Thursday, August 18, 2011

Food Palatability and Body Fatness: Clues from Alliesthesia

Part I: Is there a Ponderostat?

Some of the most important experiments for understanding the role of food palatability/reward in body fatness were performed by Dr. Michel Cabanac and collaborators in the 1970s (hat tip to Dr. Seth Roberts for the references).  In my recent food reward series (1), I referenced but did not discuss Dr. Cabanac's work because I felt it would have taken too long to describe.  However, I included two of his studies in my Ancestral Health Symposium talk, and I think they're worth discussing in more detail here.



Dr. Cabanac was initially interested in exploring the possibility that human body fatness is biologically defended around a "setpoint".  He proposed the existence of a system called a "ponderostat" (pondero = weight; stat = the same) that was responsible for this effect. Personally, I prefer the term adipostat (adipo = fat), as fat mass rather than body weight is what is regulated by this system.  His first experiments on the subject were published in the journal Nature in 1971 (2).

To search for an adipostat, he took advantage of an effect called alliesthesia.  Alliesthesia is the phenomenon whereby the pleasantness of an external stimulus depends on the internal state of the organism.  It sounds more complicated than it is.  One example is that entering a hot tub feels better when you're cold than when you're already hot.  The pleasantness of the stimulus (hot water) depends on your internal state (temperature of the extremities).  Another example is that food tastes better when you're hungry than when you've just eaten a large meal ("hunger is the best sauce").  Again, the pleasantness of the stimulus (food) depends on your internal state (hunger). 

To address the possibility that there is a setpoint for body weight regulation, Dr. Cabanac and his colleagues designed a protocol to measure changes in alliesthesia in response to food.  Volunteers were first asked to taste sweet solutions* at several concentrations, and asked to rate their pleasantness.  Second, they were asked to drink an unflavored drink containing 50 grams (~200 calories) of glucose.  Third, they were offered the palatable sweet solutions again and asked to rate their pleasantness.  Here's what the graph looked like.  Pleasantness is on the vertical axis, and the horizontal axis represents increasing concentrations of the sweet solution:

The investigators found what one might expect, that the pleasantness rating of the sweet solutions was lower after the glucose load than before, suggesting some degree of satiety.

Next, they had the same volunteers restrict their calorie intake by eating less of their typical diet, until they had lost 8-10 percent of their body weight.  The investigators then repeated the same experiment as above.  The result was quite different this time:


There was no change in the pleasantness ratings before vs. after the glucose load, suggesting that the glucose was not able to induce the same degree of satiety as it was before weight loss.  Basically, they had a hunger that could no longer be satisfied by a normal amount of calories, implying that 1) the body has a way of measuring its energy stores, 2) deciding if they are appropriate, and 3) adjusting appetite accordingly.  We now know that leptin signaling plays an important role in this process.

After the volunteers were allowed to return to their normal diet, they regained the lost weight, and their alliesthesia returned to normal.  The investigators remarked:
The results therefore support the working hypothesis, and it seems possible to conclude that there exists in the body weight control system a biological "ponderostat"...

Obesity could be a re-setting of the ponderostat at a higher value.
Part II: What Resets the Ponderostat?

Dr. Cabanac and colleagues attempted to answer this question in a subsequent study, performed in 1976 (3).  They used the same alliesthesia technique, and tested the subjects before and after weight loss just like in the previous study.  However, this time they used a different method of weight loss.  They had volunteers obtain all of their calories from a "bland liquid diet" (Renutryl), ad libitum, in other words calories were not deliberately restricted at all.  All subjects spontaneously reduced their calorie intake and lost weight (3.1 kg over ~17 days), after which the investigators used their alliesthesia protocol.  Here's what they found:


Their experiment showed no change in alliesthesia before vs. after weight loss using the bland liquid diet, suggesting that their "setpoint" had decreased in parallel with their body weight, rather than staying the same as it had in the comparison group that lost weight by eating fewer calories of a normal diet.  They concluded:
...palatability of diet influences the setpoint of the ponderostat.
Another interesting anecdote from the paper that strengthens the finding:
In the present experiment, the subjects reduced their intake voluntarily and were always in good spirits, while in the previous experiment, the subjects had to continually fight off their hunger and would spend the night dreaming of food.
That, ladies and gents, is the difference between someone who is at his setpoint and someone who is not. 

There are a few caveats that we have to keep in mind when interpreting these studies:
  • The number of participants was small
  • It was not possible to isolate palatability/reward from other factors, i.e., palatability/reward were not the only factors that differed between normal diets and the bland diet (FYI, the bland diet was high in refined carbohydrate including sugar)
  • The investigators measured body weight, an indirect proxy for body fatness
  • These studies do not imply that other factors besides palatability/reward (such as physical activity) are not important
Still, in the context of the rest of the literature on food palatability, reward, and the biological regulation of body fatness, this supports the hypothesis that there is a body weight setpoint (or whatever you want to call it) and that it can be modified by the palatabilty/reward value of the diet. 


* Made with sucrose (table sugar).

63 comments:

Matt Schoeneberger MS said...

Interesting tidbit about voluntary reduction of calories and mood. I just read a paper yesterday regarding autonomy as a predictor of weight loss success.

http://www.ncbi.nlm.nih.gov/pubmed/8558405

Basically, if someone is forcing you to do it, or you feel like someone is forcing you to do it, it ain't gonna happen.

Monica said...

Keep it coming! This makes a ton of sense in light of my own experiences. I have a difficult time eating more than 1,000-1200 calories daily on this bland diet, even when it contains 50-70% carbohydrate. (Usually it is lower than that, though). Ordinarily I ate around 1400-1800 on low carb when things were spiced and salted, and maintained my (higher) weight for years on that. It will be interesting to see if I can continue to lose and maintain long term.

And now, in other news...

http://tinyurl.com/3dz3n8p

Rob A said...

The first thought that comes to mind here, Stephan, is: do you recommend people consume a bland liquid diet to aid in lowering the adipostat? Because every time I read about this on your blog, I think- surely, here's the simple solution for those looking to lose fat.

Any reason desperate individuals shouldn't do this? Possible nutritional deficiencies? Likelihood of regaining weight on an ad libitum food-based diet upon resumption? Etc.

Also, according to some folks like those in the Health At Every Size movement, higher fat mass may not be inherently unhealthy. In fact, the associated health ills may come from the up and down weight fluctuations resulting from bouts of dieting. Any take on that? In your opinion, is being overweight and/or obese inherently unhealthy?

Kindke said...

"The investigators found what one might expect, that the pleasantness rating of the sweet solutions was lower after the glucose load than before, suggesting some degree of satiety."

It is more like gratification of hedonic hunger for glucose than "overall" satiety.

"suggesting that the glucose was not able to induce the same degree of satiety as it was before weight loss."

Neuropeptide Y is upregulated after a period of calorie restriction/weight loss, Promoting increased calorie consumption at the next meal.

I would also guess that hedonic hunger for glucose is upregulated if your liver/muscle glycogen stores are not full.

"Their experiment showed no change in alliesthesia before vs. after weight loss using the bland liquid diet, suggesting that their "setpoint" had decreased in parallel with their body weight"

Did the "bland" liquid diet contain a significant amount of glucose? If so, that explains the results of this test better than a "lowered setpoint".

The bland liquid diet would of kept thier hedonic hunger for glucose sated, thus dampening the effects of any subsequent "glucose palatability" tests.

montediaz said...

@Rob A.

Rewardless liquid diets have been helping people loose substantial amounts of weight for decades.

www.ajcn.org/content/38/1/20.full.pdf

This paper gives the ingredients of "Optifast 70" as well as the accounts of some obese adolescents who completed the program.

You can get custom protein mixes from several vendors on the internet. I suggest you make your own instead of spending money on commercial liquid diets.

It took a lot more work than I anticipated but I formulated one for my mother that I think beats the pants off of Optifast. She's loosing between 4 and 5 pounds a week.

Note: Get regular blood work done. This isn't the sort of thing you'll want to do completely in the dark. There can be numerous complications.

Stephan Guyenet said...

Hi Matt,

Interesting.

Hi Monica,

Thanks for the anecdote. That story you linked to is really disturbing.

Hi Rob,

I don't recommend it at this point, because I don't consider it food, but I wouldn't necessarily advise against it either. Body fatness is a major determinant of health, so you just have to do the cost-benefit analysis. I'd like to find a way to do the same thing using food, and I think I'm narrowing in on it. But my ideas are still developing.

Hi Montediaz,

Thanks for the link, that paper is very interesting. Seems like high-protein bland diets are a very effective way to do calorie restriction. It's like the initiation phase of the Dukan diet.

AnlamK said...

Hello Stephan,

Can you flesh out more precisely what you mean by palatability/reward as it applies to food?

And how would we go about identifying such nutrition?

THEGAP said...

Hi Stephan, Great post on alliesthesia.
The conference I gave on reward and obesity was indeed in 2007,
http://www.amessi.org/Programme-De-La-Reunion-De-L-adno
I would be happy to keep in touch with you, and perhaps to write a paper in french about this fascinating subject at the end of the year...
Best regards from Guy-André Pelouze

Colldén said...

I had sort of the same question as Kindke, how much sugar did the liquid diet contain compared to the test solutions in the alliesthesia test? It wouldn't be shocking if ad libitum consumption of a sugary liquid diet reduced the appetite for sugary liquids. I've noticed a similar reduction if taste for sweet foods in general after periods of getting a a large percentage of total calories from fresh orange juice, which I guess would not be considered a bland food.

luckybastard said...

I can't believe that I never mentioned this in my other comments because it slipped my mind. In a freaky coincidence, I had a coworker who started a bland liquid diet in an effort to lose 160lbs at the same time i started my paleo diet. He drank several cartons of a premade liquid that was purchased from a company that had a whole program designed around it including nutrition counseling etc. He lost all his weight in a 9 month period- 160lbs- whereas i had less to lose and dropped somewhat slower until i came down to about 70lbs under my starting weight- where i still remain.

Fast forward about 6 months later to yesterday on the elevator. He sees me and congratulates me on keeping the weight off(feels odd these days to hear someone congratulate me on that being how effortless it is) and then proceeds to complain that he is gaining his weight back even though he is working out and is eating relatively "healthy". I've given him tips concerning eating only whole foods- which he mostly does- and staying away from wheat and industrial seed oils, which i think are probably his problem. My simple observation without me wanting to extrapolate too far is that if people do go a bland liquid diet route- and they are out there, not that you're suggesting that- the adaptation to a whole food diet seems perilous, especially if your nutrition is based around the current conventional wisdom. I'm also curious if a bland diet that still has copious amounts of fructose in it is still harmful to the leptin receptors in the hypothalamus. The reason I believe that may be the case is because even prior to phasing real food back in, he would tell me that he had uncontrollable hunger even though he had been consuming a liquid diet for 6 or more months. By this time, I could fast 24 hours easily and routinely waited 20 hours between meals. Granted I was eating a greater number of calories but I still think that fructose intake via sugar, even in a bland liquid calorie-restricted diet, matters for the sake of healing derangement at the leptin receptor level.

Brock said...

Stephan,

1) What do these bland diets do to other health indicators? I'm particularly concerned about metabolic base energy consumption. Seth Roberts seems to have become severely hypometabolic on his diet.

2) Are there any studies that follow these patients long term? Did anyone do a one-year follow up to see how much weight came back? Most diets work at first, but we don't need another yo-yo diet.

gunther gatherer said...

Hi Stephan,

I'm confused as to how 50g of glucose in water would not taste sweet to a volunteer. I tried it myself and to me (who never touches sugar), it was crazy sweet.

Pål Jåbekk said...

Just noticed this one :http://www.ncbi.nlm.nih.gov/pubmed/21849633?dopt=Abstract

Might be of interest.

Jenny said...

The other issue here is that in the second experiment, the subjects LOST LESS WEIGHT probably over a much shorter time.

There was a loss of 8-10% of weight in the first experiment, which for a 150 lb man would be 15 lbs and take quite a few weeks. In the second study the weight loss was only on average slightly less than 7 lbs (4.6% for that 150 lb man) and lasted slightly over 2 weeks.

So the conclusion might just be that set point and it's effect on appetite doesn't get altered after short periods of dietary restriction that result in minor weight loss, but that as we approach 10% lost it does.

That would correlate very well with the experience of many long term dieters who find that weight loss gets much harder as they exceed 10-15% lost.

antispirit said...

What I would like to see is a graduated attempt at short circuiting the weight loss.
For instance, test subjects could be given one quarter of a Klondike bar or something. Just to see how much food reward (added to the bland liquid diet) it takes to derail things. That's on my wish list. Make it happen, internet!

mhb said...

In the present experiment, the subjects reduced their intake voluntarily and were always in good spirits, while in the previous experiment, the subjects had to continually fight off their hunger and would spend the night dreaming of food.

So could it also be that the satiety of the diet on which they lost weight was a factor, rather than the blandness? For example, I'm losing weight on a low carb diet without experiencing the hunger I did on low fat diets. Will this help to reduce my setpoint?

antispirit said...

Oh, and they can eat all the Klondike bars they want before the study. A veritable cornucopia of ice cream confections. Randomize the lucky pre-study ice cream eaters. See if it takes more ice cream to fizzle their steadily increasing wardrobe options.

The paper could be titled "Prior conceptions regarding a one, "Matt Stone" being a vaginal cleansing device may be untenable"

j said...

my question is what about using a standard flavourless protein shake and consuming that when you get hungry during the day.

if we apply Seth Roberts approach of plugging our noses to avoid associating any flavour sensation to the liquid, would it help to keep our appetite lower during actual feedings later on in the day?

Alex said...

I don't think 3.1kg is really comparable to 8-10% of body weight for 99% of people. Using the same group of people for the experiments muddies the water as well.

Also, was there a control group here?

David Pier said...

Gunther-
Those glucose solutions did taste sweet to the participants. I think they would be better described as "unflavored" rather than "tasteless". The whole point was the glucose sated them.
Stephan-
You should have posted this long ago. It is the most convincing study that you have discussed.

David Pier said...

Stephan-
Although I am still not convinced that free living people will find it takes less willpower to give up their favorite foods than it does to endure hunger. I personally have an easier time enduring hunger for a few hours in the afternoon than I do giving up chocolate and other favorite, highly palatable, foods. And I have it easy, as I am in control of my environment (I do the food shopping, most of the cooking, and I work alone and so am not constantly exposed to others' food).
I think your self-experimentation is great, but it appears to me that you previously had the discipline to stay lean before you adopted your bland diet. You may not miss the old food, but how can you quantify how much you previously cared about chocolate, compared to how much I care about it?

Kris said...

Hey Stephan, I'd like to thank you for those articles. You are truly changing a lot of my beliefs on obesity.

I've got two questions however.

1. You say that this system mainly regulates fat mass, not body weight.

What implications does this have for muscle mass? Should a man with a lot of muscle mass but a decent amount of fat lose mainly fat when eating a less palatable/rewarding diet, given that protein and exercise stays the same?

2. It is a fact that the sense of smell has a significant part in our enjoyment of food. What effect do you think plugging your nose with cotton or something during meals would have on food reward and therefore the body fat setpoint?

Thanks,
Kris

Justin Cascio said...

The larger body of evidence says to eat food, not a bland liquid diet, so how I'm reading this finding, in combination with what I've recently read on satiety on J. Stanton's blog suggest that stress hormones are a factor in whether setpoint comes down with body weight while dieting. If a person white-knuckles their way through a diet, feeling constantly deprived, there are metabolic markers of stress. The answer is to find a diet that is sustainable, not a short-term exercise in willpower, and which keeps you both sated and satiated. A high protein, high fat diet of mostly meat will do the trick, and is healthier, more satisfying, and tastier than a shake.

Sean Drew said...

"The investigators measured body weight, an indirect proxy for body fatness."

I seem to remember reading that sugar can have a catabolic effect on the body. Is it possible that the subjects lost lean muscle mass rather than body fat?

Monica said...

wrt Kris' and Sean's comments, I too would be really interesting in hearing Stephan comment on the idea of adipostat vs. ponderostat. Any clues as to how much lean mass can be expected to be lost on bland diets with different macronutrient ratios, or doesn't it matter? I would think this *may* have something to do with macronutrient content (even though it's not widely discussed much among paleoish types that some amino acids can be made from carbohydrates). Perhaps the amount of carb supplied by the bland diet was sufficient at preventing muscle loss by both supplying the needed glucose and serving as substrate for amino acid synthesis?

What I find interesting about the graphs from the second experiment is that there is a greater gap between perceived pleasure/non-pleasure of sugar solutions before the bland diet compared to after, when the pleasure both before and after the glucose challenge was more toward neutral. I think most people on "low carb" or various paleo diets have experienced this effect. After a month on such a diet, things like storebought ice cream will taste sickeningly sweet, while things like sugar snap peas and carrots will taste pleasantly sweet.

David Pier -- I think there is a lot of truth in what you are saying. My husband and I are great examples. My husband would rather do a 24 hour fast to keep his weight down than give up junk food. Food is a highly personal choice and I have found that it can actually be more polarizing than politics and religion.

At the same time, to get to your point, he has much more power than me at resisting the food when he "wants" to and has trained himself to have a glass of water when experiencing hunger and waiting awhile to see if the feeling goes away. He will often go whole days without eating, which was practically impossible for me when I was eating industrially processed food. But it's not for him and he's been doing that for years.

Interestingly, he claims that he could never do what I do: cut out whole categories of foods like wheat, dairy, nuts, nightshades, and eggs (which I am doing along with a bland diet for other reasons) and cook whole food items without spices and salt. My only "vice" now is really coffee. (Anecdotally, I think coffee with a dairy combination is a big rewarding item for me that increases my appetite.) The truth is, I find following this type of diet where I don't have to count every calorie and feel hungry all the time much more sustainable. Low carb or high carb, doesn't matter: as long as I am not eating wheat, sugar, and vegetable oils I do not experience any worry about when I will next eat and that nagging hunger that I can't tolerate.

My husband is much more able to decrease the frequency of his food reward episodes in order to keep his weight stable. I don't think he finds the food unrewarding, though, because if he did, he wouldn't rationalize eating this way and he'd make healthier choices. It would be interesting to examine the differences in brain chemistry of such types of people.

On a different note, I see some comments about food reward on the internet delving into the "free will" aspect of all this and claiming that food reward simply returns us to the gluttony-sloth hypothesis of obesity. I don't follow that line of reasoning. It seems to me that whether you think carbohydrate or rewarding food is responsible for obesity, in both instances a person has to make a choice to decide to avoid certain food items. The initial choice to do these things -- whether cutting carbs or cutting taste -- seems the biggest hurdle to overcome. However, in my personal opinion is that cutting taste is way more difficult than cutting carbohydrate, and I honestly think that is why so many people are averse to the whole idea of food reward.

macsnafu said...

I'm curious: how "bland" could the bland diet be if it included sugar?

Kurt G. Harris MD said...

@ Monica

You said:

"in my personal opinion is that cutting taste is way more difficult than cutting carbohydrate, and I honestly think that is why so many people are averse to the whole idea of food reward."

Well said. People in our culture of continuous serial entertainment hate the idea that food be demoted from entertainment to the moderate pleasure of satisfaction of hunger and refueling....

They LIKE thinking about food all the time.

Food Reward theory is really a much more deeply subversive idea idea than either carbohydrate or fat as the black monolith of obesity and disease.

Mirrorball said...

Anything is easier to me than restricting carbohydrate or calories. I've been slowly making my diet blander and it's amazing how fast you adapt. I don't add salt to anything any more.

Alex said...

For me, the benefit of low-ish carb paleo is that I don't have to eat tasteless crap in order to not gain unwanted weight. The only paleo food I will eat addictively to excess is nuts. Otherwise, the primary palatability offenders are fatty starches, like potato chips, tortilla chips, French fries, buttery croissants, crusty French or Italian white bread slathered with butter, puff pastry, etc.

I suppose if every rewarding food is a problem for someone, than a switch to a bland diet might be in order. But, if one can find a set of delicious foods that don't promote overeating, there's no need for puritanical eschewing of gustatory sensual pleasure.

antispirit said...

We must keep in mind, again, that bland is relative. I can bite into a cucumber and it tastes sweet and flavorful to me (more so if it isn't grown in glorified potting soil). The same can be said for grass fed meat. Because of diet, the batch that I have right now tastes and smells like mustard. I have had raw milk that tasted like blueberries when they were in season. I've probably said it before, but zero carb really changed my relationship to food. Even if you view food as fuel, you still enjoy eating it. With regards to other forms of entertainment, how many hours of live plays could you watch? How many hours of stories around the fire could you tell? My answer would be "as much as one requires and not much more".

Stephan Guyenet said...

Bonjour Dr. Pelouze,

Merci, je vous enverrai un e-mail.

Hi Collden,

Their appetite for sweet solutions was not altered, if you look at the graph it was similar before and after the bland diet intervention.

Hi Luckybastard,

That makes sense. The setpoint is only reduced for as long as you eat a low-reward/palatability diet. If reward/palatability return to their original level, so will the setpoint, gradually.

Hi Brock,

I wouldn't call Seth Roberts hypometabolic without having some kind of objective marker for that such as thyroid hormone. The weight will come back if reward/palatability returns to normal, but all evidence I've seen supports the idea that weight will remain reduced for as long as the diet remains simple.

Hi Gunther,

I'm sure it would have tasted very sweet. I don't understand your question.

Hi Jenny,

I wasn't clear about this in my post, but they had a comparison group in the second experiment that lost a similar amount of weight. I may edit the post to clarify that.

Stephan Guyenet said...

Hi mhb,

If you're losing weight on a LC diet without hunger, that suggests your setpoint is decreasing.

Hi j,

According to Seth Roberts' findings, I suspect it would.

Hi Alex,

Yes, there was a comparison group that lost a similar amount of weight by eating less of a normal diet. I may edit the post and the images to make that clear.

Hi David,

Each person has to make his own decision about what their priorities are and what would be the path of least resistance for them. Personally, I've found that simple food becomes satisfying over time, and I no longer feel under the control of hyperpalatable food. Also, calorie restriction will lower metabolism, whereas lowering the setpoint by reducing reward/palatability shouldn't (although that remains to be shown definitively).

Hi Kris,

Weight loss by simple food will be mostly fat, but it will likely include some muscle as well. That is true with any weight loss intervention that does not have a strength training component.

Hi Sean,

They didn't look at that, but it's highly unlikely in my opinion, based on other studies of bland liquid diets that did measure changes in lean mass.

Hi macsnafu,

Getting 100% of calories from a liquid diet that tastes mostly like skim milk is going to be very low reward/palatability regardless of the sugar content, although it would be even lower if it contained no sugar.

Hi Alex,

I definitely see your point. I think paleo is a good way of reducing reward factors while maintaining a reasonable degree of food enjoyment, but many people find it too restrictive. Eating simple food is also restrictive, but in a different way. I also think the reward/palatability concept offers an explanation for overweight people failing to lose weight on "gourmet paleo".

itsnotthewooo said...

"palatability/reward were not the only factors that differed between normal diets and the bland diet"
[...]
"this supports the hypothesis that there is a body weight setpoint and that it can be modified by the palatabilty/reward value of the diet."

No, it doesn't support the hypothesis. It shows that there may be a correlation between palatabilty and body weight. I think the hypothesis is interesting, but I don't believe this study supports or refutes it.

montediaz said...

In my opinion weight loss should come as hard and fast as possible while still remaining nourished so you can get off the diet as fast as possible to start a more healthy, palatable, and rewarding diet a la The Perfect Health Diet by the Jaminets.

Timing can have a big impact on how a rewarding diet impacts set points. For instance, was it not typical to have a fairly boring, repetitive, and bland diet during the work week and then "splurge" on the weekend? This cycle is carved into our social psyche and we have many traditions built around it.

This rhythm mirrors certain intermittent fasting protocols like the Leangains approach by Martin Berkhan. Eaters will typically eat an unprocessed diet of meat, veggies, and fruit during the work(out) week. After doing this for a few weeks it isn't unheard of to eat several pounds of cheesecake or whatever else in on sitting.

In light of this, I think a diet can and should have very bland and very palatable meals. That's probably the only thing that is sustainable in the long term.

Colldén said...

Stephan, what I mean is that consuming an ad libitum diet of sugary liquids might cause a decrease in the perceived pleasantness of sugary liquids that counteract the increase in appetite normally followed by weight loss, thus explaining the results of the bland diet weight loss group. I don't think this study shows that a bland liquid weight loss diet can prevent appetite from escalating in a more general sense, which is what a decrease in "adipostat" would imply.

About Seth Roberts, I think extremely low resting metabolic rate is pretty solid evidence of hypometabolism, and he's self-professed as being weight stable on 1200 kcal per day.

David Pier said...

I should point out that I've never been overweight by official standards, and I am quite lean now, but I do have some family history of weight problems and I could easily become overweight if I wasn't watchful. I also consider my diet to be near ideal in simple terms of micro and macronutrient composition, as well as hormetic phytonutrients. It is very much in keeping with what one would have thought ideal having read WholeHealthSource back to the beginning, prior to the food reward series of posts.

I think a lot of people think it makes sense to try and eat as much as possible while staying lean, but an efficient metabolism is a pretty good indicator of a healthy metabolism.

Stephan-
I do sense my metabolism slowing when I start to get really lean, but I'm OK with that in light of the apparent benefits of caloric restriction. Do you have any thoughts/information about the expression of longevity associated genes in contented bland (ancestral/natural) diet consuming people vs. caloric restricted people?

Perhaps black coffee is the only free lunch...

Sue said...

Do you have to remain on bland diet for life to avoid weight gain? Is there still room for the 20% treats?
Won't there be issues with constantly avoiding salt?
Monica, do you plan to eat this way indefinitely? Do you list foods you eat somewhere?

Monica said...

Sue,

Stephan may have a better idea on what sort of adherence is required.

I have only been eating this way (either Seth Roberts' oil protocol, for two weeks, or Stephan's step 4 of the bland diet thereafter) for two months. 1.5 months if you count only Stephan's protocol.

The weight loss seems linear when I stick to it (I am tracking it, and my diet, in Excel). I should probably track fat loss and body measurements also to make sure it's mostly fat mass I'm losing. The minute I deviate, I stop losing weight or even gain slightly.

I went partly off for approximately three weeks because family was here and I was cooking for them. I gained three pounds. I tried to eat some things bland but wasn't terribly successful.

Since starting the diet back up a little over 48 hours ago, I have lost 3 pounds and am back at my lowest weight in two years. I hope to lose about 20 more pounds, but that depends on how much weight training I do. Anyway, this means a weight loss of 8 lbs. for a total of about 3-4 weeks on the program. Not bad.

I eat all sorts of things. All sorts of fruits, meats (not bacon), fish, and vegetables. I stay away from nuts since they are a snack food. At first it was hard not to put butter on veggies or grill or fry meats and add salt. Now I just see it as boring, but not a problem. And the liberation I felt when I went from SAD to paleo, where I felt like I stopped living to eat, is now amplified again, since there's no fancy prep for anything and I don't cook for anyone but myself. I don't have to worry about fancy tasty recipes.

If I wasn't on a restricted diet due to sorting out gut issues, I would also not be concerned about potatoes, eggs, or nightshades. I will probably add those back in at some point.

If this works for significant weight loss (I have been disappointed with other diets before, so I'm not getting my hopes up that I'll get super slim on it), I imagine my diet is going to have to stay somewhat bland most of the time, but that occasional cheat meals will be OK where things are flavorful. I only gained a pound a week in the time I was off it, whereas weight loss seems pretty rapid when I am consistent. I have only had about 700 calories today, 41% from carbs, and I'm not hungry at all. I'll probably get hungry before bed and have something. Who knows.

montediaz said...

Vilhjalmur Stefansson: Adventures in Diet

"Not so long ago the following dietetic beliefs were common: To be healthy you need a varied diet... You got tired of and eventually felt a revulsion against things if you had to eat them often..."

"After some three months as a guest of the Eskimos I had acquired most of their food tastes. I no longer desired variety in the cooking, such as occasional baking – I preferred it always boils if it was cooked. I had become as fond of raw fish as if I had been a Japanese."

"During the first few months of my first year in the Arctic, I acquired, though I did not at the time fully realize it, the munitions of fact and experience which have within my own mind defeated those views of dietetics reviewed at the beginning of this article. I could be healthy on a diet of fish and water. The longer I followed it the better I liked it, which meant, at least inferentially and provisionally, ***that you never become tired of your food if you have only one thing to eat.***"

Helen said...

@ Montediaz,

Just like my cats!

But seriously....

They used to get a variety of wet food, and they got picky. When they got the kind with gravy, they would just lick off the gravy and ask for more gravy while those delicious glimmering chunks of whatever languished in their dish. And they were *obsessed with food.*

I switched them to a grain-free "venison and salmon" enhanced (but mostly chicken and sweet potato) dry food. It is all they eat. They eat in a non-obsessive way and apparently don't mind the lack of variety. (Two of them are a bit chub nonetheless. But for indoor cats it could be worse.)

Chrissy said...

I agree with Colldén that we should be careful interpreting this study.

I had no real weight problems ever but have tried out lots of different diets because my health is not the best. And if I go on a blander diet (including low-carb & low-fat) and get really lean, I immediately sense what I came to think of as my metabolism lowering - feeling cold, more chronic pain, worse digestion, plus I got a few other health issues show up when dieting. So I also have a hard time accepting that reducing calories voluntarily does not reduce metabolic rate.

Sue said...

Thanks Monica for your reply.

gunther gatherer said...

Hi Stephan, sorry about my first confusing question. Let's cut to the chase though anyway so I can get to what's really bothering me about all this: What is/are causing the diseases of civilization, in your opinion?

Because once we let go of insulin as the major player in all modern disease (a la Taubes), we're going to need something else to go on! :-)

Laura said...

I am now down 12.5 lbs in 5 months (which doesn't sound like a lot, but trust me, it is). My food is NOT bland but it's unspiced and unprocessed. I have not measured in any way whether caloric intake is lower, but I suspect that it is. Again, I am NOT HUNGRY and in good spirits; I have occasional low blood sugar headaches which were much more common when I was eating processed food. I'm just working through them, usually eating nuts or a bit of bittersweet chocolate to make them go away since they are not accompanied by what I interpret as hunger. Does any one else have to deal with low blood sugar headaches, and what do you do about it? They are much less frequent if I keep lots of protein in the diet.

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

Stephan,

I've been wondering what you think of how intermittent fasting would affect food reward and the BF% set point. I would think that using IF in conjunction with a low food reward diet would be the best way to lower the BF% set point -- a person combining the two would be going a while without any stimulus, then they would be exposed to a weak stimulus. In psychology, we know that constantly being exposed to a strong stimulus dampens the effect of the stimulus, thus requiring more of the stimulus to provoke the same response, so decreasing the strength of the stimulus and the frequency of the stimulus (food) should ultimately cause a weaker stimulus to provoke a much stronger response (satiety) than it would have before.

psychic24 said...

As interesting as the food reward theory is I think there is a major confounding variable at play that many people have overlooked: nutritional status. Losing weight, if not done correctly will exhaust the body's nutritional stores; and even if done correctly there are nutritional deficiencies that arise, which is why you see people recommending supplements regardless of the healthiness of the diet (ex. theperfecthealthdiet). Especially in these alliesthesia studies, how many people might be eating more and enjoying it more due to the body's instinct to obtain more nutrients?

(i'm sure the bland liquid drink had some synthetic vitamins/minerals added to it...seeing as how just about every bland liquid mixture does)

Aeris said...

Hi Stephan,

Your AHS talk is up: http://vimeo.com/27927729

I started to listen to it but the slides are not in the video or on the AHS website. Would it be possible for you to share them on the blog?

Thanks

Dan said...

"The setpoint is only reduced for as long as you eat a low-reward/palatability diet. If reward/palatability return to their original level, so will the setpoint, gradually."

It seems odd how one can come up with a hypothesis seemingly supported by an interesting study and then come to definitive conclusions about what raising/lowering reward will do, and that the ONLY way to lower bodymass setpoint is to eat a lower reward/palatability diet.

Can we please distinguish between reward and palatability? Yes, if you get all of your pleasures in life from food, and find that as your ultimate reward in life, you probably won't lose weight. But if you simply want to eat delicious food when you eat, you can still lower your bodyfat set point.

If what you mean by reward/palatability returning to their original level is that people eat the same things that they used to eat and in the same amounts, then sure, they are going to gain that weight back, but that's a rather self-proving statement.

FlowerVendingMachine said...

Hi Stephan,
It seems there are new studies on reward mechanisms and obesity - here is a recent lecture about this subject from UCSF
http://www.youtube.com/watch?v=WakpunDsXD4
It would be interesting to know what you think about it - it is a 20 min video

Sharky said...

Hi Stephan,
I watched the video of your AHS talk--a clear, concise presentation, IMO. As a reader of your blog I could at least imagine the off-camera slides pretty well. I wondered why no mention of David Kessler when at the end of your talk you thanked those who supplied ideas and sources important to you. Kessler's "The End of Overeating" seems close to your work, and, if I recall correctly, in it he mentions consulting your program at the U of Wash. So my question: do you see any points of disagreement or distinction between Kessler's analysis of food reward and obesity and your own view?

Stephan Guyenet said...

Hi Sharky,

Glad you enjoyed the talk. I'll post a link once the slides are synched. I enjoyed David Kessler's book and I think he's basically right, although he is too narrowly focused on sugar, fat and salt. Those are important reward/palatability factors, but there are others and the full picture is more complex. I didn't acknowledge him in my talk because his book didn't directly contribute to it-- my ideas were already well formed by the time I read his book. I still recommend it for people who are interested in the subject though.

wattlebird said...
This comment has been removed by the author.
Harry said...

@ Sharky

I also have asked Stephan about Kessler's book, as I found it strange that he didn't mention it (given the obvious similarities, in both conclusions and analysis).

As of May 22 this year, Stephan had apparently not even read it...see this link and scroll to comments section: http://wholehealthsource.blogspot.com/2011/05/fast-food-weight-gain-and-insulin.html

Having read it subsequently, and having realised that he had independently come up with pretty much an identical analysis to the one Kessler published a couple of years back, I suspect that Stephan is (quite understandably) avoiding reference to it wherever possible!

For the record, Kessler's book is excellent, and is a thorough account of the ways that eating hyper-palatable food effects our future eating patterns (and contra Stephan's suggestion, it doesn't unduly focus on sugar, salt and fats - it's much more comprehensive than that).

Having said this, I am in no way detracting from the value of Stephan's contribution. There's plenty of room in the tent for those examining the food reward angle, and Stephan is doing a great job in bringing it to the blogosphere and beyond.

David Pier said...

I just read Seth Roberts account of the Cabanac research, and Seth says the 50g of glucose was delivered via nasogastric tube. You write, "they were asked to drink an unflavored drink containing 50 grams (~200 calories) of glucose". Did they drink it or was it put in their stomach bypassing their mouth? I think this is what confused Gunther, too.

I see that Cabanac is still active. Are you going to be discussing any more of his research?

Sharky said...

@Harry

Indeed, ideas about setpoint, palatibility, and overconsumption have been around for a while. I first encountered them in "The Dieter's Dilemma," by William Bennett and Joel Gurin, from 1982. The backjacket photo on my copy shows a couple of truly lean dudes.

Kessler's book is a worthwhile, easy read. I enjoy watching Stephan refine and expand these ideas as he re-evaluates the relevant research.

antispirit said...

Dr. Guyenet-

You may have broached this in some other post, but here it is anyway. Do we have that pesky arrow of causation pointing the right way. Are we overweight because of our food reward? Or do we have excessive food reward because we are overweight?

Ryan said...

@David Pier

Looking at the two papers, it seems like the glucose was delivered by mouth in the first study and by nasogastric tube in the second.

Alex said...

Upon further reflection I feel like the body weight difference is huge. In the bland liquid portion you are talking about ~7lbs of total weight lost. Anyone losing weight knows that a large portion of the initial loss will be water weight. So these people may have only lost 3-4lbs. The calorie restriction people meanwhile lost 8-10%, which translates to 12-15 lbs, or 8-12lbs minus water weight.

I would like to see the study repeated with similar levels of weight loss. There is just too much going on here to draw any conclusions.

Stephan Guyenet said...

Hi Alex,

The second study had a comparison group that lost a similar amount of weight as the bland diet group, yet showed a similar alliesthesia change to the first study.

Scott said...

Hi Stephan: Compellis is performing stage 2 clinical trials on a nasal spray obesity treatment. The results may be relevant to your food reward theory.

http://www.compellis.com/index.php?option=com_content&view=article&id=6:pennington-biomedical-research-institute-phase-i-obesity-therapy&catid=2:press-releases-news&Itemid=3

doro said...

Hi Stephan, this is coming from a person with no scientific or nutritional training whatsoever - I got over a 8 month bingeing episode with depression but now I want to know if it has damaged my set point? I gained 20 pounds that I would rather lose.
I seemed to have a very high metabolism because prior to this I ate junk all day and way above the prescribed calorie limit, but my max weight (as it is now), is about 110 pounds at 5'4.
this is after 8 months of forcing down food about 20 hours a day.
when I didn't do that I still grazed around a bit and ate restaurant fare everyday but I lost that 20 pounds very fast without even realizing.
The weird thing is that my "set point" at an ad lib junk diet is about 95 pounds.
If/ when I eat healthily it goes much lower without me trying.
For reference I feel very sick at this 110 pounds whereas I was much healthier at 95.
It is fine right?
I am sick of stupid people who say it's "not normal" for me to eat so much and be at that weight and me having to stuff myself silly just to please those idiots.

Evelyn aka CarbSane said...

Doro, as someone who was fairly emaciated (upper torso at least) at 110 lbs and your height, 95 lbs is indeed considered considerably underweight. If you've truly been forcing food down your throat 20 hrs/day x 240 days and only gained 15 lbs, I would consult your doctor. Not a setpoint issue, methinks.