Odds and ends June 28, 2009

globe-trotter

Product review: Globe Trotter luggage

The photo you see above is of my beloved Globe Trotter Cetenary roll aboard.  I took it with me on this last trip to Hong Kong and London, much to the chagrin of MD, who hates this piece of luggage with a passion.

MD is a packer extraordinaire and is totally practical.  When it comes to packing, ‘cool looking’ isn’t in her vocabulary.  Since we travel so much, we have gone through many pieces of luggage over the years, and she has found the Hartmann bags best for her particular style of packing.  She can cram more into her Hartmann bags than any one believes possible.  And when she pulls her packed stuff out, it all looks great.

She has evaluated other luggage (usually at my insistence), but always defaults to Hartmann whenever she needs a new bag.  She picks the Hartmann bag she thinks looks the best, but would never, ever trade looks for utility.

I, on the other hand, will put up with a little loss in utility for a big load of cool.  And, in my opinion, the Globe Trotter luggage is maximally cool.  I’ve lusted over this stuff since the first time I read about it and saw a picture.  Every time we go to London, I would head for the Burlington Arcade where the main Globe Trotter store is housed and slobber over all the different pieces.  Finally, a few years ago, much to MD’s displeasure, I succumbed and purchased the above roll-aboard or trolley, as they call it.

Every time I try to take it anywhere, MD whines.  It isn’t divided into dual compartments- it’s just one empty box on wheels.  And it doesn’t open completely so that the top lays flat.  She feels it limits the amount that can be packed and easily retrieved, and she’s no doubt correct, but that doesn’t mean it’s worthless.  It has hard sides, so stuff is protected, and it has leather straps so it can’t pop open, and it has a great wheel system, so it’s easy to pull.  But those virtues mean nothing to her, so she always beats me down when I want to take it on one of our trips.

This time, however, I manned up and took it despite her protestations.  It functioned okay at best.  It was a real pain to get into in the overhead of the airplane, what with having to deal with the straps and the locks and the lid.  It’s much easier to simply unzip a bag and reach in.  All the gripes MD had about it turned out to be correct.  I’ve realized that Globe Trotter bags, which have been made since the late 1800s, were designed and built for a time when someone else handled all of your bags when traveling.  They’re made for durability and for unloading once you get to your destination – they’re not worth a flip if you live out of your suitcase as we often do while on the road.

I no doubt looked dashing as I wheeled my trolley across the lobby of the Mandarin Oriental hotel in Hong Kong, but that didn’t make up for the  all the downside.  Globe Trotter luggage does look great, but in this case, at least for my purposes, the looks don’t trump the lack of utility.

The placebo effect and observational studies

I got the following comment (reprinted here in part) on my last post:

Dr Mike, I must say I’m a bit uneasy about your attitude to observational studies. Doesn’t that in effect disparage most “traditional” knowledge, whether architectural (”If we build things in this way, they don’t seem to fall down”), medical (”People seem to recover from their fever when I give them this combination of herbs”), societal (”If we set up this kind of committee, things seem to function more or less peacefully and efficiently”)? I understand that an observational study doesn’t prove anything by itself but it seems that it’s a more formalized kind of traditional observation, one that, crucially, makes itself transparent and therefore open to future reinterpretation. I may be misunderstanding your stance, but I worry that in effect it negates most of humankind’s historical progress, and any kind of inquiry that doesn’t fit your preferred methods.

This commenter sets up the problem in a way that it can be explained easily.  And probably more clearly than I’ve explained it in the past.

As I pointed out in my post on observational studies, these kinds of studies are worthless for proving causality, but useful in defining hypotheses that can be tested.  Let’s take one line from the comment and is it to demonstrate what I mean.

“People seem to recover from their fever when I give them this combination of herbs.”

A perfect example.  Let’s say that some witch doctor sometime in the past came up with an herbal concoction that helped his ‘patients’ recover from a fever.  Over the years this herbal therapy was passed down from witch doctor to witch doctor, and it worked without fail.  A traditional doctor heard of the cure, tried it on a few patients and found that it did indeed seem to work.  Every time the good doctor prescribed this herbal remedy, patients had their fevers break and began to get well.  This doctor told other doctors, many of whom began using the herbs, and their patients, too, recovered from their fevers.  Patients swore by the stuff and rushed to their doctors to get it whenever they got sick.  Traditional doctors and witch doctors alike were in agreement that the potion works like magic.

Then comes a scientist who looks at the data and says, hey, here is a great observational study.  All the observational data indicate this stuff works like a charm, so let’s make that our hypothesis, which, simply stated, is that Herbal Mixture X reduces fever in those who take it.

Now that the hypothesis has been developed, it needs to be tested.  The best way to test it is with a randomized, double-blind, placebo-controlled study.  Our scientist recruits doctors in several clinics across the country who are familiar with the workings of Herbal Mixture X (HMX) and provides them with a study protocol and unlabeled HMX and placebo, both of which look identical.  As per the protocol, any patient who comes into the clinic with a temperature above 101 [degrees] F gets a randomly generated number and either the HMX or the placebo.  Neither the patient nor the doctor knows who is getting the real stuff and who’s getting the placebo, which makes the study double blind.  If the doctor knew who was getting the HMX, then the study would be single-blind, not double-blind, which would not remove the physician bias from the study.  The assumption is that if the doctor doesn’t know which is which, he/she will treat all patients the same and not let some subtle bias slip into the experiment.

When a patient presents to the clinic with a fever, the doctor gives either HMX or placebo and waits to see what happens.  The doctor or staff contact the patients daily and have them report their temperatures.  When temperature has returned to normal, the data point is entered on the patient’s chart.  After a specific number of patients have gone through the protocol, the codes are broken to see which patient got the HMX and which got placebo.  The scientist then crunches the data to see whether the supposed fever-lowering ability of HMX is statistically significantly different from that of placebo.  And, lo and behold, let’s say for argument’s sake there is no difference.

There is a huge outcry from all the docs who have used the treatment.  The study was flawed, they scream.  We know this stuff works.  We’ve used it for years, and we’ve seen it work.  Same goes for the patients who have taken HMX over the years: they swear by it, too.  They say, We don’t care what one stupid study showed – we know it works.

So, another group of scientists takes on the project and repeats the study.  And gets the same results.  HMWX works no better than placebo.  All the same outcries arise, and so the study is repeated a few more times, all with the same result.  Clearly, HMX works no better than placebo when compared in a double-blind, placebo-controlled study, yet thousands of doctors and countless patients firmly believe in its efficacy.  What happened?  The observational data seemed to strongly ‘prove’ that HMX worked, but the actual testing showed it to be worthless.  What’s going on here?

What’s going on and what makes HMX work is the magic of the healer telling the patient that the therapy is potent along with the patient’s belief in both the healer and the strength of the remedy.  In other words, the placebo effect.

Don’t believe me?  With the recent death of Michael Jackson, reported by some as due to an overdose of a potent painkiller, said painkiller, Demerol, is much in the news.  I just read a piece written by a doctor on the placebo effect that describes the strength of this phenomenon.  Most physicians who have been in practice for any length of time have similar stories:

Jane D. was a regular visitor to our ER, usually showing up late at night demanding an injection of the narcotic Demerol, the only thing that worked for her severe headaches. One night the staff psychiatrist had the nurse give her an injection of saline instead. It worked! He told Jane she had responded to a placebo, discussed the implications, and thought he’d helped her understand that her problem was psychological. But as he was leaving the room, Jane asked, “Can I get that new medicine again next time instead of the Demerol? It really worked great!”

A placebo as strong as Demerol?  You bet.  Happens all the time.

I’ve been lambasted by many readers over my comments on the lack of efficacy of HCG treatment for weight loss.  Many have received what they consider to be significant benefit from HCG therapy and can’t possibly believe what they were experiencing is the placebo effect.  However, based on the many studies in which HCG was compared to placebo in double-blind testing, it is no better than placebo.  But that doesn’t deter those who don’t believe.  They know it works because it worked for them.  Which, of course, is how the placebo effect operates.  According to the results of at least 20 double-blind, placebo-controlled studies, these people would have experienced the same weight loss had they been given saline (salt water) injections or drops under their tongues and been told that the therapy they were given would keep hunger at bay and make their excess weight magically disappear as it had worked for thousands of others.  Of course, the 500 kcal/day diet helps, but in the minds of those who have had success with HCG, it is the hormone that does the trick.

Fat cells and adolescence

It has long been thought that fat cell number became fixed at about the time of late adolescence, and now a study using carbon-14 labeling pretty much confirms that hypothesis.

People get fat in childhood and up to late adolescence by increasing the number of their fat cells; people who get fat after adolescence do so not by adding more fat cells, but by increasing the size of the fat cells they already have.

What this difference in method of storing fat means is that it is more difficult to lose weight after a fat childhood than after gaining excess weight as an adult.  Why?  Because obese children have a large number of normal-sized fat cells that they carry on into adulthood.  To lose weight, they must reduce normal-sized fat cells to subnormal-sized ones, a more difficult prospect than reducing the abnormally-enlarged fat cells that are a consequence of adult weight gain back to normal size.  It can be done as evidenced by all the people who were overweight as children who have lost in adulthood, but it’s a tougher row to hoe than for those who got fat as adults.

Exercise and weight loss

Gary Taubes has taken a lot of heat as have I for publishing the idea that exercise doesn’t bring about weight loss.  The body compensates for increased exercise with increased food intake, and it takes surprisingly little food to replace whatever calories were lost by exercise.  Exercise has multiple benefits, and I recommend it to everyone because of those benefits, but, sadly, increased weight loss isn’t one of them.

This concept is one like the placebo effect that many people have difficulty grasping.  I’ve had countless comments from readers who have related their own stories of how they lost weight by a rigorous exercise regimen.  And they may have, but how do they know it was the exercise that did the trick?  How do they know they were losing weight because they were exercising instead of exercising because they were losing weight?  That statement seems ridiculous on the surface because it appears so obvious that the calories expended in exercise are what causes the weight loss.  But how do we know?  Perhaps because of a change in diet the body needs to ditch a bunch of excess calories from fat stores that are being emptied and does so by increasing the desire to exercise or increase fidgeting in an effort to dissipate this energy.  The increased weight loss brought about by this increase in exercise would be perceived as being caused by the exercise whereas in reality the exercise was caused by the need to lose weight.  It’s a difficult concept to grasp, but it has pretty much been shown in controlled studies that simply increasing exercise doesn’t reliably bring about weight loss.

As I wrote above, when people exercise, they generally increase their food intake to compensate.  But it’s not just the exercises itself that increase food intake, it could be simply thinking about exercise.

Researchers from the University of Illinois reported on two studies in which they correlated food intake with advertising encouraging exercise and even with subliminal words that had exercise connotations.  People ate more when simply hearing about exercise or hearing such words as ‘action’ in the context of something else.

Wrote they:

Alarming rates of overweight and obesity in the United States have led to the development of preventive communications and interventions to promote weight loss. As weight loss is contingent on energy expenditure exceeding caloric intake, one popular approach comprises promotion of physical activity. Media and community campaigns often encourage audiences to increase their physical activity by engaging in structured exercise or active routines. The present research was designed to explore potential effects of such campaigns on eating behavior.

Their conclusion:

Overall, the findings from these two experiments are suggestive in demonstrating that exercise messages can exert inadvertent immediate effects on food intake. Such consequences may not be apparent if exercise is the only measured outcome, but could potentially jeopardize weight loss.

The body likes to keep things on an even keel and maintain homeostasis and has all kinds of mechanisms for doing so.  If you walk past a bakery and smell the aroma of freshly baked bread, your pancreas figures there is going to be some carb coming its way soon, so it releases a little insulin in anticipation.  Apparently the same thing happens if you even think about exercise.  You eat just a little bit more to compensate – even before you exercise.

The dark side of fiber

You just about can’t read anything these days without hearing the virtues of fiber extolled.  It seems that fiber is on everyone’s good list.  Even low-carb and Paleo diet advocates go to the trouble of making all aware that their diets contain plenty of fiber.  No one has anything bad to say about it.

Well, I do.  I can’t let one of these odds and ends posts end without linking to one of my own favorite posts from back in the days when I had only three readers.

Take a look here at a post about a pretty good study showing how fiber really exerts its effects.

My slogan has become: Fiber…who needs it?

Video fun
And, finally, I can’t quit without a video.  I saw a guy like the one in the YouTube below on the Johnny Carson Show years ago.  I was stunned back then that someone could do this, and I’m just as stunned now.  It just doesn’t seem possible.  Enjoy.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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50 thoughts on “Odds and ends June 28, 2009

  1. Nice, as always. I really enjoyed the older post on fiber too. People are quite obsessed with bowel movements these days, aren’t they. It certainly doesn’t make a very good yardstick for measuring health though.

    Eating copious amounts of useless (and damaging) fiber to ensure more trips to the bathroom – just so you can be assured that you’re healthy is kind of like cheating on an IQ test.

    Cheers.

    Great analogy!

  2. Not wanting to beat a dead horse (killed by you) on observational studies, I’d like to consider a variant. What about physiological studies? A great deal of Gary Taubes book (and indeed many of your writings) deal with the physiology of carbohydrate and insulin. Cannot physiological reasoning be used to motivate treatment or lifestyle issues without the rigour and expense of double blind studies?

    Yes, most of the physiology we know is worked out this way. Where studies typically come into the picture is when we want to test the efficacy of some substance (drug, herb, food, whatever) to alter damaged physiology for the better. We can use observational studies along with knowledge of physiology to set our hypothesis up to be tested.

  3. What benefits would you say come from exercise, just to clarify.

    I’m skinny and I exercise, but it would be more that I exercise because I’m skinny. If I’m sitting round all day then I get fidgety until I do something.

    I exercise for the following four reasons.

    Cardiovascular health,
    Muscle strength,
    Muscle endurance,
    Circulatory health (probably a caveat of #1).

    The middle two I know are improving and the other two I would just take in good faith. Thoughts?

    All of the above, but mainly muscle strength. The others all derive from increased muscle strength.

  4. Mike, I love being the cool traveler as much as possible–but I have to go with MD on utility over cool, every time. However–that said, my primary case is an International Traveler 20″ hardside that they don’t make anymore–and when I have to replace that, I’ll likely go with something in the eBags professional series (if they would just make it in any other color except black!)

    Or you could go for a reddish Globe Trotter Centenary trolley. I know where you could get one at a reasonable price. :-)

  5. Dr. Mike,

    This question question has no relation to today’s blog but I’m hoping you’ll answer it anyway. :)

    How to do you feel about the use of microwave ovens to cook and/or heat up food?

    Thanks for all your informative blogs and Tweets! They are appreciated by many!

    Be well!

    JP

    MD and I have a microwave and use it mainly for heating stuff up. We don’t cook it in much at all. I haven’t read the literature on the possible problems with microwaves, so I don’t really worry about it.

  6. Pairing the placebo effect together with observational study makes them all the more useless. I say get rid of them altogether – If you think you look like a duck, think you walk like a duck… you’re about to start quaking at any minute.

    Commenter’s quote:

    “Dr Mike, I must say I’m a bit uneasy about your attitude to observational studies. Doesn’t that in effect disparage most “traditional” knowledge, whether architectural (”If we build things in this way, they don’t seem to fall down”), medical (”People seem to recover from their fever when I give them this combination of herbs”), societal (”If we set up this kind of committee, things seem to function more or less peacefully and efficiently”)?”

    My problem with this is that traditional knowledge HAS come to be based on observational studies and not much more. I think it has led to a passivity among doctors and ironically robbed them of their observational skills. Unfortunately the medical community has become a ‘one size fits all’ community and the days of a doctor taking the time to dig for information in an effort to customize a treatment are gone.

    On both occasions when I asked you about statins, you mentioned having a thorough conversation with the patient; the reality is that most doctors look at a cholesterol number and immediately write a script. I am often quoted observational study results as a response to most issues I try to discuss with my doctor. it’s sad that the healthcare industry has come to this.

    Sidenote: I recall reading somewhere that a division of Yale is giving medical students art classes in an effort to improve their observational skills.

    BTW, the bag is way cool but the straps look like a major pain in the ass.

    The straps are kind of a PITA, especially when trying to get something out of the case in the overhead compartment in the middle of the night over the Pacific on a bumpy flight. It wasn’t easy.

  7. The piano-guy is faking. Look for example at position 1:33 in the video – two identical notes are played while the balls hit different positions on the “piano”. But the audience is thrilled. Perhaps they are “double blinded” too?!… 😉

    Cheers, guzolany

  8. Hey! This is exactly the kind of followup to the HCG post that I was hoping to find. I was a little confused about exactly what you were saying and it’s nice to have clarification.

    “The best way to test it is with a randomized, double-blind, placebo-controlled study.”

    Ah, how I love that phrase! I just wanted to point out though, that in a way the study example you use is somewhat voluntary, as only people who come into the clinic go through the trial. As an example, men will go less frequently to see a doctor. No biggie, but that’s the first thing that came to mind when I was thinking about the example trial. :)

    “However, based on the many studies in which HCG was compared to placebo in double-blind testing, it is no better than placebo.”

    Said it before and I’ll say it again, there is no reasonable proposed mechanism for how injecting pure water is supposed to make you lose weight. At least, none that I have heard yet and I’d be happy to hear what the other commenters have to say.

    Thanks again for the follow up, it was exactly the clarification I was hoping for.

    My example had to be voluntary because the set up from the comment was people with fevers. You can’t recruit people with fevers with newspaper ads – you’ve got to wait for them to come to you.

  9. Dr. Eades – first off, excellent example of the placebo effect. So many do not understand that RCT’s are really the only effective way to figure out whether an intervention truly works or not. Your examples are wonderful.

    I must say though I am disappointed in Taubes and his (and your) misguided/obfuscated conclusions regarding exercise. The problem being – Taubes (to my knowledge) has never actually defined what he means by “exercise”.

    Certainly he (and yourself) believe that different types of exercise (resistance training, cardiorespiratory), intensities (walking on a treadmill at 2mph vs. HIIT/tabata) of exercise differ vastly in terms of their ability to produce muscle tissue, impact hormones, burn calories and henceforth accelerate fat loss. (Of course when dietary factors are sufficient to support fat loss)

    Making blanket statements such as “exercise does nothing for weight loss” is frankly an irresponsible half-truth that requires more delineation. If you or Taubes were to say;

    “Steady state submaximal cardiorespiratory exercise in the absence of dietary change does not impact fat loss very much”.

    This would be more truthful and frankly, more responsible. I think most other discerning people would accept;

    “We’ve eaten so much dang food over the past 25 years that exercise interventions have become futile”

    or even;

    “You must employ sound dietary strategies to succeed in any weight loss endeavour.”

    The fact is, cardio combined with diet and resistance training is far more effective than any one intervention on its own. Kramer et. al in a 12 week study showed the following;

    3 groups: dietary only, dietary + cardio, dietary + cardio + resistance training.
    Fat mass losses:
    – Diet only: 6.7kg
    – Diet/cardio: 7kg
    – Diet/cardio/resistance: 10kg

    Also noteworthy – the D+C+R group lost almost no lean tissue whatsoever while the diet only group lost almost 3kg worth of muscle.

    Insofar as exercise making you hungry – you’d have to show me some consistent data to support this, rather than a random social science study on thinking about exercise.

    This is a common sense issue and a delusion that many exercisers fall under. They lull themselves into believing they can eat more and/or eat unhealthy foods as long as they exercise. You can’t out-train a crappy diet – no argument there.

    Here are some studies that show exercise DOES NOT increase appetite. If you can provide me with equally or superiorly designed studies that counter these ones, please do.

    Blundell JE, cross talk between physical activity and appetite control: does physical activity stimulate appetite? Proc Nutr Soc, 62, 651-661. 2003

    Donahoo WT, Variability in energy expenditure and its components. Curr Op Clin Nutr Metab. 7: 599-605. 2004.

    Titchenal A., Exercise and Food Intake: what is the relationship? Sports Med, 6: 135-145. 1988
    Yoshioka M, Impact of high-intensity exercise on energy expenditure, lipid oxidation and body fatness. Int J Obes. 25, 332-339. 2001

    King NA, et al, Individual variability following 12 weeks of supervised exercise: Identification and characterization of compensation for exercise-induced weight loss. Int J Obes, 32, 177-184, 2008.

    King NA, effects of exercise on appetite control: Implications for energy balance. Med Sci Sport Exer, 29(8): 1076-1089. 1997

    King, NA, The relationship between physical activity and food intake. 57: 77-84. 1998.
    Lluch A, Exercise enhances palatability of food, but does not increase food consumption, in lean restrained females. Int J Obes, 21: supp a129.Melzer K., effects of physical activity on food intake. Clin Nutr, 24: 885-895. 2005

    Slentz CA. Effects of the amount of exercise on body weight, body composition, and measures of central obesity. Arch Intern Med. 164: 31-39. 2004

    Ballard TP, Melby CL, Camus H, Cianciulli M, Pitts J, Schmidt S, Hickey MS. Effect of resistance exercise, with or without carbohydrate supplementation, on plasma ghrelin concentrations and postexercise hunger and food intake. Metabolism. 2009 Jun 2.

    Dermott M, McDaniel JL, Weiss EP, Tomazic TJ, Mattfeldt-Beman M J Nutr Elder. Is physical activity associated with appetite? A survey of long-term care residents. 2009 Jan-Mar;28(1):72-80.

    So while it’s probably true that there are “overcompensators” when it comes to exercise and overeating, I’m sure you would agree that it would be myopic to simply suggest that “exercise causes hunger”, would it not? We also need to look at factors such as timing – let apply a little common sense here. Don’t exercise if you haven’t eaten in hours or you’ll be hungry.

    And with yours and Taubes’ precious insulin-causes-fat-accumulation-and-little-else theory, would it not stand to reason that an intervention such as exercise (any kind that elevates heart rate and stimulates muscle tissue) which has been proven many times over to improve insulin sensitivity, be helpful in burning fat?

    So, what I would like to see (and I hope you can accommodate me in my request) is you and Taubes clarify precisely what you define as exercise and then reframe your statement accordingly – if in fact it changes your viewpoint.

    Because if either of you think that the type and intensity of exercise is inconsequential, well frankly you wouldn’t be a very credible expert. Conversely if Taubes DOES in fact believe there is a difference in terms of exercise type/intensity and its effect on fat loss than he is guilty of being dishonest in the name of creating “shock value” to create a stir and sell more books.

    I appreciate you addressing this Dr. Eades. Trying to learn as much as I can : )

    I’m a little too pressed for time right now to go through these studies individually and comment on each one. Perhaps I’ll do it in a post. Thanks for sending.

    The problem is that it is easy to show that exercise works (along with diet) in short-term, controlled studies where subjects are limited in what they can eat. The exercise Taubes and I are talking about is that which free-living people follow for the long term. It’s my opinion that people who aren’t in controlled studies will end up compensating for the extra exercise by increasing food intake.

  10. I so totally love your new fiber slogan. I have never been diagnosed with IBS, but I have suffered from IBS like pain and problems since I was a small child. The pediatrician recommended the water and fiber intake be increased — and my family dutifully complied — expanding my diet exponentially with fiber and water. But the pain and problems went on. And for many years I also treated my problems with fiber and water — even going to such things as psyllium seed husks and citruscil. Before I first tried a low carb diet, my first worry was “how am I going to get enough fiber?” But, a week on Atkins Induction, and I was IBS-like symptom free. Evenetually I have figured out that the less fiber I eat, the less problems I have. The more high quality fat I eat, the happier my digestive system is. I wish I had known this when I was 20. Years of pain I could have done without.

    You may be interested in reading this. I had it up on Twitter a couple of days ago, but you may not have seen it.

  11. When I came across your and Gary’s thoughts on exercise and weight loss, I was very skeptical that your position was right. At the same time, I always felt there was something very wrong when I observed so many overweight people at my club who spent hours doing cardio who never lost weight and others whom I knew to be sane eaters but fought weight gain with great difficulty.

    I’ve always exercised because I like the way it reduces general aches, particularly in my back, and reduces stess. I also believed that it helped me to maintain my weight.

    Now, after following your PPLP, with dairy (motivated to manage BS levels, not really ‘diet’), I realize that the reason exercise helps me maintain my weight seems to be two-fold, though not at odds with your position. First, the discipline of working out has always helped me make better decisions with regard to making healthier food choices – I just didn’t want to waste what I felt I gained in the gym or after a carrying a golf bag for four hours. There was a synergy created by exercise.

    Second, I find that exercise (defined to include recreational activities) distracts me from eating ‘mindless’ calories when I am really not hungry, but perhaps bored or tired. I’m always pleased at how little hunger I feel when I am focused on a physical activity.

  12. Mike,
    I’m no professional academic, but I’m a fairly smart guy and your logic on obvervational vs. double-blind studies makes sense to me.

    Correct me if I’m wrong, but it seems that you inconsistently apply these high standards to published studies. A month or so ago, when they said that eating less red meat decreases heart disease, you took them to task for citing an observational study as evidence that we should eat less red meat.

    But when a commenter reports that their low carb diet seemed to relieve their IBS symptoms, you supported them with a link to what seems like an observational study about low-carb diets relieving IBS. If this study did NOT support your position, I can imagine your response: correlation does not equal causation, these dieters were not in a controlled environment, so how can we know that it was their low-carb that helped their IBS and not some other lifestyle change they made during the study? etc.

    I’m not trying to take you to task here, I’m a big LC supporter and read your blog every day. But it seems like you’ve done this a few times lately and I’m not sure if I’m mis-reading things, or if you may be guilty as charged of applying a double standard. But I just wanted to point out that if you aren’t careful, you may undermine your own credibility with the critics out there.

    The study demonstrating an improvement in IBS was not an observational study – it was a controlled trial in which subjects went on a standard diet for two weeks, then switched to a very-low-carb diet for four weeks. This is a type of controlled study in which the subjects using themselves as both the control and the study group. After four weeks on the low-carb diet, 77 percent of subjects reported relief of symptoms. Again, this is a controlled study (there is no randomization because the subjects were themselves both the control and the study group – a fairly common practice in studies of this kind), not an observational study.

  13. Just to make sure I wasn’t crazy, I looked back through your tweets.

    The following appear to be observational:
    -low carb relieves IBS
    -lean kids have better bones: “another reason to keep your kids lean”
    -Sugar ages your skin

    Didn’t want to be accused of not providing evidence of my accusation :-)

    Again, the IBS study was not an observational study. The kids and bones study was a longitudinal study in which the same group was followed throughout a period of aging. It could be considered an observational study, but it’s kind of different. The sugar article wasn’t a study at all. It was a report from the mainstream press (the Times of London) that sugar is harmful, and I was tweeting it simply out of wonder that the mainstream press would print such a thing.

  14. Dr. Eades,

    The idea (quoting from the above statement by University of Illinois researchers) that “weight loss is contingent on energy expenditure exceeding caloric intake” is technically correct but seriously misunderstood. The problem lies with the failure to acknowledge the role of gut microbiota in energy expenditure. According to data obtained from experiments, gut microbes generate about 5 kcal of heat for each gram (dry weight) of gut microbe material contained in feces (1). It’s estimated that 50 to 60 percent of fecal matter consists of gut microbes. The digestive tract itself contains about 2 kilograms of gut microbes. Since gut microbes eat what the host eats, the energy stream from total calories ingested needs to be divided between what is utilized by gut microbes and what actually gets absorbed into the bloodstream. But to date, scientists have not tried to distinguish heat generated by gut microbes from heat generated by the body’s own metabolic activity. therein lies the basis for the controversy over calories in vs calories out.

    Good Calories, Bad Calories by Gary Taubes contains discussion about energy balance in which the research of Charlotte Young of Cornell University is mentioned. Quoting from page xvi of the Prologue, “As in other reports over the last century, she noted, her subjects seemed to lose weight by restricting only sugars and starches, without feeling any particular sense of hunger. Moreover, the less carbohydrates in their diets, the greater their weight loss, even though all her subjects were eating equivalent amounts of calories and protein. ‘No adequate explanation could be given,’ implying that further research might be needed to clarify this issue.”

    With the knowledge that gut microbes utilize a significant amount of the energy from calories ingested, scientists should be able to determine how any “extra” energy is dissipated by weighing feces and subtracting the sum of fecal energy content and gut microbe heat expenditure from total energy ingested to yield calories absorbed into the body (2).

    For more on the relationship between gut microbes and weight control visit http://www.scribd.com/people/view/3737769-gary-tivendale

    1. http://rothfus.cheme.cmu.edu/tlab/ferm/projects/t6_s99/t6_s99_manual.PDF

    2. The total available energy of a food may be defined simply as its heat of combustion, minus the heat of combustion of
    the faecal and urinary residues to which it gives rise.
    http://www.fao.org/DOCREP/MEETING/004/M2763E/M2763E00.HTM

    When Wilbur Atwater determined the caloric content of foods at the turn of the 20th century, he did subtract the energy from feces and urine from the energy of combustion of the various macronutrients.

  15. Hi Doc
    re placebo effect
    The piece on the placebo effect makes sense. The gist of your argument is that the psychological effect is powerful. I still find it hard to believe that the dramatic effect on me was just my mind. remember I was extremely skeptical. However I still ask what about animals? i am the commenter with the pig treated with the homeopathy remedy. I read a piece from e skeptic where they try to explain the placebo effect on animals

    1 it is a learned response to the drug. My pig never had this treatment before.

    2 it has to do with the extra attention and care. I gave all due care and attention from the time he began to have a problem.

    3 it is only the owner’s percepyion of a response. in this case there was a dramatic healing

    4 it is the owner’s perception of a response since the animal cannot say if pain is gone. This is a crock. The response was a healing of an ulcer not a pain.

    Now I know of all the nutty alternatives out there homeopathy is probably the nuttiest. I certainly cannot imagine a logical reason for it to work. Maybe it has to do with things this particular doctor was doing. Maybe the placebo effect itself needs study. in any event i find it hard to dismiss all anecdotal evidence out of hand

    I think you are spot on about the HGH. It is the 500cal diet that does it. i wonder though how many people were tempted to try HGH after its praises were sung in a book called “protein power”. i am teasing really because you did not promote exogenous application. But hmmm…

    martin

  16. And to think that most people get messages about exercise when they are sitting in front of the TV, with a snack likely already in hand! Some of the worst culprits of course, are the kids TV shows. Most of the ones on PBS (the ones we allow at our house) have a segment with an exercise message, urging the kids to ‘get up and move your body!’ The kids don’t of course, they just sit and watch it too.

    It’s the equivalent of posting the cigarette ads below the counter at the gas station, down at kids eye level, isn’t it!

    Ah, what government can’t fix it only makes worse.

  17. This is purely anecdotal, but my experience of diet/exercise to fully supports your description of the process that I had to share it. I have been overweight all my life, and at the age of 14 (in 1955), I put myself on a low calorie diet and lost 80 lbs in 7 months. In those days, we didn’t have the “workout”mentality, and even sports for females was not emphasized. All that was written about weight loss was about eating less. So that’s what I did. However, when I’d lost a substantial amount of weight (perhaps 40-50 lbs), I felt a compulsion to be more active. It was summer, and I remember riding my bike for miles after dinner in the early evening. I became extremely active, walking on errands for my mother and helping her around the house–willingly! It was the weight loss that drove me to more physical activity.

    I’ve now become a swimmer in my arthritic old age, and I do laps 3x a week, but I consider that an exercise for my heart and muscles. I do water exercises as well to strengthen muscles. For weight loss, I eat low carb and low calorie. I NEVER deduct calories for exercise or think I’ve “burned” enough calories that I can eat more. To me losing weight is a matter of focusing on what goes in my mouth.

    You would be correct.

  18. Back when I was doing research I collaborated with a medical scientist who was studying various control systems in the body. One interesting phenomenon we were trying to explain was that respiratory rate in response to exercise actually increased before any physical feedback from the exercise could be received. In other words, just thinking about running the treadmill would increase subjects’ heart and breathing rate. If you think about it, this makes sense: probably beneficial to crank up metabolism prior to running from a lion, rather than waiting until after the chase starts.

    On fiber: like most things, the body probably has a way of dealing with a some amount of fiber; and like most things, too much is potentially bad. High-fiber foods tend to have low caloric density, and I would guess would not have been a major part of our evolutionary diet (in contrast to a cow or gorilla, which have the machinery to digest and utilize food which is indigestible in the human GI tract). Hard to believe we would have evolved to require a substance that is indigestible, and you don’t have to look hard to find examples of hunter-gatherers who get basically no fiber. They seem to do alright.

    The point that people seem to miss about observational studies is fundamental in the practice of science. We begin with an essentially infinite number of hypotheses, say about what causes some disease. Observational studies can serve to narrow down the possibilities, but you still wind up with a large set: A could cause B; B could cause A; C, D, E, F… could cause both A and B. Observational studies provide no way of breaking the tie amongst these. Physiological studies provide some info to point the arrow of causality, but because organisms are so complex, there’s always some wiggle room. A particular effect observed in isolation in vitro doesn’t necessarily occur the same way in a complete organism, where many other mechanisms are operating simultaneously. Randomized, double-blind, placebo-controlled studies give the most leverage, because they vastly narrow down the range of possible hypotheses under test, in particular constraining the arrow of causality. This can all be worked out mathematically, and it is extremely unfortunate that researchers are almost never trained with this skill.

    We can take this a step further, in the context of making decisions. A recent study, for example, showed that red meat and dairy consumption was associated with prostate cancer. Many take this to imply that it would then at least more prudent to avoid red meat and dairy. But if you were to mathematically model this decision, you’d find it was basically a coin-flip, because a) the observational study provides almost no information on whether red meat and dairy *cause* prostate cancer, and b) the very little evidence of added risk is balanced by the very little evidence of added risk for eating whatever you substitute for red meat and dairy. To me, this is the greatest bogosity of nutrition science. Treatment decisions are too often based on an incredibly narrow view of weak evidence. If the engineering decisions that went in to constructing buildings were made with a similarly narrow view, we’d be surrounded by rubble.

  19. your demerol story helps me phrase my question from the last post perhaps a bit more clearly: if saline can be as effective as demerol, and presumably much safer (and cheaper) as well, is someone so ignorant as to be able to say “give me placebo!” better off than me?

  20. Hi Dr. Eades,

    I can see with aerobic exercise that you could end up breaking even with calories but what about strength training? Doesn’t building muscle allow you to burn more fat and change your body composition?

    In the exercise chapter of Protein Power you tell the story of a man (I think his name is Stan) that followed PP and began strength training. His before and after photos are amazing. Surly he couldn’t have gotten those results with diet alone.

    What role does building muscle play in fat loss?

    Thanks for posting all this great info!
    David

    No, Stan worked out a lot, but he didn’t lose his weight by working out. If anything working out made him gain weight. Muscle is more metabolically active than fat. In other words, muscle burns more calories than a similar amount of fat, but when you get right down to it, it’s not that much different. It doesn’t make a huge difference if you replace 5 pounds of fat with 5 pounds of muscle.

  21. Fiber is overrated, and the “fiber menace” guy describes how terrible it is to scar the inside of the bowels like that. I have gone almost zero carb. I eat virtually no plant matter whatsoever, and have perfectly fine bowel regularity. I also have no gas and very little body odor of any type. No gum or tooth problems. I don’t see why I should have to brush my teeth. Skin disorders cleared up. Mild Tourette’s gone when I avoid alcohol and diet soda. Mood swings gone. I have gained 5 pounds but unlike the past, when I was apple shaped, I am now a pear with sixpack abs–my husband says I look great. I am lifting weights intermittently, but have discovered prodigious increases in strength with almost no workout, as has my husband, who after two months of not working out and eating only meat is now able to do handstand pushups, which he never has before. My skin is oily and supple, and I look visibly more youthful. My husband’s skin cancer lesions have cleared up.

    Weird things are fixing themselves when we didn’t even know they were wrong.

    It is nice to be clear of the dietary insanity that is gaining increasing control over the industrialized world.

    We are grateful to the Eades, Taubes, etc., even The Bear, for spreading the word. Our families think we are insane. It feels to us that we have gone from being human to being ubermensch, the difference in functionality is so great. I feel for those who never have the experience of being optimum human when it is so simple.

    What a great testimonial to a very-low-carb diet. I’m happy to learn you are doing so well. Keep it up and be an inspiration to all.

  22. What benefits would you say come from exercise, just to clarify.

    I’m skinny and I exercise, but it would be more that I exercise because I’m skinny. If I’m sitting round all day then I get fidgety until I do something.

    I exercise for the following four reasons.

    Cardiovascular health,
    Muscle strength,
    Muscle endurance,
    Circulatory health (probably a caveat of #1).

    The middle two I know are improving and the other two I would just take in good faith. Thoughts?

    All of the above, but mainly muscle strength. The others all derive from increased muscle strength.

    In regards to the question/response above, are you saying that if I never do cardio or HIIT again and just lift weights that I’ll be just as healthy as anyone else? If so, you will forever be my hero because I HATE cardio and HIIT.

    That’s pretty much what I’m saying. Get a copy of Slow Burn at the library and give it a read. We go over all the reasons that this is so. Increasing muscular strength improves all kinds of other parameters. Give it a try.

  23. Do you believe in power of hypnosis? If placebo effect can be so damn dramatic and lead to so many positive results why not attempt treating obesity with hypnosis? I have heard ancdotal stories about hypnosis aiding in quiting smoking and losing weight. Have you had any experience with hypnosis? Lots of people swear by it! I was also very skeptical about it since it has to do with brain and mind. I at times dont want to pick my own brain why let a stranger do it. Who knows what can come out of it?

    I have had no experience with hypnosis and weight loss, so I can’t really speak to that issue.

  24. Dr. Mike,

    A very smart valise indeed.

    In view of your fiber commentary, might you comment on cholesterol and eggs?

    Let’s say “a person” I know loves deviled eggs, and can eat 5 to 8 a day to the exclusion of other foods on her carb cycling days. Her cholesterol is 220 on average. Her friends are horrified she might die of cardiac arrest.

    What say you?

    Karen

    I say go for it. There was an article that I wrote about in Protein Power describing an elderly guy in a nursing home who ate a dozen eggs per day without any effect. The vast majority of the cholesterol in the body, the body makes itself. If you eat more, the body simply makes less. It’s difficult to change your cholesterol reading by eating more or less cholesterol.

  25. There is a very pertinant article on exercise and Boomers that was just posted on MSN. http://www.msnbc.msn.com/id/31616136/ns/health-heart_health/
    I have read your books and reread Taubes GCBC constantly (its my Bible for ongoing inspiration) and I totally agree that exercise only increases appetite and does not bring about weight loss unless one is engaged in strenous activity for several hours a day. I exercised at least an hour everyday for years and my weight continued to creep upwards. Now that I follow very low-carb I have lost some weight and can keep it offl Hallalujah, free at last.

  26. I am a nutritionist from Sweden, and probably one of few nutritionist that do agreed with the notion that a low carbohydrate diet is a more healthy diet compared to the low fat, recommended by most nutritional authorities and health care agencies. I have red Gary Taubes book, with great caution, and I have to admit, that “Good calories, Bad calories” is a phenomenal piece of work! it is a shame that his work has received so little attention.

    However, I do agree partly with Gary Taubes that increased physical activity does not lead to weight loss. although the mechanism of action of increased physical activity on weight loss is not causally linked to the increased energy expenditure itself, increased physical activity might have a pronaunced effect on hormonal levels i.e. insulin, testosterone, growth factors, just to mention some. These hormones does effect fat oxidation and probably indirectly appetite, eventually leading to fat mass reduction.

    However, 30-60 min of walking would probably have little, if any effect on hormonal levels, which is probably why most clinical trials has failed to demonstrated any significant effect on weight loss. More vigorous traing on the other hand i.e. interval training, has a substantial effect on hormonal levels, and should therefore have an effect on fat mass reduction. This might be why most elite athletes have very little body fat.

    so does physical activity effect weight loss? it probably does if it is vigorous enough to effect systemic hormonal levels. One the other hand, if the physical activity has no effect on hormonal levels, then the increased energy expenditure will lead to increased appetite and increased calorie intake and therefore to no weight loss.

    Cheers,

    Pas

  27. @Mike,

    I also wish I had time to go through the studies you reference. From the standpoint of metabolic regulation, however, it seems hard to believe that an organism which increases its energy output does not compensate through increased appetite, UNLESS the average caloric input was already large enough to cover the difference. We know that organisms have mechanisms for dealing with excess energy, either storing it or dumping it as heat. Exercise might shift the balance, i.e. you either store less or replace extra heat generation by mechanical work.

    The case of interest for fat loss is the one where the exercise creates a caloric deficit. If the total energy available (food + available stored energy) is less than total energy expended, it seems almost certain that hunger must ensue. Otherwise your energy balance would be unstable: you could expend an arbitrary amount of energy without compensating intake, and starve to death without hunger. And I don’t believe there is any known mechanism by which the body differentiates between a caloric deficit due to exercise or one due to starvation.

    I’ll try to find time to look at those studies, but if you have a chance to post a summary on the exercise/appetite issue, it would be greatly appreciated.

    I don’t know if there have been any RCTs demonstrating this, but it does make sense that intensive weight training a la Slow Burn would increase the number of insulin receptors expressed in muscle tissue, which in turn could accelerate fat loss. But this is an anticipative adaptation (when you exhaust the muscles, they adapt in case you need that level of exertion again), not just calories in/calories out. And I can attest that Slow Burn definitely increases appetite, though the net effect on fat loss is positive (for me, at least).

    I’ll see if I can work up a post on all this in due course. But I have to admit, it is low on my hit list of things I’m interested in, so it may be a while.

    You could always post on the subject…

    Cheers

  28. The piano juggler. Observe carefully. The notes and keys don’t match. The tempo and rhythm match perfectly though. There’s a trick. The keyboard is actually a single giant key. It’s hooked up to a synth programmed with a melody but not with tempo nor rhythm. As the giant key is struck, each new strike calls for a new note or chord, in sequence, in the melody program. Hit the key in the right rhythm pattern, and with the appropriate number of balls for chords, and it looks like we’re playing piano when in fact, we’re just beating a drum with balls.

    In other words, we allow our ears to fool our eyes.

    I’m sorry son, there is no santa claus.

  29. Regarding the placebo effect: I’ve been reading about the differences between optimistic and pessimistic people. If you set up a room with a light in it, where people outside the room really have control over the light turning on and off, and you put a pessimistic person in the room and do a series of exercises where you have them try to control the light, they will figure out when they have control and report accurately how much control they had. They will see reality as it really is. But if you put an optimistic person in the same experiment, they will report that they had much more control than they actually had. Is there some link here? If you believe in something, your body will react to make it so? So it would be in a pessimist’s best interest to ignore reality and just believe in … placebos? Major cognitive dissonance here.

  30. Dr. Eades,

    You Wrote, “When Wilbur Atwater determined the caloric content of foods at the turn of the 20th century, he did subtract the energy from feces and urine from the energy of combustion of the various macronutrients.”

    What Atwater ignored (and contemporary scientists performing studies with metabolic chambers continue to ignore) is the heat generated by gut microbes. Researchers account for the heat in their calculations but they don’t distinguish between the heat generated by gut microbes and the heat generated by the body’s own metabolic activity. As I pointed out in my earlier comment, gut microbes produce about 5 kcal of heat per gram of fecal gut microbe content.

    Heat generated by gut microbes is part of the body’s temperature regulating mechanism. A good portion of that heat is derived from the metabolism of fat. Scientists have mistakenly assumed that, since only one to two percent of fat calories consumed is retained in the feces, the body must be at least 98 percent efficient at absorbing fat calories. Clearly, this is not the case. In addition, because of this assumption, scientists also assume that the any increase in heat output, as measured in a metabolic chamber, is due to a sped up metabolism.

    My point is this. It often happens that when individuals switch carbon sources (from mostly carbohydrate to mostly fat), increase their total caloric intake slightly, they still lose fat. An added benefit of high-fat/low-carb intake is appetite control so the tendency is to NOT gorge on fatty foods.

    I agree; I just probably don’t think the contribution of gut microbes is a high as you think it is. The Atwater values are much in need of an overhaul, considering all the new information that has come to light over the past 100 years. But who is going to do it? Sadly, most nutritionists would prefer an inaccurate system that is easy to use than an accurate one that might require some effort to figure out.

  31. Just to be clear – my comment @Mike above was to the Mike who commented, not Dr. Mike.

    I’d love to work up a post on exercise and appetite, but my job annoyingly gets in the way of my hobby . . . :-)

  32. Dr Mike, are you a fan of Beatles? If you are, you need to speak with Sir Paul M! He is an avid vegetarian and now he started a world-wide campaign against meat. He realizes its an impossible task but he wants people to stop eating anything meat related on Mondays. Even best chefs in London joined in on parade and will not offer Monday vegetarian meals only! Sir Paul believes that killing billions of head of meat is much more dangerous to the environment by producing more toxic gas than cars all together. So he believes anyone who loves Beatles should follow suit and become vegetarian at least once a week. Dr Mike, I know you love Beatles. Is there any chance you might skip a nice, plum juicy steak in replacement of Boca vegetarian burger on Mondays??????????? After all Love is ALL YOU NEED! And Sir Paul is asking for it by showing him love by skipping that steak. What you think?

    I’m not the big Beatles fan; MD is. And even she wouldn’t forgo a big steak once a week for Sir Paul.

  33. @Mike, (not Dr. Eades, the other Mike)

    Problem number 1

    Animal studies test not only the restricted diet but also the return to the ad libitum diet. The purpose is to find out what happens when the animals have access to unlimited food. Do they retain the new lower weight? Do they return to their previous weight? Do all the human studies you quoted also test this return to ad libitum diets? If they don’t, then the results are incomplete, at best.

    Problem number 2

    Subjects used in the various weight reduction studies were at equilibrium before they started the studies. This, whether they were normal weight or overweight or obese, i.e. they stopped growing fatter. This means their mass was maintained by their diet.

    Problem number 3

    How do we prevent the subjects, who lost weight on restricted diets, from returning to their previous weight once they return to their previous diets? The obvious answer is that we can’t.

    Problem number 4

    In order to determine if exercise has any bearing on fat loss, we must isolate exercise, i.e. we must not alter diet in any way or at worse, we must increase total caloric intake or give access to food ad libitum to compensate for the increased energy output required by the exercise. This way, we absolutely know that if weight is lost, it’s not diet. All the studies I know of that show some weight loss always alter diet in some form or other. Obviously, if we increase food intake to compensate, the precious caloric deficit just won’t be there and there won’t be weight loss. What of the claim of increased insulin sensitivity then? At least that will be tested.

    Problem number 5

    Body fat % measurement by caliper is misleading because it does not take into consideration intramuscular fat, i.e marbling. Another method, I forgot the name, is affected by water % so it too is misleading. Further, lean tissue constitutes about 70% water. The quantity of water can change dramatically from one day to the next, even within the same day, let alone from week one to week 12. Which method was used to determine body composition?

    These are reasonable questions when faced with the prospect of exercise versus diet.

  34. Dr. Eades wrote, “…I just probably don’t think the contribution of gut microbes is a high as you think it is. The Atwater values are much in need of an overhaul, considering all the new information that has come to light over the past 100 years. But who is going to do it? Sadly, most nutritionists would prefer an inaccurate system that is easy to use than an accurate one that might require some effort to figure out.”

    I’ve been studying nutritional controversies for more than three decades and have concluded that few scientists are familiar with early nutritional research. It’s fascinating stuff. And you’re right. The early “values are much in need of an overhaul.” For example, back in the Atwater era researchers determined that gut microbes constituted about 30 to 40 percent of the dry weight of feces. Now they say 50 to 60 percent. Back then they calculated the dry weight of fecal bacteria (average daily output) at 5.34 grams with values ranging from 3.34 to 8.54 grams. I haven’t yet found a set of modern figures on this yet but suspect the values may be higher. Even so, using the old figures we can calculate daily heat output generated by gut microbes ranging from 16.7 calories to 42.7 calories. Keep in mind that the yearly heat outputs would range from 6096 to 15,586 calories. These are calories that are routinely thought to be absorbed into the blood stream but are not.

    But what really interests me is the fact that foods of equivalent nutritive value produce different effects in terms of weight gain or loss. I suspect gut microbiota may have something to do with this phenomenon. http://books.google.com/books?id=hiUbAAAAYAAJ&pg=PA650&lpg=PA650&dq=Certain+experiments+of+McCollum,+Hart&source=bl&ots=_lkqMrn1Yq&sig=x-fbJXqGJmE1w01NCPc5rXB7Mnk&hl=en&ei=2U9LSprYB5KcMYmz0LQC&sa=X&oi=book_result&ct=result&resnum=3

  35. Another comment about the piano juggler.

    You said:

    “It just doesn’t seem possible.”

    I suspect you’re right. At 1:42, he drops a ball on the keyboard, but there is no sound at all. And yet, every single other note he hits with a ball creates a sound.

    Cute act, but I also believe something is being faked there.

  36. Front page of the Daily Mail (read by over two million in the UK) today: http://www.dailymail.co.uk/health/article-1196672/Should-50s-anti-cholesterol-drug-Statins-cut-heart-attack-risk-healthy.html

    “Statins cut the risk of heart attacks by 30 per cent even in healthy people, researchers say. The cholesterol-busting drugs also reduce the chances of death from all causes by 12 per cent. The findings, from a review of studies involving people without heart disease, will renew the heated debate over whether everyone over the age of 50 should be prescribed the powerful drugs.

    […]

    The Government’s heart disease czar Roger Boyle says all older people should ideally be taking statins or a polypill, new tablets being developed which contain the drugs. And last month heart expert Professor Malcolm Law wrote in the British Medical Journal that everyone over 55 should be given statins in the same way that everyone would be offered a vaccine against swine flu if it became serious.”

    In my opinion, they’re all idiots. Statins do decrease the risk of heart attacks, but they don’t decrease the risk of death from all causes. In other words, while they decrease the risk of heart attack, they increase the risk of other disorders.

  37. once the body is adapted to running off of fatty acids, as opposed to glucose, one can gain weight(and this may take a long time) and again it becomes the calorie game, however it is easier b/c of the satiety of meat. what is your view on this?

    it is very possible to gain weight on a zero carbohydrate diet once adapted to burning fatty acids and eating more fatty acids than your body needs.

    It might be possible, but it would be difficult.

  38. Dr. Mike,
    I’m 59 and about a year ago complained to you about not being able to lose weight even on a low-carb diet – at least not the way I used to. Now, I can report that In the past two months, I have restored my ability to lose weight and do so at the same brisk rate that I used to.

    You see, my physician challenged me to get some exercise because I am extremely sedentary at my desk as a graphic designer. And I was open to it because I had nothing to lose by getting some exercise. So now, by doing powerwalks of 2 miles (in 30 minutes, i.e. 4 miles/min) several times a week, I’m getting great results with my low-carb diet.

    My own limited understanding is that in recent years of sedentary living, I must have developed some insulin resistance, and that the moderate exercise has restored normal insulin sensitivity.

    I would appreciate your comments on this, particularly in light of your discussion about how exercise has no effect on weight loss. I would imagine that calorically it doesn’t, but isn’t insulin sensitivity important to achieve weight loss, even with a low-carb diet?

    Thanks,
    Gary

    It appears that exercise has been beneficial to you, but the studies show that it isn’t particularly effective for most.

  39. To lose weight, they must reduce normal-sized fat cells to subnormal-sized ones, a more difficult prospect than reducing the abnormally-enlarged fat cells that are a consequence of adult weight gain back to normal size. It can be done as evidenced by all the people who were overweight as children who have lost in adulthood, but it’s a tougher row to hoe than for those who got fat as adults.

    I assume that the body would be resistant to having something be subnormal, would that be why it is so much more difficult? Does the body have a minimal amount of fat it wants to have in each fat cell, and would this mean that it would be an ongoing struggle for someone who was overweight as a child to maintain a desired level of body fat because their body would want to keep more fat overall, simply because more fat cells exist?

    Yes, the body would have a resistance to keeping fat cells in a subnormally small size as opposed to keeping formerly large fat cells (enlarged in adult-onset obesity) at a normal size.

  40. I received Roy Mankovitz’s book, The Wellness Project, yesterday from Amazon and spent my day reading it. It appears to be well-researched; his writing style is fluent and accessible. I wrote to him and he said that he’d just sent you a copy (apparently, he’s one of your neighbors in Santa Barbara).

    I have no intention of eating organic sweet fruit as he recommends. For me, that’s the pathway to loss of ketosis, gnawing hunger pains and gross overeating of the fruit. The way I’m eating now, zero carb meat/fat with spices/condiments is keeping me happy and functioning beautifully.

    I hope you have time to read this book and report your findings in your blog. I’ve had my eye on Globe grapes for weeks but I haven’t given in.

    Marly

    I did find a copy in my mailbox, so I’ll give it a read when I get the chance. Busy, busy, busy right now with a thousand things going on.

  41. Sorry if this is off topic, but i’d very much appreciate your opionion, as it relates to one of my loved ones. One of my relatives, a female in her mid-50s, recently got some blood work done. Her doctor suggested the use of Lipitor. While i understand that you cannot give medical advice to those other than patients, I would like to know if you think she should be concerned. Here are the results of her blood tests over the last three years:

    June (2007):
    Cholesterol 281 mg/dl
    LDL 183
    HDL 66
    Triglycerides 71
    Glucose 99
    Triglycerides:HDL = 1.1

    (June 2008):
    Cholesterol 272 mg/dl
    LDL 177
    HDL 76
    Triglycerides 96
    Glucose 76
    Triglycerides:HDL = 1.3

    (June 2009):
    Cholesterol = 276
    LDL = 196
    HDL = 71
    Triglycerides = 95
    Glucose = 79
    triglyceride:HDL = 1.3

    Overall, I think her results have not changed dramatically. She is never ill and she is active and lean. Also, she does not smoke.

    I really hope to hear what you think.

    First, I don’t believe that cholesterol really has all that much to do with heart disease. Second, if the lipid hypothesis is valid, then HDL is protective, and she has plenty of HDL. If she were my patient, which she isn’t, I certainly wouldn’t put her on statin drugs, especially since they have never been shown to be effective for females of any age.

  42. Nice odds and ends, Mike. I love the bag and I agree it speaks of cool and class. But, I never use rolling luggage because the handle is too low for me. Also, when I travel I tend to use soft-sided luggage and try to only use a carry-on size bag. Saves alot of time, when possible.

    As to the placebo effect, I’m now wondering about multi vitamins. Do you think they’re any good at all?

    As for fiber, thank you for the post on fiber and your new slogan. The cave men didn’t have fibersure around. They made out ok ( I guess).

    The video was very entertaining. I’ll pass it around. Happy 4th!

    Jim

  43. @Lucy

    I would also be concerned with the marketing of “active/sports” products (e.g. powerade). These have near as much sugar as sodas, though are percieved to be more healthy.

  44. RE: Placebo effect. As a RN, I’ve seen it work so many times! But, I would love to hear your opinion on docs that order placebos without the patient knowing. Not like the doc in the example above, but docs that have “difficult” patients that order them rather than trying to work with the patient.

    RE: Fiber. I agree 100%! Curious thing with me, I can eat all the fiber I want with no trouble, as long as it’s from real foods….but once I start taking supplements, it’s almost like everything is paralyzed! I first noticed this after surgery, when my doc insisted I take fiber supplements post-op, but have confirmed the effect several times since then. Is there something they use that might be the problem?

    As for exercise? Well, I’m a child of the 50s and grew up hearing….get out and play! You have to work up an appetite!! I do agree that exercise is good for you, but I completely agree that it stimulates appetite. What always gets me, though, is the common advice that you MUST eat (mostly carbs) before and after exercise!! Before exercise you have to eat to give your muscles energy to work….and then after you have to “replenish” the glucose they used!! Most advice is for around 120-150 calories before and after, for a total of 240-300 calories….but do these people really burn off all of that?

    Love your blog and really miss it when you’re off traveling…..but boy do I envy you!!

  45. Lately, you have failed to respond to my questions. I am okay with that. But, if you choose to do so because you think that i am not a regular reader of your blog, then you would be wrong. Not only am I an avid reader, but i encourage others to view your site and read your books.

    I haven’t answered your question because I am woefully behind on dealing with all the comments. This blog is more or less a hobby for me that requires an enormous amount of time. Lately I have been up to my ears in several projects and have been in arrears in the comment answering department. Plus, the way it’s supposed to work is that I write a post, and those who want put in their two cents worth about it in the comments. Somehow it has transmogrified into a question and answer column, a situation that I am desperately trying to get away from.

  46. Thanks for promptly clearing that up doctor! Much appreciated, and I understand your desire to avoid the blog becoming a question and answer column. However, when people come across someone who they view as sagacious, they tend to want to accrue knowledge from them, hence the stream of questions. Still, I understand your sentiments.

    With regards to Cindy Moore’s question about glycogen loading following exercise: there is a wealth of data showing that the energy source for muscular contractions during exercise is free fatty acids. Therefore, the need to re-fuel with glycogen is rather fallacious. On a different, but similar note, muscle is made of almost pure protein, so why would a muscle need carbs to increase in size?

  47. Damn, I sure wish I could get the placebo effect to work in my favor regarding weight loss. I keep trying things that I am *100% POSITIVE* will finally get things moving, and yet nothing ever does. I tell myself I guess it’s a good thing I’m following a low carb, grain-free, sugar-free, good fat diet for the sake of my health, as I have not lost any weight on it in over five months!

  48. The fat cells information was interesting. I wondered why I could eat sugar/starch in the thousands of calories for years and not be f*a*t until diabetes struck (then could lose the sudden extra weight by very low carb).