Monday, July 2, 2018

Great article from Ludwig and Ebbeling

Beyond “Calories In, Calories Out” link

David S. Ludwig, MD, PhD1; Cara B. Ebbeling, PhD1

My comments in purple

The most interesting part of the article:

"Clinical Implications

With failure of conventional

low-fat, calorie-restricted diets to stem the obesity epidemic,

the CIM provides a practical alternative for public health and clinical medicine.

Primary emphasis should be placed on

the quality rather than quantity of calories consumed,

to shift calorie partitioning away from storage in adipose tissue

and improve metabolic fuel availability to the rest of the body.

This shift would, according to the CIM(Carbohydrate-Insulin Model of Obesity)

lower the apparent “body weight set point”—

the weight at which antagonistic physiological adaptations

(including rising hunger and slowing metabolic rate) kick in.

In this way, a negative energy balance and

weight loss might be achieved with less difficulty

and greater sustainability."

Comment:

On page 107 of Always Hungry, Dr. David Ludwig writes:

"Phase 2 is designed to retrain your fat cells so that your weight decreases progressively until stabilizing at it's lower set point. This process can take a few weeks or a few months."

In the article above, the authors write:

Of course,
no 1 dietary factor can fully explain variations in body weight
among individuals and populations; furthermore,
many hormones (notably including leptin and ghrelin)
and the gut microbiome may affect body composition
related to, or independently of, GL.

The CIM focuses on high-GL carbohydrates because

these elicit a greater insulin response calorie for calorie
than any other category of food.

That may be however, in the Reduced Obese state

with low leptin levels and billions of shrunken fat cells that remain, I believe it is the low leptin and the great number of fat cells that play the primary role in weight regain even in people on Low Glycemic Load diets (or LCHF with nutritional ketosis). I have tried to find a reduced obese population that succeeded in maintaining greater than 10% weight loss with Akins or Low carbohydrate high fat diet for more than 5 years . I only found nine here at this link.

I believe the inability (other than the National Weight Control Registry mostly with low fat diets link) lack of 5-10 years data on maintaining weight loss with Ludwigs, Aronne, Akins, or any other variety of low carbohydrate high fat diet to be a major flaw in the Carbohydrate-Insulin Model of Obesity

Reference

Ochner et al article Feb 11, 2015

“Irrespective of starting weight, caloric restriction triggers several biological adaptations
designed to prevent starvation.3

These adaptations might be potent enough to undermine the long-term effectiveness of lifestyle modification
in most individuals with obesity, particularly in an environment that promotes energy overconsumption.”

Ochner adds preadipocyte proliferation increases fat storage capacity.
This goes along with what I hypothesized in my Sponge Theory.

Ochner also says “that these biological adaptations often persist indefinitely,
even when a person re-attains a healthy BMI via behaviourally induced weight loss.3”

In accord with the thesis of my book, The Chronic Disease of Obesity, Ochner goes on to say

“few individuals ever truly recover from obesity;
individuals who formerly had obesity but are able to re-attain a healthy body weight via diet and exercise
still have ‘obesity in remission”