Diet Wars

[twaddle]

So I lost weight on a low-carb diet a while back, mostly kept it off for years now, but I like to pretend that any weight I gained back is pure muscle mass.

I got curious about the mechanisms involved, both for weight loss and for health improvements. I have an old never-used degree in biochemistry, so I like to think I can distinguish between signal and noise, but there is soooo much noise. Sooo much tribalism.

IOW, a good topic for a thread.

What I find interesting and hopeful is that maybe there's some convergence -- some common ground among the tribes. Let's start there:

1) We're starting to understand why being overweight is unhealthy, and BMI is probably not the best metric.

2) Diabetes used to be considered a progressive long-term disease, but now there are multiple ways to reverse it. The hive's mindset has changed and people have connected the dots.

3) The new mindset likes the "personal fat threshold" theory and the multiple data sets that support it: bariatric surgery, very low-calorie diets, and ketogenic diets. So far, nobody has tested low-fat or plant-based diets in this context, but I suspect we'll see that soon.

This is just one of the health improvements we see with weight loss. My conclusion from this and other data is that most of the health improvements I experienced on a low-carb diet were due to fat loss. Specifically due to the reduction in ectopic fat.

That's as large a wall of text as I feel like creating right now.

 

[twaddle]

Let's identify some of the tribes.

There's my tribe. The low-carbers. What I find interesting about this tribe is that because low-carb was so anti-establishment, the tribe members tend to be anti-establishment as well. I don't know if they were that way before low-carb or became that way because going against conventional wisdom worked so well for them.

There's the low-fat tribe. Also known as conventional wisdom based on dietary guidelines. They're still out there, but maybe a bit more humble than they used to be?

There's vegan. I find this group very interesting because they're in it for a mix of health and ethical considerations. They do tend to be on the lower-end of the BMI spectrum, and they do tend to have lower incidence of chronic disease. (Probably related, of course.)

And there's everybody's favorite: CICO and variations. Rational people seem to like the idea, and they will fight for it. It's a "simple" matter of keeping CI (calories-in) <= CO (calories-out).

There are more, but these are good tribes to explore.

 

[qwerty3656]

I've been overweight since I was 7 years old and have tried every diet out there. The only thing that ever worked for me is low-carb. That being said, I've since moved onto fasting (both intermittent fasting and long-term fasting) and I personally believe it is the most healthy thing you can do.

 

[twaddle]

Digging into the tribes a bit more. CICO is interesting because the idea is right, but it's not useful.

There are some people who don't believe calories matter, but that's a fairly small group I think. Certainly not all low-carbers, for example.

This may be another area where we're starting to find some common ground. I credit Kevin Hall at NIH for this. He started out as a physicist, so really the ultimate CICO/thermodynamics guy. He has some great mathematical models that consider some of the nuances associated with macronutrients and other factors.

But his recent work focuses on ultra-processed foods, and he's done several quantitative studies on the effects of both low-fat and low-carb diets as well.

The common ground: I think most tribes agree that ultra-processed food is "bad." We don't yet understand why, but Hall has some good data that quantifies the effect on people eating ad lib diets.

 

[Teacher Terry]

I count calories and have found that works long term for me. One day a week I eat what I want.

 

[twaddle]

I've been overweight since I was 7 years old and have tried every diet out there. The only thing that ever worked for me is low-carb. That being said, I've since moved onto fasting (both intermittent fasting and long-term fasting) and I personally believe it is the most healthy thing you can do.

Excellent! It worked for me as well. The controversy comes from the increase in LDL many people experience on the diet. It's still an open question, IMO.

So the thing that nags at me a bit is: can we replicate the same success, the same deliciousness, the same ease of compliance, with something that doesn't raise LDL?

 

[twaddle]

I count calories and have found that works long term for me. One day a week I eat what I want.

Yes! There is absolutely no question that works in the short term. I think it also works in the long term for *some people.* The interesting question to me is: can we identify those people for whom it will work in the long term?

There's some interesting genetic data that says: "maybe."

And you're probably familiar with this registry of people who have kept weight off long term:
http://www.nwcr.ws/

 

[qwerty3656]

Excellent! It worked for me as well. The controversy comes from the increase in LDL many people experience on the diet. It's still an open question, IMO.

So the thing that nags at me a bit is: can we replicate the same success, the same deliciousness, the same ease of compliance, with something that doesn't raise LDL?

I've bought into that anti-establishment you talked about in an earlier post - I think high cholesterol is not a problem and is only kept up as a boogey man by the drug companies.

 

[6miths]

Lipids are certainly a risk factor for cardiovascular disease. The issue is that the situation is much more nuanced than people have been led to believe and our level of understanding is still relatively limited. Dietary cholesterol itself is definitely not the problem. Simple sugars, in excess, are almost certainly a problem. Personally, I think that highly refined carbs are also an issue as are the many unnatural things that we put in processed foods.

 

[twaddle]

Where I landed on LDL a long time ago: no question that lowering LDL reduces CHD risk. Shown by multiple studies and by multiple lowering mechanisms.

But CHD is multi-factorial for sure. BP, chronic inflammation, insulin resistance are all bigger risk factors than LDL. So if your diet lowers the others, relatively safe to let LDL increase a bit I think.

 

[6miths]

Where I landed on LDL a long time ago: no question that lowering LDL reduces CHD risk. Shown by multiple studies and by multiple lowering mechanisms.

But CHD is multi-factorial for sure. BP, chronic inflammation, insulin resistance are all bigger risk factors than LDL. So if your diet lowers the others, relatively safe to let LDL increase a bit I think.

Absolutely. And likely the biggest risk of all, for many bad things, smoking. And not just CHD, vascular disease in all its many and nasty forms.

 

[twaddle]

There is a lot of lore around the weight loss mechanisms of low carb. One thing is clear: it works well for a lot of people. Many studies back this up, although the design of most of them makes me a little crazy.

It's hard to get a handle on the mechanisms because there's so much going on here. Some pretty wild changes in macronutrients, obviously. And some fascinating physiological changes. But also some less obvious changes in food quality.

The result is that there are several splinter groups within the low-carb tribe: the carb/sugar/fructose group (led by Lustig), the insulin group (led by Taubes and Ludwig), the ketone group (led by Phinney and Volek), the protein group (Simpson and Raubenheime), and an emerging group focused on food quality (mostly Hall).

 

[twaddle]

The cool thing is that they're all right. But some are more right than others.

I think the science is still evolving, but carbs per se don't seem to be the main factor. Ultra-processed carbs are a bigger factor, but they're even worse when combined with ultra-processed fat. Think donuts.

Insulin plays a role, but the real issue here is going from a state of insulin resistance to insulin sensitivity. It was considered a chicken-and-egg problem for a while, but I think it's pretty clear at this point that being over-fat causes insulin resistance, and not vice versa.

Ketones are sill a bit controversial, but I think the evidence suggests they do help with appetite suppression. I consider them a weight-loss booster, but not essential.

Protein is interesting because it is clearly a major satiety factor. It's virtually impossible to over-eat protein. But there are still some low-carbers who insist that it's not a high-protein diet. I don't understand that particular group. High protein helps, without a doubt.

The "high fat" aspect of LCHF drives me bonkers. There's no evidence that high-fat helps. Avoid those fat bombs. Depending on the quality of the fat, it can be somewhat neutral. But it is the main factor that causes LDL to increase. There's also not much evidence that the increase in ketones due to an increase in fat helps much. You'll make plenty of ketones just by keeping carbs sufficiently low. Don't fear protein.

 

[MRG]

Yes! There is absolutely no question that works in the short term. I think it also works in the long term for *some people.* The interesting question to me is: can we identify those people for whom it will work in the long term?

There's some interesting genetic data that says: "maybe."

And you're probably familiar with this registry of people who have kept weight off long term:
http://www.nwcr.ws/

Wife and I were obese in 2015, we dropped a combined 120lbs(30% of our weight almost equally distributed) and have kept it off since. No plans to go back to the old ways.

When we changed our diet we really changed a lot. No processed foods or artificial crap, we ate and cooked like our grandparents, sans lard. I learned a great deal, for me less carbs are better but we aren't in ketosis. Using Myfitnesspal gave me a much better idea of what I was consuming. Our diet would be what MFP described as a standard American diet with a tilt toward lower carb. Our lipids are great.

If you could have seen my face when I realized my normal serving of pasta was 1600 calories before I added sauce, meatballs, cheese or garlic bread. [emoji39] I don't eat like that anymore.

That said I don't really have a dog in the fight. People lose weight different ways, whatever works for you is my team.

 

[twaddle]

No processed foods or artificial crap, we ate and cooked like our grandparents, sans lard. I learned a great deal, for me less carbs are better but we aren't in ketosis. Using Myfitnesspal gave me a much better idea of what I was consuming.

Yes! (And congrats!)

I think tracking macros/calories is useful, if for no other reason than it makes you more aware of what you're eating. Eating on auto-pilot is dangerous unless you've developed really good habits.

I also agree that it's probably more a function of dropping processed foods than carbs. I'm hyper-aware of foods that are "kryptonite" for me and I just say "no." They're all low-satiety and slightly addictive.

LCHF offers a mechanism that works for many of us. It worked for me. Low-fat did not. Vegetarian did not. Vegan did not.

Same. But I still want to understand why LCHF worked and vegan failed.

Looking back (for me), vegan/vegetarian didn't work because, well, chocolate-chip cookies can be vegan/vegetarian.

 

[Chuckanut]

chocolate-chip cookies can be vegan/vegetarian.

You are not kidding! I can make the best ChocoChip cookies complete with organic peanut butter, organic coconut oil, organic whole wheat flour, organic chocolate, and good old organic sugar. Lots of organic sugar. Lots and lots and lots of organic sugar.

Enough said.

 

[mpeirce]

No processed foods or artificial crap, we ate and cooked like our grandparents, sans lard.

Why avoid lard?

I do avoid the "highly processed" fats mentioned above, i.e. seed oils (corn, canola, etc) which are produced using industrial processes.

Lard and beef tallow are delicious. So are butter and olive oil.

Yes, I've been in the low carb tribe for over 10 years now. Lost 30 lbs and kept it off.

 

[harllee]

I don't limit what I eat--I limit how much I eat. When I want to lose weight I just eat smaller portions and increase my exercise. Works for me.

 

[MRG]

Why avoid lard?

I do avoid the "highly processed" fats mentioned above, i.e. seed oils (corn, canola, etc) which are produced using industrial processes.

Lard and beef tallow are delicious. So are butter and olive oil.

Yes, I've been in the low carb tribe for over 10 years now. Lost 30 lbs and kept it off.

We used butter, olive oil, and avocado oil for cooking. Nothing wrong with lard we just don't use it like our grandparents did.

 

[garyt]

Excellent! It worked for me as well. The controversy comes from the increase in LDL many people experience on the diet. It's still an open question, IMO.

So the thing that nags at me a bit is: can we replicate the same success, the same deliciousness, the same ease of compliance, with something that doesn't raise LDL?

Ease of compliance? I can't think of anything harder to follow than a low carb diet. I love me some carbs

 

[twaddle]

I don't limit what I eat--I limit how much I eat. When I want to lose weight I just eat smaller portions and increase my exercise. Works for me.

You don't mention the word specifically, but it sounds like old-school "willpower."

I'm still trying to understand it. For years, I subscribed to the view that willpower is an easily-exhaustible resource. For example, I can will myself to not drink water. Or go to the bathroom. Eventually my willpower fails. Same with eating, eventually.

But there are two emerging views: one is that there's a genetic component to willpower, and the other is that there's a gut-brain connection, and willpower can be modulated by what you eat, body fatness, etc.

Anyway, it seems to be one of the more complex subjects, but if it works for you, then it seems very simple.

 

[twaddle]

Ease of compliance? I can't think of anything harder to follow than a low carb diet. I love me some carbs

Yeah, easy once you get into the habit. The hardest thing for me to drop was "heart-healthy, whole-grained" granola-like cereal.

It was a bit of an epiphany, though. Trying to avoid TMI here, but it changed my perception of "normal" bathroom habits.

 

[Crewer]

Veganish here with little flour, very little sugar, and not much in the way of processed foods. We do eat fish, I have eggs from our CSA when they come in the winter delivery, and we like fresh pasta, which has eggs. I also limit my eating window. Our tastes have changed and I don't crave sweets like I used to (I don't think DH ever did), last time we had steaks neither of us liked them, and DH never liked chicken so we haven't had that for years. As a result we've dropped enough weight to get to normal BMIs without counting calories or any dieting. Best of all DH's knees no longer ache and he can now walk for miles.

I can see that low carb could definitely work, I just don't much like meat and never really have. Things like continuous blood glucose monitoring as well as other studies and theories of causes of insulin resistance are great and should really help the diet world.

 

[twaddle]

@Crewer, I find your approach very compelling, and it's well supported by evidence.

Sounds like you're getting plenty of protein, and that's where vegans often run into a problem (that can result in being a bit frail).

 

[harley]

Veganish here with little flour, very little sugar, and not much in the way of processed foods. We do eat fish, I have eggs from our CSA when they come in the winter delivery, and we like fresh pasta, which has eggs.

Sounds like being a little bit pregnant.

It actually sounds pretty healthy. I think vegan tends to be more ethics based than health based, so if you're in it mostly for the nutrition I think some healthy (and delicious) exceptions are a good idea. Although I can't do that on my low carb eating plan. Once I make it through the carb cravings (usually a couple of weeks) I can't just take a break and eat some Ben and Jerry's. It starts the whole process over, and usually results in a multi-month fall off of the wagon. I'm in one of those stages right now. Dammit.