A doctor from Mexico emailed today to tell me he enjoyed the previous two posts on calories. He apologized for his English (which a lot better than my Spanish), so I cleaned up the spelling and punctuation a bit, but here’s how he views the explanation that people get fat because they consume more calories than they burn:

It’s like saying it rains because water falls from the sky.

Somebody replies, “No, really, WHY did it rain?”

And you shout, “BECAUSE WATER FELL FROM THE SKY! ARE YOU DUMB?”

Yes, it’s true that when it rains, water drops fall from the sky, but that is not WHY it rains. You are simply saying it’s raining because it’s raining. What is the meteorological explanation? What conditions get together to cause the rain?

And later in the email:

In weight gain, the cause in the majority of the cases is the alteration of the hormonal pathway that normally controls that area of the physiology. The human body has multiple mechanisms of regulation. For everything else, scientists have very complex biochemical explanations. But for obesity, all they have is a religious explanation of gluttony and sloth, expressed in a mathematical form.

The hormone that controls the storage of energy is insulin. There are other factors in obesity, but all of them are affecting the hormonal, physiological mechanisms of control.

Well said, Doctor – in any language.

As for those other factors, I thought I’d mention a couple that I left out of the previous posts because the posts were already lengthy.

How many fat cells do you have?

This is an area I hope gets a lot more attention in future research. Apparently scientists have only known since 2008 that the number of fat cells we carry as adults is constant. Here are some quotes from a New York Times article:

Every year, whether you are fat or thin, whether you lose weight or gain, 10 percent of your fat cells die. And every year, those cells that die are replaced with new fat cells, researchers in Sweden reported Sunday.

The result is that the total number of fat cells in the body remains the same, year after year throughout adulthood. Losing or gaining weight affects only the amount of fat stored in the cells, not the number of cells.

“There is a system waiting to be discovered,” said Dr. Jeffrey S. Flier, an obesity researcher and dean of Harvard Medical School.

Dr. Flier and other obesity researchers cautioned, though, that even if scientists knew how the fat cell system worked, it was not clear that it would be safe or effective to treat obesity by intervening. One of the hard lessons of the past couple of decades has been that the body has redundant controls to maintain weight.

Redundant controls to maintain weight? Nawww, this stuff’s simple. If you consume fewer calories, your body goes and retrieves calories from your fat cells to make up the difference, and you lose weight. Works that way for everyone … although I seem to recall writing this in the Fat Head Kids book, in the chapter where we explained that Marty Metabolism, the ship’s chief engineer, is like a super-complicated software application:

Like all important apps, Marty’s code includes something called redundancy. That’s a programmer’s term that means if one block of code doesn’t work, the program switches to another … and another, and another, until the command is obeyed.

Anyway, back to the New York Times article:

“This is a new way of looking at obesity,” said Dr. Lester Salans, an obesity researcher and emeritus professor at Mount Sinai School of Medicine in New York.

“I suspect that the body’s regulation of weight is so complex that if you intervene at this site, something else is going to happen to neutralize this intervention,” Dr. Salans said.

Complex regulation? If you intervene, the body may respond by neutralizing the intervention somewhere else?

Geez, these obesity researchers just don’t seem to get it. It’s a simple matter of calories in vs. calories out, so just cut the calories. No other intervention needed.

There was a time a few decades ago, before the current interest in how the brain regulates how much is eaten, when obesity researchers spent all their time studying and discussing fat cells. Investigators discovered that fat people had more fat cells than thin people and that fat cells shrank with weight loss and bulged with weight gain.

The result was the fat cell hypothesis, a notion that obsessed researchers. Fat cells, the hypothesis said, are laid down early in life and after that, they can change only in size, not in number. When people lose weight and their fat cells shrink, that creates a signal to fill the cells again, making people regain.

There’s more to the article, but here’s the important point: Yes, it appears that when we get fatter as kids, we do so mostly by creating new fat cells. But when we get fatter as adults, we do mostly by enlarging our existing fat cells.

I poked around online for more information and found that some researchers believe (but haven’t proved) the number of fat cells we’re born with is largely genetic. In other words, people with a tendency to get fat easily — a trait that clearly runs in families — may have been carrying more fat cells from birth.

I also found that lean people typically have between 25 billion and 35 billion fat cells, while fat and obese people may have anywhere from 75 billion to 150 billion fat cells. (Another study, by the way, demonstrated that adults can grow new fat cells if they gorge themselves to gain weight quickly, but it’s a few billion, not an extra 100 billion.)

So … let’s suppose I make it to adulthood at a lean 15% body fat and have 30 billion fat cells. Let’s also suppose I’m six feet tall and weigh 200 pounds. That means I’m carrying 30 pounds of fat – one pound for each billion fat cells. Let’s suppose that’s the normal size for fat cells.

Now suppose my best friend is also six feet tall and has about the same lean body mass, but is cursed with 150 billion fat cells, perhaps because of genetics, or perhaps because he became very fat as a kid.  Or perhaps a bit of both.

If his fat cells are the same size as mine, he’ll be carrying 150 pounds of fat. I weigh 200 pounds (170 lbs. lean, 30 lbs. fat), but he weighs 320 pounds (170 lbs. lean, 150 lbs. fat). I’m at 15% body fat, he’s at 47% body fat … but our fat cells are the same size.

If I live on pizza and beer during my 20s and balloon up to 250 pounds, I’m not saying it would easy to lose the weight. But to return to 200 pounds, I’d only have to shrink my overly-large fat cells back to their normal size.

But for my obese buddy to get down to 200 pounds, he’d have to shrink all his fat cells to one-fifth their normal size and keep them shrunk. I’d be very, very surprised if those redundant controls to maintain weight don’t fight against that.

So if change my diet and get back down to a lean 200 pounds, and my buddy changes his diet but only manages to get down to 245 pounds, it still means he shrunk his fat cells to half their normal size, while I merely shrunk mine back to normal. I’d be a bit of a jackass if I judged him a failure because he’s still 45 pounds overweight. His weight loss was almost certainly more difficult than mine, and will be more difficult to maintain.

Gut Bugs

In my review of the 2017 low-carb cruise, I wrote this:

Another lecture I enjoyed was delivered by Erynn Kay, a physician’s assistant who works with Dr. Jeffrey Gerber. She spoke about the importance of feeding our good gut bacteria – a topic I don’t believe gets enough attention in low-carb circles. Our hunter-gatherer ancestors weren’t gathering bacon, after all. They were gathering plants with fibers that feed the gut microbiome.

If you’re trying to lose weight by living on cheeseburgers, bacon, eggs, butter, heavy cream and a bit of broccoli now and then, you’re not feeding your gut bugs. Bad idea. That’s why there’s a chapter in the Fat Head Kids book titled To stay healthy, you need to feed trillions of your closest friends.

One of the low-carb doctors who does write extensively about the importance of feeding the gut microbiome is Dr. William Davis, author of Wheat Belly and, more recently, Undoctored.

Speaking of Undoctored, pardon me while I go on a bit of sidebar rant …

————————————————

In Undoctored, Dr. Davis stresses again and again that we can’t simply trust the health-care system (which he points out is a sick-care system that has little to do with health) to take care of us. We have to pay attention and be our own advocates.

We saw another example of that recently. Chareva’s father was hobbled by a stroke many months ago. He’s also an insulin-dependent type 2 diabetic. He recently fell and broke his hip while trying to limp to the bathroom in the middle of the night.

After surgery to repair the hip, he was placed in a rehab center. Someone forgot to tell someone else he’s a diabetic, even though it was written on the admission form. He wasn’t given insulin for four days, and only then because Chareva’s mom asked someone on the staff how his blood sugar was doing. Then, and only then, did a nurse finally check his blood sugar. It was over 600, and had probably been that high since he was admitted.

In an age when one-fourth of all senior citizens are type 2 diabetics, how in the @#$% do you not check a 75-year-old man’s blood sugar?

Don’t just trust the medical staff to pay attention and do their jobs. Ask. Demand.

End of rant.

————————————————

Anyway, here’s a video by Dr. Davis I think everyone on a low-carb or keto diet should watch and consider carefully:

In a post back in 2015, I explained why I went back to a high-protein diet. It’s still low-carb, but not VLC, and not ketogenic.  I gave the same explanation, albeit more briefly, during a Q&A session aboard the low-carb cruise later that year.

(Jimmy Moore was so upset with me for explaining why I dropped the keto diet, he bought me drinks in the bar later, encouraged me to give another presentation on the next cruise, and made plans to visit over Thanksgiving. You know how these with me or against me types think.)

Going with a low-carb approach (75 to 100 grams per day, sometimes a bit more) certainly gives me more flexibility. I like that. But more importantly, it means I can eat more of the foods that feed the gut microbiome.

Since I knew I’d be writing this post tonight, I measured and counted the ingredients in two of my meals today instead of just eyeballing them. I looked up the calorie and macro counts. I also checked my blood sugar reactions.

Breakfast was three eggs, two tablespoons of butter, a cup of shredded cheese, and a medium potato — cooked and cooled and then rewarmed. Add plenty of salt, mash it all together, and it’s delicious. It comes out to 770 calories, 37 grams of protein, 32 carbs. An hour later, my glucose peaked at 121. It was at 85 an hour after that.

Dinner was 4 ounces of chicken breast meat, one cup of refried black beans, one cup of shredded Mexican cheese, two tablespoons of sour cream, some hot sauce, and a big scoop of salsa. It comes out to 640 calories, 55 grams of protein, 41 carbs, and – the important part – 13 grams of fiber from the black beans. That’s the feed-the-gut-bugs part of the meal. My glucose peaked at 110.

In a podcast interview with Tim Ferriss, Dr. Peter Attia said most of the patients he put on ketogenic diets did very well. They lost weight and their lab markers moved in the right direction. But he said a dozen or so patients didn’t do well at all. Their markers moved in the wrong direction, and some of them gained weight quickly. So he did the smart thing and took them off the diet.

When asked, he said he doesn’t know why some people don’t get good results. Based on what Dr. Davis explained in the video, I’d say failure to feed the good gut bacteria might be part of the problem.

So don’t do that.  Feed your little friends.

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53 Responses to “Fat Cells And Gut Bugs”
  1. James says:

    This definitely has given me something to think about. I never really considered the gut bacteria aspect of it. It might explain why my weight settled at the current point.

    I was wondering if you had any links or recommendations for something like an eating guide? I’m always looking for suggestions and ideas for low-carb meals and ways to plan out menus ahead of time. I know you did a food diary for when you were doing Fat Head, but do you have something similar to what you do these days?

  2. Zachary says:

    I usually end up on keto because I honestly have to go out of my way to eat a lot of carbs these days. I’m satisfying with some chicken, burger meat, ribs, etc. Cheap, easy to cook and keeps me satisfied all day. I’ve been getting pistachios and tiger nuts to eat as a snack after meals to help feed my gut bacteria, and it seems to work pretty well.

  3. Stephen Blackbourn says:

    Good article Tom. I’ll keep doing the resistant starch thing and might add some beans at some stage. Although lectins in beans might be a concern.

    • Tom Naughton says:

      I quit worrying about the lectins in beans a long time ago, after hearing Matt LaLonde explain how those lectins are inactivated by processing and cooking.

  4. Paul Eilers says:

    Reminds me of a song we sang when I was a kid:

    Beans. Beans. Good for your heart.
    The more you eat, the more you fart.
    The more you fart, the better you feel.
    So eat your beans at every meal.

    Who knew kids had so much wisdom?

  5. Firebird7478 says:

    I love hearing about doctors who get it, or who have changed their minds about diet. Recently on Twitter, an orthopedic surgeon began a study on a “carnivore diet”. He calls it that because he concedes that there are trace amounts of carbs in meat and eggs. It’s a 90 day study where people will eat nothing but meat and water.

    The subject of fiber came up. Myself and others talked about bad experiences with too much fiber. In my case, I was referring to a friend who had to go to the hospital because he consumed too much fiber…and didn’t consume enough liquids.

    A doctor trolled the conversation, a pediatrician, and spent three days telling everyone that their N=1 experiences were nonsense and that everyone is lying. Rather than say, “Interesting, tell me more…” he blew us all off as people with nothing better to do than spend a Saturday tweeting tall tales. Not a doctor I would take my kid to!

    FYI…black beans > kidney beans in chili.

    • Tom Naughton says:

      As Dr. Davis explains in Undoctored, the type of fiber matters as well. He’s no fan (of course) of fiber supplements extracted from grains.

    • chris c says:

      Oh I know exactly who you mean. What a narcissistic waste of space, he spends all his spare time on Twitter trolling Real Doctors who routinely achieve Real Results in Real Patients, which he could only dream of, except he has no interest in Outcomes, just his Rules. He is so dense he actually believes he is following Evidence Based Medicine when he is actually following Marketing Based Marketing.

      He should be kept away from patients at all costs, especially children. Likewise some of the others I could name.

      • chris c says:

        I was a bit rude about him on Marika’s blog, also his Italian colleague who is always boasting about how many carbs he eats, and who is far from slim, and who is convinced that surgery is the only “cure” for obesity.

        I have no doubt such idiots sit on Ethics Committees routinely banning research into low carb/keto, right before they turn round and claim there is “no evidence” for such diets. Probably they also sit on the editorial boards of journals which used to refuse publication of the few studies that made it past the Ethics Boards. Things *are* changing, but despite rather than because of such luminaries.

        Did you see where he was sucking up to @pharma_ceo ? He probably thought he was for real and might offer him a job.

        • Firebird7478 says:

          He sees something on his feed, starts an argument about it then calls anyone who disagrees with him an “anonymous troll”. He’s a real beauty.

          • chris c says:

            I’ve heard of artificial intelligence but I’m more and more convinced there are also teams working on artificial stupidity.

  6. So you think, “hey — only have a certain amount of fat cells? — Let’s just remove a bunch of them.”

    Here’s why:

    “A study on the long-term effects of liposuction has been published in the Obesity journal. The results were unanticipated. Not only did individuals regain all suctioned fat within the span of a single year, but it reappeared in different locations on their bodies.”

    Dammit, Marty!

    Cheers

  7. Dianne says:

    I’m sure glad you keep track of what you wrote when. Wondering why you quit keto, I followed the link above to your post, “Yes, It’s a High-Protein Diet.” Then I followed some links in that post. And now I have a pretty good idea why attempting to maintain myself on a keto diet while avoiding gluconeogenesis left me feeling pretty droopy, and why I developed strong food cravings after a while that no amount of added fat could satisfy. So now I’m upping my protein (the Eades’ book “Protein Power” just arrived today). And now I’m back to tracking calories and carbs, at least for a while, with the addition of tracking protein grams. I HATE keeping a food diary, but knowledge is power. Thanks, Tom, for all you do.

    • Tom Naughton says:

      You may find after keeping a log for a while, you can get by with the eyeball method, since you’ll recognize the right proportions.

      I don’t dismiss ketogenic diets, either … I’ve met too many people who lost a great deal of weight and look and feel great after going ketogenic. But keto isn’t the right tool for everyone, and ultimately you have to go by the results. I do better with more protein, more carbs and less fat that a strict ketogenic diet. As a percent of calories when I measure and count, it’s roughly 25-30% protein, 20-25% carbs, 50-55% fat. That’s actually pretty close to what Loren Cordain’s research says was a typical proportion for paleo diets.

      • Dianne says:

        This time around I’m trying not to drive myself bonkers by being completely, perfectly precise in measuring and calculating absolutely every morsel. An extra tablespoon of salad dressing matters — and extra cup, or even two, of shredded romaine does not.

      • FtAnother Mike says:

        We know that Inuit and the Kitavan can thrive on quite different diets, which have in common a lack of large quantities of refine sugar.

  8. Firebird7478 says:

    Speaking of rants, I always liked this one by Lewis Black. It’s funny but I think what he says has a lot of truth to it. NSFW.

  9. chris c says:

    Your first line reminded me of the irrefutable but completely wrong logic of Spike Milligan

    There are holes in the sky
    Where the rain gets in
    The holes are small
    That’s why rain is thin

    “Where are you from, Milligan?”
    “London, sah!”
    “Which part?”
    “All of me, sah!”

    and the all time classic

  10. chris c says:

    When I first read that the mass of bacteria in the gut exceeded that of the brain, my first thought was

    “That explains dieticians then”

    Actually it’s interesting how much research is now concentrating on the biological content of the gut, and also on the biological content of our cells, ie. mitochondria. We Are Not Alone.

    Also I forgot to mention that this is brilliant

    http://www.fathead-movie.com/index.php/2011/01/25/fat-accounts-and-the-laws-of-fiscaldynamics/

  11. Orvan Taurus says:

    “Put more fuel oil in the tank if you want it warmer.”

    and/or

    “Get a smaller gas cylinder if you want it cooler.”

    But keep right on ignoring that thermostat, why, that has nothing at all to do with heating and fuel consumption, no sir….

  12. Tom Welsh says:

    Sorry to comment so late in the day, but this took a little thinking through.

    I am sure that, when I read Gary Taubes’ “Good Calories, Bad Calories” (actually I read the British version “The Diet Delusion” – a much worse title), Taubes described visiting poor countries and seeing emaciated babies and children, thin teenagers and young adults, and very obese middle-aged and elderly people. He concluded that they were ALL suffering from the same malnutrition, which had different effects in their appearance at different ages. (His logic began by asking incredulously, “How could a fat mother have such an obviously malnourished baby?” To which the answer turned out to be that she, too, was malnourished).

    That seems to clash badly with the “number of fat cells” model, which predicts that you will be likely to stay fairly slim or fairly plump depending on how you are at 21.

    Or not?

    • Tom Naughton says:

      It would certainly tell us the number of fat cells isn’t the whole story.

      I’ve seen other research suggesting that when we’re starved for a long period of time, the body reprograms itself to become more efficient at storing fat in order to survive the next famine. More interestingly, the trait seems to be passed on to the next generation.

  13. BenG says:

    Hi, Tom

    There are studies (like this one https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4371661/) that suggest rapid weight regain after dieting can cause new fat cells to form.

    IMO, one of the reasons obesity is largely intractable is that 30lbs of small, shrunken fat cells produce less leptin than 30lbs of overstuffed levels. I’ve seen studies that post-obese people will typically have 40% the leptin levels of someone the same weight who was never fat as the post-obese person has hypo inflamed, insulin supersensitive fat cells.

    This puts all the hunger levels through the roof like AgRP, NPY, Ghrelin, the satiety hormones in the tank, like CCK, PYY-36 in the tank, the HPA axis through thre roof, and kills dopamine levels. (Plus the usual 15-18% RMR reduction, reduced T3 levels, etc).

    Other than certain hacks the only real way to deal with is leptin replacement therapy once post-obese.

    • Tom Naughton says:

      Very good article on the many ways the body resists maintaining weight loss.

      I only saw a reference to rodents forming new fat cells during regain.

  14. Josh says:

    Tom

    Are you continuing to do the resistent starch thing? Successfuly, I assume.

    • Tom Naughton says:

      My diet includes foods that provide resistant starch (beans, cooked/cooled potatoes, tiger nuts), and I occasionally stir some raw potato starch into water and drink it.

      • Bob Niland says:

        Tom Naughton wrote: «…resistant starch (beans, cooked/cooled potatoes, tiger nuts), … raw potato starch…»

        Tom, do you have a reference source that you consider reliable on the RS content of tiger nuts? Any number of pages describe the total fiber content (~33%), but it’s probably not all prebiotic (and FDA NF panel data is useless on this). The net carb content is also non-trivial, at 30% (but that at least can be figured from NF data).

        I’m keeping a page on prebiotic fiber sources, and wondering if tiger nuts are worth adding.

        Are you soaking your beans? ConsumerLab just happened to send out an email on that today, indicating that if phytate avoidance is a goal, a 10 hour soak seems to be about right. They didn’t mention it, but timing matters with phyates too; don’t take your mineral supplements at the same meal as a high phytate source.

        My understanding of the re-cooled potato issue is that the reploymerized fraction is not impressive. Your glucometer would be the final authority.

        RPS may be Raw, but absent a credible claim on the package, can’t be counted on to be Resistant. I use it, but assume it’s 50% net carb.

        • Tom Naughton says:

          I don’t start with beans from scratch. I buy cans of refried black beans.

          I’m not sure of the exact resistant-starch content of the tiger nuts, but they’re certainly high in fibers I consider beneficial. Given how tough they are, I consume them in small quantities.

          I’ve checked my glucose reactions to all the starches in my diet. That’s why I decided to avoid rice, safe starch or not. The stuff jacks up my blood sugar rather dramatically. Potatoes, sweet potatoes, tiger nuts and refried black beans beans don’t. I also recently tried a pasta made from beets, lentils and sweet potatoes. Three ounces (pre-cooked) produced a brief peak of 127, and I’m fine with that. I was back in the 80-90 range an hour later.

          • Firebird7478 says:

            I have found that rice is out for me, too, but not because of any spikes. Rather, I like it so much, especially the pastas and my homemade cream of rice, that I tend to overeat. It is not uncommon for me to end up consuming 300 gms of carbs per day of nothing but rice.

            It’s just too easy.

            • Tom Naughton says:

              I always found it way too easy to overeat wheat pasta. Once I started, I was hungry until I’d eaten a lot of it. I’m not finding that to be the case with the lentil pasta.

  15. Patrick Schlüter says:

    On the calorie in/calorie out nonsense I still think that J.Stantons blog series is still the most convincing (at least for the sciency guys like me).

    http://www.gnolls.org/tag/calories-in-calories-out/

    I especially love the rat study where 2 groups of rats were fed the same food at the same quantity and the 1 became obese the other not. The only difference in the food was that one was powdered and re-agglomerated the other not. This would for instance explain why powdered foods tend to make people fat (flour, sugar, processed potatoes (pringles, instant mashed etc)).

    • Tom Naughton says:

      I remember that series of posts. Good stuff indeed.

    • Josh says:

      A very good point on whole foods. Many of us (like me) can consume modest amounts of grains if they are in whole, in chunks or even flattened like oatmeal flakes, without a significant negative effect on a maintenance diet. The highly processed stuff and what Dr. Lustig calls ‘pulverized’ flours digest in a New York minute. The big chunks take quite a lot longer. Who would have guessed??

      As usual, it is the individual’s experience that matters the most. I can get away with it. Perhaps others can’t. Just don’t let sugar get near me!!!

    • Tom Naughton says:

      Hmmm, she never says (and probably never knew) what kind of LDL she was producing. Small and dense or large and fluffy? She apparently just accepts the idea that LDL is bad and should be low.

  16. sandi says:

    More novel thinking. Above all, don’t feed your gut microbiome excessive artificial light and nnEMFs…

    https://www.facebook.com/drjackkruse/posts/1885391188191893

    “…Artificial or alter light frequencies are fully capable of directly changing ETC. Cytochrome C reacts to blue and red light for an example. Blue light causes your mitochondrial ECT to slow because the respiratory proteins enlarge to slow electron tunneling….…..when it slows you up regulate carbohydrate metabolism by way of AMPK pathways or nnEMF it can change your microbiome. This has massive impacts on the microbiome. It alters its ability to make beta hydroxybutyrate, oligosaccharides, Vitamin K2, and something called FIAF. FIAF is what cause human obesity and can lead to changes that lead to diabetes and beta cell destruction. All this can occur from the change in frequency of light release from the microbiome and from your own cells. This work has been published for quite sometime in biophysics and …”

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