Sunday, May 8, 2011

Ask Me a Question

On May 13th, I'll be recording a podcast with Chris Kresser of The Healthy Skeptic. Chris interviewed me about a year ago, and I thought it went well. Chris is a good host and asks interesting questions.

This time around, we're going to do things a bit differently. I'll start with a little overview of my current thoughts on obesity, then we'll answer reader questions. The show is going to be mostly about obesity and related matters, but I may answer a couple of questions that aren't related to obesity if they're especially interesting. There are two ways to leave questions: either in the comments section of this post, or the comments section of Chris's post. The show will air on May 24th.


There are going to be a lot of questions, and I apologize in advance that I won't be able to answer them all. I'm more likely to answer a question if:
  • It's asked repeatedly
  • The answer will be particularly informative for listeners
  • It fills a gap in what I've written
  • It offers a constructive challenge to my ideas
Looking forward to hearing from you.

Update: We recorded the show today (5/13), so I won't be taking any more suggestions.  Thanks!

63 comments:

Sushil said...

1.What are your thoughts on hormesis?
2. (related) I have read a few accounts on blogs where people give up wheat for a long time and then happen to have a sandwich and get extremely sick. Is consuming small amounts of wheat actually beneficial?

mfairchild said...

Both of your dates are in April, do you mean May? I will not miss it, very riveting stuff you've been writing.

Stephan Guyenet said...

Ha, welcome to badproofreading.com

Just fixed it

a said...

What to do about weight loss? Lower fat like Don Matesz and Paul Jaminet are suggesting (that's what I'm leaning towards, but I'm curious), or LCHF? Why do so many people stall on paleo?
Will this be outlined in your next post?

Also, what do you think the optimal diet is? I know you answered this a long time ago in the comments of a post, but I'm wondering if your views have changed at all or been refined.

Tuck said...

You've mentioned on your blog that you think that wheat, sugar, and seed oils are particularly implicated in obesity. Can you give a quick explanation of why for each?

Garry said...

1) Regarding omega-6 fatty acids, what do you make of Walter Willett's recent remarks that n6s are NOT pro-inflammatory but are actually beneficial? To my knowledge, most everyone else views excess n6s as a problem. Is Willett simply wrong, or is there some nuance here?

2) Can you review the current state of dietary saturated fats? The likes of Dariush Mozaffarian and others are on record these days as saying saturated fats are not harmful.

3) While omega-3 fatty acids are usually considered to have health benefits, is there any potential downside to supplementing them? (I guess I'm thinking oxidation)

Norm said...

Are alcohol and fructose equivalent as far as your liver is concerned? If I consume 1/2 a bottle of wine, that's 45g of alcohol. Is this really the same as 2 cans of coke? (90g of sucrose or HFCS is 45g of fructose, right?) We've eliminated wheat, sugar, processed food, PUFAs, eat mostly LCHF etc... But we're oenophiles and can't give up wine, are we doomed!

Alex Gorski said...

On the last podcast you discounted exercise from a cal in vs cal out perspective, but suggested it might be beneficial as a positive stressor. Any new insights on the hormonal response of intense lactate accumulating training - GH, adrenaline, nor-adrenaline, dopamine? These are all lipolytic hormones and tend to be suppressed in insulin-resistant persons.

From personal experience, lactate accumulating training (hill sprints, circuit training with little rest) makes the thought of food nauseating and makes the body feel like a furnace (heavy breathing, elevated heart rate) for hours until it returns to normal. This appears to be the opposite effect of slow and long cardio. Thoughts?

CrossFit Junkie said...

1. What are your thoughts on the connection between diet and Type 1 Diabetes?
2. What dietary recommendations would you give to someone who has Type 1 Diabetes?

Dennis said...

I want to piggy-back on what Alex G. asked: Once the body is no longer insulin resistant, how can physical activity not move the body towards using fat as fuel source if low serum levels of glucose is the current state of the body? I'm thinking of a work out 12 hours since the last food intake. Doesn't exercise (especially intense, lactate producing exercise) make muscles LESS insulin resistant? I understand exercise in an insulin resistant body may accent the problem if food intake increases but how does the counter-balancing effect of less insulin resistance, at the muscle level,play out?

David Moss said...

Question:
Why should palatability (etc.) be viewed in terms of influencing the 'body fat setpoint'?

(What does this mean? If we think that it lowers setpoint, simply because it lowers bodyfat, then it the setpoint actually an informative, substantive, theory? If the setpoint is a substantive hypothesis, then why do we think that food palatability is reducing it?)

David said...

1) Is there a safe way to eat wheat? WAP foundation promotes sourdough for example.

henrydrn said...

What are your thoughts on treating diverticulosis?

What are your thoughts on cavities? preventing? filling them or treating them?

Thanks,

Henry

majkinetor said...

1. What are your thoughts about fish oil supplementation. Some authors think its a bad idea, for instance Ray Peat in article "The Great Fish Oil Experiment" or even Brian Peskin's papers.

Oxidation is mentioned as just one of the problems.

2. Thoughts about amount and type of fruit consumption. Should fruits be avoided on weight loss diet ? Should some of the fruits be eaten ?

3. What is your opinion on intermittent fasting. How about skipping breakfast ? Some nutritionist are strongly against skipping breakfast and suggest that eating should be mandatory during first hour of waking. On the other hand, paleo folks claim its a good thing, prolongs overnight fast which leads to more fat burn (and lower insulin levels) and is more likely to be the way people lived in paleo times.

4. Your thoughts about diet induced hypothyroidism - how fast it happens, does it happen at all ? Some researchers say that it happens fast and that is the one reason for cheat day on low carb diet. Others say its a myth (for instance Todd Becker @ GettingStronger)

rogojin said...

As a male, non-professional rock climber, I have spent 15 years trying to achieve minimal body fat. In order to get below 10%, I have always felt like I am starving myself. In light of your recent writings, I should believe that the easiest way to achieve my goal without feeling starved, is to eat boring food. Is it time to replace my fridge contents with a jug of liquid mush and a tube?

Mitch Fletcher said...

Dear Stephan,

I really enjoy your blog and look forward to hearing the podcast.

My question is "given the effects of highly palatable foods on reward circuits, isn't withdrawal from such a rewarding diet likely to produce cravings, potentially leading to binge-eating behaviour. Will these effects disappear with down-regulation of the reward response after following a relatively bland diet, and if so how long would this take?"

Many thanks.
Mitch

Sarah Smith said...

I noticed that sugar consumption was not decreased on the Mellanby's tooth decay reversal diet. I know that processed sugars are no good, but am unclear on the effects of natural sugars and whether there is anything about them that inherently increases tooth decay.

So, my question is: Have you seen any research on what effect consumption of unrefined sweeteners and fruit has on tooth decay?

STG said...

Why is that some paleo bloggers fail to distinquish whole foods versus processed foods? Nuts and seed oils are an example. Seed oils are processed which result often in a heat or chemically(e.g. hexane) damaged product and are stored in unrefrigerated areas that result in more oxidation. Seed oils are extremely unhealty as a result of their processing. Nuts in their natural state and stored appropriately (refrigerated) are a different product with Omega-6 packaged with antioxidants and minerals. They are not the same as processed seed oils. If I am incorrect, please show me the science and give me some studies that confirm that nuts should never be eating by humans. Lastly, why do some paleo bloggers have no problems drinking highly processed so called coconut milk which contains guar gum, "natural flavors" (MSG ?) but won't eat a real food like nuts?

Kris said...

Do people with no gall bladder have any special challenges that those who do have gall bladders do not? I have hit a road block in trying to find out how fat is processed once the gall bladder is removed,and wonder if increasing my saturated fat intake (as with the Paleo diet) even matters if I can't aborb it properly?

Elizabeth Walling said...

I would love to hear your thoughts on this:

Can stressing out over eating the ideal diet or macronutrient ratios negate the benefits of eating a healthy diet?

kly3 said...

I have been a paleo 90%er and gluten-free 99%er for 5-6 months now. I haven't worked out in about 20 years, but continue to lose weight and just feel qualitatively better.

A lot of my friends and acquaintances just do not believe that I am "healthy under the covers", so I plan on getting blood work done soon to prove to them (and frankly myself) that the methods I'm using are effective.

However, I also know that the standard blood panel they do can miss a lot of the more important markers. My problem lately has been trying to find a good list of the "extra" stuff to ask for.

I know about direct LDL, cholesterol particle size and B12. What else do both of you recommend?

Thanks!

kly3 said...

Heh. Not sure how that "0" got in there. It was 2 years, not 20.

Anika said...

What levels of carbohydrates are truly appropriate for fat loss? None? or just veggies? or a few grains/fruit?

d4aa2a26-7a56-11e0-b491-000bcdcb471e said...

hi, Stephan -- i LOVE your blog.

i'm curious about the risks of using sucralose and sugar-alcohols. often, i see them "not recommended", but i never see WHY, except the vague condemnation of being processed non-foods....

thanks!

Charlie said...

Would love to hear more about current state of melatonin research. How does it fit into the general insulin-leptin-melatonin hormonal feedback system. What else is out there?

David Pier said...

I know you have suspicions about sweetness, even in the absence of fructose. Is this due to the simple "superstimulus" food reward mechanism of inducing excess consumption, or do you see non-oral sweetness sensors playing some sort of role? If so, what?

Jan said...

I would like to know if there is scientific validity to my personal observation, that after eating low carb for months, if I go back to moderate carb with some high carb days, I gain weight rapidly. My calorie content is about the same. Do low-carbers lose the ability to burn off carb calories? If so, why, and is there anything to do to fix and/or prevent that?

Katya said...

There was a paper in Nature that just came out that identified 3 "types" of bacterial microbiomes across different populations. Sounded like it could be up your alley!

http://www.nature.com/nature/journal/vaop/ncurrent/full/nature09944.html

Peter said...

What did you have to eat the day before.

nelson said...

What is a "typical day" of eating like for you?

Thanks!

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

Stephan, I'm interested in hearing more about the correlation between poverty and obesity.

Also, I'm interested in hearing more about the apparent passing on of our broken metabolisms to our children.

These questions are based on our casual observations at the grocery store----the striking differences we see in the people at the grocery stores on the poor side of the county and on the affluent side of county. Night and day.

The Joyful Garden said...

Like Nelson said, what's a typical day of eating for you?

Also, what is the food you're most tempted by? (like croissants or what)

R. K. said...

Are there useful differences between the metaphors of set point, settling point, and lipostat? And are these even the right metaphors?

Erik said...

You mentioned in the last podcast that much of the theory behind low carb diets--that they lead to some kind of 'metabolic advantage'--you do not think to be very significant for fat loss. By 'metabolic advantage' did you mean lowered insulin levels leading to increased insulin sensitivity of lean tissue? Is it possible to lowering insulin levels could make fat tissue (not just muscle tissue) more insulin sensitive, thus leading to greater fat gain if insulin levels rise? (e.g. By eating carbs after not eating them for a while?) By extension could the hormetic effect of moderate carbs be the ideal for maintaining a healthy metabolism?

Erik said...

Related to what I just asked, could increased insulin sensitivity of fat cells explain why some folks plateau on weight loss on low carb diets? If this happens, how does one lose weight? If exercise, low carb, and reducing calories don't work, what is left?

Beth@WeightMaven said...

I'll be the only one to ask this question, so won't expect to hear it on the podcast ;). But consider this just a suggestion, perhaps for a blog post down the line!

I somehow missed your podcast with Chris a year ago, so was somewhat astonished to hear that you talked about the endocannabinoid system back then.

So given that you were looking at this a year ago, but don't seem to still consider it much, my question is to what extent you attribute obesity to appetite disrupters in the brain.

It seems to me that talking about fat mass setpoints and homeostasis don't give enough weight (no pun intended) to the idea that excessive modern foodstuffs aren't just moving setpoints up, they're just obliterating the idea of a setpoint ... it's more like the fat mass thermostat is completely broken.

Perhaps this is semantics, but to me, it gets at the idea that it's not so much palatability per se, as much as it is what's delivered with the package.

Mark said...

Do you think there is an epidemic of hypothyroidism in America due increased consumption of seed oils? Also, does sugar consumption affect the thyroid?

Laura said...

Strange question: what are your thoughts and what is the evidence relating to wheat/gluten and fertility? I have completed 3 weeks of a wheat free diet and even though I thought I was menopausal (9-12 months w/o), I had a period and seem to be returning to my previous cycle. I find this extremely bizarre. What kind of literature is there on this?

Other info - I've gone to a "diet" that basically includes anything that I could pick or kill - any vegetables or fruits, or meat, or nuts that would have been available prior to food "production". I have however included cheese and yogurt. No weight change but see the above.

Also, so you don't take it too seriously, I'm an adoptive parent with three beautiful children. I just find it strange that there seems to be a correlation (although causality has not been shown).

Josh said...

Do you think that it is advisable to cut back on red meat and dairy consumption based on their N-Acetylneuraminic acid content which triggers antibody production in humans (due to an evolutionary quirk that occurred 2.5 - 3 million years ago) and is also absorbed and incorporated onto cell surfaces creating a unique autoimmune process which is speculated to lead to chronic low grade inflammation, increased cancer risk, and increasing the toxicity of E Coli?

Tyson said...

re: carbs - if low carb is best, why is it that the healthiest populations (Kitivans and Okinawans) are the healthiest we have on record, considering their relatively high carb intake (sweet potatoes and rice, respecively)?

elhnad said...

Have you looked into the works of Broda Barnes, Ray Peat, Brian Peskin, and Melvin Page? If not why not? something wrong with their research? or just haven't got to it yet?

Adam said...

Hey man! Firstly, kudos to by far the most amazing blog I currently read in the health spectrum. Keep doing, man!

Question:

How do you feel about the quote "Any diet can work if you stick to it" But really, more of, documentaries like this: http://www.forksoverknives.com/
Something that is growing in viewings and I'm already reading stories of it converting individuals to vegans.

Really: How do we differentiate "what can work" vs. "What is truly optimal" (for health, longevity, performance, etc.) that will prevent obesity and disease in the long run.

Thanks! Take care. -Adam

Trey said...

Stephan - Love your web site. Would love to know what you eat on a typical day, or in a typical week. Relatedly, how often do you eat grains/legumes, if at all? Thanks.

Mickey said...

1) Gary Taubes once opined that for some people who have been obese for a long time there may not be any way to lose the extra weight. Does this mean that people could go the route of those lab rats who starved to death while maintaining their fat and remaining obese? Is that possible?

2) I've read that big agra came out with a genetically modified, high yield wheat plant about 10 or 15 years ago. Is there any evidence that IBS and other bowel diseases have become more widespread in the population since the new wheat hit our supermarket shelves?

3) Are you going to recommend a bland diet mixture or do we have to wait for the book? ;)

Mattman26 said...

I'd like to "second" the questions about "stalling out" on Paleo, or worse yet, suffering an unwanted weight gain caused by a brief departure from paleo/low carb that doesn't seem to want to go away upon return to paleo/low carb diet.

Thanks. I love this blog.

Atlantic6 said...

Please talk about a solution for those of us stuck with a high setpoint. I have been eating very low-carb/Paleo plus cheese type diet for over two years and have not lost weight. I feel so much better, blood work all excellent but no change. I am female, 44, pear shape, Crossfit 3 times a week.

Love the blog. Thanks for discussing this.

Kelly A. said...

High cortisol is supposed to cause fat gain, especially around the middle. What if your cortisol is already on the low side (barely in normal range) on the 4 time/day saliva test?

Would it be preferable to lower it more and would raising it to optimal levels cause more weight gain? (talking about those stubborn extra 10-15 pounds.)

Nate said...

Fantastic Blog. I am very interested in your current series of posts, on setpoints, "rewarding foods" and obesity.

I am curious for more on this, as I am intrigued but not sure if I am following your arguments completely. It seems as if you are saying that our bodies develop a "set point" that our bodies will defend through behavioural mechanisms that will alter our intake or expenditure of energy. Rather than behavior (eating, moving) being the driving force, there are internal mechanisms driving the behavior, making the behavior more of a symptom.

Absent highly rewarding stimuli, our bodies will maintain this balance relatively automatically, but in the presence of highly rewarding foods, the same mechanisms that drive our behaviors to maintain balance will instead drive our behaviors to increase the amount of fat stored, in effect, increasing the set point. This is subtly different than saying that rewarding stimuli cause us to consume more which cause us to then gain weight. Are you are saying that rewarding stimuli cause our bodies to recalibrate its "espectations", and subsequently increase the drive for more food, which is stored as body fat? Or am I missing the boat? I'd love more clarification on this, either on the blog or on the podcast.

Josh said...

Typo correction: Should be N-glycolylneuraminic acid NOT N-acetylneuraminic acid

Me said...

I'm 70 but family history suggests I've got at least 30 more years. I've stalled out on low-carb after losing 25 or so pounds. Great blood work but would love to lose more weight primarily to take some stress off my knee joints.

Any tips greatly appreciated.

Stacy said...

I love your blog and Chris' as well - Thank you so much for all you do, you have no idea how many people you and Chris are helping.

I think I speak for a lot of women when I say ...

I'm a mid-40's female Zucker rat who can't lose fat to save her life. I've been very low carb/paleo for seven months (cut out all grains, sugar, artificial sweeteners, vegetable/seed oils, nuts, processed foods, most dairy (have a little cream),eat only grass-fed meat, etc.). First three months lost 30 pounds, have not lost a pound since (and I have A LOT more to lose). I continue to feel happy and GREAT -- no more daily headaches, brain fog, chronic leg edema, have great bloodwork, etc. I've tried adding more fat, less fat, less protien, more carbs (caused waight gain), less calories, more calories, and I just started stength-training but that hasn't helped either.

What is a girl to do?!

I'm willing to do anything but I just need the super-secret formula.

Please help.

P.S. I have a slow metabolism -- low pulse (low 50's) and low body temperature (96.5 on average) and I already take thyroid medication (nature-throid). Is more exercise the answer (even though some say no)?

elhnad said...

1. What do you think about Getting Stronger's diet methodology, which seems similar to Seth Roberts flavor calorie theory, but I guess I didn't read it carefully enough cuz he says he's different.
"The Deconditioning Diet. The purpose of the Deconditioning Diet is not to lose weight directly but rather to permanently change how you respond to food." http://gettingstronger.org/diet/
Seems to me too dependent on insulin and Intermittent Fasting.

2. Stupid question but why don't you have more recommended books? For instance books by Mccarrison or Cordain, as they are in your hall of fame? or why not include Colpo or Trowel and Burkitt in your hall of fame, as they are recommended books' authors?

? said...

Hi Stephan,

Question from Malaysia:

I see many people here these days being obsessed with pre workout shakes consisting mostly BCAA's and some blend of sugar/creatine etc, being the most popular one by Gaspari's Superpump 250/MAX (kindly google it for the ingredients). My concern is, what would be the long term side effects of having such supplement as a long term commitment? It is processed food anyway, shouldn't that cause an alarm?

Thank you!.

Bryce said...

I'd love to hear more about Leptin, and any possible up/downstream relationship it has to Insulin in fat loss.

Obviously, they both seriously effect it, since tackling either can cause decreased fat mass (low-carb vs. liquid diet - both effective).

Can you elaborate on what metabolic repair must occur in a person, once they've changed their diets, before they'll actually see changes in calorie partitioning and etc? For some people it seems to happen immediatel, wehreas others must eat a "neolithic food free diet" for months before the repair is complete and their bodies can use fuel effectively.

Finally, with tooth decay healing, what results are realistic to expect? Can I heal a dental carry in 3 months? In one?

Thanks for all you do Stephan!

montediaz said...

When is your tube diet formula going on sale? :)

Wouldn't the casomorphin (opioid) by-products of goat milk defeat the purpose of a "low reward" diet?

After putting your concoction into a recipe analyzer at nutriondata it actually faired extremely well. Anything else you would like to add?

What do you think are the downsides, if any, to a tube diet?

Thanks for your awesome blog, hope you'll give your opinion on some of these questions. People want to know!

gibby1979 said...

When you talk about food reward how do non food related factors come into determining your fat set point. Things like acid reflux, lactose intolerace etc.
My father has pretty intense swallowing problems, a result of long term acid reflux problems which caused a tear in his esophagus due to trauma. He still eats but his diet is limited to things with specific textures, content etc. He's lost a lot of weight, mainly fat, but has maintained or increased his intake. I think that the pain from swallowing when eating has changed the food response.

John said...

Related to Gibby's post: when you eat a pizza and then shortly thereafter start feeling the symptoms of a severe stomach virus unrelated to the pizza. You don't want to look at pizza for a long time after that (speaking from experience). Maybe the strong association between the deliciousness of the pizza and the calories in it is fundamentally altered.

-saIN- said...

sorry first question - Anything about eating large amounts of saturated fats that IS bad?

-saIN- said...

1. Is there anything about about eating even large amounts of saturated fats (in the form of say virgin coconut oil, grass fed milk fat, free-range/equivalent poultry or pork?
2. The balance between factors which lead to obesity:
-it seems carbohydrates are not inherently bad - yes? (khitvan studies)
-but volume of calories seems to have an effect (tasty food leads to being overweight? Mice studies)
-what about fructose? (mentioned before)
-insulin vs leptin (and beyond?) (mentioned before)
in short: How do the various contributing factors balance?
3. Ketogenic diets: Are there any negatives to EXTREME low carb/high fat diets and ketosis provided you're also getting the necessary nutrients (ie NOT the older pure bacon and cream ketogenic diets, but rather more reasonable diets)? Can ketosis be reached if you do include lots of vegetables and other high-nutrient food? Is this desirable outside of the context of epilepsy, autism, etc? And even more of an interest: How does ketosis work in terms of being in a ketogenic state ie. is it an on/off state, or is it more a matter of degree?

Razwell said...

Stephan

Could you talk about whether scientists have made any progress at all in understanding the extremely complex chemical behavior of fat cell receptors ?



I realize this is "heavy" stuff no pun intended LOL !


Thanks.


Raz

Megan said...

On breakfast TV this morning the resident GP explained that although eggs contain a lot of cholesterol it has a negligible effect on serum cholesterol - hoorah, the message is getting through!

However, she promptly blotted her copybook by adding "but don't fry them because saturated fat does raise cholesterol"! So...

1. Is there any actual evidence at all that suggests this could be the case?

2. Is there any evidence that saturated fat could cause ANY problems in the body?

Thanks

Stephan Guyenet said...

Hi Folks!

We just recorded the interview so I'm no longer taking questions. Thanks! 5/13/11 2 pm.