Peter Attia rags on CICO

[Adam Skillin]

Jordan "The Friggin Bomb" - Thought you might be willing to post this for discussion (or, if we're really lucky, you might even have a comment or two):

Dr. Peter Attia's latest article: http://eatingacademy.com/weight-loss...ns-of-fat-flux

He touches on the insulin question that you addressed recently, as well as the omnipresent issue of CICO:

Brief digression: I’m always troubled by folks who have never tried to take care of someone who is struggling to lose weight (fat), and who themselves have never been overweight, but who insist obesity is ‘simply’ an energy balance problem – people eat too many calories. When eternally lean people preach about the virtues of their ‘obvious’ solutions to obesity – just eat less and exercise more – I’m reminded of a quote (source unknown to me), “He was born on the finish line, so he thinks he won the race.” You only need to meet one woman with PCOS, or one person with hypothyroidism, or one child with Cushing’s disease to know that adiposity can – and is – largely regulated by hormones. The fact that such patients need to create a positive energy balance (i.e., eat more calories than they expend) to allow it does not seem to provide a meaningful insight into the mechanism of why.

[Jordan Feigenbaum]

Discuss away. Dr. Attia and I have similar thoughts on these topics in sum, though I'm not as sold on any sort of significant advantage in outcomes long term with low carb/keto interventions except for in a handful of populations.

[Adam Skillin]

Discuss away. Dr. Attia and I have similar thoughts on these topics in sum, though I'm not as sold on any sort of significant advantage in outcomes long term with low carb/keto interventions except for in a handful of populations.

Noted. I just thought it was an educational piece. I like writing that's technical-ish but written for peeps like me who get all their nutritional learnin' from the interwebz.

[tzanghi]

Discuss away. Dr. Attia and I have similar thoughts on these topics in sum, though I'm not as sold on any sort of significant advantage in outcomes long term with low carb/keto interventions except for in a handful of populations.

Perhaps the use of "significant" changes things, but wouldn't the dearth of hyper-palatable foods, the relative nutrient density(this isn't always higher), the preference for fat-burning and the satiety signals that come with low carb/keto be advantages for those in need of dietary intervention? I always wonder why people say they don't know if there's a metabolic advantage to eating high-fat; I always thought it was just that your body becomes more efficient at burning fat for energy.


I'm believing less and less that low-carb is the holy grail of dieting, but I think the advantages of low-carb over diets including carbs are rather evident as well as the advantages higher carb diets have over low-carb diets(e.g., power output).

[Jordan Feigenbaum]

Perhaps the use of "significant" changes things, but wouldn't the dearth of hyper-palatable foods, the relative nutrient density(this isn't always higher), the preference for fat-burning and the satiety signals that come with low carb/keto be advantages for those in need of dietary intervention

Sure, but just because you burn fat better (and in higher amounts) does not mean you'll lose more body fat. What I think needs to be said, accepted, then moved on from is that by doing low carb/keto you can't eat significantly more calories than you would with another dietary intervention except for very rare circumstances. If it helps compliance, hormonal signaling (which affects compliance on many levels), and does all the right things spontaneously then YOLO. But it doesn't have to be an either or kind of thing. It's just another tool in the tool box.

[Adam Skillin]

If it helps compliance, hormonal signaling (which affects compliance on many levels), and does all the right things spontaneously then YOLO.

And if it doesn't, then FROYO?

[tzanghi]

Sure, but just because you burn fat better (and in higher amounts) does not mean you'll lose more body fat.

I agree. However, I think there's a better chance you'll lose more body fat than by some other type of intervention. As an analogy, eating carbs doesn't ensure that you will lift more, but it sure as hell gives you the best chance, ceteris paribus.

What I think needs to be said, accepted, then moved on from is that by doing low carb/keto you can't eat significantly more calories than you would with another dietary intervention except for very rare circumstances.

Now I have seen MUCH less of the literature than yourself, but I'm not so sold on this. I've seen of and heard too many stories of people just slamming meat, veggies, and fat, and not gaining the significant amount of weight that would normally be seen in isocaloric consumption with higher carbs. Now I don't think you can lose weight overeating low-carb, but I also thought the latest research indicated that adipose tissue is not bad in and of itself but rather is generally an indicator of poor health.

If it helps compliance, hormonal signaling (which affects compliance on many levels), and does all the right things spontaneously then YOLO. But it doesn't have to be an either or kind of thing. It's just another tool in the tool box.

I agree with this, but spontaneous compliance is worth A LOT in my book. If you don't have to even guess how much food your taking in, but your body naturally "controls" your intake, it indicates optimal diet to me. This is probably just a personal preference, though.

[Jordan Feigenbaum]

And if it doesn't, then FROYO?

Indeed.

I agree. However, I think there's a better chance you'll lose more body fat than by some other type of intervention. As an analogy, eating carbs doesn't ensure that you will lift more, but it sure as hell gives you the best chance, ceteris paribus.

Ok, I'll bite. Why do you suspect this?

Now I have seen MUCH less of the literature than yourself, but I'm not so sold on this. I've seen of and heard too many stories of people just slamming meat, veggies, and fat, and not gaining the significant amount of weight that would normally be seen in isocaloric consumption with higher carbs.

This is not reflected in the literature when you correct for protein intake, a known confounder because it's very thermogenic.

Now I don't think you can lose weight overeating low-carb, but I also thought the latest research indicated that adipose tissue is not bad in and of itself but rather is generally an indicator of poor health.

I'm not exactly sure what you're trying to say here.

I agree with this, but spontaneous compliance is worth A LOT in my book.

Mine too, but this doesn't answer any of these questions being brought up.

If you don't have to even guess how much food your taking in, but your body naturally "controls" your intake, it indicates optimal diet to me. This is probably just a personal preference, though.

Okay, I'll bite again. Define optimal. I think your last sentence is correct.

[Milo's Ghost]

Jordan, you say (and have said before) that one of, if not the, advantage to a low-carb diet seems to be the increased spontaneous compliance it offers - i.e. people often eat less than they would on a different dietary intervention.

I think Attia would probably agree with this, but he'd argue that it's the hormonal changes prompted by a low-carb diet that makes this the case. First and foremost amongst those changes would involve insulin (the title of his blog was originally 'The War on Insulin'), though no doubt it would be an oversimplification to say it's *just* a matter of 'lowering insulin.'

In other words, people spontaneously reduce their calories not because of a decrease in palatability of the foods available to them; not because their food becomes more satiating (which suggests it's the change in the *food* that matters, rather than the hormonal changes produced by the low-carb intervention that increases satiety, period); not because they lack food variety and this eat less; etc. Both he and Taubes have been very specific about not buying the 'without the bread, you don't eat the butter' argument.

All that leaves aside the spontaneous increase in TDEE argument, which is where the 'you can eat all the steak and eggs you want and you won't gain weight' people come in (which I think Taubes would subscribe to at least within limits). All the above is just on the 'calories in' side of the equation.

My sense, from what you've written in this forum, is that you either don't agree with this argument, or you think it's a relatively small part of what makes a low-carb diet work. Which is why I was a little surprised to see you say you mostly agree with Attia.

OTOH, maybe I've mis-read you, in which case I apologize.

Is this covered in the book? Or is it a little too far afield for a book meant for athletes?

[tzanghi]

Ok, I'll bite. Why do you suspect this?

I'm strictly speaking from an intuitive sense. Given that one's body prefers to use fat tissue as substrate for fuel, it is more likely that they will use fat for energy when consumption doesn't provide adequate energy than another whose body is adapted primarily to carbohydrate use. I would be inclined to believe that the latter person, adapted to carbohydrates, is more likely to resort to carbohydrate for fuel or even just decrease energy expenditure than the person who is adapted to the largest fuel source available.

This is not reflected in the literature when you correct for protein intake, a known confounder because it's very thermogenic.

I completely acknowledge that the literature doesn't reflect what I'm stating. I'm speaking from testimony of a number of others who allegedly have overeaten on protein and fat to a large extent, while limiting carbs, and have not gained a lot of weight if any. I know this counts only infinitesimally in nutrition, but I can't help what I believe.

Mine too, but this doesn't answer any of these questions being brought up.



Okay, I'll bite again. Define optimal. I think your last sentence is correct.

These can both be addressed at once. By "optimal" I mean most suited for the human being in its natural state to remain healthy. When a diet works without a lot of effort, that indicates to myself that my body is very suited for the diet, and vice versa.

I just want to clarify, I'm not on a low-carb crusade. I've seen the limits and the lack of "magic", mainly due to this forum and personal experience. I just think that the advantages, subtle or insignificant as they may be, are pretty clear.