I exercised Patience today.

It was Exhausting.

Any reader who has paid attention to my posts here at DietHobby knows that...

I highly respect the work of Journalist, Gary Taubes, who wrote "Good Calories Bad Calories"  and "Why We Get Fat".  In fact DietHobby's section; BOOKTALK  features "Why We Get Fat", together with summaries of what I personally found in every single chapter.

Since these books were published, I have conducted quite a few personal Experiments-of-One with Low-carb eating. In fact,  I'm involved in one at present.

However, my own experience and education leads me to believe that this not a one-size-fits-all-world, and that while Every Diet Works for Someone, No One Diet Works for Everyone.

As a lay person with no biochemistry education,  I'm interested in Gary Taubes' Low-carb Theories, and am open to the issues involved in his alternative hypothesis ..., although I will admit at this point I am not convinced that the hormone "insulin" is the sole and ultimate answer. 

Based on my own personal Experiments-of-One, and life experience of observing others, I am still convinced that Calories matter. While I can see that the body processes macronutrients differently, and that additional processing differences exist between individual bodies due to genetic and/or hormonal differences etc., no matter HOW nutrients are processed within the body, it seems obvious to me that ultimately, fat gain, loss, or maintenance, is a matter of Energy balance in and out. This is despite whether, or not, one makes the choice to label that Energy with a caloric number. While body processing differences can make it difficult for one to know precisely how much energy each molecule of food possesses, I cannot help but think that Discounting this Truth as  "CICO garbage", as many people in the the low-carb community tend to do, is a rather stupid way to throw out the baby with the bathwater.

I also respect the work of the obesity specialist, Dr. Yoni Freedhof, M.D. and find his take on Gary Taubes NuSi's potential Research very interesting, so I'm sharing two of his related articles about it here at DietHobby. The first article he posted today, and the bottom one is from a year ago. 

 Here's the current one:

I Predict Gary Taubes' NuSi's First Experiment Will Show Dramatic Low-Carb Benefits 
             by Dr. Yoni Freedhof, M.D. 8/28/13 www. weightymatters.ca

Because that's exactly what it appears it's designed to do.

Taubes lays out the experiment in his recent NuSi promoting Scientific American piece. He's going to take 16 individuals with overweight and obesity and house them in a research facility so as to ensure careful and total control over their dietary intake. Next he'll feed them a diet that's 50% carbs, 35% fat and 15% protein. He'll then tweak calorie intake until subjects are neither gaining or losing weight. Once weight stable he's going to pull the carbs out from under their feet and drop the 50% carbs in their diets down to 5% but will do so while keeping calories entirely stable.

And here's Taubes' description of the implications of his study design,

"In this case, if fat accumulation is primarily driven by an energy imbalance, these subjects should neither lose nor gain weight because they will be eating precisely as many calories as they are expending. Such a result would support the conventional wisdom—that a calorie is a calorie whether it comes from fat, carbohydrate or protein. If, on the other hand, the macronutrient composition affects fat accumulation, then these subjects should lose both weight and fat on the carbohydrate-restricted regime and their energy expenditure should increase, supporting the idea that a calorie of carbohydrate is more fattening than one from protein or fat, presumably because of the effect on insulin."

I'll get to why in just a second, but I predict they'll all lose between 6-20 pounds in the first 2 weeks of a diet consisting of 5% carbs following a step down from one that consisted of 50% despite the fact calories will remain constant. I also imagine that the experiment won't last much longer than the time it'll take for them to lose that weight as most folks don't have the time/luxury of spending months and months in a metabolic ward.

So why will they lose so much weight while calories are kept stable? Won't that indeed confirm Taubes' hypothesis is right on the money?

Not exactly. No doubt some of their losses may well be consequent to the fact that there are differences in what I'll broadly describe as the bioavailable calories of different foods and macronutrients - and so indeed, Taubes may well demonstrate that calories in and calories out is a far from perfect equation (though that's not exactly news), but the bulk of their losses will be consequent to the fact that during the low-carb phase these individuals will burn through their bodies' natural carb stores, their glycogen, and in so doing they'll liberate all the water stored with it.

Depending on your source and each body's level of training, by weight glycogen is responsible for 1-4% of muscle weight in an individual with fully stocked stores (as the study subjects' here will given their 50% carb loading diets). Every gram of glycogen in turn also carries with it near 3 grams of water and if you lose the glycogen, you'll lose the water too. Folks with obesity carry a great deal of muscle. According to friend and author Brad Pilon, in his work he'd found those with obesity to sometimes have a full standard deviation more lean mass than he'd have predicted and regularly carried with them 100lbs of muscle (especially taller men). That's consistent with my findings here in my office and also passes McMaster Professor Stuart Phillips' sniff test.

Consequently this study subjects' muscles' glycogen stores will weigh somewhere in the neighbourhood of 1-4lbs. Add in the water associated with those pounds and now we're talking 4-16lbs that will be rapidly mobilized when carbs are cut (and even more if the deck is super-stacked by only including men with class II or higher levels of obesity). They'll also have liver glycogen stores of between 50-150 grams which when lost along with associated water, will drop them an additional 0.5-1.25lbs. Couple those losses with the tiny bit extra you might expect consequent to the differing thermic effects of food and I'd bet, in total, losses will range between 6-20lbs despite the fact total calories won't have changed.

I'd bet too that there's a great chance this will be a crossover study (or one will soon follow) where Taubes will show us his subjects' massive and total regains when carbs are reintroduced (and glycogen and water reaccumulate) as that will certainly appear to support his hypothesis. Subjects may even gain back more as some papers suggest glycogen starved muscles are able to acutely store larger amounts of glycogen following a carb reintroduction.

I imagine glycogen will be mentioned in the study's discussion section, how could it not be, but what do you think the headlines are going to focus on when the findings that keeping calories constant in a metabolic ward setting but dropping carbs led to massive weight loss are published? Do you think the press will appreciate the result is entirely expected and hence perhaps not even newsworthy?

If simply cutting carbs was a sustainable, enjoyable, and consequently realistic, strategy for the masses, the world would already be slim as it's been down the low-carb road plenty of times before, and I'm unclear on how this particular study is going to do anything other than confirm something we already know to be true.

Lastly, I must as always point out, I'm not anti-low carb. I don't think low-carb is unsafe. I do think low-carb helps many with weight loss. And I do think society's increased reliance on heavily processed carbs has been a contributor to its growing weight. But I also think that low-carb diets have proven themselves to be difficult for many to sustain and consequently that low-carb diets are far from a realistically applicable global panacea for the problem at hand.

Taubes has rightly raged against the damage done by the oversimplified application of calories-in-calories-out, which is why I find it so confusing that he seems to be championing the equally oversimplified message of, to paraphrase, it's the carbs stupid.

[UPDATE: A source who wishes to remain anonymous has informed me the study's formal primary endpoint will be energy expenditure and the secondary endpoint changes in fat mass.]

  Here's the previous one:

Gary Taubes Launches Non-Profit to Prove His Low-Carb Hypothesis
             by Dr. Yoni Freedhof, M.D. 9/12/12 www. weightymatters.ca

Today marks the formal launch of Gary Taubes' new non-profit organization NuSI whose stated mission is to, "improve the quality of science in nutrition and obesity research", and whose implied mission is to prove Gary Taubes' carbohydrate hypothesis of obesity is as correct as he clearly believes it to be.

So let's for a moment presume that Gary Taubes is one hundred percent right. That what his NuSI backgrounder calls a "controversial" hypothesis,

"that the fundamental cause of overweight and obesity is the overconsumption of food in relationship to physical activity",

is truly dead wrong and that instead it's,

"the quantity and quality of the carbohydrates – plays the more critical role in both the accumulation of excess body fat and the chronic diseases that are associated with obesity"

So that means for the moment just ignore data like those from the Ewe tribe who were recorded as having an obesity rate of 0.8% despite diets that were 84% carb. Ignore the various studies that held calories constant while varying macronutrients that demonstrated weight stability. Ignore the results from Cuba's "natural experiment" in the 1990s. Ignore the folks from the National Weight Control Registry who've lost and sustained their losses with widely divergent dietary strategies. Ignore the fact that even the most low-carb positive studies demonstrate only minor differences in weight loss as compared with higher or middle of the road carb diets. Instead I want to ask you whether or not, assuming Mr. Taubes' shiny new researcher's bench is entirely, incontrovertibly, 100% right in placing blame squarely on carbohydrate consumption, would that bench-side proof actually have broadly applicable clinical utility for folks who struggle with their weight?

My bed-side says no.

That's certainly not to say that low-carb dieting doesn't help some manage their weights and health, it just means that no amount of bench-made "proof" will change the fact that low-carb dieting, for many, is far more of a restrictive diet than it is a livable, long-term lifestyle. Meaning that even if low-carb were the holy grail of diets on paper, that fact would be worthless in practice unless you happened to enjoy low-carb enough to stick with it, and judging from the folks I see regularly in my office, that's far from a given. In fact it's a very rare person that I meet who hasn't tried a low-carb diet at least once. And all of those folks? No doubt when they undertook their low-carb diets they were true believers. As far as they were concerned low-carb was to be their salvation, and many report to me having had real success losing but that they just as rapidly regained everything when they couldn't stomach living low-carb anymore. It's that last bit that makes me think that regardless of the outcomes of Mr. Taubes' new non-profit's future studies, low-carb diets aren't going to be a panacea, just as they weren't in Banting's 1860s or Atkins' 1990s.

Mr. Taubes thinks that study design is the broken paradigm that's crippling weight management. He thinks that nutritional research hasn't asked the right questions or used the right methodologies and so that's why we're mired in this mess. And while it's easy to agree with him that there have been libraries filled with poorly designed studies, as far as clinical weight management utility goes, more effectively asking or studying whether low-carb diets have better outcomes than low-fat or other diets isn't likely to help much.

I think the paradigm that's crippling weight management are "diets" themselves.

Whether it's low-carb diets, low-fat diets, GI diets, middle-ground diets, vegan diets, and even bat-shit crazy diets, there are long term success stories and recurrent failures with each and every one, where the common ground to success is a person actually liking their life enough to sustain their new patterns of reduced dietary intake, and where the common ground to failure is suffering or restriction beyond an individual's capacity to enjoy their life.

And so while I don't share Mr. Taubes' view that there is one simple or predominant cause and treatment for obesity, and would in fact argue that anyone who thinks there's a singular cause for the society's weight struggles almost certainly doesn't work with actual living, breathing, human beings on their weights, I do agree that the research on what works and what doesn't work is inherently flawed. But it's a flaw that Mr. Taubes' is likely setting out to sustain and fund in that the flaw I see from my bedside is the arrogant belief that there's one right way to go and only one path to weight gain (or loss).

There's also the issue of spin. Now I appreciate you've got to tell a good story when you're trying to raise money, but given Mr. Taubes has built his empire on the notion that science has misrepresented data on obesity for decades, you'd sure hope that he wouldn't simply do the same.

Without getting into it too deeply I want to present one graph that he includes in his non-profit's backgrounder that he uses to prove his point that it's the carbs, stupid.

The graphs are meant to be very clear. Carbohydrate intake has gone up since 1971 while fat and protein have gone down, and hey look, weight's gone up too. Must be the carbohydrates, right?

But yet a deconstruction of the first graph by Evelyn over at her Carb-Sane Asylum really gets right to the meat of things with this statement when considering the graph on the left.

"looking at this data, we have the men reducing fat % from 37 to 33% while carbs rose from 42 to 49% of intake. And the women? Fat went from 38% to 33% while carbs rose from 45% to 52%. Given all the studies done where the low carb diets were "hardly low carb" according to the militant keto wing of the movement, can we at least have a wee bit of intellectual honesty here and admit that the differences in macro proportions is largely insignificant?"

What she's saying is that from a macronutrient percentage perspective, the difference between the 1970s consumption of a diet containing 45% carbs (for women) and the 2000s diet of 52% (and for men the difference between 42% and 49%) is pretty insignificant and that 1970 diets were anything but low-carb and yet our weights were so much better.

But more disingenuous is the fact that Mr. Taubes left out his arch nemesis from the graph. Calories.

Here's a graph from Stephan Guyenet that superimposes increased American calorie consumption over that graph on the right hand side of Mr. Taubes' slide.

And would you look at that. As weight rose, so too did caloric intake. Pretty much perfectly.

Sigh.

Why we're eating more is the question that needs to be answered, and while the increased consumption of highly refined carbohydrates may indeed be a player, there's zero doubt in this bed-side's mind, the game that's being played isn't one-on-one. There's no doubt it's not as simple as, "eat less, move more", and there's equally no doubt it's not as simple as just cut carbs. If either were true, everyone who wanted to be would already be skinny.

So huge props to Mr. Taubes for being such a passionate man and for truly wanting to see his theories proven - honestly, his bordering on pathological tenacity is genuinely laudable, though I wish he would hold his own spin and writing up to the same degree of scrutiny to which he holds others'. But ultimately, whereas Mr. Taubes now wants to trade in his pen for a bench and conduct research that presumably he himself won't instantaneously and churlishly deride as being useless, when it comes to clinical utility and weight management, the last thing the world needs is to believe that there's only one right way to go.

   SO.... what does this all mean?

I'll be watching, paying attention to further developments.  
Meanwhile, .... I'll just keep on Running Down the Up Escalator.  

In life we often experience multiple wants and desires. Frequently these desires are incompatible with each other and, even worse, sometimes we make decisions that result in neither one of our desires getting fulfilled. 

Self-sabotage can be the result of conflicting desires, where a person has two (sometimes more) desires that are incompatible with each other. Fulfilling one of these desires means losing out on the other. This often involves two or more conflicting goals, often one being a short term goal (like the desire to overeat) and the other being a long term goal (like wanting a "normal" bodysize).

The short term goal often tends to win out, however, because the behavior supporting that goal feels more immediately satisfying, while the behavior supporting that more distant, long-term goal seems more difficult. Yet, in the long run choosing short term goals over long term goals leads us down that path in life of "how did I end up here?"

Sometimes just taking even a brief moment to think about the conflicting desires present within us can help us avoid self-sabotage. Calmly accepting and considering each desire before acting, knowing that we always have a choice, can help reduce the inner fighting and make that battle easier.