28-Jul-22 Washington Post Article on The Carbohydrate-Insulin Model
Hi Danny, I'm curious as to your take on this story from today's Washington Post: https://wapo.st/3Jgv61q (hope you can get to that, it's behind a paywall but I've "gifted" it). It appears to be yet another riff on the "it's not about calories in / calories out, it's about the 'quality' of the calories" them. This might be a big ask, but 1) does the Post article accurately reflect the paper (https://www.nature.com/articles/s41430-022-01179-2), and 2) is the paper credible? I have my own opinion on the former but am interested in your take, in part to see whether or not I'm actually learning what I'm trying to learn from you and Alan. So my over-long story, which I promise will have a question at the end of it: The whole calories in / calories out controversy really intrigues me, partly because I'm an engineer by training ;), partly because I've read a fair bit of Stephan Guyenet, but mostly because, I think, I've made it work for me. A decade or so ago my BMI was in the low 30's; it's been very stable at around 24.5 for over a year now. Now I know that different things work for different people, but I swear I've done this with calories in / calories out. I've never bothered trying to count calories because I know that's a mug's game - it's really easy to underestimate what you consume and overestimate what you expend. I just dropped my caloric input (and cranked up my expenditure - I spend a ton of time on my bicycle) until I found myself losing around a pound a week most weeks and, when I hit a weight that I liked, I increased my caloric intake until my weight stabilized. Sometimes I'll overeat on vacation and gain a few pounds, or if I injure myself I have to cut back on the cycling, but I know how to lose a couple of pounds so I don't sweat that. But here's the thing - apart from excluding the flesh of air-breathing animals (okay, so I have a slice of turkey at Christmas and Thanksgiving - if I'm going to go the all the trouble of cooking the thing for my family I'm going to enjoy a bit of it!) I eat pretty much everything, including a fair bit of carbs (one of my new hobbies in retirement is making all my own bread and it's hard to only eat a little bit of that...). So - calories in / calories out seems to have worked for me. But part of my inspiration for writing this is one of the comments on the Post story, something along the lines of "I lost all the weight I wanted to with calories in / calories out but I still have to keep 'dieting' to keep it off" (my quotes on 'dieting'). While I take some issue with the use of the word "dieting" here, I agree with this comment! I still watch - and limit - my caloric intake quite rigorously to keep my weight where it is. I don't measure it or anything, but I've developed a pretty good instinct for when I'm consistently consuming enough excess calories to gain wait and still weigh myself weekly, although I don't call this "dieting". In my experience the deal seems to be this - if you're accustomed to a 400 calorie / day caloric surplus and you establish new eating patterns that give you a 400 calorie / day caloric deficit, you're going to lose weight. But once you've lost all the weight that you wanted to lose, that doesn't mean that you can go back to your 400 calories / day surplus! You can't add back the whole 800 calories / day, you can only add 400 calories / day, and, guess what, you're going to be hungry as a result. This is actually fairly hard - I'm mildly hungry much of the time, but I'm used to that and feel it's worth the minor discomfort for the comfort I get from knowing that I'm doing something good for my health (I'm a cancer patient and have been told many times that maintaining a healthy weight may help keep the cancer away), just as I decided that it was worth enduring the cravings when I quit drinking way back when. In fact, I've actually got to the point where I kind of enjoy this discomfort, in the same way that I enjoy the ache I feel after a long ride or a good hard run. So, another question based on that! It's common knowledge that most people lose weight when they "diet", and that most gain the weight they've lost and more when they stop. Is there any data out there about people's post-"diet" eating habits, i.e. is there evidence that people simply revert to the eating patterns that caused them to gain weight in the first place rather than finding that happy medium where their weight stays constant? Sorry for the long-winded post, and thanks very much for the most sensible and evidence-based podcast that I've been able to find.
Anorexia and morbid obesity and metabolic compensation
Can you talk about the conditions of anorexia and morbid obesity and how they essentially defy the rules of metabolic compensation? In other words- I understand anorexia to be a mental health condition where the individual starves themselves with a purpose to control weight. And morbid obesity being excessive consumption despite over fatness, etc. If the body has these numerous mechanisms by which calorie restriction or calorie over- consumption results in these compensatory processes-driving us to eat more/less slow us down/speed us up, and many more; do these individuals NOT "hear" these signals or are they just adept at ignoring them or is it that their bodies have lost the ability to compensate for their under or over consumption? Additionally, can anyone become anorexic or morbidly obese or is it merely genetics, and if you are in the proper life circumstance- you set these tendencies off? Thanks so much for your consideration of this convoluted question! Kristen in Dallas.
Obesity - Are the only efficacious interventions drugs and bariatric surgery?
It seems like there are significant differences in policies put forth between researchers from biomedical backgrounds and ones from public health policy backgrounds. Pr Allison touched on this during recent interviews, noting that there is very little evidence regarding the efficacy of upstream obesity prevention interventions, such community gardens, combatting food deserts, nutrition education, and cooking classes. On the other hand, governments are increasingly turning to such interventions, as well as policies such as front of pack labelling (Canada, 2022), nutrition facts tables, calorie labelling on menus, as well as the aforementioned ones. Given your research on determinants of health and obesity, what are some of the most promising interventions to prevent NCD morbidity, as well as stones unturned in public health policy? Would you agree with individuals such as Pr Allison that in our current environment, the only efficacious interventions are drugs and bariatric surgery? Regards, Gabriel
Bacteria, obesity, and the brain
In 2018 a poster was presented at the annual meeting of the Society for Neuroscience titled “The human brain microbiome; there are bacteria in our brains!” which showed bacteria apparently penetrating and inhabiting the cells of healthy human brains. While the work was preliminary, have you heard of any further work in this area? What is your opinion on the possibility that, if bacteria do inhabit the brain, they could play a part in appetite regulation and/or obesity similar to how the gut microbiome can affect our health?