Sunday, January 31, 2010

The Body Fat Setpoint, Part IV: Changing the Setpoint

Prevention is Easier than Cure

Experiments in animals have confirmed what common sense suggests: it's easier to prevent health problems than to reverse them. Still, many health conditions can be improved, and in some cases reversed, through lifestyle interventions. It's important to have realistic expectations and to be kind to oneself. Cultivating a drill sergeant mentality will not improve quality of life, and isn't likely to be sustainable.

Fat Loss: a New Approach

If there's one thing that's consistent in the medical literature, it's that telling people to eat fewer calories isn't a very effective fat loss strategy, despite the fact that it works if strictly adhered to. Many people who use this strategy see transient fat loss, followed by fat regain and a feeling of defeat. There's a simple reason for it: the body doesn't want to lose weight. It can be difficult to fight the fat mass setpoint, and the body will use every tool it has to maintain its preferred level of fat: hunger, increased interest in food, reduced body temperature, higher muscle efficiency (i.e., less energy is expended for the same movement), lethargy, lowered immune function, et cetera.

Therefore, what we need for sustainable fat loss is not starvation; we need a treatment that lowers the fat mass setpoint. There are several criteria that this treatment will have to meet to qualify:
  1. It must cause fat loss
  2. It must not involve deliberate calorie restriction
  3. It must maintain fat loss over a long period of time
  4. It must not be harmful to overall health
I also prefer strategies that make sense from the perspective of human evolution.

Strategies
: Diet Pattern

One treatment that fits my criteria is low-carbohydrate dieting. Overweight people eating low-carbohydrate diets generally lose some fat and spontaneously reduce their calorie intake. In fact, in several diet studies, investigators compared an all-you-can-eat low-carbohydrate diet with a calorie-restricted low-fat diet. The low-carbohydrate dieters generally reduced their calorie intake and body fat to a similar or greater degree than the low-fat dieters, despite the fact that they ate all the calories they wanted (1). This may suggest that their fat mass setpoint had changed. At this point, I think moderate carbohydrate restriction may be preferable to strict carbohydrate restriction for some people, due to the increasing number of reports I've read of people doing poorly in the long run on extremely low-carbohydrate diets.  Furthermore, controlled trials of low-carb diets show that the long-term weight loss, despite being greater than low-fat diets, is not that impressive for the "average person".  Some people find it highly effective, while most people find it moderately effective or even ineffective.

Another strategy that appears preferable is the "paleolithic" diet. In Dr. Staffan Lindeberg's 2007 diet study, overweight volunteers with heart disease lost fat and reduced their calorie intake to a remarkable degree while eating a diet consistent with our hunter-gatherer heritage (3). This result is consistent with another diet trial of the paleolithic diet in diabetics (4). In post hoc analysis, Dr. Lindeberg's group showed that the reduction in weight was apparently independent of changes in carbohydrate intake*. This suggests that the paleolithic diet has health benefits that are independent of carbohydrate intake.

Strategies: Gastrointestinal Health

Since the gastrointestinal (GI) tract is so intimately involved in body fat metabolism and overall health (see the former post), the next strategy is to improve GI health. There are a number of ways to do this, but they all center around four things:
  1. Don't eat food that encourages the growth of harmful bacteria
  2. Eat food that encourages the growth of good bacteria
  3. Don't eat food that impairs gut barrier function
  4. Eat food that promotes gut barrier health
The first one is pretty easy in theory: avoid fermentable substances of which you're intolerant.  This can include lactose (milk) and certain polysaccharides, and a number of other FODMAPs.  For the second and fourth points, make sure to eat fermentable fiber. In one trial, oligofructose supplements led to sustained fat loss, without any other changes in diet (5). This is consistent with experiments in rodents showing improvements in gut bacteria profile, gut barrier health, glucose tolerance and body fat mass with oligofructose supplementation (6, 7, 8).  However, oligofructose is a FODMAP and therefore will be poorly tolerated by a subset of people.

The colon is packed with symbiotic bacteria, and is the site of most intestinal fermentation. The small intestine contains fewer bacteria, but gut barrier function there is critical as well. The small intestine is where the GI doctor will take a biopsy to look for celiac disease. Celiac disease is a degeneration of the small intestinal lining due to an autoimmune reaction caused by gluten (in wheat, barley and rye). This brings us to one of the most important elements of maintaining gut barrier health: avoiding food sensitivities. Gluten and casein (in dairy protein) are the two most common offenders. Gluten sensitivity is more common than most people realize; just under 1% of young adults and the prevalence increases with age.

Eating raw fermented foods such as sauerkraut, kimchi, yogurt and half-sour pickles also helps maintain the integrity of the upper GI tract. I doubt these have any effect on the colon, given the huge number of bacteria already present.

Strategies: Miscellaneous

Anecdotally, many people have had success using intermittent fasting (IF) for fat loss. There's some evidence in the scientific literature that IF and related approaches may be helpful (14). There are different approaches to IF, but a common and effective method is to do two complete 24-hour fasts per week. It's important to note that IF isn't about restricting calories, it's about resetting the fat mass setpoint. After a fast, allow yourself to eat quality food until you're no longer hungry.

Insufficient sleep has been strongly and repeatedly linked to obesity. Whether it's a cause or consequence of obesity I can't say for sure, but in any case it's important for health to sleep until you feel rested. If your sleep quality is poor due to psychological stress, meditating before bedtime may help. I find that meditation has a remarkable effect on my sleep quality. Due to the poor development of oral and nasal structures in industrial nations, many people do not breathe effectively and may suffer from conditions such as sleep apnea that reduce sleep quality. Overweight also contributes to these problems.


* Since reducing carbohydrate intake wasn't part of the intervention, this result is observational.

66 comments:

Glenn said...

Thanks for the great posting Stephan. I've made a donation for all this great researching you have done.

I was going to e-mail you this comment, but just in case some other folks might find useful, I'm going to put it here in the comments:

Over the last couple of weeks, I began to notice my pants are fitting a little more loosely. Also, I noticed on some days I simply did not want to eat as much as I usually did. That is definitely not the norm for me.

"What's this?" I thought to myself. Although I have made some improvements in my diet, it's still pretty bad at times, and the holidays were pretty rough as far as sweets and goodies as always, and that lasted into the second week of January. But there's no doubt about it, my waist has gotten smaller, and it came at no great effort on my part. What had changed on a consistent basis that could cause this?

Then a lightbulb went on after I read part three in this series as to what it probably was.

A few months ago, not as a weight-loss strategy at all, but in an effort to improve general health, I began taking about one to 2000 IU of vitamin D3 daily. It's become such a habit I hadn't even thought of it first. It may not be the only factor, but I suspect this is the primary one in causing me to lose weight "without trying." My D3 status had probably been piss poor before I started supplementing as I just don't get much sun. Come to think of it, this "nutrient boost/weight-loss phenomenon" may have happened to me before a few years ago when I began taking chromium picolinate - I just lost weight without trying.

Next on the agenda: bump up to 4000 IU vitamin D, add back in six to 800 micrograms of chromium picolinate, and try to improve my sleep by darkening my room and not shortchanging my sleep time.

I'll keep trying to improve my diet too, although that's tougher going mainly because of all the planning, logistics, and cooking involved in eating this way. But I know it would be well worth the effort.

David Moss said...

Great summary Stephan! Perfect for sending to all the people I know who're interested in health and weight loss, but aren't as dedicated (read: such health geeks) as I.

On 3. "Don't eat food that impairs gut barrier function." I think tannins (e.g. from coffee, cocoa, tea) could be another commonly overlooked factor. Personally I seem to have a prevailing intolerance to tannin foods (originally attributed to caffeine) and my digestion does seem comparatively bad, but I've not come across much comment elsewhere on the matter. It's known that they can cause digestive upset, are anti-nutritious and they do encourage tissue to slough away, so it seems plausible that (given how much they're consumed) this could also be a factor in gut permeability?

Bill Millan said...

Dr Davis, of "Track Your Plaque," recommends almost exactly the same diet. He says "go low carb," and "eliminate all sugar, wheat and corn." By not eating anything that contains flour or cornstarch you really make a difference in your approach to eating. I dropped 35 pounds the first six months I did it, and have maintained that loss a year later.

As someone with CAD, the addition of high fish oil, Niacin, and high vitamin D has really made a difference. Dr Davis didn't have a lot of success in reversing heart scan scores until he got his patients over a 60 serum level on Vitamin D and then started seeing major drops. I got my level up to 83 by taking 8000IU a day in gel caps. My heart scan score a year later was 32% lower. At that point I had another bad looking kidney cyst after already having a cancerous one removed. The Doc wanted to pull it but I went "watch and wait" for a year. A CT last month showed that it had gone from complex to simple and had dropped in size. The Doc has no explanation for this. But there is a lot of evidence out there that vitamin D is stopping cancer.

Jim Purdy said...

There's a huge amount of very useful information here. And I wasn't aware that Taubes has a new book in the works. I'll have to watch or it.

The 50 Best Health Blogs

madMUHHH said...

Nice!
Not really of any concern to me, since I'd probably benefit from getting my body fat setpoint UP, but still a very nice article.
And while I do think that it is important to exclude the majoir gut irritants, I really don't know how far you should take it. After all, there are a lot of substances in food that might cause major troubles for some and no troubles at all for others. So I think the most important thing would be to find out whether you have any sensitivities, avoid those foods and generally keep a very varied diet.
On the other hand, I'm not sure whether it would be smart to avoid all kinds of food sensitives all the time. After all, a healthy body should in my opinion very well be able to handle a diet that includes all kinds of foods without a big problem.

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zach said...

Thanks Stephan, always enjoy it. It's interesting that for all the attacking of him on some paleo sites, this article could have been written by Dr. Mercola- Now or even 10 years ago, specifically vis-a-vis the failure for some people of chronic, severe carbohydrate restriction.

Aaron said...

Glenn,

Those are pretty interesting results. The D3 was fairly obvious to me (I'm in the north and it's easy to see that I don't get a ton of sunlight most days). But what prompted the chromium picolinate?

Aaron

SamAbroad said...

Thanks for this series Stephen, the oligofructose is a new one on me.

What would you consider 'moderate' carbohydrate restriction? Would that preclude ketosis?

Matt Stone said...

If the loss of body fat doesn't also include a rise in body temperature, I think it's more or less useless. I've never seen much indication that body fat levels are that important. More important seems to be the body temperature. When low, it signals the root of the problem, which is leptin resistance. Besides, most health problems stem from low body temperature, not excess body fat. The fact that the two often go together is probably the reason for the negative health associations with obesity.

Starting to think that the higher level of omega 6 in the diet of a low-carber may be offsetting many of the benefits of going lower in fructose and other refined carbs on a long-term basis.

Ned Kock said...

Oligofructose has been a popular dietary supplement in Japan for more than 10 years now.

I would add sunlight exposure to the list, for vitamin D, but not necessarily supplementation. I blogged about the reasons here:

http://healthcorrelator.blogspot.com/2010/01/vitamin-d-deficiency-seasonal.html

Dave said...

Very nice. To paraphrase, the key is to control those aspects of metabolic regulation that you can control (since most of it works without your help). Avoiding foods which cause major swings in blood sugar and metabolic hormones like insulin is a big one. Low carb is probably the easiest route, though low-glycemic is likely effective as well, both having the same end effect. On the other end, you want to maximize insulin sensitivity, which can be done both with D3 and exercise. Here's an interesting recent study on exercise and insulin sensitivity (not particularly significant results, but at least consistent with what we know about metabolism):

http://jap.physiology.org/cgi/content/abstract/01106.2009v1

One thing I would add is magnesium supplementation. Magnesium seems to be important for proper metabolic function, and hard to get in the modern food supply.

Your point about very low-carb diets is well-taken. Muscle meat is not particularly micronutrient dense, so one probably wants to supplement with organ meats, eggs, and soups or sauces made from bone stocks.

J. A. Deep said...

Awesome work, Stephan! When can we expect a book from you?

May I suggest just one more factor if only because it may well be the drop-dead easiest of all to do: Have a spoonful of virgin coconut oil about an hour prior to each meal.

Not only does the coconut oil immediately eliminate cravings for empty calories, but it is a simple matter of observation that a tablespoon of coconut oil taken faithfully an hour prior to eating measurably increases thermogenesis and, ineluctably, reduces the fat mass setpoint.

How does coconut oil do it? It seems to achieve --- in one fell swoop -- what other "metabolic strategies" may be trying to do piecemeal: reduce infection/inflammation of both:

1) the external or barrier organs of the gut and skin, and

2) the crucial internal organs that are protected by the gut/skin barrier (thyroid/pancreas/liver/hypothalamus/heart/brain, etc.).

All of this may well be done by one simple mechanism: the complex of fatty acids found in coconut oil may provide an optimal environment in which "good" symbiotic organisms can thrive and therefore outcompete "bad" ones.

One could ask, if it's so simple, why is there a study of "nutrition science" or even "medical science" at all?

I believe the answer is, evolution has designed humans to make simple elegant answers as complicated as possible in order to derive a "profit," either in return for reputation as so-called "experts", or for monetary or other economic gain.

Brave readers, what have you to lose? If you are faithful, and have a spoonful of virgin coconut oil an hour prior to each meal, you will be amazed at what you see and how you feel.

Rainer said...
This comment has been removed by the author.
Ed said...

Stephan,

I've seen a few folks point out that the typical "low carb" diet might actually be working because of a higher protein intake, which is more satiating. Apparently when you control for protein, the composition of the rest of the calories becomes less important. I can't pull any references offhand, what are your thoughts on simply increasing protein intake as a mild strategy for fat loss? I suppose this is a subset of increasing nutrient density.

Rainer said...
This comment has been removed by the author.
Rainer said...

Stephan, have you ever heard about a Swedish movement with Annika Dahlquist in front of it called LCHF? An English short version is available here http://annikadahlqvistblogenglish.blogspot.com/
2009/09/introduction-to-lchf-lowcarbhighfat.html.
I think that this diet is the right one to set the body fat setpoint down. This is shown by many reports. Please look for this interristing diet.

madMUHHH said...

@J. A. Deep: Do you think it really is important to take the oil before the meal? I use coconut oil imberally but usually in with my meals, which seems to make more sense to me, since 1)I'm not trying to lose weight 2)there probably are some synergistic effects with other foods like enhanced nutrient absorption.

J. A. Deep said...

@madMUHHH

As Stephan and many others here suggest, addictive fake food made by the Big Food companies is almost certainly the cause of nearly all obesity and illness. IMHO, these Big Food companies should be highly regulated and, like the tobacco companies, subject to billion dollar penalties for their willful poisoning of hundreds of millions of people. Of course, that day is not here yet.

But for now, simply taking coconut oil one hour before the meal eliminates the addiction to these Big Food poisons.

FWIW, advocates of the Shangri La Diet also take tasteless oil purely for weight loss one hour in advance of the meal.

Of course, if you can somehow otherwise avoid the many addictive foods made by Big Food companies, then God bless, and yes, coconut oil will work whenever you take it.

madMUHHH said...

Now that is starting to sound kinda "religious". Well whatever, I don't eat processed food anyways, so this really is not a reason for me.

Mikael said...

Daily 20-22 hour fasts! Works wonders for stubborn fat, even though you get to stuff yourself silly before you doze off each night. :-)

Like Ori Hoflmekler's Warrior Diet, but maybe without the fruit and veggie juices.

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darwinstable said...

Thanks for the great post!!! Very informative as always.

Chris said...

superb summary.

Lisa said...

I hear great things about Magnesium but it gives me GI problems. Is there a formulation that won't do this?

Lisa

Glenn said...
This comment has been removed by the author.
paulriemann said...

Lisa said:

"I hear great things about Magnesium but it gives me GI problems. Is there a formulation that won't do this?"

Mike and Mary Dan Eades say that a chelated form of magnesium is "more absorbable and a bit less likely to stimulate diarrhea...When you purchase a magnesium chelate, look for the words citrate, malate, or aspartate..." (The Protein Power LifePlan - CH. 9 P. 222-223)

You could also try trimming back the dosage. And if you're using a chelated form, it is--as the Eades say--more "absorbable", so you wouldn't need as much as you would if you were using an elemental form such as magnesium oxide.

Russell Demczak said...

^^^...chromium is supposedly effective in improving insulin sensitivity. probably in part why certain ancient cultures used onions to treat diabetes long ago, as they are one of the better dietary sources.

Russell Demczak said...

...and the advice on magnesium is spot on.

Anna said...

Lisa,

I'm assuming you are referring to the laxative effect of magnesium. There are lots of choices with magnesium. Magnesium oxide is the most common and it's cheap, but it has a pronounced laxative effect in high dosed or for sensitive people because it isn't well absorbed and attracts water to the bowel/prevents water resorption (remember Milk of Magnesia laxative?).

You can try a couple of things if you want to supplement with magnesium (beyond magnesium-rich foods). You can try to find your tolerance level by trying small doses of magnesium and slowly increase the amount until it "gives you grief" then a back off a bit on the dose.

You can also try different magnesium compounds, such as magnesium taurate (that's what I'm taking now), magnesium citrate, magnesium aspartate, or a blend of several compounds (that's what my husband takes, plus a magnesium oxide at bedtime). Different preparations have different amounts of elemental magnesium and different absorption rates, therefore some have more of a laxative effect than others.

There are a couple of good books on magnesium: The Magnesium Factor and The Magnesium Miracle. There is some overlap, but I found both books were worthwhile. I first started taking magnesium to prevent painful nighttime leg cramps when I was pregnant.

Jack Cameron said...

A recent clinical study found that some of the health-promoting effects of exercise are due to presumably harmful reactive oxygen species (ROS) which bring about amelioration of insulin resistance (increased glucose infusion rate and adiponectin)and causes an adaptive response promoting endogenous antioxidant defense capacity. These health promoting effects were blocked by supplementation with 1000 mg/day of vitamin C and 400 IU/day of vitamin E.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680430/?tool=pubmed

Glenn said...

Aaron re: chromium

There had been a lot of news reports about chromium in the media and I decided to try it. Come to think of it, this had to be several years ago not just two or three. I eventually got out of the habit of taking it for whatever reason.

I suspect the chromium probably helped because it improved my metabolism somehow with regard to insulin and/or glucose.

JA Deep:

"May I suggest just one more factor if only because it may well be the drop-dead easiest of all to do: Have a spoonful of virgin coconut oil about an hour prior to each meal."

Fallon's book "Eat Fat Lose Fat" recommends the same strategy. I did this too but only sporadically.

ItsTheWooo said...

Chromium GTF has made a huge difference for me.

Inositol is another great vitamin. I suggest you research it. It is possibly more effective than chromium, at least for me.

Bright light therapy is also useful for both mood and metabolism. People get fat in the late fall/winter for a reason.

Mikael said...

ItsTheWooo,

The interesting part about darker days is that some of us gain weight without changing our diets or getting hungrier - which leads me to the conclusion that eithar a) one eats just slightly more, or b) the body stores more of what you eat.

I would have understood the gain if I had a raving hunger 24/7, but that is not the case.

J. A. Deep said...

Stephan, I very much appreciate the thoughtful and kind tone of your post. May I be so bold to ask, is your post meant to be only about weight loss?

Or are you hinting at a new view, in which weight, as described by fat mass setpoint, is correlated with many other so-called illnesses. In this new view, espoused I believe now by Taubes and others, the very idea of what illness is --- is transformed, so that a single metabolic marker of fat mass setpoint predicts whether a person is healthy or not? As the fat mass setpoint goes up or down, the likeliness of a spectrum of illness, whether diagnosed or not, goes with it.

I wonder if this may be implicit in how you begin, "many health conditions can be improved, and in some cases reversed, through lifestyle interventions"? Sorry if I've wrongly presumed.

Olga said...

Hi Stephan:

The body has a mechanism for regulating vitamin D whereby, once you've made enough from the sun, any extra vitamin D made by your skin, will be degraded to avoid overdose. Does this system also take into account vitamin D consumed. So that if you take the recommended 1000 IU per day per 25 lb of body weight, year round, you will make slightly less vitamin D from the sun than if you didn't supplement at all?

Olga said...

Ooops, forgot to check off Email follow-up option

Google Beta User said...

Does one derive moderate benefits from "moderate cardio" as opposed to low cardio if one is disciplined?

I'm on week 4 of Paleo. The weight loss is good. I'm not a health noob, so I do try to take care of myself.

However, so far, the lack of variety from a strict PAleo is driving me nuts. Boredom.

If one allows themselves to eat some carbs (sweet potatoes, rice, whole bread, etc) for example every other day does 1. It still cause insulin spikes? and 2. Will it cause a rapid weight gain and 3Will it cause the hunger cravings to return? and 4. Will problems arrive once I hit my 40s?

This post along with Richards interesting post on his Paleo problems (over on freetheanimal)is why I'm asking these questions.

Regards,

Barkeater said...

Regarding magnesium supplementation, there is a nice do-it-yourself alternative -- mag water -- that I have used for months, and find simple, cheap and without side effects. The following is a post (not by me) from http://www.mgwater.com/email02.shtml. Dr. William Davis, a solid and trustworthy guy, asserts that mag-water is well absorbed and recommends it.

Date: Sat, 7 Sep 2002 19:32:56 EDT
HOMEMADE Mg-BICARBONATE WATER
For some time I've been drinking a Mg-bicarbonate water that I make very inexpensively from Milk of Magnesia (magnesium hydroxide) and seltzer water (CO2 water). It has (by math) ~84 mg Mg and ~422 mg bicarbonate per liter and tastes great. The downside is that this water has no other minerals, but I do take a multi-mineral tablet. Here's the recipe:

The equation Mg(OH)2 + (CO2)2 = Mg(HCO3)2 is interesting, because Mg(OH)2 is magnesium hydroxide, as in milk of magnesia (MoM), and CO2 is the fizz in carbonated (seltzer) water. Combining them produces Mg(HCO3)2 (magnesium-bicarbonate), as in ... and Adobe Springs ("Noah's") water. Be sure to get the MoM in which the "active ingredient" is Magnesium-hydroxide and nothing else, and the "inactive ingredient" is purified water and nothing else. You'll see on the label that one teaspoon of MoM = 400 mg of Mg-hydroxide. 42 % of Mg-hydroxide is Mg, which equals 168 mg of Mg per teaspoon. Chill for an hour or two in the refrigerator a 1 liter bottle of seltzer water (not soda water), which consists of water and CO2 only. Open it, and when the fizzing settles down, spoon in 2 tablespoons (6 teaspoons) of milk of magnesia, put the cap back on, shake gently every few minutes and watch the cloudiness disappear as the Mg-hydroxide reacts with the CO2 and becomes Mg-bicarbonate. This 1 liter (approximately 1 quart) will have ~1,008 mg of magnesium + ~5,061 mg of bicarbonate.

Summary: 1 liter seltzer water + 2 tablespoons (6 teaspoons) milk of magnesia = ~1,008 mg of magnesium + ~5,061 mg of bicarbonate per liter (~ 1 quart). You should dilute this, 1 part Mg bicarbonate water with 11 parts regular water, so 1 liter of the concentrated will yield 12 liters (about 3 gallons) of drinkable water with ~84 mg Mg and ~422 mg bicarbonate per liter, close to Adobe Springs water, below, for Mg and bicarbonate, and probably for pH also: Adobe Springs ("Noah's") magnesium and bicarbonate rich spring water is from some mountains in California - see adobe.shtml Adobe Springs water has 120 mg Mg and 410 mg bicarbonate per liter, with a pH of 8.3, according to their web-site.

. . .

2 tablespoons (6 teaspoons) of MoM per one liter of seltzer water seems to be the correct amount- it all reacted with all of the CO2 (no MoM residue and no apparent fizzing, even when shaking the bottle). My cost is $ 0.81 per gallon using reverse osmosis water from the machine at the local market @ 39 cents per gallon. Using tap water it would be 42 cents per gallon. Cheap!

My cost: MoM, $4.29 for 71 tsp = $ 0.36 for 6 tsp.
Seltzer water ----------------$ 0.89 for 1 liter

* * *

The taste of this is not that great, but if you make it a little less potent -- 1.75 tablespoons to the quart, it is palatable. I make it full strength and add just a tad of OJ to it. I drink 8 to 12 oz a day to get my intake (combined with dietary sources)well North of the 420mg or thereabouts that is the recommended daily allowance level for men over 30.

Barkeater said...
This comment has been removed by the author.
Adolfo David said...

About heart disease and supplements, never forget Q10!

I am going to remove butter from my diet because since weeks after begining to take it I have developed a strange chest pain I have never had. I will mantain a very small amount of coconut oil. I will go to my cardiologist but I feel more comfortable obtaining K2 and D3 from supplements and Omega3-eggs.

Gabriella Kadar said...

Google Beta User,

It's ironic that not consuming rice, bread and other grains results equates to dietary boredom. The foods you mention are the ones with the least amount of flavour.

I've had people express the opinon that low carb/no bread must be boring. So I ask them if eating bread for breakfast, lunch and supper isn't even more boring and if not, why not.

I don't think it's possible to become addicted to meat or fish but it's sure easy to get addicted to grains and sugar.

It takes a while before not making toast for breakfast is totally normal and there is no desire to eat grains for breakfast.

Which reminds me, I've got to put the toaster away. It's taking up valuable counter space.

Stephan said...

Hi Glenn,

Thanks! I wonder about vitamin D. There was a clinical trial showing that it doesn't cause fat loss on average. But maybe certain people respond to it.

Hi David,

Good point about the tannins. I think disrupting digestion is their job.

Hi Bill,

That's great, I hope you continue to make progress.

Hi Sam,

By moderate LC, I'm talking about roughly 25-40% carb. Yes, that precludes ketosis.

Hi J.A. Deep,

I don't know, maybe I'll write a book someday. I'm not ready yet.

Stephan said...

Hi Ed,

I don't really know. I do think protein is satiating, but whether eating high protein leads to weight loss in the long term I'm not sure. I think there's some data to that effect. But what is the protein replacing? Typically carbohydrate.

Hi Rainer,

I know of Dr. Dahlqvist because she links to my posts periodically, but unfortunately I don't know much about her approach because I can't read it!

Hi Jack,

That's a cool study. ROS aren't all bad!

Hi J.A. Deep,

My post really is about fat loss. There is a connection between overweight and the diseases of civilization, but it's complex and I'm still trying to understand it.

Stephan said...

Hi Ed,

I don't really know. I do think protein is satiating, but whether eating high protein leads to weight loss in the long term I'm not sure. I think there's some data to that effect. But what is the protein replacing? Typically carbohydrate.

Hi Rainer,

I know of Dr. Dahlqvist because she links to my posts periodically, but unfortunately I don't know much about her approach because I can't read it!

Hi Jack,

That's a cool study. ROS aren't all bad!

Hi J.A. Deep,

My post really is about fat loss. There is a connection between overweight and the diseases of civilization, but it's complex and I'm still trying to understand it.

Chris said...

Stephan Re your last comment - Here is a related study. I know it is in Diabetics but the point seems to be that replacing carbs with either fat or protein is the benefit.

http://www.ncbi.nlm.nih.gov/pubmed/20113388?dopt=Abstract

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prag said...

Stephan,

Do you think tannins should be avoid then, or used in moderation, especially in the aforementioned (coffee, tea, cocoa) substances?

I drink one of those three (without caffeine or sugar) almost every day.

I also love wine and smoked meats.

Stephan said...

Hi Chris,

Good to know.

Hi Prag,

I wouldn't worry about the tannins in moderate quantities of tea, coffee and wine. We're built to tolerate a certain amount of them.

Anna said...

Google Beta User,

I have to agree with Gabriella. As a new mother with a new routine, I'd become bored with cooking and had succumbed to the ease and convenience of too many prepared foods from Trader Joe's (I had fooled myself into thinking TJ's packaged foods were somehow better than the supermarket prepared foods and I had 20 extra pounds to show for it).

In early 2004 when I began eating a low carb diet in earnest (not like when I ate low carb for a few months because of a gestational diabetes diagnosis), I found my interest in preparing good food invigorated and renewed. It really helped that I read up a LOT on low carb diet strategies in general and revamped my cookbook collection to reflect recipe options that were either already low carb our could be easily adjusted. I donated (or in the case of Jane Brody's low fat/high carb cookbook, I tossed it into the trash) many of my old cookbooks because their emphasis on sugar, starch, or grains didn't earn their space on my shelves. I think having cookbooks that took a care of a lot of the calculations was a key factor in my successful transition from a Carb Addict. Non-starchy veggies were increased, and in more varieties.

About 3 years ago I joined a CSA (Community Supported Agriculture) farm subscription program which provided a weekly or biweekly box of fresh produce to play with.

I became far more creative with my cooking and really expanded my horizons into more ethnic cooking styles, more seasonal and local ingredients, and less reliance on 30 minute emergency meal strategies (I often slow roast or BBQ a big roast that can be served in several meals in different ways or frozen for future use).

But it took some and a willingness to think about my food in a new way (and advance planning so I wasn't caught in a food bind - such as making sure I brought something low carb to share at a party so there would be at least one thing I knew I could eat). It was great preparation for going completely gluten-free.

guyberliner said...

Great synopsis, Stephan.

I hope these kinds of refreshing insights start to become much more widely disseminated. I have good friends who could benefit from hearing these things, but I would be afraid to ever mention them. I know a lovely lady with morbid obesity who might benefit from this, but she has developed such a complex around body image and "fat acceptance" that she may never find out, and I wouldn't dare tell her.

EL66K said...

Hey, Stephan, you that are in the big leagues, or going there, are you planning to ever do a study like the ol' classic ones? I mean, get a bunch of rats munching on a fine Weston Price like diet and another at SAD (Sattan's approved diet, sad atherogenic doer, sarcastic advent of destruction, etc.) and see which thrive and which get utterly annihilated. Pure gold. I know it sure can be hard to get such a thing recognized, but it would be pure gold. Is there any recent study that does that?

Stephan said...

Hi EL66K,

I think the kind of studies you mentioned are great, unfortunately they're not prioritized by modern science. There have been some studies in rodents looking at "Western diets" or "cafeteria diets" that are basically a lot of pastries and sweets. They do the same thing to rodent health that they do to humans, minus the heart attacks. Most of them are using normal rodent chow as the comparison group, unfortunately.

Actually, there was a pretty interesting study that Staffan Lindeberg did a while back, now that I think about it. It was the "paleolithic pig" study:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1635051/

prashant said...

I simply did not want to eat as much as I usually did. That is definitely not the norm for me.

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DG! said...

Any suggestions on oligofructose supplements? I found inulin (FiberChoice at my local grocery store). I've seen products with names like "inulin FOS", but it's not clear to me if they have the shorter oligosaccharides or not. I think I can realistically eat more onions and leeks, but probably not every day - that's why I'm asking about supplements. Thanks.

exerwise said...

Great post the only thing that I didn't agree with is the part where exercise isn't necessarily important for fat loss.

Does not resistance training have a muscle sparing effect? Would this not help to maintain a higher basal metabolic rate therefore leading to increased caloric expenditure?

Totally in agreement with H.I.T.T, its great to see the paradigm shift finally occurring in "cardiovascular" training.

Andy

Andrea said...

As always, great post! I have a question about the section on IF, and I really don't know much about fasting. However, is there a way to over come the effects of low blood sugar during fasting, or do you just try to ignore it? The effects I'm talking about are irritability (will people want to be near me or run in fear?), light-headedness, naseau, and just a general obsession with food?

Thanks!
Andrea

J. A. Deep said...

Andrea,

I think you'll find that if you do a 16 hour fast starting when you wake up, and not having any substantial calories until late in the day, you'll be surprised that you will not suffer from energy crashes.

The energy crash we're all so familiar with seems to be caused by eating, or even drinking, more than say 10 calories or so, but not by true intermittent fasting. Anecdotally, IF'ers report that they actually feel better while doing a 16 hour fast, with greater clarity and energy.

More than 16 hours can work, too, but you might want to start there to see how it goes.

Please let us know how it works for you!

robrob said...

interesting article. thanks for posting it. it is nice to see there are some people in the sciences that believe obesity is not a moral problem.

another way to lower triglycerides to allow for better leptin sensitivity is vigours exercise. fasting for 24 hours for me is too hard(I suffer from mild hypoglycemia), but my doctor, really nice lady said if you exercise vigoursly which I have been, lowers insulin levels hence lowers triglycerides which are high.also i try to eat lower glycemic carbs and very limit of grains whole grains included.

I started a high fiber supplementation, protein drink in the morning with my low carb breakfast, moderate carb (usually high quality carb only) supper and lower carb rest of the day. with higher fiber additive, oligosaccride and inulin I think that is what it is.

chromium gtf, vitb complex, and heavier vita c (such as lemons, grapefruit, berries in my shake etc)

my goal? lower my insulin resistance, decrease middle of the night hypoglycemia, I don't take insulin, so far my glucose levels are well within normal, the only number indicator of my insulin resistance (besides physical symptoms) is high tryglycerides, I wanted insulin levels checked too but she did not do it for some reason.

I take bp medication, and I am hoping too eventually be able to get off of it.

some of your suggestions are good, tannins are touted as bad but I read others who say it helps fight bad bacteria and fungi (after all it is a plants defense chemical for such things).it also helps with inflammation.so it it protects the plants why not you?

teas are very good for insulin resistance, black tea being the strongest followed by green tea then white tea. I like green tea myself.

RR

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HiramP said...

I've been "living" the set point theory for the past couple of months. I've really ramped up my exercise level (started the P90X program) but my weight has stayed at the exact same level.

This is a great article with some very useful tips on how to change my set point. I appreciate the work that went into it.

Lisa said...

I just discovered your blog, in my own seemingly never-ending attempt to find the truth - and a solution for my obesity.

I know you're not intending to give medical advice, but this particular blog gives me a great place to start, and areas to focus on.

So thanks - wonderful site, in general!

Lisa from Boston

Unknown said...

When I was working out at the gym 1-1/2 hrs 5x/wk and living on not much more than chicken, eggs, and salads for 2 years, I got my setpoint to 142 (down from 152) in my late 20's. Racked with tendonitis from competing in lifting, I quit bodybuilding and started craving fats and salt. I ate Big Macs, etc. almost every day for 6 months, and did not gain a pound! Shows the Setpoint keeps the weight stable.
After I gained 4 lbs, I cleaned up my diet, going low-glycemic/ high(ish) protein (120 gms/day). When I was 9 months pregnant, I had gained only 20 lbs, and returned to my normal 152 afterwards.

Now (after 25 years of low-glycemic eating), if I have ANY sugar, it quickly jumps my setpoint about 4 lbs per normal-sized box of candy. As an example, on one 4-day road trip, I bought 2 boxes of (yummy!) Hot Tamales at a truck stop and had a beer at dinner one night, and came back 8 lbs heavier. It did not drop off. After a few other minor 'cheats' over the years, I am now 30 lbs heavier. It always happens in jumps, too: 10 lbs in a week or two, and usually in the spring. There is no creeping-on of weight, except if I work out at the gym.
All my blood and thyroid tests are very normal.

After 2 weeks of Atkin's super low-carb 'Induction' last month, I lost my high blood pressure and all of two measely pounds, and it is now a fight to keep them off! I seem to have a very strong weight setpoint, and it seems very easy to bring it up compared to down. Sugar and thus Insulin somehow changes it.

With all the biochem and health experts here, there must be some trick to bringing the weight setpoint down, since it sure goes up easily enough (in days)from simple sugar.
What we need is the antithesis of Hot Tamales!

Anyone know of any leads on the research fronts? Closest I heard is coming out soon (5/12?) from new high-end vitamin & health product company Ariix (product codename: 'Secret Sauce'), pending the patent process, but no info has leaked out about what is in it or how it works. The test subjects said the weight just fell off and stayed off.

Nathan Max said...

I've looked into the research on the high intensity exercise that is mentioned and it is a 20 minutes total of cycling - the intervals are 8 seconds high, followed by 12 seconds or slow cycling... 3 times a week, total 15 weeks.
The usual recommended HIIT we hear from pelo guys is 30 seconds high and 3 minutes of slow... Is there any research on this pattern?

Jennifer Dussault said...

Hi i have a quick question: i am on day one of doing a paleo-like diet, and am having a really hard time with the cravings...i eat a really nice big meal with meat and veggies and an hour later im starving and ready to binge on chips and chocolate....is this normal? should i be doing anything else? I want to lose the 90 lbs i need to lose to be healthy. thanks

Maria Sterling said...

I have a question. I have been eating paleo for a while now and lost about 20 lbs and i have hit a wall. I can't seem to lose any more and when i have a cheat day my weight shoots up almost 4-5 lbs. I think I am plateauing and need to reset my fat mass set pt like you talk about in this article. In order to do this i need to reduce my carbs by cutting out fruits and starchy vegetables like sweet potatoes. To re-set my fat mass set point by restricting carbs is there a time period, like for a week or until I hit some sort of milestone, to do this or is this reduced carb intake something that I need to do until I have reached my weight loss goal? I crossfit and get about 4 hours of exercise per week. Thanks so much!