Frequently Asked Questions (again)

      190 Comments on Frequently Asked Questions (again)

I’ve spent rather a lot time this week answering questions from viewers who just discovered Fat Head on Netflix. Since the questions are often the same, I believe it’s time for another Frequently Asked Questions post.

Would you mind letting me see a copy of your fast-food diet log?

I don’t mind at all. It’s been online since I started this blog, with a link under Helpful Links.

A few people have commented that if you multiply the carbs and protein by 4 calories per gram and add them to the fats multiplied by 9 calories per gram, the total doesn’t exactly match the calorie totals I posted. That’s true, but it’s because food labels use rounded numbers. If a lab determines the average Quarter Pounder contains 44.2 grams of protein, it’ll be listed as 44 on the label, but the all of the calories will still be counted.

Also, the 4 calories/gram and 9 calories/gram figures aren’t exact. Fat actually contains a teeny bit more or less than 9 calories per gram (can’t remember which). So my log lists the macronutrients and the calories provided by the restaurant nutrition guides.

Could I see your food log for the month when you ate all those high-fat food?

I didn’t keep a food log for the saturated-fat pigout month. I cut all sugar and starch from my diet and ate a lot of foods high in fat, but I didn’t count the calories or macronutrients specifically. I’m sure the daily carb count was below 30, though.

Did you lose any weight during the saturated-fat pigout month?

I wasn’t trying to lose weight; I was trying to stuff myself with saturated fat to see what would happen to my cholesterol levels.  I made no effort to limit my portions and ate quite a bit.  Nonetheless, I lost another two pounds that month.

Is it possible to get a copy of the spreadsheet program you used to track your calories and macronutrients?

It wasn’t a spreadsheet. It was a little Access database program I threw together. It doesn’t even work correctly in the newer versions of Access. But I’ve had so many requests for a copy of the program over the past two years, I may just put a new one together and sell it for a small donation.

You never mentioned the Atkins diet by name, but weren’t you following the Atkins diet during that second month?

Low-carb diets have been around for a long, long time, under various names. I didn’t see any reason to label the saturated-fat pigout experiment specifically as The Atkins Diet — especially since I tried that experiment at the suggestion of Dr. Mike Eades, who calls his program The Protein Power Diet.

How many carbs per day should I eat if I want to lose weight? Is 100 per day the magic number?

There is no magic number for everyone. Most people go into a ketogenic  state (meaning they deplete their stored glycogen and begin using more fat for fuel) if they limit their carbs to 120 per day, so I chose a number below 120. If we could convince everyone with metabolic issues to go at least that low, a whole lot of health problems would go away.

However, it ultimately depends on how sensitive you are to carbs and what type of carbs you’re eating. That’s why most low-carb diet books instruct dieters to start very low, then gradually raise the carb count until weight loss becomes more difficult or stalls.

How many carbs per day do you consume now? / What is your diet like now?

I don’t count carbs these days, but my daily total is well below 100 and probably below 50 on many days. I live on an almost-paleo diet —  mostly meat, eggs, seafood, low-starch vegetables, nuts, and a bit of low-sugar fruit. Once in awhile I’ll eat beans or sweet potatoes, but not often. I say it’s almost paleo because I still consume some dairy products. I like cream in my coffee and cheese on my burger patties.

I don’t eat grains at all anymore, mostly because after shooting the film I learned more about the lectins in grains and how they can provoke autoimmune reactions. When I cut out the grains, my occasional bouts of arthritis went away and never came back. That was pretty convincing.

Aren’t you concerned about ketosis? I read that ketosis can damage the brain and the kidneys.

People who claim ketosis is dangerous are either misinformed or trying to scare you away from low-carb diets for some reason. (Ketosis kills! seems to be a favorite strategy among the radical vegans, so that should tell you something.)

Ketosis is often mistaken for ketoacidosis. They’re not the same. Ketoacidosis is an extreme form of ketosis that affects untreated diabetics and can lead to a dangerous pH imbalance in the blood. Ketosis simply means you have ketones in your bloodstream, since burning fat releases ketones.

Your brain, heart, and many other organs will happily use ketones for fuel. If you eat dinner at 5:30 PM and don’t eat again until morning, you probably wake up in a state of mild ketosis — which means the people warning you about the dangers of ketosis are probably in ketosis rather often.

I want to try a low-carb diet, but don’t want to eat meat for ethical reasons. Is that possible?

More difficult, certainly, but still possible. If you go to Amazon and search for “low carb vegetarian” you’ll see several books listed. You can also find recipe sites online. I found this one pretty quickly.

Hmmm, I love meat, but I may have to try one of those recipes … as a side dish, of course.

How can I convince my wife/husband/sister/parents/friends to go low-carb?

You can’t. Enjoy your low-carb diet and the results. If they notice the positive changes and ask what you’re doing, tell them. If they reply that you look good but will probably die of a heart attack from all that fat, tell them there are plenty of books that explain the science if they’re actually interested. Then let it go.

How can I get my spouse to stop warning me that my high-fat diet is going to kill me?

Move to another state.  (What? Oh, I see; you like your spouse.) It’s probably futile to ask a doubting spouse to read Good Calories, Bad Calories or another book that explains the science, but if you scroll down and find the Recommended Reading links on the left sidebar, you’ll find some articles that might do the trick. (That reminds me: I need to update those links sometime.)

Why didn’t you cover (insert topic here) in the documentary?

If I’d covered every topic I found interesting while doing my research, it would’ve been a six-hour miniseries. I had to let some stuff go. The distributors suggested limiting the running time to 1:30. I got it down to 1:44. They were okay with that.

Have you ever heard from Morgan Spurlock?

No, but I’ve heard from plenty of Spurlockian True Believers. Those are interesting conversations.

Is there going to be a Fat Head II or another follow-up documentary?

I don’t think so, but you never know. Perhaps some simple productions, not as complicated as Fat Head but more involved than the Big Fat Fiasco speech.

Have you considered taking all the research from your film and your blog and putting it into a book?

I certainly don’t want to write anything along the lines of the books by Gary Taubes, Drs. Mike and Mary Dan Eades, Dr. Uffe Ravnskov, or Dr. Malcolm Kendrick. They’ve already been there and done that, and I couldn’t do it as well anyway.

However, my wife and I are kicking around the idea of producing an illustrated book to explain to parents and children how various foods affect our health. The idea would be to present the biochemistry simply and visually, kind of like the blood sugar/insulin sequence in Fat Head. I write, she draws, we have a marriage that’s happy and secure enough to survive working together, so why not?

You mentioned several books in the film and list several more on the Recommended Reading page of your blog. I don’t have time to read them all, so which one should I read first?

Wow, that’s a tough one. It would depend on what you most want to learn. If you’re looking for a low-carb diet program to follow, I like A New Atkins For A New You. There are also some good study references in there.

If you’re looking to go a little more radical on the diet to jump-start your weight loss and then ease into a permanent low-carb diet, I’d suggest The 6-Week Cure For the Middle Aged Middle.

If you want to understand the science — why the Lipid Hypothesis is wrong, why insulin promotes weight gain, etc. — you can’t beat Good Calories, Bad Calories. It’s pretty dense on the biochemistry, though. Why We Get Fat and What to Do About It covers much of the same territory, but it’s written for a lay audience and is easier to follow.

If you want to know about paleo diets and why they’re probably the best for humans, I’d suggest The Primal Blueprint.

Is there a Facebook fan page?

I admit to being Facebook-challenged, mostly because I think the interface is awful and refuse to deal with it any more than I have to.  However, my wife created a Fat Head group awhile back.  She also created a Fat Head fan page yesterday, since so many people asked.  (I don’t understand the difference between the two.  No, don’t try to explain it to me.  That would require me to actually think about Facebook.)

I found a 42-point puzzle in the book of Matthew, I grew up Jewish and didn’t realize everyone did not know the puzzle was there, nor that it split the Gospels into tools for the human mind to see through time with accuracy. So, from 2000 years ago, Bush had to the False Prophet. So, with the help of the German Chancellor, I rose to True Prophet so I could @#$% BUSH in a way he couldn’t touch me.

The BIGGEST ROLE in Bush’s version of Armageddon was TRUE PROPHET. I managed to get the Chinese to not pull the loans nor the Russians to attack during Bush because the German Chancellor realized my argument that the Bush family double-crossed Hitler using computer game design logistics they pulled from the Torah. Thus, when I found Bush using these logistics in his behavior, and the USMC did not see it, I had to do something. Can you help me with this project?

Okay, that’s not actually a frequently-asked question. But when your film goes on Netflix and the emails start piling up, you never know what somebody will ask you next.

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190 thoughts on “Frequently Asked Questions (again)

  1. Marcus

    By the way Tom, I’m glad we’ve seemingly moved beyond the attacks (both of us). Let’s try to keep it that way. 😉

    Fair enough.

    Reply
  2. gallier2

    Is Tom a Republican or Democrat?

    Hey Mister PhD, false dichotomy, look it up, you may learn something. Oh, no you’re PhD, you’re past that stage, you can’t learn, you know… bwahahahaha

    Hey Tom, rofl, this one was the best until now, the all caps insulting twat could somehow be thought of as redeemable, but Marcus is the perfect illustration of the source of the problem: unbrideld superiority complex coming from meaningless academic decorations.

    Marcus wasn’t asking about my politics. It was someone else.

    Reply
  3. Marcus

    @Tom:

    re: studies. Meta-analyses meaning analysis of all existing studies on the topic. While single studies are helpful, it’s often useful to take a look at the broader picture of the current research and analyze all studies that are available. This helps to account for statistical anomalies, weird groups of subjects, and so forth. The article I linked to provided a literature review where they conducted a meta-analysis and they show that the sodium –> bp link is pretty strong (particularly among women). These include both controlled studies and field studies.


    [See my updated comment, Dr. Rosch’s analysis of what the literature actually shows.]

    re: carbs. I’m referring to the notion that carbs taste good. Americans, it seems, like to eat them. As such I’m wondering what makes not eating carbs any different from depriving yourself of anything one likes. In the end, won’t our natural desire to eat carbs win out?

    [Yes, some people refuse to give up refined carbs. Others who used to live on them (like me) find that the desire goes away, just like smokers who quit cigarettes eventually don’t crave them anymore. We still need to ask why people on low-carb diets eat less even when they’re not calorie-restricted.]

    re: calories in/out. Your son doesn’t need to eat the same number of calories everyday in order to stay at the same weight. He simply needs to average the same number everyday. Remember, this is a long-term thing. You should look at the studies of food intake – it’s amazing how many people hit a number, or pretty darn close to it, on a weekly/monthly basis (day to day is more variable of course). But that’s why over the course of a year if you can manage to be below that average number, you’ll lose weight.

    [I’m not talking about every day. I’m saying that over the course of a year that would include a million calories, he’d only need to be off by 7,000 to gain two pounds. But he never gains those two pounds. It’s highly unlikely he accidentally eats precisely the number of calories — with better than 99.7% accuracy — that maintains his weight. His body doesn’t want to be fat (he’s tried to gain weight by over-eating, but it doesn’t work for him), which means his body is matching the calories out to the calories in.]

    re: exercise. So do you really believe that there isn’t a correlation between exercise and weight loss? Marathoners are thin because they’re selected out (i.e. fat people don’t run marathons)? You cited your son. I can cite myself. I was 200lbs before I started running a few years ago. Now I’m at 175. I still eat a disgusting amount of food and drink way too much beer. But I’m running 35-40 miles a week. Do I probably eat more some days than I would otherwise, because I ran and I’m hungry? Sure. But on average I doubt it. In addition, there is a lot of evidence that exercise has beneficial effects on metabolism (muscle burns more calories than fat, and so forth).

    [Yes, fat people don’t run marathons. They don’t have the energy. Too much of their energy is being stored. This study concluded that exercise led to weight loss only in women who were already at normal weight — in other words, not geared to accumulate excess fat:

    http://jama.ama-assn.org/content/303/12/1173.abstract?home=

    This study concluded that kids become fat first, then become inactive:

    http://adc.bmj.com/content/early/2010/06/23/adc.2009.175927.abstract

    A person who isn’t in fat-accumulation mode may be able to go out and run and lose some weight. But someone who is in fat-accumulation mode (the fat people) will just deplete their bodies of energy, which they can’t offset by releasing fatty acids quickly enough to make up the difference, and they’ll become ravenously hungry. Ignore the hunger, and they’ll lose muscle mass, end up with a slow metabolism, or both. People on The Biggest Loser exercise like crazy. But a recent study concluded that they end up with slower metabolisms that can’t be accounted for by the weight loss.]

    Reply
  4. Marcus

    @gallier2:

    I know it is sometimes hard to keep people straight, but you could try not attributing quotes to me incorrectly.

    As for Tom’s politics, who gives a crap? I’m interested in the science and weight loss debate.

    Reply
  5. Eric Ryan Harrison

    This Marcus vs. Tom debate is absolutely fascinating. I’m not a fanboy of the low-carb diet or anything and I’m just now starting to research dietary changes so I’m not convinced one way or other.

    But wow, this back-and-forth is great. Keep it up you two… I’ll continue to refresh every couple of hours and hope for more… 😀

    In a nutshell, Marcus and I have a fundamental disagreement about what causes people to become fat. He thinks it’s about character — if you’d just exert the discipline to eat less and move more, you wouldn’t be fat. I think it’s about chemistry — if you are being hormonally driven to accumulate fat, you will … unless you’re willing to spend your life feeling half-starved, which goes against basic human nature. So in my view, it’s about fixing that hormonal problem first.

    Reply
  6. Eric Ryan Harrison

    This Marcus vs. Tom debate is absolutely fascinating. I’m not a fanboy of the low-carb diet or anything and I’m just now starting to research dietary changes so I’m not convinced one way or other.

    But wow, this back-and-forth is great. Keep it up you two… I’ll continue to refresh every couple of hours and hope for more… 😀

    In a nutshell, Marcus and I have a fundamental disagreement about what causes people to become fat. He thinks it’s about character — if you’d just exert the discipline to eat less and move more, you wouldn’t be fat. I think it’s about chemistry — if you are being hormonally driven to accumulate fat, you will … unless you’re willing to spend your life feeling half-starved, which goes against basic human nature. So in my view, it’s about fixing that hormonal problem first.

    Reply
  7. Distinction

    My question is quite simple and not about fat. Tom, do you think your fast-food diet as portrayed in the documentary is healthy? Would you encourage others to adopt a fast-food based diet?

    No, I was making a point about how “fatty food” is not the problem, nor is fast food responsible for the rise in obesity. Bad food is the culprit, and I see people buy just as much sugary-starchy junk at our local grocery store as they do at McDonald’s.

    Don’t know if you saw the entire film. I stated near the end that a fast food diet is not a good diet.

    Reply
  8. Marcus

    @Tom and @Eric:

    “He thinks it’s about character — if you’d just exert the discipline to eat less and move more, you wouldn’t be fat.”

    Precisely. And I have yet to see any solid evidence that suggests over the long term that this isn’t true. I also think that you don’t necessarily need to even eat less. Simply exercising more and making sure that you don’t compensate by eating more at the same time will help you lose weight.

    We have two anecdotal pieces of evidence in my favor. First there is myself. I went from 200 to 175 by changing nothing other than running. I suspect that I even did compensate by eating a bit more – and I still lost weight.

    The other is Tom. My hypothesis is that he lost weight because he restricted his diet to 2000 calories and also added in exercise. He could have eaten McDonald’s, bowls of sugar, or asparagus all day long and if he was under 2000 calories a day he’d shed the pounds.

    In short it’s not that I don’t believe in the chemical and hormonal evidence; it’s that this stuff only matters on the margins. The more important move you can make in your life to lose weight is to eat less and move more.

    Also on an abstract level I do think there is some danger in feeding the laziness problem in this country. I’m not a fan of diets that say you can eat fast food and not exercise and be just fine. That strikes me as, at best misleading, and at worst downright dangerous (I’ve cited reasons why I believe this above, such as blood pressure changes and so forth).

    Marcus, with your PhD and all, you realize my one-man experiment involved multiple variables, and there’s no way of knowing which variable or combination of variables was responsible. I also have no way of knowing if ALL you changed was your level of exercise. And even if you did, frankly that doesn’t prove much. Go back and read our comments. I’ve said over and over that for people whose hormones are driving them to accumulate fat, all exercising does is deplete the body’s energy, which the body can offset through lower body heat. You may not have fallen into that category. That’s why I linked to the study showing that exercise resulted in weight loss for women who were already at normal weight, but not for women who were overweight or obese. In the study of obese mice whose food supply was reduced by 5%, they became fatter and loss muscle mass. (Yes, I know, we’re not mice. I bring it up because people who don’t know better claim that eating less will always lead to fat loss because of the laws of thermodynamics.)

    As for you not seeing solid evidence that fat accumulation is driven by hormones, well, you’ve got me there. I agree 100% that you have not, in fact, seen the solid evidence. That’s because you’re not interested in seeing the evidence and haven’t bothered to look at it. That would risk causing you to change your mind, which I can tell from our exchanges is way out of your comfort zone.

    If you are interested in the evidence, it’s out there. “Good Calories, Bad Calories” is jam-packed with evidence. The studies in which people on low-carb diets spontaneously ate less despite having no caloric restrictions are also evidence — unless you believe cutting sugar and starch from the diet produces a change in a person’s character. The Lustig study in which giving obese teens an insulin-suppressing drug led to a reduction in appetite, weight loss, and a large and spontaneous increase in physical activity is also evidence — again, unless you believe those teens had a sudden change in character.

    Reply
  9. Marcus

    @Tom:

    We apparently have two very different conceptions of human nature. You seem to view humans as automatons that lack free will. What we consume and burn is a function of a biochemistry and nothing else. Put another way, your privileging predispositions while I’m privileging action. It may very well be the case that for some people “hormones are driving them to accumulate fat.” That’s a predisposition. One doesn’t *need* to accumulate fat, however, unless one satisfies the body’s desire to do so. Do you follow?

    [If I drink 12 beers, I get drunk. I can’t exert my will to stop it from happening. If I jog, my bum knee hurts. No amount of character will prevent it. If a person has a damaged thyroid, he or she will be hormonally driven to accumulate fat. If a person takes certain steroid medications, he or she will be hormonally driven to accumulate fat. Only by exerting super-human willpower — in the form of being willing to go through life feeling half-starved — can they avoid those effects from the hormonal drive. That doesn’t mean I don’t believe in free will (if you think otherwise, you sure as heck haven’t watched Fat Head), nor does it mean humans are automatons. It means we can’t change biology through willpower. It means insulin has powerful biological effects, and if we consume a diet that provokes chronically elevated insulin, we’re going to gain weight and have one hell of a difficult time losing it — unless we’re willing to go through life half-starved. That’s why programs based on the simple “eat less, move more” meme, such as Weight Watchers, have an abysmal success rate. They don’t address the hormonal issue.]

    But more importantly, I need to disabuse you of this notion that single studies are positive of anything. You cite a single study and conclude that exercise doesn’t lead to weight loss. The least you can do is explain why the hundreds of other studies that say the OPPOSITE are wrong. To wit: http://www.annals.org/content/133/2/92.1.short

    [That is the one area where we’d agree: if you engage in the type of exercise that improves insulin sensitivity (as happened in the study), you’ve moved in the direction of solving the hormonal drive to accumulate fat. That’s why when people ask me about exercising, I suggest going with sprints and progressive resistance — the type of exercise that improves insulin sensitivity.

    I need to disabuse you of the notion that you need to disabuse me of the notion that I think a single study proves a hypothesis. I don’t. I approach it from the opposite direction: if I find black swans, the hypothesis that all swans are white has been invalidated. If I find several studies in which exercise fails to produce weight loss, I consider the hypothesis that exercise induces weight loss to be unsupported, if not totally invalidated.]

    Re: exercise. I still don’t think your theory makes any sense at all. Look around. If exercise made you fatter because you simply eat more after exercising, wouldn’t those who regularly exercise be the fattest? I think there is something going with the observation that people who exercise are usually fit. It’s the ones who don’t exercise that have the problems.

    [Say what? I don’t believe exercise makes anyone fatter. I just don’t believe that for someone who is hormonally driven to accumulate fat, burning off calories through exercise is going to lead to weight loss — unless the hormonal issue is solved first. Once again, we disagree about cause and effect. When Dr. Lustig gave an insulin-suppressing drug to kids who had become obese and lethargic, they lost weight and began exercising spontaneously. They didn’t lose weight because they were exercising; they became active because their bodies were no longer storing a disproportionate share of the energy they consumed in their fat cells.]

    Finally, again, I don’t dispute the hormone studies. I’m just suggesting that hormone studies are not sufficient to dispute the claim that it is character that matters. Like I said, hormones matter. On the margins.

    [There are countless people who are amazingly successful in nearly all areas of life, but struggle with their weight. Oprah Winfrey is one example. This woman went from poverty and an abusive childhood to smashing success. You don’t accomplish what she’s accomplished without terrific drive and discipline. So by your theory, her obvious drive and discipline disappear in this one area of her life. The vast majority of dieters don’t lose weight long term, and many end up fatter than when they started. Weight Watchers has a long-term success rate of about 1%. So by your theory, 99% of the people who go to Weight Watchers lack character. I don’t think so. I think the vast majority of the people who go to Weight Watchers don’t respond biologically to the low-fat, high-carb diet they promote.]

    Reply
  10. Distinction

    My question is quite simple and not about fat. Tom, do you think your fast-food diet as portrayed in the documentary is healthy? Would you encourage others to adopt a fast-food based diet?

    No, I was making a point about how “fatty food” is not the problem, nor is fast food responsible for the rise in obesity. Bad food is the culprit, and I see people buy just as much sugary-starchy junk at our local grocery store as they do at McDonald’s.

    Don’t know if you saw the entire film. I stated near the end that a fast food diet is not a good diet.

    Reply
  11. Marcus

    @Tom and @Eric:

    “He thinks it’s about character — if you’d just exert the discipline to eat less and move more, you wouldn’t be fat.”

    Precisely. And I have yet to see any solid evidence that suggests over the long term that this isn’t true. I also think that you don’t necessarily need to even eat less. Simply exercising more and making sure that you don’t compensate by eating more at the same time will help you lose weight.

    We have two anecdotal pieces of evidence in my favor. First there is myself. I went from 200 to 175 by changing nothing other than running. I suspect that I even did compensate by eating a bit more – and I still lost weight.

    The other is Tom. My hypothesis is that he lost weight because he restricted his diet to 2000 calories and also added in exercise. He could have eaten McDonald’s, bowls of sugar, or asparagus all day long and if he was under 2000 calories a day he’d shed the pounds.

    In short it’s not that I don’t believe in the chemical and hormonal evidence; it’s that this stuff only matters on the margins. The more important move you can make in your life to lose weight is to eat less and move more.

    Also on an abstract level I do think there is some danger in feeding the laziness problem in this country. I’m not a fan of diets that say you can eat fast food and not exercise and be just fine. That strikes me as, at best misleading, and at worst downright dangerous (I’ve cited reasons why I believe this above, such as blood pressure changes and so forth).

    Marcus, with your PhD and all, you realize my one-man experiment involved multiple variables, and there’s no way of knowing which variable or combination of variables was responsible. I also have no way of knowing if ALL you changed was your level of exercise. And even if you did, frankly that doesn’t prove much. Go back and read our comments. I’ve said over and over that for people whose hormones are driving them to accumulate fat, all exercising does is deplete the body’s energy, which the body can offset through lower body heat. You may not have fallen into that category. That’s why I linked to the study showing that exercise resulted in weight loss for women who were already at normal weight, but not for women who were overweight or obese. In the study of obese mice whose food supply was reduced by 5%, they became fatter and loss muscle mass. (Yes, I know, we’re not mice. I bring it up because people who don’t know better claim that eating less will always lead to fat loss because of the laws of thermodynamics.)

    As for you not seeing solid evidence that fat accumulation is driven by hormones, well, you’ve got me there. I agree 100% that you have not, in fact, seen the solid evidence. That’s because you’re not interested in seeing the evidence and haven’t bothered to look at it. That would risk causing you to change your mind, which I can tell from our exchanges is way out of your comfort zone.

    If you are interested in the evidence, it’s out there. “Good Calories, Bad Calories” is jam-packed with evidence. The studies in which people on low-carb diets spontaneously ate less despite having no caloric restrictions are also evidence — unless you believe cutting sugar and starch from the diet produces a change in a person’s character. The Lustig study in which giving obese teens an insulin-suppressing drug led to a reduction in appetite, weight loss, and a large and spontaneous increase in physical activity is also evidence — again, unless you believe those teens had a sudden change in character.

    Reply
  12. Marcus

    @Tom:

    re: free will. “If I drink 12 beers, I get drunk. I can’t exert my will to stop it from happening.” Exactly! The biochemistry will get you drunk. But you don’t need to drink 12 beers. You can drink 2 and not get drunk. Just as you don’t *have* to eat 5000 calories a day. You can eat 2500 and feel fulfilled.

    [The point being we can’t just will away the biological effects of food. We can’t just will away the excess hunger that carbohydrates induce in many people. But we can, once we understand the problem, choose to stop eating the carbohydrates that trigger the elevated insulin.

    Your vision of how people should lose weight actually does fit the drinking analogy in a way: you’re telling the dietary equivalent of alcoholics to just have two or three drinks and then STOP already, ignoring the fact that their bodies don’t process alcohol like a normal person’s does.

    And how on God’s green earth do you know for a fact that we can all feel full on 2500 calories?!! Just because you can?]

    re: half-starved people. Do you really think this is the problem in this country? People are eating too much and putting on weight because they’re eating carbs that don’t satisfy them? All of the carbs make them want more food? How about Occam’s Razor here, Tom: Maybe, just maybe, people are simply eating too much period. We lack the discipline and self-control to stop. Because it’s fun to eat.

    [Here’s Occam’s Razor: People eat when their appetites tell them to eat. It’s a biological urge. Most obese people hate being fat. Nearly all obese people have tried “eat less, move more” diet programs, and most have tried several. Nearly all of those programs have a sky-high failure rate, even among people who are disciplined and driven to succeed in other areas of life. So the simple, Occam’s Razor conclusion: something is wrong with the advice.]

    re: hormones. “I just don’t believe that for someone who is hormonally driven to accumulate fat, burning off calories through exercise is going to lead to weight loss.” How many people are hormonally driven to accumulate fat?? Are you? Am I? How do we know?

    [Most obese people these days are insulin-resistant, and 85% of insulin-resistant people are overweight or obese. Unless you disagree with the biochemistry textbooks that detail how insulin increases fat accumulation and inhibits lipolysis, that means lots and lots of people are hormonally driven to accumulate fat.]

    “I just don’t believe that for someone who is hormonally driven to accumulate fat, burning off calories through exercise is going to lead to weight loss.” But why? It seems to me that we have countless examples of this not being true. You don’t believe the success stories of obese people getting weight under control through exercise?

    [You read the articles quoting researchers in the field who explained how exercise doesn’t seem to lead to weight loss very often, correct? Yes, people who aren’t hormonally driven to accumulate fat can run off some weight. In a nation of 300 million, I suppose that small percentage could add up to a sizable number. But it doesn’t change the statistical fact that exercise has a low success rate as a cure for obesity, and it doesn’t change the biological fact that people who are hormonally driven to accumulate fat can’t just run it off unless they solve the hormonal issue first. Otherwise, they simply drive their fat mass below the point where it can supply fatty acids rapidly enough to keep blood sugar level, causing their bodies to panic and slow their metabolisms and ramp up hunger. That’s why the “setpoint” theory came along. Researchers noticed that our bodies fight very hard to maintain a particular level of body fat.

    (I’m going to presume, based on this ongoing debate, that you’ve never ready anything on how our fat mass keeps our blood sugar level.)]

    re: Oprah. I’m not sure what point you’re trying to make. Oprah has admitted that her problem is willpower: http://www.scientificpsychic.com/blogentries/oprah-winfreys-diet-failure.html.

    [Yes, of course that’s what she believes. That’s what Dr. Oz told her. Too bad she believed him. Poor gal gets these huge cravings, and Dr. Oz tells her she should exert her willpower and ignore them. But it’s not natural to feel starved half your life. Dr. Oz should be asking why she gets those cravings in the first place. (Okay, he did say why: she’s not really craving food; she’s craving love. New Age Idiot.]

    re: WW statistics. Do you have a cite for the 1% long-term success rate? How is success defined (and measured)?

    [http://fatfu.wordpress.com/2008/01/24/weight-watchers/]

    My personal feeling is that the whole concept of a diet is BS. What people need is lifestyle changes that are sustainable. Exercising more is sustainable.

    [The concept of “go on a diet, eat less and you’ll automatically lose weight and keep it off” is b.s. indeed. For people who don’t have the energy to exercise because their bodies are sucking up calories and storing them as fat, exercise isn’t sustainable. It’s exhausting. Look what happens to the Biggest Losers who try losing weight by eating less and exercising furiously:

    http://www.weightymatters.ca/2011/02/biggest-loser-destroys-participants.html?utm_medium=twitter&utm_source=twitterfeed

    That’s what happens when you shrink your fat mass without solving the hormonal imbalance that caused your body to accumulate fat in the first place: you screw up your ability to supply yourself with fatty acids for energy at the necessary rate. So your body does what it has to do … it finds a way to require less energy. No amount of character or willpower changes the biochemistry.
    ]

    Reply
  13. Marcus

    @Tom:

    We apparently have two very different conceptions of human nature. You seem to view humans as automatons that lack free will. What we consume and burn is a function of a biochemistry and nothing else. Put another way, your privileging predispositions while I’m privileging action. It may very well be the case that for some people “hormones are driving them to accumulate fat.” That’s a predisposition. One doesn’t *need* to accumulate fat, however, unless one satisfies the body’s desire to do so. Do you follow?

    [If I drink 12 beers, I get drunk. I can’t exert my will to stop it from happening. If I jog, my bum knee hurts. No amount of character will prevent it. If a person has a damaged thyroid, he or she will be hormonally driven to accumulate fat. If a person takes certain steroid medications, he or she will be hormonally driven to accumulate fat. Only by exerting super-human willpower — in the form of being willing to go through life feeling half-starved — can they avoid those effects from the hormonal drive. That doesn’t mean I don’t believe in free will (if you think otherwise, you sure as heck haven’t watched Fat Head), nor does it mean humans are automatons. It means we can’t change biology through willpower. It means insulin has powerful biological effects, and if we consume a diet that provokes chronically elevated insulin, we’re going to gain weight and have one hell of a difficult time losing it — unless we’re willing to go through life half-starved. That’s why programs based on the simple “eat less, move more” meme, such as Weight Watchers, have an abysmal success rate. They don’t address the hormonal issue.]

    But more importantly, I need to disabuse you of this notion that single studies are positive of anything. You cite a single study and conclude that exercise doesn’t lead to weight loss. The least you can do is explain why the hundreds of other studies that say the OPPOSITE are wrong. To wit: http://www.annals.org/content/133/2/92.1.short

    [That is the one area where we’d agree: if you engage in the type of exercise that improves insulin sensitivity (as happened in the study), you’ve moved in the direction of solving the hormonal drive to accumulate fat. That’s why when people ask me about exercising, I suggest going with sprints and progressive resistance — the type of exercise that improves insulin sensitivity.

    I need to disabuse you of the notion that you need to disabuse me of the notion that I think a single study proves a hypothesis. I don’t. I approach it from the opposite direction: if I find black swans, the hypothesis that all swans are white has been invalidated. If I find several studies in which exercise fails to produce weight loss, I consider the hypothesis that exercise induces weight loss to be unsupported, if not totally invalidated.]

    Re: exercise. I still don’t think your theory makes any sense at all. Look around. If exercise made you fatter because you simply eat more after exercising, wouldn’t those who regularly exercise be the fattest? I think there is something going with the observation that people who exercise are usually fit. It’s the ones who don’t exercise that have the problems.

    [Say what? I don’t believe exercise makes anyone fatter. I just don’t believe that for someone who is hormonally driven to accumulate fat, burning off calories through exercise is going to lead to weight loss — unless the hormonal issue is solved first. Once again, we disagree about cause and effect. When Dr. Lustig gave an insulin-suppressing drug to kids who had become obese and lethargic, they lost weight and began exercising spontaneously. They didn’t lose weight because they were exercising; they became active because their bodies were no longer storing a disproportionate share of the energy they consumed in their fat cells.]

    Finally, again, I don’t dispute the hormone studies. I’m just suggesting that hormone studies are not sufficient to dispute the claim that it is character that matters. Like I said, hormones matter. On the margins.

    [There are countless people who are amazingly successful in nearly all areas of life, but struggle with their weight. Oprah Winfrey is one example. This woman went from poverty and an abusive childhood to smashing success. You don’t accomplish what she’s accomplished without terrific drive and discipline. So by your theory, her obvious drive and discipline disappear in this one area of her life. The vast majority of dieters don’t lose weight long term, and many end up fatter than when they started. Weight Watchers has a long-term success rate of about 1%. So by your theory, 99% of the people who go to Weight Watchers lack character. I don’t think so. I think the vast majority of the people who go to Weight Watchers don’t respond biologically to the low-fat, high-carb diet they promote.]

    Reply
  14. Marcus

    @Tom:

    re: free will. “If I drink 12 beers, I get drunk. I can’t exert my will to stop it from happening.” Exactly! The biochemistry will get you drunk. But you don’t need to drink 12 beers. You can drink 2 and not get drunk. Just as you don’t *have* to eat 5000 calories a day. You can eat 2500 and feel fulfilled.

    [The point being we can’t just will away the biological effects of food. We can’t just will away the excess hunger that carbohydrates induce in many people. But we can, once we understand the problem, choose to stop eating the carbohydrates that trigger the elevated insulin.

    Your vision of how people should lose weight actually does fit the drinking analogy in a way: you’re telling the dietary equivalent of alcoholics to just have two or three drinks and then STOP already, ignoring the fact that their bodies don’t process alcohol like a normal person’s does.

    And how on God’s green earth do you know for a fact that we can all feel full on 2500 calories?!! Just because you can?]

    re: half-starved people. Do you really think this is the problem in this country? People are eating too much and putting on weight because they’re eating carbs that don’t satisfy them? All of the carbs make them want more food? How about Occam’s Razor here, Tom: Maybe, just maybe, people are simply eating too much period. We lack the discipline and self-control to stop. Because it’s fun to eat.

    [Here’s Occam’s Razor: People eat when their appetites tell them to eat. It’s a biological urge. Most obese people hate being fat. Nearly all obese people have tried “eat less, move more” diet programs, and most have tried several. Nearly all of those programs have a sky-high failure rate, even among people who are disciplined and driven to succeed in other areas of life. So the simple, Occam’s Razor conclusion: something is wrong with the advice.]

    re: hormones. “I just don’t believe that for someone who is hormonally driven to accumulate fat, burning off calories through exercise is going to lead to weight loss.” How many people are hormonally driven to accumulate fat?? Are you? Am I? How do we know?

    [Most obese people these days are insulin-resistant, and 85% of insulin-resistant people are overweight or obese. Unless you disagree with the biochemistry textbooks that detail how insulin increases fat accumulation and inhibits lipolysis, that means lots and lots of people are hormonally driven to accumulate fat.]

    “I just don’t believe that for someone who is hormonally driven to accumulate fat, burning off calories through exercise is going to lead to weight loss.” But why? It seems to me that we have countless examples of this not being true. You don’t believe the success stories of obese people getting weight under control through exercise?

    [You read the articles quoting researchers in the field who explained how exercise doesn’t seem to lead to weight loss very often, correct? Yes, people who aren’t hormonally driven to accumulate fat can run off some weight. In a nation of 300 million, I suppose that small percentage could add up to a sizable number. But it doesn’t change the statistical fact that exercise has a low success rate as a cure for obesity, and it doesn’t change the biological fact that people who are hormonally driven to accumulate fat can’t just run it off unless they solve the hormonal issue first. Otherwise, they simply drive their fat mass below the point where it can supply fatty acids rapidly enough to keep blood sugar level, causing their bodies to panic and slow their metabolisms and ramp up hunger. That’s why the “setpoint” theory came along. Researchers noticed that our bodies fight very hard to maintain a particular level of body fat.

    (I’m going to presume, based on this ongoing debate, that you’ve never ready anything on how our fat mass keeps our blood sugar level.)]

    re: Oprah. I’m not sure what point you’re trying to make. Oprah has admitted that her problem is willpower: http://www.scientificpsychic.com/blogentries/oprah-winfreys-diet-failure.html.

    [Yes, of course that’s what she believes. That’s what Dr. Oz told her. Too bad she believed him. Poor gal gets these huge cravings, and Dr. Oz tells her she should exert her willpower and ignore them. But it’s not natural to feel starved half your life. Dr. Oz should be asking why she gets those cravings in the first place. (Okay, he did say why: she’s not really craving food; she’s craving love. New Age Idiot.]

    re: WW statistics. Do you have a cite for the 1% long-term success rate? How is success defined (and measured)?

    [http://fatfu.wordpress.com/2008/01/24/weight-watchers/]

    My personal feeling is that the whole concept of a diet is BS. What people need is lifestyle changes that are sustainable. Exercising more is sustainable.

    [The concept of “go on a diet, eat less and you’ll automatically lose weight and keep it off” is b.s. indeed. For people who don’t have the energy to exercise because their bodies are sucking up calories and storing them as fat, exercise isn’t sustainable. It’s exhausting. Look what happens to the Biggest Losers who try losing weight by eating less and exercising furiously:

    http://www.weightymatters.ca/2011/02/biggest-loser-destroys-participants.html?utm_medium=twitter&utm_source=twitterfeed

    That’s what happens when you shrink your fat mass without solving the hormonal imbalance that caused your body to accumulate fat in the first place: you screw up your ability to supply yourself with fatty acids for energy at the necessary rate. So your body does what it has to do … it finds a way to require less energy. No amount of character or willpower changes the biochemistry.
    ]

    Reply
  15. Marcus

    @ Tom:

    re: urges. “Here’s Occam’s Razor: People eat when their appetites tell them to eat. It’s a biological urge. Most obese people hate being fat.” Here we go again with the automaton stuff. We all have biological urges, Tom. That doesn’t mean we have to act on them. Part of being a human being is being able to reason. Do I really need that 4th beer? Do I really need to eat that 3rd Big Mac? How about in addition to the hormones we get you to admit that Americans could probably benefit from a little more personal responsibility on the food front? You act as if a hormone goes off and all the sudden we are forced to stuff our faces. And then you use hyperbole like “half-starved” to insinuate that if you don’t stuff your face until you’re full you’re malnourished. Maybe a little middle ground can be reached here?

    [I actually did need that fourth beer, or at least some other form of quick energy. The alternative was dangerously low glucose, which is why I craved the beer. It was a fuel emergency. That will be the topic of an upcoming post. My fat cells couldn’t release fat, my liver couldn’t produce glucose, and my brain was screaming for fuel. When I changed my diet, the urge to drink beer after beer went away. Either something changed biochemically, or I suddenly developed character. Details to follow.

    Fat Head is largely about personal responsibility. You haven’t seen it, obviously. But telling people to adopt “healthy” diets that induce hunger in the form of fuel shortages at the cellular level and then lecturing them about eating less is beyond useless.]

    re: WW stats. I read that blog piece and it’s not compelling in the slightest, mostly because he makes a basic math mistake (and doesn’t even have the latest numbers to boot). But I’ll comment on his blog as he’s the one who wrote the interpretation. But let’s run with the 1% number. Now where are the studies highlighting the 5+ year outcomes of high-fat, low-carb diets? What’s the success rate of the Mediterranean Diet?

    [I haven’t seen any. There haven’t been any long-term studies on low-carb diets because the geniuses in academia decided that would be asking people to give themselves heart disease.]

    re: Oprah. What if Oprah’s urges were for shoplifting or for hitting children? Would you then say it was simply a hormonal issue and not about character?

    [Now you’re just being silly. Very weak analogy. There is no biological need to hit children (if they’re not armed and making threats) or to shoplift. Once again, you can’t distinguish between character and chemistry.]

    Why is it ok to make a person responsible when it comes to not acting out on some urges but perfectly acceptable to let the person off the hook when it comes to food?

    [Because when you experience a fuel shortage at the cellular level, it’s not an “urge,” it’s a biological emergency. If cells run out of fuel, they die. Several million years of evolution have programmed our bodies to fight starvation at all costs. Since you haven’t actually read anything about the biochemistry involved, you still think if a person is fat, he can’t be starving. It doesn’t matter how much energy is stored in the fat cells; if the fatty acids are trapped by elevated insulin, you can starve at the cellular level. If I fill your pantry with food and then bolt it shut, you can starve if your refrigerator is empty and you can’t leave the house.]

    And hey, whoever said weight loss was supposed to be easy? If you want to lose weight, maybe feeling hungry is a *good* thing. Because one thing is certainly true: while we may feel starved, we certainly aren’t. Have a look around.

    [See above. You haven’t read up on the biochemistry of hunger, so you’re expressing an uninformed and (let’s be honest) snotty opinion about fat people that has nothing to do with biological reality. If your fat cells are sucking up energy and trapping it, you can sure as hell be starving at the cellular level.

    Tell me specifically which of these points is incorrect and why:
    1. Blood sugar must be kept within a narrow range because high blood sugar is toxic and low blood sugar leads to cell death in the brain.
    2. Keeping blood sugar within a narrow range requires alternately storing and retrieving fatty acids to and from adipose tissue.
    3. Adipose tissue is metabolically active. Fatty acids move in and out of fat cells all day long. When we wake up in the morning, we’re getting about 60-80% of our energy from fatty acids released by the fat cells.
    4. When blood sugar is high, circulating fatty acids are stored in fat cells so glucose will be burned first and prevented from reaching toxic levels. Excess glucose is also converted into glycogen to clear it from the bloodstream. If glycogen stores are full — which they often are — the liver converts excess glucose to fat.
    5. When blood sugar begins to fall, fatty acids are released from the fat cells and burned as the primary fuel for muscles and organs to prevent glucose from falling too rapidly and to preserve glucose for the brain, which will experience cell death without adequate glucose.
    6. The storing and releasing of fatty acids is orchestrated by several hormones, especially insulin. Insulin drives glucose into cells and drives fatty acids into adipose tissue. When blood sugar is high, insulin is released to bring it down by driving glucose into cells for fuel and storing fatty acids in adipose tissue. When blood sugar begins to drop, insulin goes down so fatty acids can be released and fulfill the function described in #5.
    7. Insulin (via the actions of lipoprotein lipase, which responds to insulin levels) promotes esterification of fatty acids into triglycerides in the fat cells and inhibits lipolysis. In the presence of elevated insulin, triglycerides cannot be broken down, and therefore can’t escape the fat cells because they’re too large — only individual fatty acids can escape fat cells. Therefore, a person with chronically elevated insulin will store a disproportionate number of calories as fat and release fatty acids at an inhibited rate.
    8. As glucose begins to fall after a meal or during sleep, the inhibited release of fatty acids creates a fuel shortage, since fatty acids aren’t sufficiently available to meet the fuel needs of the muscles and organs by replacing the glucose that is less and less available.
    9. As a result of the fuel shortage, the insulin-resistant person will be driven to eat again, even though people with more discipline and character believe he should be full on the 2500 calories he already consumed that day.
    10. If the insulin-resistant person refuses to eat again to demonstrate his great discipline and fine character, his body will fight to prevent cellular death through a combination of finding alternate fuel and using less fuel. The alternate fuel will be lean muscle mass broken down and converted to glucose through the process known as gluconeogenesis. Using less fuel means lowering body heat and otherwise slowing the metabolism — neat little things like not wasting energy on repairing tissues … one of the reasons semi-starvation diets can cause hair loss.
    11. Sensing the chronic threat of fuel shortages caused by the inhibited release of fatty acids, the body will work to increase the size of the fat mass, since bigger fat cells release more fatty acids. The body accomplishes this goal by ramping up appetite, slowing metabolism, and inducing feelings of lethargy to prevent movement.
    12. The process described in #11 continues until the fat cells are big enough to release fatty acids at a sufficient rate to keep blood sugar level. Thus, getting fatter is the body’s way of overcoming the chronic fuel shortage caused by insulin resistance and re-acquiring a state of energy balance.
    13. If the insulin-resistant person who became fatter decides to eat less and exercise more to lose weight and demonstrate his discipline and fine character, but doesn’t resolve the problem of chronically elevated insulin, moving more and eating less will produce a fuel shortage at the cellular level as described above. The insulin-resistant person may horsewhip himself into continuing the eat less/move more program, but as he loses fat mass, he also loses his ability to supply his muscles and organs with fatty acids at the rate required to keep blood sugar level. As a result, he will lose muscle mass, since his body must have fuel for his cells and will choose sacrificing lean tissue over cell death in the brain and other organs. His metabolism will also slow down as his body fights to avoid cellular starvation by matching the calories expended to the calories consumed.
    14. Because of the process described in #13, weight loss will stall and the insulin-resistant dieter will suffer from overwhelming biological urges to eat and increase his fat mass to the point where it can once again perform its crucial metabolic function.
    15. Frustrated, chemically depressed, and suffering from chronic hunger, the insulin-resistant dieter gives up and eats enough to satisfy his appetite. Since his metabolism has slowed down, he regains the weight even more rapidly than he lost it. Metabolically, his body is now back in a state of energy balance, which was its goal all along. Mentally, the insulin-resistant dieter feels like a failure who lacks character and discipline.
    16. The insulin-resistant dieter is told by Dr. Oz that he lacks willpower and gained back the weight because he’s craving love.

    Tell me where I’ve got it all wrong. Explain how none of what I described actually happens, so it’s all a simple matter of willpower.]

    Reply
  16. Marcus

    @ Tom:

    re: urges. “Here’s Occam’s Razor: People eat when their appetites tell them to eat. It’s a biological urge. Most obese people hate being fat.” Here we go again with the automaton stuff. We all have biological urges, Tom. That doesn’t mean we have to act on them. Part of being a human being is being able to reason. Do I really need that 4th beer? Do I really need to eat that 3rd Big Mac? How about in addition to the hormones we get you to admit that Americans could probably benefit from a little more personal responsibility on the food front? You act as if a hormone goes off and all the sudden we are forced to stuff our faces. And then you use hyperbole like “half-starved” to insinuate that if you don’t stuff your face until you’re full you’re malnourished. Maybe a little middle ground can be reached here?

    [I actually did need that fourth beer, or at least some other form of quick energy. The alternative was dangerously low glucose, which is why I craved the beer. It was a fuel emergency. That will be the topic of an upcoming post. My fat cells couldn’t release fat, my liver couldn’t produce glucose, and my brain was screaming for fuel. When I changed my diet, the urge to drink beer after beer went away. Either something changed biochemically, or I suddenly developed character. Details to follow.

    Fat Head is largely about personal responsibility. You haven’t seen it, obviously. But telling people to adopt “healthy” diets that induce hunger in the form of fuel shortages at the cellular level and then lecturing them about eating less is beyond useless.]

    re: WW stats. I read that blog piece and it’s not compelling in the slightest, mostly because he makes a basic math mistake (and doesn’t even have the latest numbers to boot). But I’ll comment on his blog as he’s the one who wrote the interpretation. But let’s run with the 1% number. Now where are the studies highlighting the 5+ year outcomes of high-fat, low-carb diets? What’s the success rate of the Mediterranean Diet?

    [I haven’t seen any. There haven’t been any long-term studies on low-carb diets because the geniuses in academia decided that would be asking people to give themselves heart disease.]

    re: Oprah. What if Oprah’s urges were for shoplifting or for hitting children? Would you then say it was simply a hormonal issue and not about character?

    [Now you’re just being silly. Very weak analogy. There is no biological need to hit children (if they’re not armed and making threats) or to shoplift. Once again, you can’t distinguish between character and chemistry.]

    Why is it ok to make a person responsible when it comes to not acting out on some urges but perfectly acceptable to let the person off the hook when it comes to food?

    [Because when you experience a fuel shortage at the cellular level, it’s not an “urge,” it’s a biological emergency. If cells run out of fuel, they die. Several million years of evolution have programmed our bodies to fight starvation at all costs. Since you haven’t actually read anything about the biochemistry involved, you still think if a person is fat, he can’t be starving. It doesn’t matter how much energy is stored in the fat cells; if the fatty acids are trapped by elevated insulin, you can starve at the cellular level. If I fill your pantry with food and then bolt it shut, you can starve if your refrigerator is empty and you can’t leave the house.]

    And hey, whoever said weight loss was supposed to be easy? If you want to lose weight, maybe feeling hungry is a *good* thing. Because one thing is certainly true: while we may feel starved, we certainly aren’t. Have a look around.

    [See above. You haven’t read up on the biochemistry of hunger, so you’re expressing an uninformed and (let’s be honest) snotty opinion about fat people that has nothing to do with biological reality. If your fat cells are sucking up energy and trapping it, you can sure as hell be starving at the cellular level.

    Tell me specifically which of these points is incorrect and why:
    1. Blood sugar must be kept within a narrow range because high blood sugar is toxic and low blood sugar leads to cell death in the brain.
    2. Keeping blood sugar within a narrow range requires alternately storing and retrieving fatty acids to and from adipose tissue.
    3. Adipose tissue is metabolically active. Fatty acids move in and out of fat cells all day long. When we wake up in the morning, we’re getting about 60-80% of our energy from fatty acids released by the fat cells.
    4. When blood sugar is high, circulating fatty acids are stored in fat cells so glucose will be burned first and prevented from reaching toxic levels. Excess glucose is also converted into glycogen to clear it from the bloodstream. If glycogen stores are full — which they often are — the liver converts excess glucose to fat.
    5. When blood sugar begins to fall, fatty acids are released from the fat cells and burned as the primary fuel for muscles and organs to prevent glucose from falling too rapidly and to preserve glucose for the brain, which will experience cell death without adequate glucose.
    6. The storing and releasing of fatty acids is orchestrated by several hormones, especially insulin. Insulin drives glucose into cells and drives fatty acids into adipose tissue. When blood sugar is high, insulin is released to bring it down by driving glucose into cells for fuel and storing fatty acids in adipose tissue. When blood sugar begins to drop, insulin goes down so fatty acids can be released and fulfill the function described in #5.
    7. Insulin (via the actions of lipoprotein lipase, which responds to insulin levels) promotes esterification of fatty acids into triglycerides in the fat cells and inhibits lipolysis. In the presence of elevated insulin, triglycerides cannot be broken down, and therefore can’t escape the fat cells because they’re too large — only individual fatty acids can escape fat cells. Therefore, a person with chronically elevated insulin will store a disproportionate number of calories as fat and release fatty acids at an inhibited rate.
    8. As glucose begins to fall after a meal or during sleep, the inhibited release of fatty acids creates a fuel shortage, since fatty acids aren’t sufficiently available to meet the fuel needs of the muscles and organs by replacing the glucose that is less and less available.
    9. As a result of the fuel shortage, the insulin-resistant person will be driven to eat again, even though people with more discipline and character believe he should be full on the 2500 calories he already consumed that day.
    10. If the insulin-resistant person refuses to eat again to demonstrate his great discipline and fine character, his body will fight to prevent cellular death through a combination of finding alternate fuel and using less fuel. The alternate fuel will be lean muscle mass broken down and converted to glucose through the process known as gluconeogenesis. Using less fuel means lowering body heat and otherwise slowing the metabolism — neat little things like not wasting energy on repairing tissues … one of the reasons semi-starvation diets can cause hair loss.
    11. Sensing the chronic threat of fuel shortages caused by the inhibited release of fatty acids, the body will work to increase the size of the fat mass, since bigger fat cells release more fatty acids. The body accomplishes this goal by ramping up appetite, slowing metabolism, and inducing feelings of lethargy to prevent movement.
    12. The process described in #11 continues until the fat cells are big enough to release fatty acids at a sufficient rate to keep blood sugar level. Thus, getting fatter is the body’s way of overcoming the chronic fuel shortage caused by insulin resistance and re-acquiring a state of energy balance.
    13. If the insulin-resistant person who became fatter decides to eat less and exercise more to lose weight and demonstrate his discipline and fine character, but doesn’t resolve the problem of chronically elevated insulin, moving more and eating less will produce a fuel shortage at the cellular level as described above. The insulin-resistant person may horsewhip himself into continuing the eat less/move more program, but as he loses fat mass, he also loses his ability to supply his muscles and organs with fatty acids at the rate required to keep blood sugar level. As a result, he will lose muscle mass, since his body must have fuel for his cells and will choose sacrificing lean tissue over cell death in the brain and other organs. His metabolism will also slow down as his body fights to avoid cellular starvation by matching the calories expended to the calories consumed.
    14. Because of the process described in #13, weight loss will stall and the insulin-resistant dieter will suffer from overwhelming biological urges to eat and increase his fat mass to the point where it can once again perform its crucial metabolic function.
    15. Frustrated, chemically depressed, and suffering from chronic hunger, the insulin-resistant dieter gives up and eats enough to satisfy his appetite. Since his metabolism has slowed down, he regains the weight even more rapidly than he lost it. Metabolically, his body is now back in a state of energy balance, which was its goal all along. Mentally, the insulin-resistant dieter feels like a failure who lacks character and discipline.
    16. The insulin-resistant dieter is told by Dr. Oz that he lacks willpower and gained back the weight because he’s craving love.

    Tell me where I’ve got it all wrong. Explain how none of what I described actually happens, so it’s all a simple matter of willpower.]

    Reply
  17. Brett Stone

    You really did need that 4th beer? Dude, you’re just validating Marcus’ point: NO YOU DIDN’T. You can use all the hyperbole you want, but you didn’t have an emergency that required you to drink a 4th beer, you weren’t starving, and you could have said no. You chose not to. You’re proving his point better than Marcus is. You are no better than Dr. Oz except you’re going in the opposite direction: “it’s ok your fat.. your body needs to be fat.. you’re having a hunger emergency.” hahahah that’s absurd.

    Biochemically, I needed the beer OR another quick source of fuel, which is what I stated. My glucose was dropping, my fat cells were locked up, and the alcohol was preventing my liver from producing new glucose. Alcohol often induces low blood sugar by blocking the conversion of glycogen into glucose.

    Sure, I could’ve just said no and refused to eat or drink anything … then passed out from low blood sugar. (If you don’t think low blood sugar is a biological emergency, we can just stop right here. That would simply prove you, like Marcus, are full of strong but uninformed opinions.)

    If “you’re having a hunger emergency” is so ha-ha-ha absurd, just tell me which of the points I spelled out is wrong. I listed the whole process. Since you’re declaring it all absurd, surely your understanding of the biochemistry involved is deeper than mine … so pretty please, do me the favor of explaining which of those points is incorrect and why.

    Reply
  18. Marcus

    @ Tom;

    re: beer. “I actually did need that fourth beer, or at least some other form of quick energy. The alternative was dangerously low glucose, which is why I craved the beer. It was a fuel emergency.” Are you suggesting that most fat people are now actually diabetics? I’ve never heard anyone ever claim that a 4th beer was *necessary* because they were undergoing a “fuel emergency.” News to me. Now tell me, what would happen if you ignored the fuel emergency? Would you, gasp, stay hungry? Oh the horror!

    [No, I would’ve passed out from low blood sugar. Beer specifically wasn’t necessary, but some quick source of sugar was definitely necessary. Are you honestly going to tell me you’ve never heard of diabetics taking a quick shot of sugar to avoid dangerously low glucose? I once witnessed paramedics shoot glucose into a diabetic neighbor who’d passed out to prevent brain damage. If only I’d had your deep understanding of the biochemistry, I could’ve explained to the paramedics that since my neighbor was obese, she should say hungry for awhile and burn off some fat.

    I’m suggesting that most obese people are insulin-resistant. If you’re not aware of that fact, you might stop and wonder why you consider yourself such an expert on the subject of obesity and weight loss.]

    re: personal responsibility. “Fat Head is largely about personal responsibility. You haven’t seen it, obviously.” I have seen it. But I’m making a distinction between what you write here on this blog and what was in the movie. The movie was actually mild in its claims; you didn’t use words like “fuel emergency” and “hormones force us to eat.” The reason, it seems to me, is that no one would take that seriously. You can make the claims here because mostly it is your fans who are reading this blog. 😉

    [I make the claims here because I’ve read a helluva lot more since I made the film. Hormones don’t force us to eat. Hormones create a fuel shortage at the cellular level, ramping up appetite.]

    re: WW stats. So if there are no studies of the long-term effects of a low-carb diet (kind of interesting in its own right), do you think you should be criticizing WW’s success rate? You have no evidence at all that your ideas are any better in the long term; indeed they could be much much worse. My suggestion would be get some good long-term studies first, then criticize WW.

    [Nope, no clinical studies on the long-term effects. However, I’ve lost count of the emails I’ve received from people thanking me for making Fat Head and telling me that once they got off the low-fat/low-calorie merry-go-round, they lost weight easily. My composer also lost 20 pounds, my sound engineer lost 25 pounds (and was able to stop taking Prilosec), and the music producer lost 30 pounds. My brother lost 20 pounds, my mom lost 15. So far the long-term effects have been improved lab scores all around.

    There are clinical studies, however, showing that people on low-carb diets spontaneously eat less, even without calorie restrictions. I’ve asked several times for you to explain that result, since you think this is all about willpower. You still haven’t.]

    re: biological determinism. “There is no biological need to hit children (if they’re not armed and making threats) or to shoplift.” Baloney. Everything is in our biology. Urges to have sex, aggression, to kill.. these are linked to hormones in the same exact way that you’re arguing the urge to eat is linked to hormones. Don’t believe me? Look up the studies on testosterone in males and social cues.

    [An urge is not a biological need, whether caused by hormones or not. If my testosterone produces an urge to hit someone, what negative biological consequences will I suffer if I ignore the urge? Oh, did I hear “None”? That’s right, none, unless you consider frustration a biological emergency. Your body won’t begin to chew up its own muscles if you ignore your urge to hit someone.

    On the other hand, falling glucose is very much a biological emergency. Low glucose has very definite negative consequences and is indeed an emergency.]

    There is a vicious cycle between testosterone increasing and young men acting violent. If we viewed these hormones in the same way that you’re viewing food hormones then the answer would simply be that young men who are violent don’t lack character, rather their hormones made them do it (just as our hormones make us eat). That’s obviously absurd and would not hold up anywhere (court, in a discussion at a bar, etc.).

    [Nor would I want it to hold up in court, since refusing to beat someone despite your high level of testosterone causes no biological emergencies for your body and is therefore very much a matter of controlling your urges.]

    Therefore you want it one way but not the other: in some realms of life you want to suggest that our biochemistry forces us toward certain behaviors and it’s not a question of character; I would imagine in other areas you are not comfortable making this claim. Seems like a double standard to me.

    [No, it’s a single standard. We can indeed ignore hormonally-induced urges. If we ignore the urge to kill, the result is that we don’t go to prison. If we’re insulin-resistant and ignore the urge to eat, we create a fuel shortage. If we continue creating those fuel shortages, we lose our muscle mass and slow our metabolisms and set up our bodies to fight even harder to regain any weight we’ve lost.]

    I think the far more appropriate position to hold is that both matter at varying levels: character AND hormones are important. I was hoping that we could meet in the middle on this, though you appear to be fully on the hormone train.

    [I’m not interested in meeting in the middle for the sake of meeting in the middle. Consensus is lovely in politics but has nothing to do with science. Character certainly matters insofar as we can, if we’re properly informed, choose the diet that solves the hormonal imbalance that drives us to accumulate fat. But the usual advice — gosh, just eat less and move more, you lazy slobs — is doomed to fail in insulin-resistant people, whether they have character or not … unless they’re willing to lose muscle mass, go through life feeling half-starved, and end up with a slower metabolism, for all the reasons I described.]

    re: causal story. Your story has a contradiction. To wit:

    “When we wake up in the morning, we’re getting about 60-80% of our energy from fatty acids released by the fat cells.”

    and

    “As a result of the fuel shortage, the insulin-resistant person will be driven to eat again, even though people with more discipline and character believe he should be full on the 2500 calories he already consumed that day.”

    There isn’t a fuel shortage, as you note, since we live just fine during the night and in the morning even though we are burning fatty acids.

    [The person waking up in the morning with a reliable supply of fatty acids is a normal person … insulin-resistant people are different, although their insulin level is usually lowest in the morning. Many insulin-resistant people wake up in the middle of the night to raid the refrigerator. Either way, insulin resistance leads to elevated insulin, which drives calories into the fat cells and inhibits the release of fatty acids.]

    The same is true AFTER we eat. You may feel hunger but that doesn’t make anything a fuel emergency – you will simply start burning fat again for energy. You would be better served explaining to people how they can overcome the feeling of hunger even when they don’t need food for energy.

    [“You will simply start burning fat again.” And you know this how, exactly? There’s no such thing as insulin-resistance? Elevated insulin doesn’t inhibit lipolysis? If lipolysis is inhibited, that doesn’t create a fuel shortage that will require the body to find another source of fuel? Dieters who restrict calories beyond what their bodies can offset with fatty acids escaping the fat cells don’t lose muscle mass and end up with slower metabolisms? The Biggest Loser dieters didn’t end up with slower metabolisms? (Someone alert the authors of the study! They got it all wrong!) Obese mice didn’t end up with more fat mass and less muscle mass when they were calorie-restricted? (Someone alert the study authors! They must’ve gotten it wrong! Marcus has declared that when those mice were going hungry, they would’ve simply started burning fat again!)

    This is truly pathetic now, Marcus. It’s reached the point where you can’t dispute any of the biology involved, so you just repeat your opinions: “You will simply burn fat again for energy.” You’re in the embarrassing position of trying to wave away biochemical facts that don’t suit you … apparently because just admitting you don’t actually understand the biochemistry of fat accumulation and may have expressed some uninformed opinions early in this debate would cause your head to explode.

    I spelled out the biology involved. I asked you to tell me specifically which of those points is incorrect — because for losing weight (without sacrificing muscle mass and slowing the metabolism) to come down to a matter of simple willpower, some of those points MUST be incorrect. All you have to do is tell me which points are wrong and why. (Writing “No, that doesn’t happen” doesn’t qualify as refutation, by the way.) ]

    re: insulin. Again I’ve never heard of these “insulin-resistant” people except in the context of diabetes discussions. The way you take it would seem that most of Americans have diabetes because we still want to eat even after we’ve had enough.

    [Well, gee, if you haven’t heard of them, we can only presume they don’t exist. There are no facts in the world that Marcus doesn’t already know, and if he doesn’t already know them, they’re not facts. At least that’s what I’ve gathered from the discussion thus far.

    I’m sorry to hear you’re so ignorant of the data on insulin resistance in the population, which is widely available. I’ve noticed, however, that ignorance on a topic doesn’t prevent you from having strong opinions. You remind me of a quote from economist Murray Rothbard:

    “It is no crime to be ignorant of economics, which is after all a specialized discipline and one that most people consider a dismal science. But it is totally irresponsible to have a loud and vociferous opinion on economic subjects while remaining in this state of ignorance.”

    Substitute “obesity” for “economics” and it sums up your positions in this debate.]

    Reply
  19. Marcus

    @ Tom:

    Have you considered setting up a discussion forum like vBBS or something on this site? The reason I ask is that it is quite difficult to have an in-depth exchange like we’re having in the comment section. You’re able to edit posts and can put your responses right beneath what I say. I don’t have the ability so it is awkward quoting the relevant sections, out of context, and then responding to them. I’ll continue, but it is tricky.

    I’m not sure. I edit posts and include my own replies because it’s a one-step job. Otherwise, I have to approve a comment in the admin section, go out write my reply as another comment, come back and approve my own reply. Not going to happen.

    Reply
  20. Marcus

    @ Brett:

    I completely agree. I don’t think Tom was going to pass out if he didn’t have a 4th beer and, frankly, the assertion is rather absurd. He makes it sound like most of the population is “insulin-resistant” (whatever that means) and people are passing out left and right because of “fuel emergencies” unless they have that 3rd Big Mac or 4th beer.

    I’ve never seen someone so vociferously (and apparently seriously) argue that one needs to eat so much food.

    Once again, Marcus, nothing but an uninformed opinion. Look up glucose and alcohol, read how alcohol produces low blood sugar. With your PhD and all, it shouldn’t be a tough read. As someone who was insulin resistant at the time, I wasn’t replacing the falling glucose with fatty acids. My blood sugar was crashing, and hard. I needed fuel. It didn’t have to be another beer, but I needed fuel. Since alcohol is the fastest-acting of all fuels, I craved alcohol. I always wondered why another beer would wake me up when I started to crash, since alcohol is a depressant. Now I know.

    The mere fact that you wrote …

    “insulin-resistant” (whatever that means)

    … and have no idea what proportion of the obese population is insulin-resistant pretty much says it all, doesn’t it? If we needed any more proof that you’re simply spouting opinions that aren’t based on actual knowledge, there it is. Like I said before, the fact that you continue spouting opinions despite clearly (and by your admission) being unfamiliar with the topic really makes me wonder if they’re just passing out PhDs like candy these days. A true scientist wouldn’t argue about the effects of insulin resistance in one comment, then write (whatever that means) in another comment. Your unwillingness to actually look at some evidence and familiarize yourself with the topic before spouting off and painting yourself into a corner is a sad commentary on the state of science education.

    Reply
  21. Brett Stone

    You really did need that 4th beer? Dude, you’re just validating Marcus’ point: NO YOU DIDN’T. You can use all the hyperbole you want, but you didn’t have an emergency that required you to drink a 4th beer, you weren’t starving, and you could have said no. You chose not to. You’re proving his point better than Marcus is. You are no better than Dr. Oz except you’re going in the opposite direction: “it’s ok your fat.. your body needs to be fat.. you’re having a hunger emergency.” hahahah that’s absurd.

    Biochemically, I needed the beer OR another quick source of fuel, which is what I stated. My glucose was dropping, my fat cells were locked up, and the alcohol was preventing my liver from producing new glucose. Alcohol often induces low blood sugar by blocking the conversion of glycogen into glucose.

    Sure, I could’ve just said no and refused to eat or drink anything … then passed out from low blood sugar. (If you don’t think low blood sugar is a biological emergency, we can just stop right here. That would simply prove you, like Marcus, are full of strong but uninformed opinions.)

    If “you’re having a hunger emergency” is so ha-ha-ha absurd, just tell me which of the points I spelled out is wrong. I listed the whole process. Since you’re declaring it all absurd, surely your understanding of the biochemistry involved is deeper than mine … so pretty please, do me the favor of explaining which of those points is incorrect and why.

    Reply
  22. Marcus

    @ Tom:

    re: sugar. I’m very confused as to what part of the population we’re talking about here. Are we talking about diabetics or non-diabetics. I can assure you that most of the population will not pass out because they need more sugar after drinking 3 beers.

    [We’re talking about both. If your glucose drops far enough, you will indeed pass out. Alcohol can induce low blood sugar — it’s a fact. You can look it up. If alcohol can induce low blood sugar (fact) and low blood sugar can lead to passing out (fact), what exactly is the point of contention here?]

    re: hormones. “Hormones don’t force us to eat. Hormones create a fuel shortage at the cellular level, ramping up appetite.” Agreed! (Finally). The difference between you and me is that I don’t think the answer to that ramped up appetite is eating more food. That’s if you want to lose weight. If you don’t want to lose weight or gain weight, then by all means go ahead and eat that 3rd Big Mac.

    I don’t really understand why it is such a bad thing to be hungry. Can you explain?

    [Your contention is that if a person with elevated insulin simply refuses to eat as his energy is depleted, he will burn body fat, period. My contention is that elevated insulin blocks lipolysis (known biological fact), which means he can’t burn body fat quickly enough to make up for the depleted level of glucose and will begin to lose muscle mass instead. That would explain, for example, why obese mice who were calorie-restricted (a mere 5% reduction) lost muscle mass and ended up fatter than before, with slower metabolisms to boot. For your contention to be correct, “elevated insulin blocks lipolysis” would need to be a false statement.]

    re: studies. The knock on WW is that their *long-term* success rate is low (though it is overstated in that blog post because he misread the study). You citing how your composer lost 20 lbs says nothing about the high-fat diet’s long-term effects. Heck, your documentary hasn’t been out long enough to constitute long-term (in the WW study it is defined by 5+ years).

    [Yes, I know. Since there are no long-term studies, all I have is experience to go by so far. As for long term health effects, as opposed to compliance, there are no clinical studies, but there have been societies in which people lived almost entirely on meat and fish — Inuits, buffalo-hunters, etc. They were healthy people, according to doctors who examined them back in the day.]

    One of the knocks on the high-fat diet is that it is unsustainable for a variety of reasons. These studies, illustrating the high attrition rates of high-fat (and the fact that they don’t work) are important:

    http://jama.ama-assn.org/content/293/1/43.abstract

    http://www.ncbi.nlm.nih.gov/pubmed/20679559

    Check out this 1st one in particular. The money shot: “CONCLUSION: Successful weight loss can be achieved with either a low-fat or low-carbohydrate diet when coupled with behavioral treatment. A low-carbohydrate diet is associated with favorable changes in cardiovascular disease risk factors at 2 years.”

    What have I been saying all along? Reasonable food intake (lower calories) + behavioral changes = success.

    [I’ve said the same thing. If you’re not insulin resistant, you can reduce intake on a low-fat diet and your body will tap fatty acids. If you are insulin resistant, good luck with that. The Gardner study concluded that for people who are insulin resistant, it’s necessary to reduce carbohydrate intake (thus lowering insulin levels) to achieve meaningful weight loss.

    Notice that line about behavioral treatment. You can, as I said previously, horsewhip yourself into sacrificing your fat mass at the cost of also sacrificing your lean muscle mass and ending up with a slower metabolism. Group therapy probably helps people stick to that misguided path. However, people on low-carb diets eat less spontaneously. No group therapy, no horsewhipping. Again, why do you suppose that happens?]

    re: emergencies. Can you give me a scientific definition of a “fuel emergency”? I don’t recall ever seeing that in my studies. I suspect it is a Naughton creation.

    [If you have to burn up your own muscles to keep glucose in the safe range, that’s an emergency. If you’re at risk of passing out because your glucose is dropping, that’s an emergency. I borrowed the term from (I think) Nora Gedgaudas. I don’t know what terms academics prefer to describe those situations, nor do I care. As Richard Feyman pointed out, knowing the proper word for a thing isn’t the same as understanding it.

    What studies of yours are you talking about? Since you have no idea what proportion of the population is suffering from insulin resistance, I didn’t get the impression you’ve done heaps of research on this topic.]

    re: insulin-resistance. “The person waking up in the morning with a reliable supply of fatty acids is a normal person … insulin-resistant people are different, although their insulin level is usually lowest in the morning.” So then shouldn’t you put a disclaimer up on your website that your ideas only pertain to a percentage of the population?

    [This blog is for people interested in the many health benefits of restricting refined carbohydrates. One of those benefits is weight loss for those who want to lose weight, especially for those who’ve failed to lose weight on low-fat/low-calorie diets because they’re insulin resistant. Insulin resistance is rampant among the adult population in America:

    http://www.aace.com/meetings/consensus/irscc/irsfs.php
    http://www.chiro.org/nutrition/ABSTRACTS/Insulin_Resistance.shtml%5D

    re: insulin. “”You will simply start burning fat again.” And you know this how, exactly?”” Um, because what is the alternative, death? Of course even insulin-resistant individuals will start burning fat again for energy, just as they do when they sleep. If they didn’t they would, literally, drop dead. Your theory makes no sense.

    [Yet another uninformed opinion. “Of course even insulin-resistant individuals will start burning fat again for energy.” Oh, really? Then explain why the calorie-restricted mice ended up fatter and with less muscle mass. Didn’t they know that “of course” they should start burning fat instead of muscle? No, they wouldn’t drop dead. Millions of years of evolution protect against that. They would instead (for the zillionth time) start consuming their lean tissue to prevent glucose from dropping into the danger zone.

    Elevated insulin inhibits lipolysis:

    http://www.medbio.info/Horn/Time%203-4/homeostasis_2.htm

    That isn’t controversial, and it’s not an opinion. Insulin inhibits lipolysis. So the “of course they’ll burn body fat” statement is, quite simply, flat-out wrong. If insulin prevents fatty acids from escaping the fat cells, you cannot burn them for fuel.]

    re: other tidbits. The poster above commenting on Atkins may be right, lots of evidence that Atkins was not only obese but suffered from hypertension: http://www.snopes.com/medical/doctor/atkins.asp

    [Yank, yank, yank, same old PCRM propaganda. Atkins was given a steroid in an attempt to prevent damage to his brain. The steroid caused massive water retention. People who met him shortly before his death, including Gary Taubes, described as slender. Did you just decide to skip the paragraph that said according to hospital admission records, he weighed 195 when he was taken to the emergency room? Do you think his diet put 70 pounds on him between then and his death some days later?]

    I do worry about the long-term health consequences for those on the high-fat diet. ”

    [Goody for you. I’ll immediately forget all the research I’ve read and base my diet on your uninformed opinions.]

    Reply
  23. Marcus

    @ Tom:

    re: insulin resistance. I know precisely what insulin resistance is from a scientific perspective, but I have no clue as to how you are using it. You’ve suggested that those with insulin resistance will have a “fuel emergency” and pass out if they don’t consume enough sugar. That’s far different than my understanding of insulin resistance which is a poorly understood physiological case of insulin not working as well as it should. And it’s underlying cause is unknown.

    No, I’ve suggested that people who are insulin resistant will have elevated levels of insulin and therefore have a more difficult time releasing fatty acids for fuel as glucose drops. If glucose drops and fatty acids aren’t sufficiently available, a fuel shortage is inevitable.

    The cause of insulin resistance has been blamed on excess fructose consumption (with compelling evidence to back it up) by Dr. Robert Lustig. Find his YouTube video titled “Sugar: the bitter truth.”

    Reply
  24. Marcus

    @ Tom;

    re: beer. “I actually did need that fourth beer, or at least some other form of quick energy. The alternative was dangerously low glucose, which is why I craved the beer. It was a fuel emergency.” Are you suggesting that most fat people are now actually diabetics? I’ve never heard anyone ever claim that a 4th beer was *necessary* because they were undergoing a “fuel emergency.” News to me. Now tell me, what would happen if you ignored the fuel emergency? Would you, gasp, stay hungry? Oh the horror!

    [No, I would’ve passed out from low blood sugar. Beer specifically wasn’t necessary, but some quick source of sugar was definitely necessary. Are you honestly going to tell me you’ve never heard of diabetics taking a quick shot of sugar to avoid dangerously low glucose? I once witnessed paramedics shoot glucose into a diabetic neighbor who’d passed out to prevent brain damage. If only I’d had your deep understanding of the biochemistry, I could’ve explained to the paramedics that since my neighbor was obese, she should say hungry for awhile and burn off some fat.

    I’m suggesting that most obese people are insulin-resistant. If you’re not aware of that fact, you might stop and wonder why you consider yourself such an expert on the subject of obesity and weight loss.]

    re: personal responsibility. “Fat Head is largely about personal responsibility. You haven’t seen it, obviously.” I have seen it. But I’m making a distinction between what you write here on this blog and what was in the movie. The movie was actually mild in its claims; you didn’t use words like “fuel emergency” and “hormones force us to eat.” The reason, it seems to me, is that no one would take that seriously. You can make the claims here because mostly it is your fans who are reading this blog. 😉

    [I make the claims here because I’ve read a helluva lot more since I made the film. Hormones don’t force us to eat. Hormones create a fuel shortage at the cellular level, ramping up appetite.]

    re: WW stats. So if there are no studies of the long-term effects of a low-carb diet (kind of interesting in its own right), do you think you should be criticizing WW’s success rate? You have no evidence at all that your ideas are any better in the long term; indeed they could be much much worse. My suggestion would be get some good long-term studies first, then criticize WW.

    [Nope, no clinical studies on the long-term effects. However, I’ve lost count of the emails I’ve received from people thanking me for making Fat Head and telling me that once they got off the low-fat/low-calorie merry-go-round, they lost weight easily. My composer also lost 20 pounds, my sound engineer lost 25 pounds (and was able to stop taking Prilosec), and the music producer lost 30 pounds. My brother lost 20 pounds, my mom lost 15. So far the long-term effects have been improved lab scores all around.

    There are clinical studies, however, showing that people on low-carb diets spontaneously eat less, even without calorie restrictions. I’ve asked several times for you to explain that result, since you think this is all about willpower. You still haven’t.]

    re: biological determinism. “There is no biological need to hit children (if they’re not armed and making threats) or to shoplift.” Baloney. Everything is in our biology. Urges to have sex, aggression, to kill.. these are linked to hormones in the same exact way that you’re arguing the urge to eat is linked to hormones. Don’t believe me? Look up the studies on testosterone in males and social cues.

    [An urge is not a biological need, whether caused by hormones or not. If my testosterone produces an urge to hit someone, what negative biological consequences will I suffer if I ignore the urge? Oh, did I hear “None”? That’s right, none, unless you consider frustration a biological emergency. Your body won’t begin to chew up its own muscles if you ignore your urge to hit someone.

    On the other hand, falling glucose is very much a biological emergency. Low glucose has very definite negative consequences and is indeed an emergency.]

    There is a vicious cycle between testosterone increasing and young men acting violent. If we viewed these hormones in the same way that you’re viewing food hormones then the answer would simply be that young men who are violent don’t lack character, rather their hormones made them do it (just as our hormones make us eat). That’s obviously absurd and would not hold up anywhere (court, in a discussion at a bar, etc.).

    [Nor would I want it to hold up in court, since refusing to beat someone despite your high level of testosterone causes no biological emergencies for your body and is therefore very much a matter of controlling your urges.]

    Therefore you want it one way but not the other: in some realms of life you want to suggest that our biochemistry forces us toward certain behaviors and it’s not a question of character; I would imagine in other areas you are not comfortable making this claim. Seems like a double standard to me.

    [No, it’s a single standard. We can indeed ignore hormonally-induced urges. If we ignore the urge to kill, the result is that we don’t go to prison. If we’re insulin-resistant and ignore the urge to eat, we create a fuel shortage. If we continue creating those fuel shortages, we lose our muscle mass and slow our metabolisms and set up our bodies to fight even harder to regain any weight we’ve lost.]

    I think the far more appropriate position to hold is that both matter at varying levels: character AND hormones are important. I was hoping that we could meet in the middle on this, though you appear to be fully on the hormone train.

    [I’m not interested in meeting in the middle for the sake of meeting in the middle. Consensus is lovely in politics but has nothing to do with science. Character certainly matters insofar as we can, if we’re properly informed, choose the diet that solves the hormonal imbalance that drives us to accumulate fat. But the usual advice — gosh, just eat less and move more, you lazy slobs — is doomed to fail in insulin-resistant people, whether they have character or not … unless they’re willing to lose muscle mass, go through life feeling half-starved, and end up with a slower metabolism, for all the reasons I described.]

    re: causal story. Your story has a contradiction. To wit:

    “When we wake up in the morning, we’re getting about 60-80% of our energy from fatty acids released by the fat cells.”

    and

    “As a result of the fuel shortage, the insulin-resistant person will be driven to eat again, even though people with more discipline and character believe he should be full on the 2500 calories he already consumed that day.”

    There isn’t a fuel shortage, as you note, since we live just fine during the night and in the morning even though we are burning fatty acids.

    [The person waking up in the morning with a reliable supply of fatty acids is a normal person … insulin-resistant people are different, although their insulin level is usually lowest in the morning. Many insulin-resistant people wake up in the middle of the night to raid the refrigerator. Either way, insulin resistance leads to elevated insulin, which drives calories into the fat cells and inhibits the release of fatty acids.]

    The same is true AFTER we eat. You may feel hunger but that doesn’t make anything a fuel emergency – you will simply start burning fat again for energy. You would be better served explaining to people how they can overcome the feeling of hunger even when they don’t need food for energy.

    [“You will simply start burning fat again.” And you know this how, exactly? There’s no such thing as insulin-resistance? Elevated insulin doesn’t inhibit lipolysis? If lipolysis is inhibited, that doesn’t create a fuel shortage that will require the body to find another source of fuel? Dieters who restrict calories beyond what their bodies can offset with fatty acids escaping the fat cells don’t lose muscle mass and end up with slower metabolisms? The Biggest Loser dieters didn’t end up with slower metabolisms? (Someone alert the authors of the study! They got it all wrong!) Obese mice didn’t end up with more fat mass and less muscle mass when they were calorie-restricted? (Someone alert the study authors! They must’ve gotten it wrong! Marcus has declared that when those mice were going hungry, they would’ve simply started burning fat again!)

    This is truly pathetic now, Marcus. It’s reached the point where you can’t dispute any of the biology involved, so you just repeat your opinions: “You will simply burn fat again for energy.” You’re in the embarrassing position of trying to wave away biochemical facts that don’t suit you … apparently because just admitting you don’t actually understand the biochemistry of fat accumulation and may have expressed some uninformed opinions early in this debate would cause your head to explode.

    I spelled out the biology involved. I asked you to tell me specifically which of those points is incorrect — because for losing weight (without sacrificing muscle mass and slowing the metabolism) to come down to a matter of simple willpower, some of those points MUST be incorrect. All you have to do is tell me which points are wrong and why. (Writing “No, that doesn’t happen” doesn’t qualify as refutation, by the way.) ]

    re: insulin. Again I’ve never heard of these “insulin-resistant” people except in the context of diabetes discussions. The way you take it would seem that most of Americans have diabetes because we still want to eat even after we’ve had enough.

    [Well, gee, if you haven’t heard of them, we can only presume they don’t exist. There are no facts in the world that Marcus doesn’t already know, and if he doesn’t already know them, they’re not facts. At least that’s what I’ve gathered from the discussion thus far.

    I’m sorry to hear you’re so ignorant of the data on insulin resistance in the population, which is widely available. I’ve noticed, however, that ignorance on a topic doesn’t prevent you from having strong opinions. You remind me of a quote from economist Murray Rothbard:

    “It is no crime to be ignorant of economics, which is after all a specialized discipline and one that most people consider a dismal science. But it is totally irresponsible to have a loud and vociferous opinion on economic subjects while remaining in this state of ignorance.”

    Substitute “obesity” for “economics” and it sums up your positions in this debate.]

    Reply
  25. Marcus

    @ Tom:

    There are many potential causes of insulin resistance, both environmental and genetic. Surely you’re not suggesting a single cause here in fructose, are you?

    No, I’m suggesting that Lustig makes a compelling case that fructose is the major contributor. Given that insulin resistance and type 2 diabetes were nearly non-existent before sugar and white flour became dietary staples, I think he’s onto something. Did you watch the video?

    Reply
  26. Marcus

    @ Tom:

    Have you considered setting up a discussion forum like vBBS or something on this site? The reason I ask is that it is quite difficult to have an in-depth exchange like we’re having in the comment section. You’re able to edit posts and can put your responses right beneath what I say. I don’t have the ability so it is awkward quoting the relevant sections, out of context, and then responding to them. I’ll continue, but it is tricky.

    I’m not sure. I edit posts and include my own replies because it’s a one-step job. Otherwise, I have to approve a comment in the admin section, go out write my reply as another comment, come back and approve my own reply. Not going to happen.

    Reply
  27. Marcus

    @ Brett:

    I completely agree. I don’t think Tom was going to pass out if he didn’t have a 4th beer and, frankly, the assertion is rather absurd. He makes it sound like most of the population is “insulin-resistant” (whatever that means) and people are passing out left and right because of “fuel emergencies” unless they have that 3rd Big Mac or 4th beer.

    I’ve never seen someone so vociferously (and apparently seriously) argue that one needs to eat so much food.

    Once again, Marcus, nothing but an uninformed opinion. Look up glucose and alcohol, read how alcohol produces low blood sugar. With your PhD and all, it shouldn’t be a tough read. As someone who was insulin resistant at the time, I wasn’t replacing the falling glucose with fatty acids. My blood sugar was crashing, and hard. I needed fuel. It didn’t have to be another beer, but I needed fuel. Since alcohol is the fastest-acting of all fuels, I craved alcohol. I always wondered why another beer would wake me up when I started to crash, since alcohol is a depressant. Now I know.

    The mere fact that you wrote …

    “insulin-resistant” (whatever that means)

    … and have no idea what proportion of the obese population is insulin-resistant pretty much says it all, doesn’t it? If we needed any more proof that you’re simply spouting opinions that aren’t based on actual knowledge, there it is. Like I said before, the fact that you continue spouting opinions despite clearly (and by your admission) being unfamiliar with the topic really makes me wonder if they’re just passing out PhDs like candy these days. A true scientist wouldn’t argue about the effects of insulin resistance in one comment, then write (whatever that means) in another comment. Your unwillingness to actually look at some evidence and familiarize yourself with the topic before spouting off and painting yourself into a corner is a sad commentary on the state of science education.

    Reply
  28. Marcus

    @ Tom:

    re: sugar. I’m very confused as to what part of the population we’re talking about here. Are we talking about diabetics or non-diabetics. I can assure you that most of the population will not pass out because they need more sugar after drinking 3 beers.

    [We’re talking about both. If your glucose drops far enough, you will indeed pass out. Alcohol can induce low blood sugar — it’s a fact. You can look it up. If alcohol can induce low blood sugar (fact) and low blood sugar can lead to passing out (fact), what exactly is the point of contention here?]

    re: hormones. “Hormones don’t force us to eat. Hormones create a fuel shortage at the cellular level, ramping up appetite.” Agreed! (Finally). The difference between you and me is that I don’t think the answer to that ramped up appetite is eating more food. That’s if you want to lose weight. If you don’t want to lose weight or gain weight, then by all means go ahead and eat that 3rd Big Mac.

    I don’t really understand why it is such a bad thing to be hungry. Can you explain?

    [Your contention is that if a person with elevated insulin simply refuses to eat as his energy is depleted, he will burn body fat, period. My contention is that elevated insulin blocks lipolysis (known biological fact), which means he can’t burn body fat quickly enough to make up for the depleted level of glucose and will begin to lose muscle mass instead. That would explain, for example, why obese mice who were calorie-restricted (a mere 5% reduction) lost muscle mass and ended up fatter than before, with slower metabolisms to boot. For your contention to be correct, “elevated insulin blocks lipolysis” would need to be a false statement.]

    re: studies. The knock on WW is that their *long-term* success rate is low (though it is overstated in that blog post because he misread the study). You citing how your composer lost 20 lbs says nothing about the high-fat diet’s long-term effects. Heck, your documentary hasn’t been out long enough to constitute long-term (in the WW study it is defined by 5+ years).

    [Yes, I know. Since there are no long-term studies, all I have is experience to go by so far. As for long term health effects, as opposed to compliance, there are no clinical studies, but there have been societies in which people lived almost entirely on meat and fish — Inuits, buffalo-hunters, etc. They were healthy people, according to doctors who examined them back in the day.]

    One of the knocks on the high-fat diet is that it is unsustainable for a variety of reasons. These studies, illustrating the high attrition rates of high-fat (and the fact that they don’t work) are important:

    http://jama.ama-assn.org/content/293/1/43.abstract

    http://www.ncbi.nlm.nih.gov/pubmed/20679559

    Check out this 1st one in particular. The money shot: “CONCLUSION: Successful weight loss can be achieved with either a low-fat or low-carbohydrate diet when coupled with behavioral treatment. A low-carbohydrate diet is associated with favorable changes in cardiovascular disease risk factors at 2 years.”

    What have I been saying all along? Reasonable food intake (lower calories) + behavioral changes = success.

    [I’ve said the same thing. If you’re not insulin resistant, you can reduce intake on a low-fat diet and your body will tap fatty acids. If you are insulin resistant, good luck with that. The Gardner study concluded that for people who are insulin resistant, it’s necessary to reduce carbohydrate intake (thus lowering insulin levels) to achieve meaningful weight loss.

    Notice that line about behavioral treatment. You can, as I said previously, horsewhip yourself into sacrificing your fat mass at the cost of also sacrificing your lean muscle mass and ending up with a slower metabolism. Group therapy probably helps people stick to that misguided path. However, people on low-carb diets eat less spontaneously. No group therapy, no horsewhipping. Again, why do you suppose that happens?]

    re: emergencies. Can you give me a scientific definition of a “fuel emergency”? I don’t recall ever seeing that in my studies. I suspect it is a Naughton creation.

    [If you have to burn up your own muscles to keep glucose in the safe range, that’s an emergency. If you’re at risk of passing out because your glucose is dropping, that’s an emergency. I borrowed the term from (I think) Nora Gedgaudas. I don’t know what terms academics prefer to describe those situations, nor do I care. As Richard Feyman pointed out, knowing the proper word for a thing isn’t the same as understanding it.

    What studies of yours are you talking about? Since you have no idea what proportion of the population is suffering from insulin resistance, I didn’t get the impression you’ve done heaps of research on this topic.]

    re: insulin-resistance. “The person waking up in the morning with a reliable supply of fatty acids is a normal person … insulin-resistant people are different, although their insulin level is usually lowest in the morning.” So then shouldn’t you put a disclaimer up on your website that your ideas only pertain to a percentage of the population?

    [This blog is for people interested in the many health benefits of restricting refined carbohydrates. One of those benefits is weight loss for those who want to lose weight, especially for those who’ve failed to lose weight on low-fat/low-calorie diets because they’re insulin resistant. Insulin resistance is rampant among the adult population in America:

    http://www.aace.com/meetings/consensus/irscc/irsfs.php
    http://www.chiro.org/nutrition/ABSTRACTS/Insulin_Resistance.shtml%5D

    re: insulin. “”You will simply start burning fat again.” And you know this how, exactly?”” Um, because what is the alternative, death? Of course even insulin-resistant individuals will start burning fat again for energy, just as they do when they sleep. If they didn’t they would, literally, drop dead. Your theory makes no sense.

    [Yet another uninformed opinion. “Of course even insulin-resistant individuals will start burning fat again for energy.” Oh, really? Then explain why the calorie-restricted mice ended up fatter and with less muscle mass. Didn’t they know that “of course” they should start burning fat instead of muscle? No, they wouldn’t drop dead. Millions of years of evolution protect against that. They would instead (for the zillionth time) start consuming their lean tissue to prevent glucose from dropping into the danger zone.

    Elevated insulin inhibits lipolysis:

    http://www.medbio.info/Horn/Time%203-4/homeostasis_2.htm

    That isn’t controversial, and it’s not an opinion. Insulin inhibits lipolysis. So the “of course they’ll burn body fat” statement is, quite simply, flat-out wrong. If insulin prevents fatty acids from escaping the fat cells, you cannot burn them for fuel.]

    re: other tidbits. The poster above commenting on Atkins may be right, lots of evidence that Atkins was not only obese but suffered from hypertension: http://www.snopes.com/medical/doctor/atkins.asp

    [Yank, yank, yank, same old PCRM propaganda. Atkins was given a steroid in an attempt to prevent damage to his brain. The steroid caused massive water retention. People who met him shortly before his death, including Gary Taubes, described as slender. Did you just decide to skip the paragraph that said according to hospital admission records, he weighed 195 when he was taken to the emergency room? Do you think his diet put 70 pounds on him between then and his death some days later?]

    I do worry about the long-term health consequences for those on the high-fat diet. ”

    [Goody for you. I’ll immediately forget all the research I’ve read and base my diet on your uninformed opinions.]

    Reply
  29. Marcus

    @ Tom:

    re: insulin resistance. I know precisely what insulin resistance is from a scientific perspective, but I have no clue as to how you are using it. You’ve suggested that those with insulin resistance will have a “fuel emergency” and pass out if they don’t consume enough sugar. That’s far different than my understanding of insulin resistance which is a poorly understood physiological case of insulin not working as well as it should. And it’s underlying cause is unknown.

    No, I’ve suggested that people who are insulin resistant will have elevated levels of insulin and therefore have a more difficult time releasing fatty acids for fuel as glucose drops. If glucose drops and fatty acids aren’t sufficiently available, a fuel shortage is inevitable.

    The cause of insulin resistance has been blamed on excess fructose consumption (with compelling evidence to back it up) by Dr. Robert Lustig. Find his YouTube video titled “Sugar: the bitter truth.”

    Reply
  30. Marcus

    @ Tom:

    There are many potential causes of insulin resistance, both environmental and genetic. Surely you’re not suggesting a single cause here in fructose, are you?

    No, I’m suggesting that Lustig makes a compelling case that fructose is the major contributor. Given that insulin resistance and type 2 diabetes were nearly non-existent before sugar and white flour became dietary staples, I think he’s onto something. Did you watch the video?

    Reply
  31. Marcus

    Tom:

    “Given that insulin resistance and type 2 diabetes were nearly non-existent before sugar and white flour became dietary staples,” Again this is nothing more than correlation, not causation. Lustig’s point about the role of fructose is a good one. But so is glucosamine, coritsol, superoxide dismutase, bad cellular receptors, hepatitis C, and so forth.

    Again, fructose may be a piece of the puzzle. How big? That’s open to debate and further research.

    Reply
  32. Marcus

    Tom:

    “Given that insulin resistance and type 2 diabetes were nearly non-existent before sugar and white flour became dietary staples,” Again this is nothing more than correlation, not causation. Lustig’s point about the role of fructose is a good one. But so is glucosamine, coritsol, superoxide dismutase, bad cellular receptors, hepatitis C, and so forth.

    Again, fructose may be a piece of the puzzle. How big? That’s open to debate and further research.

    Reply
  33. Nichole

    Please do write a children’s book! As a primal/paleo Mother to 6 primal kids, it’s hard to get them to understand just WHY they shouldn’t eat that cupcake! I let them on occasion have junk (like for a school class party).. but it would be nice for them to come to a point where they CHOOSE not to partake in eating junk. Meh, a girl can dream.

    It’s on my to-do list for later this year.

    Reply
  34. Nichole

    Please do write a children’s book! As a primal/paleo Mother to 6 primal kids, it’s hard to get them to understand just WHY they shouldn’t eat that cupcake! I let them on occasion have junk (like for a school class party).. but it would be nice for them to come to a point where they CHOOSE not to partake in eating junk. Meh, a girl can dream.

    It’s on my to-do list for later this year.

    Reply
  35. Nathan

    Can I just read all the Marcus comments and I was wondering if I can have my time back on the frequently asked questions?

    Marcus insists he was only trying to educate you with his “It’s true because I know it’s true” approach to the science.

    Reply
  36. Nathan

    Can I just read all the Marcus comments and I was wondering if I can have my time back on the frequently asked questions?

    Marcus insists he was only trying to educate you with his “It’s true because I know it’s true” approach to the science.

    Reply
  37. Dave

    Too bad WordPress doesn’t have an “Ignore posts from {person}” feature (i.e. Marcus). Tom, you should know better. What happened to not “Arguing With Idiots With PhDs”? Incidentally, I’ve read all of your exchanges between the two of you (I keep an open mind towards everyone), but this thread is too long, with Marcus occupying most of it (and I’m now sick of listening to him).

    Loved the NetFlix download of your production…will be ordering the DVD. Your “Fathead” is no longer included in the NetFlix “Documentary” list, but “Super Size Me” is. What’s up with that? Luckily it’s still in my queue, so I can play it for people who come over.

    REAL QUESTION: How does alcohol play into all of this? Is it as simple as the number of carbs in the beverage (easily found on the ‘net, for those that complain about product labeling) count equally as food carbs?

    Hey, your wife is a BABE! Quote: “Are you a moron?” TOO FUNNY! If things don’t work out between you two, I’m the same age, height, and weight as you (though a bit less hair). Tell her to keep an open mind, OK buddy? 😉

    FANTASTIC WORK TOM, THANK YOU!

    I eventually had to enforce my “Arguing With Idiots” rule on myself with Marcus. Should’ve done it earlier. The carbs in alcoholic drinks matter, and the alcohol itself will become your primary fuel as soon as you drink it. Alcohol that you don’t burn off will be processed in your liver and deposit fatty droplets there. So a little alcohol is fine, perhaps even beneficial in some ways, but obviously too much is a big problem.

    Reply
  38. Dave

    Too bad WordPress doesn’t have an “Ignore posts from {person}” feature (i.e. Marcus). Tom, you should know better. What happened to not “Arguing With Idiots With PhDs”? Incidentally, I’ve read all of your exchanges between the two of you (I keep an open mind towards everyone), but this thread is too long, with Marcus occupying most of it (and I’m now sick of listening to him).

    Loved the NetFlix download of your production…will be ordering the DVD. Your “Fathead” is no longer included in the NetFlix “Documentary” list, but “Super Size Me” is. What’s up with that? Luckily it’s still in my queue, so I can play it for people who come over.

    REAL QUESTION: How does alcohol play into all of this? Is it as simple as the number of carbs in the beverage (easily found on the ‘net, for those that complain about product labeling) count equally as food carbs?

    Hey, your wife is a BABE! Quote: “Are you a moron?” TOO FUNNY! If things don’t work out between you two, I’m the same age, height, and weight as you (though a bit less hair). Tell her to keep an open mind, OK buddy? 😉

    FANTASTIC WORK TOM, THANK YOU!

    I eventually had to enforce my “Arguing With Idiots” rule on myself with Marcus. Should’ve done it earlier. The carbs in alcoholic drinks matter, and the alcohol itself will become your primary fuel as soon as you drink it. Alcohol that you don’t burn off will be processed in your liver and deposit fatty droplets there. So a little alcohol is fine, perhaps even beneficial in some ways, but obviously too much is a big problem.

    Reply
  39. Laura

    I realized, after reading this whole post including comments, that “Arguing With Idiots” (and reading their posts) is a lot like eating refined carbs. You know it’s not good for you but you think you can handle just one or two. But then you realize that it’s one in the morning and you’re not going to get that time back. Next time I will exercise some willpower and just say no (to all of the above)!

    And you can add me to your proof that LCHF works. After watching your film I changed my diet and lost 40lbs. After 6 months of feeling great I joined a gym because I felt I had to move more.
    Thanks Tom

    Fantastic result, Laura. Yup, sometimes I get drawn in by idiots and then kick myself for taking the bait.

    Reply
  40. Laura

    I realized, after reading this whole post including comments, that “Arguing With Idiots” (and reading their posts) is a lot like eating refined carbs. You know it’s not good for you but you think you can handle just one or two. But then you realize that it’s one in the morning and you’re not going to get that time back. Next time I will exercise some willpower and just say no (to all of the above)!

    And you can add me to your proof that LCHF works. After watching your film I changed my diet and lost 40lbs. After 6 months of feeling great I joined a gym because I felt I had to move more.
    Thanks Tom

    Fantastic result, Laura. Yup, sometimes I get drawn in by idiots and then kick myself for taking the bait.

    Reply

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