exist and has been demonstrated countless times.

Before we proceed to the question of metabolic advantage and macronutrient consumption there is one other notion we need to discuss and clarify: data presented in medical studies as averages of all the data collected. This often confusing issue will be the subject of the next post.

Yesterday a reader sent me a film clip from ABC news about resistant starch. (Click here to view the video) In this film clip a young woman who is a registered dietitian (RD) spoke about the virtues of a “type of fiber” that she referred to as resistant starch. According to her, this substance can cure a multitude of ills.

There is a type of fiber called resistant starch that’s naturally found in some high carbohydrate foods.

And it’s amazing, the benefits. It ranges from helping us burn fat, helping us boost our immune system, control blood sugar, reduce the risk of type II diabetes and reduce the risk of cancer.

She’s really excited because, as she points out, there are over 160 studies showing the benefit of resistant starch.

Wow! Where do I sign up to get some? It sounds great. Or does it?

There are probably over 1600 studies showing the purported benefits of statin drugs, but we all know what those are. The 160 studies purporting to show benefit for resistant starch are probably in the same mold. Let’s forget about the studies right now and focus more on what we really know about starch and resistant starch to see how well this lady’s claims hold up to scientific scrutiny.

When asked about how resistant starch works, she claims that

it basically gets fermented in the digestive tract, and it creates beneficial fatty acids. One is called butyrate. And what that does is it helps to shut off the burning of carbohydrates. So carbohydrates are the preferred source of fuel, but if they can’t be burned, your body is going to turn to body fat and recently consumed fat instead.

All fiber goes through the digestive tract unabsorbed until it reaches the colon where it is acted upon by colonic bacteria (I suppose you could loosely call it fermented) that convert it to short chain fatty acids, one of which is butyrate (a four-carbon fat). These short chain fatty acids can be absorbed through the colon and used for energy just like any other fat.

So if butyrate “shuts off the burning of carbohydrates,” as our RD says it does, then wouldn’t it make sense to get as much of it as we can? And what happens to all that carbohydrate we don’t burn? Does it just continue to circulate in the blood running our blood sugar sky high? Or does it get stored as glycogen? Does butyrate encourage carbohydrates to head into storage? These are all questions she doesn’t address. Let me help clarify.

The list of foods containing resistant starch she mentions specifically are the following:

• Beans
• Potatoes
• Barley
• Corn
• Brown rice
• Under ripe bananas

She claims that these foods contain about 5 percent of their starch as resistant starch (which prety much agrees with other similar claims I’ve seen in the medical literature). If true, this means that 95 percent of the starch is not resistant starch and breaks down in the GI tract to glucose.

One half cup of any of these foods – so she says – contains all the resistant starch one needs to provide all the above benefits. Let’s take a look.

According to the USDA database if we consume a half cup of cooked potato we’ll end up with 12.9 grams of carbohydrate (almost three teaspoons), of which 10.5 grams are starch. If we go by our RD’s estimate that 5 percent of the total starch is resistant starch, we calculate that our half cup of potato contains about half a gram of resistant starch (0.5265 g to be exact). If we then convert this starch to butyrate we find that we have about 2.3 grams of butyrate (assuming 100 percent conversion to butyrate, which isn’t the case because some is converted to other short chain fatty acids).

So, we eat our half cup of cooked potato, and what do we get? We get almost three teaspoons of sugar and carb that convert almost immediately to glucose and head directly into the bloodstream. The blood volume of a person with a normal blood sugar contains about a teaspoon of sugar, which means that consuming the potato almost quadruples the amount of sugar in the blood. The pancreas then secretes insulin to drive this excess sugar into the cells. This extra insulin then does all the things excess insulin is famous (or infamous) for doing.

But what about the butyrate from the resistant starch? Oh yeah, the 2.3 grams of butyrate. I don’t see how the butyrate is going to do much to stop the insulin spike resulting from the ingestion of the sugars and starch from the non-resistant starch part of the potato. And even if butyrate really does all it is cracked up to do, we wouldn’t really need the potato with all its accessory easily absorbed carb because we can get the equivalent amount of butyrate from a single pat of butter. (Or almost the same – a pat of butter contains 1.45 g butyrate. Two pats of butter contain 3 g or about 1.5 times the amount generated by the resistant starch component of the potato.)

If the benefits of the resistant starch come from its conversion to butyrate as our RD avers, and if it requires the amount per day found in only one half cup of potato (or of the other foods she lists) as she also avers, then why not provide ourselves with one and a half times as much by eating a couple of pats of butter per day, which come without the extra three teaspoons of sugar? We get the butyrate without having to convert and we don’t get the extra carbs. Makes perfect sense to me.

Amazingly, our RD recommends adding the half cup of one of the resistant-fat-containing foods to the rest of whatever you’re eating that day. So, if you’re already on a ‘normal’ diet, i.e., one pretty high in carbs already, she is recommending that you add, say, a half cup of cooked potato to the mix so that you will ‘lose fat, reduce blood sugar, and lower insulin levels.’ Hmmm. Sounds a little snake oily. Sounds like she’s telling porkies.

While I’m at it, I have to mention one other little porky she tells during the interview. Says she

…and because resistant starch doesn’t get digested or absorbed it fills you up but you don’t get any calories from it.

Okay. Let me get this straight. First, she tells us that it converts to butyrate, a fat, which is absorbed and works miracles once it is absorbed. Second, she tells us that we don’t get any calories from it. Have I got that right?

She is correct in saying that resistant starch (as well as any other type of fiber) gets converted to short-chain fatty acids. And she is correct in saying that the short-chain fatty acids get absorbed. But when they do get absorbed, they contain 9 kcal per gram, just the same as any other fat. So they are not free of calories. That’s why fiber is counted in the total calorie count on nutritional labels. Fiber does make it’s way through the upper digestive tract without being absorbed, but it does get converted to fat and absorbed in the lower GI tract, i.e., the colon. So, I guess we could say she’s a fibber when it comes to fiber. At least in terms of its calorie content.

This brief discourse should put you off of resistant starch even without knowing what anti-nutrients are (resistant starch is an anti-nutrient), why they’re there and what they do. We’ll save that for a later post.

Now that you know the real story behind resistant starch, go back and watch the video to see how filled with misinformation it really is. Which also goes to show why you should never believe anything like this you see in a short spot on a news program without checking it out first.

Hat tip to Terry for sending me the video clip

In late November of this year Gary Taubes gave a number of talks to members of various departments at the University of California at Berkeley. One of these talks – The Quality of Calories: What Makes Us Fat and Why Nobody Seems to Care – was recorded and can be viewed by clicking here. You need Real Player to watch the video. If you don’t have it, simply Google real player or real player mac and you will find a free download of the program.

Gary’s talk expands on one of the theses in his book Good Calories, Bad Calories: the idea that obesity isn’t caused by gluttony and sloth, but by excess carbohydrate intake instead. If you haven’t read the book or if you have and you want the weight-loss section explained in greater depth, this video is for you. He’s a little more open than he was in the book about naming names and pointing the finger at people who for whatever reason can’t see the forest for the trees. The video is long – almost two hours – but well, well worth watching.

I’m going to be seeing Gary in about a week. We’ll have one of our many hour visits at a coffee house in downtown Manhattan. If anyone has a question for Gary, put in in a comment, and I’ll ask him as many as I can while I’m overdosing on caffeine.

So take a break from your Christmas shopping this weekend, kick back and watch this video. You’ll be glad you did.

Hat tip to blog reader Art D for giving me the heads up on this one.

For those of you unaware of the tempest in a teapot drama that has been going on for the past month or so, here’s the story.

About two months ago I wrote a post describing the Ancel Keys starvation studies of the 1940s and compared the data from these studies with those published by John Yudkin about 25 years later. I selected the Yudkin study because the subjects switching to low-carb diets spontaneously dropped their caloric intake to 1560 kcal, which was almost exactly the same as the 1570 kcal the Keys subjects consumed. I wrote then that I wasn’t

…truly comparing apples to apples with these studies, but they do confirm Yudkin’s 15 years of experience before he wrote his paper and they confirm my 20 plus years of experience taking care of patients on low-carb diets. I’ve had many, many patients who have stayed on low-carb diets for much, much longer than the men in Keys’ experiment stayed on their diets of roughly the same number of calories. Most of the papers in the medical literature on low-carb diets show a spontaneous drop in caloric intake that’s about what Yudkin documented when people switch over to low-carb diets. It stands to reason that if someone had replicated Keys’ experiment using the same number of calories, but with much more fat and a lot less carbohydrate, that the outcome would have been much different.

When I wrote those words it was at the end of a long post and I was ready to be done with it. I could have probably said what I meant a little better. If anyone wants a more comprehensive explanation of why I chose this specific Yudkin study, let me know, and I’ll post on it later.

This Keys/Yudkin post got Anthony Colpo agitated to the max. Why? As near as I can figure, for a couple of reasons. First, I said I thought that calories aren’t always calories in the way most people think of them. Second, because I implied that such a thing as a metabolic advantage exists. And third because in response to one of the comments I had the temerity to opine that I thought Colpo might be wrong on the metabolic advantage issue.

That’s it. That’s what has inspired all the name calling, accusations of idiocy and other foaming at the mouth that has been going on since.

It started with an open letter to me that I received by email. Here is a pdf of the letter, email and follow up that I copied from Anthony’s site. an-open-letter-to-dr-michael-eades.pdf

As you can see when you read it, Anthony is fond of using fonts to make his points. One wonders where he is going to get all the fonts he may need as this interchange ensues?

For some reason Colpo seems to have a lot of his ego tied up in being correct on the metabolic advantage. After doing what he considers his due diligence, he has decided that there is no metabolic advantage, and that anyone who says there is qualifies as a moron. Richard Feinman and Eugene Fine both believe there exists a metabolic advantage, ergo they’re morons. Same holds for Gary Taubes. Last thing I read from Anthony was that he hadn’t read Gary’s book yet, but he (Colpo) had heard that Gary refutes the calorie is a calorie idea, ergo Taubes is a moron. Same goes for me for all the same reasons. Colpo has gotten so worked up over this issue that he has actually taken the time to write a 50 page book attacking Taubes, Feinman, Fine and me. You can download your very own copy below.

Now as you read all this sturm and drang remember that what we’re talking about as a metabolic advantage is at the max about 300 kcal per day. That’s the most I’ve ever seen demonstrated in a study, so that’s probably the outside range. Calorically that represents about two frankfurters per day or a medium bagel. What that means is that if you figured out how many calories you had to eat to maintain your weight on a low-fat diet, you could consume that many very-low-carb calories plus the two frankfurters and still maintain your weight. Of course, if instead you ate the bagel, which has about the same number of kcal as the two wieners, you would lose your metabolic advantage because almost all of its calories are carbs.

So we’re not talking about a whole lot of calories here. It’s not as if I’ve written that you could eat 10,000 kcal per day and still lose weight as long as you follow a low-carb diet. I’m talking about a few hundred calories per day at best. It’s just not that big a deal. Certainly not a big enough deal to make all this fuss over.

Before I give you my thoughts on the metabolic advantage issue, I want to speak for Feinman, Fine, and Taubes, even though they haven’t asked me to.

Feinman and Fine are experts on the laws of thermodynamics, a subject on which they have published a number of papers. Recall in an earlier post of mine that of all the laws of nature, the laws of thermodynamics are the least likely to ever be overturned. Even Anthony Colpo with his self-proclaimed towering intellect hasn’t been able to defy or refute the laws of thermodynamics.

The very nature of the second law of thermodynamics implies that there has to be a metabolic advantage. Feinman and Fine published a paper stating this and discussing a number of recent papers showing that there does indeed appear to be a measurable metabolic advantage that accrues to those following a low-carb diet. Here is another Feinman/Fine paper and another in pdf. thermodynamics-and-metabolic-advantage-of-weight-loss-diets.pdf

I seriously doubt that Anthony Colpo can understand the math, biochemistry and/or the reasoning in any of these papers. But he doesn’t have to because, you see, he just knows that there isn’t a metabolic advantage, so anyone who writes a paper saying that the second law of thermodynamics virtually demands that there be one is a fool. Thus his criticism of Fine and Feinman. No substantive discussion of their work; no intelligent criticism; simply a dismissal because their work contradicts what Anthony believes with all his heart to be true.

Same with Gary Taubes. I suspect that Anthony has yet to read Gary’s book, which lays out in great detail the basis for his ideas. Colpo heard that Gary wrote that one can consume more calories on a low-carb diet than on a low-fat diet and still lose weight, which is all Anthony had to hear. It saved him from having to read that great big book because he just knows Taubes has to be an idiot to write such twaddle. Never mind that Gary researched the subject in greater depth than anyone who has ever written on it – that doesn’t matter. What matters is that after spending five plus years of his life studying the subject Gary’s conclusions contrast with Anthony’s. Therefore Gary is just another diet book author preying on the simple minded to harvest his millions.

Since this entire brouhaha stems from a difference of opinion on the existence of a metabolic advantage, let me go on the record and state my opinion.

I didn’t just wake up one morning and decide that by God there is a metabolic advantage, and that’s all there is to it. My opinion has been formed by my comprehensive reading on the subject (contrary to what Colpo thinks, he is not the only person who reads the medical literature. I was humping it to the medical library and pulling papers when Anthony was still in diapers) and my 25 plus years of medical practice taking care of overweight people. I do think that calories count. That is an unquestionable fact. But they don’t count in the way most people think they do. Let me explain.

Insulin is the primary metabolic hormone responsible for both storing fat in the fat cells and keeping it there. If your insulin levels are up, fat is on a one way street into the fat cell. And it’s pretty much trapped there until insulin levels fall, allowing fat to escape. When you go on a low-carb diet, you reduce insulin levels markedly, and you do it quickly. You put yourself into a metabolic situation in which fat can easily flow from the fat cell to the tissues where it is burned. But just because you’ve put yourself in a situation where fat can easily come out of the fat cell doesn’t necessarily mean that it will. In order for the fat to come out, you must create a caloric deficit.

If you are eating enough fat (the main macronutrient on a low-carb diet) to meet all your body’s energy needs, your fat cells have no reason to give up their fat, and they don’t. Despite the door’s being open, the fat won’t come out unless it’s needed.  Even on a low-carb diet you have to create the caloric deficit to get the fat out and get it burned and lose weight. So far, it all sounds pretty Anthony Colpo-ish, but that’s about to change.

As far as I’m concerned there are two parts to the metabolic advantage question. One that will send our good friend Anthony into a rage – another that will make him absolutely apoplectic.

First, the metabolic advantage in the context of diet is simply measured as the difference in caloric intake required to lose weight on either a low-fat or a low-carb diet. Let’s say that you closely monitor a group of subjects on a low-fat diet, and you find that as their caloric intake falls to, say, 1800 kcal per day, they begin to lose weight. Above 1800 kcal they hold steady or start to gain; below 1800 kcal they lose.

Now you start those same subjects on a low-carb diet. You find that now they start to lose weight as their intake drops below 2000 kcal and they maintain at 2000 kcal or above. This 200 kcal difference is the metabolic advantage created by the low-carb diet. In other words, on the low-carb diets these subjects can eat 200 more kcal than they can on a low-fat diet and still lose weight. The scientific literature is full of studies showing this phenomenon, so don’t let Anthony Colpo tell you it doesn’t exist. Plus the second law of thermodynamics predicts it. And looking at the biochemistry it’s easy to see why.

Basically what happens is that the body uses more energy to maintain blood sugar levels during a low-carb diet than it does during a low-fat diet. When you eat glucose or starch it hits the blood as glucose, so there isn’t really any energy expended in converting it. When you don’t eat enough carbs to provide all the glucose the body needs, the body has to make it from protein. It’s obviously more costly energy-wise to make glucose from protein than it is to use the glucose ready made. Colpo mistakenly believes this energy has already been accounted for as the thermic effect of the protein, which is higher than the thermic effect of carbohydrate or fat. The thermic effect of protein is simply the energy required to metabolize the protein normally, not that required to run it through the gluconeogenic machinery to convert it to glucose.  This latter process consumes more energy.

But wait, there’s more. The increased dietary fat in a low-carb diet increases the mitochondrial density within the cells, and this fat also increases the synthesis of uncoupling proteins that dissipate energy within these mitochondria. Along those same lines data indicate that both the elevated fat and subsequent ketone formation increase the proton leak across the inner mitochondrial membrane, which dissipates even more excess energy. And this doesn’t even include the increase in futile-cycling that can go on within the mitochondria, getting rid of more.

Now the above is the part of the metabolic advantage idea that gives Anthony hives. What will really put him over the edge is what comes next.

Remember when I wrote a few paragraphs back that when insulin levels are low fat is no longer held in the fat cells? The doors to get out are wide open and fat can easily flow out – but only if there is a caloric deficit and that fat is needed to make it up. If there isn’t a deficit the fat stays where it is and there is no weight loss. There is another side to that equation. When insulin levels are low, it is extremely difficult to increase the amount of fat inside the fat cells.

Both MD and I have had patients who complained to us that they were following our program to the letter and weren’t losing any weight. When we asked them for their diet diaries we found that they were consuming huge amounts of food but were rigorously keeping their carbs below 30 grams per day. Sometimes we calculated that these patients were eating 4000+ kcal per day, which could have even been higher given that patients tend to under report what they eat instead of over reporting. What was amazing to us was that they weren’t gaining. They were pretty much maintaining their weight on an enormous number of low-carb calories.

We would explain to them about how they needed to create a caloric deficit to lose. Most people will create the caloric deficit when they go on a low-carb diet because the increased fat and protein in the absence of carbs is extremely satiating. But some folks don’t have the off switch that most others do and can eat large amounts of fat and protein along with very little carb without seeming full. You would think they would gain weight like crazy, but they don’t because with low insulin levels it’s tough to pack fat into the fat cells.

This isn’t so strange when you consider that typically the first symptom experienced by a type I diabetic is an unexplained weight loss. Many of these people go to their doctors saying that they’re eating like hogs, yet are losing weight like crazy. All it takes is a quick check of their blood sugar, which is always sky high to make the diagnosis.

These type I diabetics have no insulin so they can’t really stuff fat into their fat cells. And they are breaking protein down, converting it to glucose and urinating it away. They are voraciously hungry and eat, eat, eat but they can’t store any fat. If they go untreated they will ultimately develop severe life-threatening problems.  Their fragile situation demonstrates that in the absence of insulin it’s virtually impossible to gain weight.

After following a low-carb diet for a while, our overweight patients lower their insulin levels, so, as with type I diabetics, it is difficult for them to store fat as well. They crank up all the futile cycling, elevate levels of uncoupling protein synthesis and increase proton leakage to dissipate the excess energy they’re consuming, but they don’t store it as fat. This situation creates an enormous metabolic advantage, but one that is used to maintain weight, not lose it. This is why it is pretty easy to maintain your weight loss on a low-carb maintenance diet. If you start throwing back the carbs, however, you will lose this advantage.

A number of studies have shown a metabolic advantage of the first type discussed, but the second type – the weight-maintenance type – arises from MD’s and my hands-on treatment of many patients. And from our thinking the biochemistry through. As far as I know there are no recent papers that have studied this phenomenon specifically, but a few skirt around the edges. Much of the work done by Pennington back in the 1940s and 1950s discusses the same phenomenon. And I have heard other doctors who take care of patients with low-carb diets remark on it as well.

That’s pretty much my take on the metabolic advantage. Until he reads this, Anthony won’t see the second part of my metabolic advantage beliefs, so the driving force behind all his outrage the past couple of months is over the measly couple of hundred calories that I believe exist as a metabolic advantage as a consequence of rigorously following a low-carb diet. The amount of huff he has put up over this seemed a little extreme to me, but then I started looking a little more closely at our friend Anthony, and a few things started to become clear.

Anthony is seeking the attention and publicity, which he considers his due for having written a book that few people bought.

What follows is The Anthony Colpo Reader, a few gems from Anthony’s pen to give insight into his character. (Some with my commentary) Plus the promised free book.

The following is the post that made me realize his quest for attention.  I apologize for the foul language, but it’s his, not mine.

A reader of his wrote him asking why he couldn’t carry on a civil debate with me and others and why he had to resort to nastiness. This person also pointed out that he (AC) would be better received as a serious researcher were he to tone down his vitriol. Here is his answer, positively brimming with civility.

You know, I really am starting to find this all quite amusing. On one hand, folks like you claim that my style will cause me to be dismissed as some kind of nut job, but at the same time, you are all furiously typing about me on web forums.

If I am so irrelevant and such a non-entity, why do you all spend so much time talking about me?

It’s because I AM important to you. That’s not my opinion, but yours. You unwittingly reiterate this viewpoint every time you make a post about me. Obviously, what I say does indeed matter to you because otherwise you wouldn’t spend so much time writing about it. If I was the ostracized lone voice you so desperately wish to believe I am, then people wouldn’t waste their time on me. My impact would be non-existent. The truth is, my impact is very real – and that’s exactly what eats at you folks.

A lot of low-carbers thought it was great when I used to rip on the low-fat movement for all the rubbish that crowd used to spin. But when I started highlighting the equally unscientific nonsense spouted by many within the low-carb camp, then these same low-carbers started foaming at the mouth and launching repeated attacks on me.

By doing so, they have shown the world what utter hypocrites they are. Evidently, they are happy to jump all over the low-fat movement for the slightest transgression, but are happy to embrace the most absurd BS from within their own camp if it supports what they wish to believe.

Imagine if someone in the low-fat movement came out and said that we should ignore metabolic ward trials because people on low fat forums vigorously insist that they did indeed lose more weight by eating an isocaloric low-fat diet. You jokers would be dumping on their comments to no end. And yet, when people within the low-carb camp make an equally absurd claim, you have the gall to suggest they should be taken seriously!!

UNFKNBLVBL !!!

Sorry, but BS is BS, whether it comes from Ornish, Campbell, Atkins, or Eades…or from their goofball followers on low-fat and low-carb forums.

You folks are going to have to deal with the following facts:
I am right on the metabolic advantage issue.
A LOT of people from all over the world listen to me.
Like I said, what you folks really need to do is spend less time slagging off at me and a lot more time doing some serious soul searching. Why are you folks so pathetic that you will spend so much time and effort denigrating someone who tells you things you don’t want to hear – even when he has the evidence to back up his claims?

I’m sorry, but the whole “Colpo is a rude, rude man” thing is starting to wear a bit thin, it’s so transparent. With all the injustice and deceit going on in the world right now, you get upset over THIS?

Like I said, you poor bastards really need to turn your attention inwards. It will be a disturbing and unsettling experience for many of you, but you need to start sometime. It’s either that, or keep going through life with your heads up your a*sholes.

If you need to be reminded of the dire consequences that can result from such an insistence on being such easily-distracted, gullible, banality-obsessed dolts, then I suggest you watch the following movie immediately: ZEITGEIST

Another answer to a similar question about why he is so rude to people with whom he disagrees. This answer, too, shows how much he relishes the attention.

What a pack of wankers on web forums, many of whom have already demonstrated themselves to be ignorant, gossip-mongering losers, are saying is of little consequence to me. I suspect that deep down inside these jokers really value people like me because I give these losers something to gossip about and occupy their otherwise empty and meaningless lives.

Again, since this whole hoo-hah, my web hits and book sales have remained elevated.

Which means MORE people are now listening to me, and being exposed to the facts.

That’s the reality, whether you wish to believe this uncomfortable fact or not.

So, I should really thank these jokers for the increased publicity. As Oscar Wilde once said: “The Only Thing Worse than Being Talked About is Not Being Talked About”.

And I suspect that what really gets under the skin of people like you is that I’m the one with the nads to stand up and highlight this kind of BS. What are you doing to further public health and knowledge, besides coming on to this forum and sounding like a nagging, serial whining spouse?

Here is AC’s response to a reader of his who had the temerity to ask a few reasonable questions. Admittedly there are more than a few typos here, but the questions are pretty clear. And very reasonable.

Question: I have two basic questions –can you give a response to the “metabolic ward study” that muscular develpoment [Muscular Development - a body building magazine] cites—?? and can you explain how one can gain fat if unsulin levels are low (lowering ones carbs means insulin levels will be low)—can you also adress the fact that people with type 1 diabeties lose weight rapidly because they produce little or no insulin??? There are no insults here just questions—an what is the big deal–if you are correct then you should welcome this debate…

Uh oh. AC is pulling out the fonts again. It must be bad.

I don’t know how many times I have to repeat myself, but here goes again:

YOU ARE, BEYOND ANY SHADOW OF A DOUBT, A DERANGED F*CKWIT. Your behavior on this forum has been appalling. You are NOT welcome here and I WILL NOT BE ANSWERING ANY OF YOUR QUESTIONS. I DO NOT WASTE MY TIME ANSWERING QUESTIONS NOR GIVING FREE ADVICE TO A**HOLES WHO DEMONSTRATE MALEVOLENT INTENT TOWARDS ME, AS YOU HAVE.

I am nice to those who are nice to me, I have no time whatsoever for those who behave like a*sholes towards me. Quite simple really, although I have no doubt that such a straightforward concept is beyond the comprehension of a little peanut like yourself.

Everything I have to say about the fat loss/metabolic ward study issue is in my book, The Fat Loss Bible. If you were to get off your fat lazy ass and read it, all your stupid questions would be redundant. If you choose not to read the book, then do not expect me to give of my time discussing issues that are addressed in the book.

BTW, YOU LITTLE WEASEL…if you live in, or ever visit, Australia, be sure to forward me your full name and location so we can arrange a little one-on-one ‘meeting’ to see who really is the coward.

FFS, move out of your Mum’s home, get a job, throw away your gay porn collection, and get a goddamn life…you little bed-wetting pissant…

Charming.

Finally, here is the link to Anthony’s piteous whine about why he took down his TheOmnivore website and replaced it with an advertorial for his book. I will post this as a link because it is on another website, and I don’t think AC can take it down at will. If he does, fear not, I have a pdf copy that I’ll put up.

It seems that AC got miffed because he put a lot of time and effort into his website figuring that it would lead people to buy his book. But they didn’t. At least not in the quantities he expected. So he took the website down, picked up his toys and went home.

At the end of this sniveling dreck AC writes the following words.

I am also working on a fat loss book that will once and for all address the unrepentant stupidity of people who think that eating high/low-fat/carbs/protein at the same caloric intake awards some sort of magical weight loss advantage.

And, folks, Anthony is a good as his word. He has written an ebook titled The Fat Loss Bible doing that very thing – addressing the unrepentant stupidity of people like me. (More about this book in a moment)

But he didn’t stop there. AC is so convinced of his righteousness that he buckled down and wrote another book attacking not just unrepentantly stupid people like me, but actually attacking me personally along with Feinman, Fine and Taubes. My unrepentant stupidity has earned me an entire chapter of my own, replete with color picture. And best of all, AC is not selling this book, he is giving it away. He has made it available for me to give to all the readers of my blog absolutely free of charge. Download your free book in pdf right here compliments of Anthony Colpo. they_are_all_mad.pdf

Now, about The Fat Loss Bible…

You can get a harbinger of things to come by simply reading the Acknowledgments. I won’t bore you with the whole thing, but just a taste here and there.

AC decides to “part with tradition” and instead of thanking those who helped him he thanks those who attacked him. He wants to

acknowledge a group of people who attacked me in late 2005 after I wrote an Internet article explaining why caloric intake – not the proportion of protein, carbohydrate or fat – is the primary determinant of weight loss.

Low-carbohydrate devotees the world over were outraged at my temerity to state this indisputable fact. I was demonized on Internet forums, and accused of lying.

…[Yada yada yada yada. More of the same. If you've read much AC, you get the picture.]…

The staggering level of willful ignorance displayed by my detractors in 2005 impressed upon me the urgent need for a book explaining the true scientific facts about weight loss. Clearly, a lot of people had been brainwashed by gimmicky nonsense.

I suspect the book has come too late for my venomous critics of 2005. I have to seriously question whether those who unfairly slandered my integrity, who ignored the evidence I presented, and who chastised me for daring to present the facts that allegedly harmed their pet ’cause’ possess any real sense of logic or reason. But regardless of whether it will help them, by inspiring the creation of this book, their actions will indirectly benefit thousands of others…

One wonders how many of these ruthless attackers there were out there slandering, ignoring and chastising? A half dozen maybe? This guy is truly a legend in his own mind.

To give him credit, though, he does write one worthwhile paragraph in this two page whine when he discusses a common facet of human nature.

Namely, many people really don’t care for the truth. They are more concerned with reinforcing what they have already come to accept as true. It takes a certain strength of character to discard long-cherished beliefs. Sadly, many people simply cannot muster the requisite strength of character, even when the evidence is overwhelming.

Sadly, I suspect AC is one of those people.

I have read The Fat Loss Bible and I can summarize it in one sentence: Eat less, exercise more, and you’ll lose weight. Of course that message is buried in with all the typical AC folderol about how smart he is and how ignorant everyone else is. If you want to spend $40 to be told to eat less and exercise more while learning what a misunderstood and viciously slander genius AC is, then The Fat Loss Bible is the book for you.

The first chapter lays out the basis for AC’s belief that there is no metabolic advantage. It is a compendium of misread or misinterpreted studies, the famous “NINETEEN metabolic ward studies” AC mentions in his open letter to me. (There were only SEVENTEEN in the version of the book I read, but who’s counting?)

Here is what I propose to do. Since this chapter of this book is the foundation for AC’s bedrock belief in the non-existence of a metabolic advantage, I will go through it and in meticulous detail demonstrate just what a shaky foundation that is. But I will do it only if you – the readers of this blog – want me to. It will take a little time that could otherwise be spent in posting on the stuff I usually post on. You can vote with your comments. I’m not going to respond to any of these comments, but I will put them up and tally them. If the yeas outnumber the nays, I’ll do the critique.

My only worry is that AC is a pretty slippery fellow. One of the readers on his site asked why AC didn’t publish his book as a real, bound book instead of an ebook. AC responded that with the ebook he could change it at will and continue to add new material. Chapter One has gone from the 20 pages it was when I first looked at this book back in late August to 26 pages when I pulled it down a few days ago. So I may be trying to hit a moving target. But I do have a copy of the book as it exists right now and that’s what I will critique if the votes send me in that direction. If, for whatever bizarre reason, you happen to decide to drop forty bucks later on to purchase this book, you may find you bought a different book than the one I’ll dismember.

So, as they say in Chicago: vote early and vote often.  Meanwhile I’ll be off dealing with all the comments that have been stacking up while this post was being written.

Link for complete cartoon by Erik Sansom

If you spend any time roaming around low-carb websites you will have stumbled upon posts about the now infamous Kimkins Diet. I haven’t made an in depth investigation into the situation, but from my brief readings it appears that an unscrupulous woman has been outed.

As I understand it a year or two ago a lady appeared on various bulletin boards and in low-carb chat groups alleging to have lost 198 pounds in 11 months on a modified version of the Atkins’ diet. Soon this woman had established a website and was promoting said plan as the Kimkins Diet, which sold for about $60. The Kimkins site had an affiliate program that paid others to send their friends to the site, which people apparently did in droves. The big Kimkins break happened when the diet got a cover article in Woman’s World magazine complete with cover copy proclaiming the diet to be “Better than gastric bypass!”

Since the Woman’s World article the Kimkins empire has begun to crumble. Many of the top poster children for Kimkins have seen the light and have turned apostate on their former guru. Kimmer, the sort of namesake of the Kimkins plan, has been revealed by a private detective to be one Heidi Kimberly Diaz, who, far from the svelte petite woman she represented herself as being, is definitely obese. A Los Angeles television news show has done a multi-part series on the Kimkins Diet, and now it looks like there will be a class action suit filed against the program and its promoter as well (if it hasn’t been filed already).

If you’re interested you can read about the entire affair replete with surveillance photos and videos and video testimonials of former Kimkins apostles who have seen the light through the following links (here, here, here, here and here)

I’m not writing here today to add further to the Kimkins story or to pile on this poor woman. I’m writing to provide reassuring information to a whole lot of Kimkins followers who are in distress. Based on my admittedly cursory trawling through a number of bulletin boards and in reading the comments on some of the sites I linked to above it became clear to me that many people who have followed the Kimkins Diet have had major hair loss.

Let me tell you what has happened.

You are experiencing a common problem called telogen effluvium, which is the medical term for acute hair loss due to a metabolic, hormonal or drug stress.

So you can better understand what has happened, let’s take a look at the normal hair growth cycle. Hair has a growth phase call anagen and a resting or dormant phase called telogen. Typically for hair on the head, anagen lasts around three years followed by telogen that lasts about three months.

During anagen, the growth phase, the hair follicle is active and the hair grows; during telogen the hair follicle becomes dormant and the hair quits growing. But the hair stays in the hair follicle, and since you can’t really measure the growth of a single hair, you don’t know that the hair is actually dead and the follicle dormant. When the follicle reactivates during anagen, the new hair growing in pushes the old, dead hair out, and the hair falls from the scalp. That’s why we all find hairs on our pillows, in the shower, and other places it’s noticeable. Those old are hairs pushed out by the new hair growing in.

This waxing and waning of anagen and telogen is why we continuously lose hair and yet our head of hair doesn’t continuously thin. And, I suppose, it goes without saying that not all of our hair is in lock step in this cycle otherwise we would have hair for 2-3 years, then it would all fall out at once. The estimate is that about 10% of hair on the head is in telogen at any given time, which means that the other 90% is growing normally. And even the 10% in telogen appears normal if you looked at an individual hair. It’s just not growing and will ultimately be pushed out when the follicle converts to anagen.

But sometimes this cycle can be disrupted.

A number of stresses can send hairs from anagen to telogen before their time. Pregnancy, a major illness, a high fever, an injury, surgery (usually from the anesthesia), some medications and a major change in diet, especially going on a starvation diet.

The Kimkins Diet is nothing if not a starvation diet. It is a very-low-calorie diet, containing from 400-700 kcal per day. You saw the photos I posted of the subjects on the famous Keys’ 1600 kcal per day semi-starvation diet back in the 40s, so you can imagine what the Kimkins diet would do were you on it for a substantial amount of time. You would probably look like one of the women I posted on yesterday.

So, for those of you who went on Kimkins and suffered a major hair loss, here’s what happened. The nutritional stress from semi-starvation nature of the diet shocked your hair from anagen into telogen prematurely. You didn’t even notice it when it happened because you lost no hair. Months later when your follicles again went into anagen and became active, the new hair growing in began to push the old hair out. And because the nutritional stress sent much more than your normal ongoing 10% into telogen, you seemed to lose hair by handfuls.

Many people probably started losing their hair as they went off Kimkins and back to a more normal diet. At that time the hair follicles said (assuming hair follicles could speak): hey, stress is over; let’s start growing again. And they did start growing, pushing out the old dead hair.

So, the take home message is that if you lost a lot of hair during your time on Kimkins (or any other diet), don’t sweat it. It will come back. If it doesn’t, then you’ve got something more going on than telogen effluvium, and you need to pay a visit to your doctor. But usually if you look closely at your scalp (or have someone look for you), you’ll see little hairs growing back in. If you’re a female and have long hair, it will take a long time for your hair to grow back to its full length, but it will.

Is their anything you can do to hurry it along? Just make sure you get plenty of good quality protein and essential fats. And don’t worry about it.

I hope this helps a few of you rest a little easier.

I had a question from a friend today about migraine headaches. I remembered reading about them in Dr. Larry McCleary’s new book The Brain Trust Program, so I thumbed through the book to see what he had to say. (I had read the book in manuscript form, but couldn’t remember the specific recommendation for migraine headaches.) I became engrossed in the material all over again, and after a couple of hours of reading it dawned on me that I hadn’t reviewed the book for this blog.

First, a bit of disclosure. Dr. McCleary is a good friend of mine as well as a business partner for a number of years. And MD and I wrote the Introduction to his book. But we didn’t write it because he was a friend and partner, but because the book is so good.

Before we delve into the book let me tell you a little about Dr. McCleary. He is one of the smartest people I’ve ever met, and I’ve met a lot of smart people in the medical and nutritional business. He graduated at the top of his class from an Ivy League university, got accepted into a big name physics Ph.D program where he stayed for three years and ended up with Roger Penrose (the guy who co-writes the books with Stephen Hawking) as his mentor. When Penrose decided to go back to the UK he wanted to take Larry with him, but Larry had decided that he wanted to bolt from physics and go into medicine instead, so the timing worked out nicely. He graduated first in his class in medical school, then ended up doing a neurosurgery residency and a pediatric neurosurgery fellowship. He had a huge practice in Denver, Colorado where – along with carrying a heavy neurosurgical load – he was the Director of the Neuroscience Research Program at the prestigious Children’s Hospital. And he is the only person I know who reads more medical papers on a daily basis than I do.

MD and I had been encouraging him to write a book for years, and he finally took the plunge. And what a book it is. Most books on the brain written by medical professionals present programs to forestall the inevitable mental decline that comes with aging. These books typically recommend low-fat diets along with a few supplements and some brain exercises to help you keep your mental abilities from drifting away as you reach your golden years. Dr. McCleary’s book is the only one I’ve really seen that tells you not only how to keep your brain from deteriorating with age but shows you how to actually improve cognitive function. And guess what? You don’t improve cognitive function with a low-fat diet. But the book is much more than simply a book on improving your thinking. Among other things it shows how to reduce migraine headaches, improve your ability to study (Dr. McCleary goes into the techniques he used to study so that he could graduate first in his class in every school he attended), protect your brain from excitotoxins and even how to markedly reduce symptoms of menopause.

I’m going to excerpt a little from his section on supplemental nutrition for the brain. Many readers of this blog appear to be interested in krill oil, so we’ll see what Dr. McCleary has to say about it.

Krill, tiny shrimp-like creatures, inhabit the lowest rung of the food ladder, dining mainly on plankton, which are the actual omega-3 factories. As a result, krill enjoy a low risk of being contaminated by the mercury or other toxins present in their larger fishy cousins. Their oil, in my opinion, is the best source of essential brain fats available. Not only does krill oil provide substantial amounts of EPA and DHA but it also contains a rich supply of another group of critical fatty substances necessary for brain and nerve cell membranes to function properly: the phospholipids, which play important roles in signal transmission, in energy generation, and in the construction of the insulation coating myelin (which helps speed conduction along the brain’s communication pathways). The omega-3 fatty acids in krill oil are bound to these phospholipids. This unique relationship greatly facilitates the passage of the fatty acid molecules through your intestinal wall making them much more bioavailable (easily incorporated by the body). The predominant phospholipid in krill oil is phosphatidylcholine, making it a rich source of choline, which many studies have demonstrated as being important in brain development, learning, and memory. It is also the precursor for the vital memory neurotransmitter acetylcholine.

Krill oil also naturally contains high concentrations of a number of healthy antioxidant compounds that not only protect the krill oil but also protect your brain… These include vitamin A, vitamin E, astaxanthin, and canthaxanthin. Astaxanthin forms a special linkage with EPA and DHA, thus making it more readily available to the body than other antioxidants on the market. For this reason, while consumption of fish oil breaks down and therefore decreases your body’s antioxidant concentrations, krill oil actually increases levels of antioxidants in the body.

The parts of the book I found most intriguing are in Part III: Novel Applications of the Brain Trust Program.

One of the incredible interesting applications of the nutritional advice provided in this book is in the reduction of the symptoms of menopause. I’m all for anything that reduces the symptoms of menopause because a certain person I know well who shall remain nameless from time to time experiences these symptoms. And when she experiences them, so do I in a second-hand sort of way. So since I’m impacted, I’m interested.

And I’m not the only one who is interested. I saw a recent blurb showing the results of an Archer Daniels Midland survey showing that a majority of women want their doctors to inform them about non-medical options for relieving the symptoms of menopause.

As part of the ADM-sponsored survey, “Women & menopause: a look at supplement use,” 1,258 women between the ages of 40 and 55 were polled.

A third of these women indicated they do try natural supplements for the relief of menopausal symptoms, and a quarter said natural supplements are their “treatment of choice.”

Also, according to ADM, nearly all the respondents who are using dietary supplements for hot flashes say these are their “favorite method of treatment”.

Of course, this survey is totally self-serving because what ADM is really interested in is selling women on the idea of using soy products, produced naturally by ADM, to relieve these symptoms. But given the recent controversy over hormone replacement therapy, I’m sure many women are indeed looking for a natural way to reduce the often completely miserable symptoms of menopause.

(By the way, I would encourage anyone thinking of taking soy to reduce the symptoms of menopause or for anything else to spend the time going through the soy section of the Weston Price Foundation site.)

Dr. McCleary’s method of treating menopausal symptoms doesn’t use soy, but uses another natural substance instead: ketone bodies.

How do ketones treat these symptoms? They do so by replacing glucose that’s lacking from the estrogen-deprived brain.

Dr. McCleary provides a fascinating discussion of what happens in the brain that results in hot flashes when estrogen is withdrawn after many years of constant exposure. During these years of exposure estrogen becomes intimately involved in the development of the shuttles that transport sugar into the brain cells. With estrogen present – as it is in the premenopause years – these shuttles transport about 40 percent more sugar into the brain cells than would be transported without the estrogen. When the estrogen goes away at menopause, the shuttling of sugar into the brain cells decreases, and the brain cells become a little starved for energy. Dr. McCleary explains how the hypothalamus responds to this starvation by

stepping up the release of norepinephrine [adrenaline], which acts to raise the level of sugar in the blood, to raise the heart rate, and to raise the body temperature. The hot flash, then, is a specific outward sign of the brain’s trying to protect itself from blood sugar starvation.

Long time readers of this blog will know that ketone bodies are water-soluble fat breakdown products that can pinch hit for glucose in the brain and other tissues. Dr. McCleary shows how ketones do this to prevent hot flashes, and he even gives a recipe for a ketone cocktail to provide even more ketones to feed the hungry brain that isn’t getting enough sugar.

No other brain book written discusses this kind of information, I can assure you. And the bits I’ve discussed here just scratch the surface. I encourage you to order a copy of The Brain Trust Program and add it to the core of your low-carb library. You can get additional information and updates about his research from Dr. McCleary’s blog.