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	<title>Comments on: Thermodynamics and weight loss</title>
	<atom:link href="http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/feed/" rel="self" type="application/rss+xml" />
	<link>http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/</link>
	<description>A critical look at nutritional science and anything else that strikes my fancy.</description>
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		<title>By: Kate Baldwin</title>
		<link>http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/comment-page-2/#comment-229808</link>
		<dc:creator>Kate Baldwin</dc:creator>
		<pubDate>Mon, 31 Aug 2009 17:31:38 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=963#comment-229808</guid>
		<description>Is this why, on my low-calorie days, I can feel heat radiating from my abdomen?

&lt;em&gt;I don&#039;t know. Perhaps.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Is this why, on my low-calorie days, I can feel heat radiating from my abdomen?</p>
<p><em>I don&#8217;t know. Perhaps.</em></p>
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		<title>By: William Mullen</title>
		<link>http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/comment-page-2/#comment-223598</link>
		<dc:creator>William Mullen</dc:creator>
		<pubDate>Sun, 02 Aug 2009 16:41:11 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=963#comment-223598</guid>
		<description>It just seemed from your comment immediately after the study excerpt -- &quot;Bear all this in mind the next time you tell someone that it is possible to lose more weight on a greater number of calories as long as those calories are low-carb calories, and that someone pooh poohs you with the old ‘That can’t be possible. It violates the laws of thermodynamics.&quot; -- that you attribute the increased calorie burn to the difference between carb intake, when it seems like it might very well be the difference in protein intake.  Sorry if I misunderstood.  I&#039;d be interested to see a similar study that kept protein levels the same and just varied the carb/fat components.

&lt;em&gt;I see what you mean now.  I guess by saying low-carb calories that I was implying higher-protein calories since most low-carb diets are higher in protein.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>It just seemed from your comment immediately after the study excerpt &#8212; &#8220;Bear all this in mind the next time you tell someone that it is possible to lose more weight on a greater number of calories as long as those calories are low-carb calories, and that someone pooh poohs you with the old ‘That can’t be possible. It violates the laws of thermodynamics.&#8221; &#8212; that you attribute the increased calorie burn to the difference between carb intake, when it seems like it might very well be the difference in protein intake.  Sorry if I misunderstood.  I&#8217;d be interested to see a similar study that kept protein levels the same and just varied the carb/fat components.</p>
<p><em>I see what you mean now.  I guess by saying low-carb calories that I was implying higher-protein calories since most low-carb diets are higher in protein.</em></p>
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		<title>By: William Mullen</title>
		<link>http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/comment-page-2/#comment-223517</link>
		<dc:creator>William Mullen</dc:creator>
		<pubDate>Sun, 02 Aug 2009 07:55:09 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=963#comment-223517</guid>
		<description>Hi Doc,

Love your blog (obviously, as I&#039;m in the archives).  Sorry for the late comment, but I had a question that I didn&#039;t see asked in any of the comments: doesn&#039;t the fact that the low-carb diet consisted of 24% protein and the low-fat diet consisted of 12% protein cast doubt on the idea that it was the non-protein composition responsible for the increase in metabolic output?

Thanks!

&lt;em&gt;Unless I&#039;m misunderstanding your question, I think that was the point of the article in AJCN.  According to the authors, it was the increase in protein that brought about the increased metabolic output.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Hi Doc,</p>
<p>Love your blog (obviously, as I&#8217;m in the archives).  Sorry for the late comment, but I had a question that I didn&#8217;t see asked in any of the comments: doesn&#8217;t the fact that the low-carb diet consisted of 24% protein and the low-fat diet consisted of 12% protein cast doubt on the idea that it was the non-protein composition responsible for the increase in metabolic output?</p>
<p>Thanks!</p>
<p><em>Unless I&#8217;m misunderstanding your question, I think that was the point of the article in AJCN.  According to the authors, it was the increase in protein that brought about the increased metabolic output.</em></p>
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		<title>By: Scott Miller</title>
		<link>http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/comment-page-2/#comment-189747</link>
		<dc:creator>Scott Miller</dc:creator>
		<pubDate>Sun, 16 Nov 2008 04:35:51 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=963#comment-189747</guid>
		<description>Your range of knowledge is remarkable.  As is your ability to explain things.  Just a quick note that I appreciate your blog tremendously, and will continue to read it going back to your first post as I find time.

FYI, not on your blog roll, another blog I&#039;ve read through and found to be quite informative (and compatible in most ways with your ideas, I think):
http://wholehealthsource.blogspot.com/

And while here, here&#039;s something I wrote in a private forum earlier today, FYI:

An Austrian study ( http://tinyurl.com/5mz4us ) indicates that higher levels of D3 correlated with longer lifespans.  Period.  In other words, higher levels of D3 reduce the all-cause mortality rate.  There&#039;s simply no man-made drug that can claim anything close to this. 

The study included 3,258 with an average age of 62 year, and over an average follow up of about 7.5 years just over one-fifth had died.  The study concluded that people with the lowest blood levels of D were 2.5 times more likely to die from cardiovascular disease, and twice as likely to die from all remaining causes, such as cancer.  Lower D levels are also associated with higher CRP and other markers of inflammation. 

A second recent study (13,331 people enrolled) comes to the same conclusion, this time by the Albert Einstein College of Medicine.  Can&#039;t find a link.  The lead doctor was Michal L. Melamed, M.D. if anyone wants to try to find it. 

Note that various studies have reported that most Americans are deficient in vit. D, up to 95% of those in northern regions of the States.  And this is one of the cheapest supplements available.  There&#039;s no reason anyone should be deficient.

&lt;em&gt;Here is the link for the Melamed study:

http://tinyurl.com/5qjkv6

Neither the Melamed nor the Austrian study you linked to proves that Vit D reduces all-cause mortality.  Both these studies show there is a correlation between low Vit D levels and increased all-cause mortality, but that&#039;s not the same as proving that vit D levels have anything to do with mortality levels.  Correlation is not causality.

In order to &#039;prove&#039; that Vit D reduces all-cause mortality requires a randomized, placebo-controlled trial, which, as far as I know, hasn&#039;t been done in humans.

I believe that Vit D is extremely important for good health and that it probably does decrease all-cause mortality, but neither of these studies proves it.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Your range of knowledge is remarkable.  As is your ability to explain things.  Just a quick note that I appreciate your blog tremendously, and will continue to read it going back to your first post as I find time.</p>
<p>FYI, not on your blog roll, another blog I&#8217;ve read through and found to be quite informative (and compatible in most ways with your ideas, I think):<br />
<a href="http://wholehealthsource.blogspot.com/" rel="nofollow">http://wholehealthsource.blogspot.com/</a></p>
<p>And while here, here&#8217;s something I wrote in a private forum earlier today, FYI:</p>
<p>An Austrian study ( <a href="http://tinyurl.com/5mz4us" rel="nofollow">http://tinyurl.com/5mz4us</a> ) indicates that higher levels of D3 correlated with longer lifespans.  Period.  In other words, higher levels of D3 reduce the all-cause mortality rate.  There&#8217;s simply no man-made drug that can claim anything close to this. </p>
<p>The study included 3,258 with an average age of 62 year, and over an average follow up of about 7.5 years just over one-fifth had died.  The study concluded that people with the lowest blood levels of D were 2.5 times more likely to die from cardiovascular disease, and twice as likely to die from all remaining causes, such as cancer.  Lower D levels are also associated with higher CRP and other markers of inflammation. </p>
<p>A second recent study (13,331 people enrolled) comes to the same conclusion, this time by the Albert Einstein College of Medicine.  Can&#8217;t find a link.  The lead doctor was Michal L. Melamed, M.D. if anyone wants to try to find it. </p>
<p>Note that various studies have reported that most Americans are deficient in vit. D, up to 95% of those in northern regions of the States.  And this is one of the cheapest supplements available.  There&#8217;s no reason anyone should be deficient.</p>
<p><em>Here is the link for the Melamed study:</p>
<p><a href="http://tinyurl.com/5qjkv6" rel="nofollow">http://tinyurl.com/5qjkv6</a></p>
<p>Neither the Melamed nor the Austrian study you linked to proves that Vit D reduces all-cause mortality.  Both these studies show there is a correlation between low Vit D levels and increased all-cause mortality, but that&#8217;s not the same as proving that vit D levels have anything to do with mortality levels.  Correlation is not causality.</p>
<p>In order to &#8216;prove&#8217; that Vit D reduces all-cause mortality requires a randomized, placebo-controlled trial, which, as far as I know, hasn&#8217;t been done in humans.</p>
<p>I believe that Vit D is extremely important for good health and that it probably does decrease all-cause mortality, but neither of these studies proves it.</em></p>
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		<title>By: Jeremy</title>
		<link>http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/comment-page-2/#comment-148284</link>
		<dc:creator>Jeremy</dc:creator>
		<pubDate>Wed, 09 Jul 2008 21:51:40 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=963#comment-148284</guid>
		<description>Dr. E,

I&#039;ve heard that cold water burns calories because our bodies have to heat up the water in order for it to be used. But at the same time, I&#039;ve heard that we use some of energy keeping our temperature low enough, so wouldn&#039;t that mean the cold water would help this process and thus not burn more calories? What do you think?

I should probably stick to mountain biking for keeping the fat low I guess :)</description>
		<content:encoded><![CDATA[<p>Dr. E,</p>
<p>I&#8217;ve heard that cold water burns calories because our bodies have to heat up the water in order for it to be used. But at the same time, I&#8217;ve heard that we use some of energy keeping our temperature low enough, so wouldn&#8217;t that mean the cold water would help this process and thus not burn more calories? What do you think?</p>
<p>I should probably stick to mountain biking for keeping the fat low I guess <img src='http://www.proteinpower.com/drmike/wp-includes/images/smilies/icon_smile.gif' alt=':)' class='wp-smiley' /> </p>
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		<title>By: Ljubica Filipovic</title>
		<link>http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/comment-page-2/#comment-118700</link>
		<dc:creator>Ljubica Filipovic</dc:creator>
		<pubDate>Sat, 05 Apr 2008 23:34:51 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=963#comment-118700</guid>
		<description>Warmest greetings to everybody from Belgrade, Serbia.

Maybe you&#039;ll be glad to hear these posts are praised internationally.

It seems like all the words of admiration to Dr. Eades and his work have been spent out, so (although I have a great desire to) I won&#039;t bother to say anything impressive or extraordinary, I shall simply agree and confirm what have already been said.
Being on LC diet 7 days for the first time in my life, and having read extensive ammount of articles on this subject, stil some questions remain unclear, and I found them somehow very important from the practical point of view:

1. I want to lose fat, not only weight. It comes logically to me that I have to intake less calories in the form of protein+fat (which are approx. fifty-fifty in my diet)in order to start burning body fat. Am I right? It makes no sense to me that I can eat fat+protein w/o control and still lose fat, even LC dieting.
In other words I have hard time to calculate the wise number of fat+protein calories which will lead to the most efficient fat burning regime.
If it takes long time and space to explain, maybe you just refer to a link.

2. Is prolonged ketosis per se related to health risk, irrespectively of KB concentration in the blood. I mean, is it legitimate to say there is increased blood concentration of KB, if we assume that all the excess of KB is being excreted through urine? Or more precisely, is this transient state of raised KB levels in the blood before being eliminated harmful? Then maybe it will be better to burn all the excess with exercise rather than waiting to be eliminated. OK, I know, some exercising is always welcomed. Then, is it better to take long walks for hours, or to do 30 min aerobic exercise on daily basis?
Again, besides your direct answer, I&#039;ll appreciate if you link me to useful articles on this issue.

3. The last, but not the least, what is your professional opinion about Metabolic typing? This approach is completely new to me, just to find out that Internet is full of respective questionnaires. Of course, I couldn&#039;t resist them, and what comes out as a result is that I belong to Protein type with recommended 50% fat:30% protein:20% carbs diet proportion for the rest of my life in order to stay slim and healthy.
Is there any reasonable scientific support for such a typing?

Well, I realized the post is dedicated to thermodynamics and weight loss and I happen to be off-topic with my questions. I apologize. I simply was not enough eager to read all the previous posts. Guru had similar questions, but when I tried given link for further explanations it didn&#039;t work (and still doesn&#039;t work, maybe you can check out what is going on).

Oh, I would almost miss to mention that I&#039;m in a serious &quot;negotiations&quot; with my husband to start with the intermittent fasting.

Dr. Eades, I feel extremely lucky to come across to your Protein power web site.

P.S. English is not my native language. Sorry for the spelling, grammar and style mistakes.

&lt;em&gt;Hi Ljubica--

Welcome to the blog.  I&#039;m glad you&#039;re enjoying it.

In answer to your questions...

1. Yes, you need to watch your calories.  I&#039;ve received so many questions about this that I&#039;m going to do a post on it soon.

2. No, prolonged ketosis in not a health risk.  Only if an individual is a type I diabetic is ketosis a risk.  All others have built-in mechanisms to shut of ketone production before they become a problem.

3. I think Metabolic Typing is bogus.

I&#039;ve fixed the link in Guru&#039;s comment so that it goes to the appropriate post.  Here is the &lt;a href=&quot;http://www.proteinpower.com/drmike/2007/05/22/metabolism-and-ketosis/&quot; rel=&quot;nofollow&quot;&gt;link&lt;/a&gt;.

Keep me posted on the negotiations with your husband about the IF.

Best--

MRE&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Warmest greetings to everybody from Belgrade, Serbia.</p>
<p>Maybe you&#8217;ll be glad to hear these posts are praised internationally.</p>
<p>It seems like all the words of admiration to Dr. Eades and his work have been spent out, so (although I have a great desire to) I won&#8217;t bother to say anything impressive or extraordinary, I shall simply agree and confirm what have already been said.<br />
Being on LC diet 7 days for the first time in my life, and having read extensive ammount of articles on this subject, stil some questions remain unclear, and I found them somehow very important from the practical point of view:</p>
<p>1. I want to lose fat, not only weight. It comes logically to me that I have to intake less calories in the form of protein+fat (which are approx. fifty-fifty in my diet)in order to start burning body fat. Am I right? It makes no sense to me that I can eat fat+protein w/o control and still lose fat, even LC dieting.<br />
In other words I have hard time to calculate the wise number of fat+protein calories which will lead to the most efficient fat burning regime.<br />
If it takes long time and space to explain, maybe you just refer to a link.</p>
<p>2. Is prolonged ketosis per se related to health risk, irrespectively of KB concentration in the blood. I mean, is it legitimate to say there is increased blood concentration of KB, if we assume that all the excess of KB is being excreted through urine? Or more precisely, is this transient state of raised KB levels in the blood before being eliminated harmful? Then maybe it will be better to burn all the excess with exercise rather than waiting to be eliminated. OK, I know, some exercising is always welcomed. Then, is it better to take long walks for hours, or to do 30 min aerobic exercise on daily basis?<br />
Again, besides your direct answer, I&#8217;ll appreciate if you link me to useful articles on this issue.</p>
<p>3. The last, but not the least, what is your professional opinion about Metabolic typing? This approach is completely new to me, just to find out that Internet is full of respective questionnaires. Of course, I couldn&#8217;t resist them, and what comes out as a result is that I belong to Protein type with recommended 50% fat:30% protein:20% carbs diet proportion for the rest of my life in order to stay slim and healthy.<br />
Is there any reasonable scientific support for such a typing?</p>
<p>Well, I realized the post is dedicated to thermodynamics and weight loss and I happen to be off-topic with my questions. I apologize. I simply was not enough eager to read all the previous posts. Guru had similar questions, but when I tried given link for further explanations it didn&#8217;t work (and still doesn&#8217;t work, maybe you can check out what is going on).</p>
<p>Oh, I would almost miss to mention that I&#8217;m in a serious &#8220;negotiations&#8221; with my husband to start with the intermittent fasting.</p>
<p>Dr. Eades, I feel extremely lucky to come across to your Protein power web site.</p>
<p>P.S. English is not my native language. Sorry for the spelling, grammar and style mistakes.</p>
<p><em>Hi Ljubica&#8211;</p>
<p>Welcome to the blog.  I&#8217;m glad you&#8217;re enjoying it.</p>
<p>In answer to your questions&#8230;</p>
<p>1. Yes, you need to watch your calories.  I&#8217;ve received so many questions about this that I&#8217;m going to do a post on it soon.</p>
<p>2. No, prolonged ketosis in not a health risk.  Only if an individual is a type I diabetic is ketosis a risk.  All others have built-in mechanisms to shut of ketone production before they become a problem.</p>
<p>3. I think Metabolic Typing is bogus.</p>
<p>I&#8217;ve fixed the link in Guru&#8217;s comment so that it goes to the appropriate post.  Here is the <a href="http://www.proteinpower.com/drmike/2007/05/22/metabolism-and-ketosis/" rel="nofollow">link</a>.</p>
<p>Keep me posted on the negotiations with your husband about the IF.</p>
<p>Best&#8211;</p>
<p>MRE</em></p>
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		<title>By: Portail</title>
		<link>http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/comment-page-2/#comment-105915</link>
		<dc:creator>Portail</dc:creator>
		<pubDate>Sun, 24 Feb 2008 13:07:21 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=963#comment-105915</guid>
		<description>I only just now discovered this article.
Thank you.  It explains beautifully the advantage of Protein-Power.
I do love that 2nd law of thermodynamics !
Portail

&lt;em&gt;Glad you enjoyed it.

MRE&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>I only just now discovered this article.<br />
Thank you.  It explains beautifully the advantage of Protein-Power.<br />
I do love that 2nd law of thermodynamics !<br />
Portail</p>
<p><em>Glad you enjoyed it.</p>
<p>MRE</em></p>
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		<title>By: Judy</title>
		<link>http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/comment-page-2/#comment-99854</link>
		<dc:creator>Judy</dc:creator>
		<pubDate>Fri, 08 Feb 2008 05:38:18 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=963#comment-99854</guid>
		<description>Thank you for the answer!!</description>
		<content:encoded><![CDATA[<p>Thank you for the answer!!</p>
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		<title>By: Judy</title>
		<link>http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/comment-page-2/#comment-98486</link>
		<dc:creator>Judy</dc:creator>
		<pubDate>Wed, 06 Feb 2008 07:22:53 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=963#comment-98486</guid>
		<description>Hi,I&#039;m trying to understand all of this and have a question.Atkins said that we should not stay in ketosis for more then a year...is this wrong with all we know now??? Gary Taubes says he eats virtually no carbs so he would be in a permanent state of ketosis would he not? I love it,hunger is controlled,feel so much better but am confused now if I should &#039;up&#039; the carbs slowly as the plan says or enjoy what I&#039;m doing for good.Please help!!!!!

&lt;em&gt;Paleolithic man ate a very-low-carb diet most of his life.  People who stay on low-carb diets tend to adapt and usually don&#039;t stay in as heavy a level of ketosis as those just starting a low-carb diet.  Besides, ketones are normal fuels for the body, and many tissues prefer them to anything else.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Hi,I&#8217;m trying to understand all of this and have a question.Atkins said that we should not stay in ketosis for more then a year&#8230;is this wrong with all we know now??? Gary Taubes says he eats virtually no carbs so he would be in a permanent state of ketosis would he not? I love it,hunger is controlled,feel so much better but am confused now if I should &#8216;up&#8217; the carbs slowly as the plan says or enjoy what I&#8217;m doing for good.Please help!!!!!</p>
<p><em>Paleolithic man ate a very-low-carb diet most of his life.  People who stay on low-carb diets tend to adapt and usually don&#8217;t stay in as heavy a level of ketosis as those just starting a low-carb diet.  Besides, ketones are normal fuels for the body, and many tissues prefer them to anything else.</em></p>
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		<title>By: jbh</title>
		<link>http://www.proteinpower.com/drmike/metabolism/thermodynamics-and-weight-loss/comment-page-2/#comment-77799</link>
		<dc:creator>jbh</dc:creator>
		<pubDate>Thu, 06 Dec 2007 02:25:59 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=963#comment-77799</guid>
		<description>Well....I&#039;ve read all your post and all the responses...not because I&#039;m really into this kind of thing but because my 9 year old grandson is overweight and we were discussing the best way to help him fight the problem.  He is very energetic and gets quite a bit of exercise...lots more than his 11 year old brother...but he continues to gain weight.  

We are cutting out almost all sweets and drastically reducing the carbs in his diet so I think based on what I&#039;m reading that we&#039;re on the right track. 

The big question that had me searching the net was created because of a difference in opinion as to what an &quot;efficient metabolism&quot; is.  One of us says the 8 year old has a more efficient metabolism because he uses more energy but still has excess fat.  One says that the 11 year old has a more efficient metabolism because his body burns his calories even though he is less active....

I hate to admit that even after reading all of the above posts I still can&#039;t figure it out...
Can anyone help?

Thanks.....

&lt;em&gt;Two people who are the same size consume the same number of calories.  One of these people loses weight, the other doesn&#039;t.  The one who doesn&#039;t lose would have the more efficient metabolism, at least as I understand it.  That person&#039;s metabolism would more efficiently store calories instead of wasting them.  Efficient metabolism isn&#039;t really a scientific term that has a specific definition.  But if it did, I suspect it would be the one I just gave.

Cheers--

MRE&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Well&#8230;.I&#8217;ve read all your post and all the responses&#8230;not because I&#8217;m really into this kind of thing but because my 9 year old grandson is overweight and we were discussing the best way to help him fight the problem.  He is very energetic and gets quite a bit of exercise&#8230;lots more than his 11 year old brother&#8230;but he continues to gain weight.  </p>
<p>We are cutting out almost all sweets and drastically reducing the carbs in his diet so I think based on what I&#8217;m reading that we&#8217;re on the right track. </p>
<p>The big question that had me searching the net was created because of a difference in opinion as to what an &#8220;efficient metabolism&#8221; is.  One of us says the 8 year old has a more efficient metabolism because he uses more energy but still has excess fat.  One says that the 11 year old has a more efficient metabolism because his body burns his calories even though he is less active&#8230;.</p>
<p>I hate to admit that even after reading all of the above posts I still can&#8217;t figure it out&#8230;<br />
Can anyone help?</p>
<p>Thanks&#8230;..</p>
<p><em>Two people who are the same size consume the same number of calories.  One of these people loses weight, the other doesn&#8217;t.  The one who doesn&#8217;t lose would have the more efficient metabolism, at least as I understand it.  That person&#8217;s metabolism would more efficiently store calories instead of wasting them.  Efficient metabolism isn&#8217;t really a scientific term that has a specific definition.  But if it did, I suspect it would be the one I just gave.</p>
<p>Cheers&#8211;</p>
<p>MRE</em></p>
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