In this video, Dr. Attia talks a lot about energy balance and implies the only reason Keto would work is that you are cutting back on certain food groups which he interprets as eating fewer calories. That is, any diet would work that limits certain food groups.

Isn’t there evidence that carbohydrates spike insulin thereby promoting fat storage, and preventing fat burning? Wouldn’t this be one of the accepted "biochemistry phenomenons" he is trying to teach us?

https://www.youtube.com/watch?v=b_d-drdcfJo&t=446s
(I have the link advanced to the relevant part)

Dr atkins discussed a study that looked at weight loss based on three levels of carbs. All three lost body weight, each a bit more with each level of constricting carbs. AND it looked at % body fat loss: Again the lowest carb level netted most body fat loss.

Each method resulted in weight loss but the very low carb level preserved muscle mass and drops the most body fat.

Another benefit is ehen carbs are especially eliminated the ketone levrld remain high around the clock and appetite drops. Im not sure of the mechanism that connects these two, but i knowy appetite drops and aIm not cruising the kitchen looking for food all day. Perhaps its the consumption of ultra processedfoods like bread and crackers and duch that may be the driver to eat. So ny eliminating that and other trigger foods, we naturally are satified. And eat less.

Energy balance is a weird subject. We simply say Calories in - calories out. In livestock we track feeds by Digestible Energy, not total energy. AND its been calculated for every type of animal feed fir each type of animal. A ruminant has data at the metabolical level, ME for cracked corn or whole corn, whole wheat, rolled oats etc. No such data seems to be applied to humans.

The calorie count of a food is based on a bomb calorimeter and a math equation. Not a real functioning digestive system.

Makes no sense to me.

The WLS community has been fascinating me on Youtube. Between the content creators and the comment section, I can say Keto is mainstream (with all the misconceptions that means) and the smart ones quickly realize their problems are the carbs. But they are taught CICO.

This works for people with such a large amount to lose, because they were eating as much as 10,000 calories a DAY. And anything lower than NOVA-4 is rarely eaten, supporting the recent studies showing how UNsatisfying this food is, by design. Usually, one would look at Worst Case Scenario and get real insights from people dealing with an extreme food pattern. And it does warn us of how addictive and insidious it is, now that it's clear how much not-food is in the American diet.

The ones who simply build a shrunken version of what they ate before are doomed to fail, and binge again. I was there. As a teen, I could look at a meal and know how many calories, but fat was the most caloric micronutrient. People wind up eating 1200 calories of carbs and the hunger is immense.

As to why he's picked this hill to die on, I have no idea. I tracked for a couple of months whenever I tried a big change, and it was clear:

Calories: 1600 Carbs:30 = NO loss

Calories: 1800 Carbs:20 = LOSS

So no one can talk to me about calories. And have me believe them.

He didn’t say that, but listed three ways diets could work, including limiting what you eat (carbs). The carbs you eat are a small portion of insulin in your body…understanding Personal Fat Threshold was key for me.

When will both diet camps agree that the "carbohydrate - insulin hypothesis" and the "energy balance hypothesis" are just that … models that give an indication how obesity might occur. Neither is "accepted". The Carbohydrate-Insulin hypothesis has too many "black swans" to be a viable theory though some parts of it work in the beginning. Longer term, the Energy Balance model has more studies to support it, and now incorporates some of CIM, so Dr Attia followed the science to focus on Nutrients and Satiety, minimizing both LCHF and Fasting.

If you’re already low carb, you need to address the 70-80% of your body’s insulin production that is simply related to how much fat you’re carrying. Simply minimising carbs, while an important step, is missing the main game! Marty Kendall has these 3 good articles explaining Insulin, more on his blog and in The Big Fat Keto Lies book.

Insulin is not making you fat. https://optimisingnutrition.com/doe...n-make-you-fat/

What Is Insulin Resistance (and How to Reverse It)? https://optimisingnutrition.com/wha...lin-resistance/

The Personal Fat Threshold Model of Insulin Resistance, Diabetes & Obesity
https://optimisingnutrition.com/personal-fat-threshold/


Dr Naiman also was ahead of Dr Attia incorporating the Energy Balance model in his advice.

"Diet Doctor contributor Dr. Ted Naiman tweeted “Eating less refined carbs improves outcomes due to higher satiety per calorie — not the internal starvation of the ‘carbohydrate-Insulin’ model [CIM], which I declared dead years ago.”

When asked for a comment, Dr. Naiman clarified that carbs and insulin still play a role in obesity, but the concept of “internal starvation” from high insulin doesn’t make sense to him when blood levels of glucose and triglycerides are elevated.

Additionally, Dr. Naiman is clear that carbs and insulin can drive food choices, and that is an important concern for people wanting to lose weight. Focusing on nutrients and satiety per calorie, and worrying less about CIM, is likely the best path to healthy weight loss."

https://www.dietdoctor.com/carbs-in...l-dead-or-alive


My success story here and on DietDoctor shows how using both hypotheses can lead to weight loss after years being stalled on LCHF well above my ideal weight. Satiety Per Calorie.

You are correct, I was paraphrasing. Here are his words:



To say that low carb and intermittent fasting (IF) are simply ways to reduce calories is irresponsible and dangerous. When a previously legitimate diet advisor moves in this direction, it is usually out of frustration and a dropping audience or income. Low carb and IF are difficult, they involve recovery from severe culturally induced addictions. People are not lining up to do this. With the corporate establishment narrative of CICO, they will get more invitations to speak and sell more books. It is a subtle version of the old TV diet commercial where they make sure to say: “and you can still eat all your favorite foods”.

The biggest problem I see is that most diet doctors with books to sell think there has to be one key cause of obesity and one solution. I think there are many and it depends on the individual. I do agree with Marty's Personal Fat Threshold, but feel that some may also have a Personal Carb Threshold above which the carb-insulin response becomes disordered depending on how/why they got fat in the first place.

I know thin, fit farm boys/girls and athletes who ate large quantities of real, unprocessed food when growing up but gained weight eating the same food when working sedentary jobs. These are the only people I know for whom eating less of the same foods (&/or exercising more) worked. Their carb/insulin balance was never disordered.

Others ate a balanced diet of real foods growing up and never had a weight problem until puberty or pregnancy when hunger & carb cravings led to eating bread & sweets that set them off on a carbohydrate-insulin roller coaster of high-carb binging alternating with low-fat dieting. I am in this category, but after ~20 years in the normal weight range am only "in remission" (with normal waking glucose and BG curves) if I eat a very low carb diet. Eating a stick of butter a day won't cause me cravings & binges, but eating 100g of grains/day will, putting me right back on the roller coaster. No thanks.

If I did not restrict carbs I would quickly gain a lot of weight. I would binge eat because I would never feel full. When I finally started eating a low carb diet I no longer was ravenously hungry all the time and as a consequence I ate less food and therefore fewer calories. I still practice portion control because my satiety signals are not as reliable as I would like them to be, but I no longer feel that ravenous hunger that never seemed to go away. The combo of restricting carbs and prioritizing protein is what works for me now, and eating only real foods, nothing ultra processed. I am so grateful that I discovered low carb eating. I have tweaked things along the way but low carb eating is still the mainstay of how I eat.

Dr Attia is not suggesting using CICO model, that has been proven wrong by virtually every weight loss program designed. Same with extended fasting, he used it and he lost significant muscle mass, and does not recommend it except for severe metabolic disregulation.

He did suggest focusing on Protein, and getting enough Nutrients. You can call that Protein : Energy Ratio or Satiety Per Calorie, but the Keto diehards don’t like that term either. Calories is a trigger word, and Energy Balance comes in second. Good summary of the subtle differences.

Satiety Per Calorie vs Calories In – Calories Out. Eight points of Clarification

https://optimisingnutrition.com/sat...out/#more-41269

Since this is a Low Carb forum, everyone has and continues to use carb restriction. Many use time restricted eating too. But in the end your Energy Balance is important to maintaining ideal lean muscle mass and metabolic health.

Dr Attia's website explains Nutritional Biochemistry:

https://peterattiamd.com/category/n...l-biochemistry/

We have another thread on Dr Attia's evolution, and another YT clip, in Nutrional Advice from April 2022. https://forum.lowcarber.org/showthr...00&page=1&pp=15
And book summaries: https://forum.lowcarber.org/showthr...00&page=1&pp=15

I like a nuanced approach. I want to hear there's a customized solution because it explains why I failed every single time for many years. When you're desperate you risk death with Atkins, I suppose.

Once I had settled in with Atkins. I was transformed. Even before I lost weight, I was free of the constant screaming hunger. The anxieties. The exhaustion. People telling me this was gonna kill me made no sense because I had never felt so good before.

The confusion out there is made worse because it's often, also, an addiction. No we deal with rationalizations. There's no end to the absurdity there.

I'm not so much opposed to CICO per se, as I am opposed to the way in which CICO is generalised to the wider public, as if it implies that it doesn't matter at all what we eat, we just need to be eating less of it, and/or moving more to compensate. Which is exactly what I was taught to believe for 20+ years, and what much of our current health policy continues to claim today.

But that's basically just one of Attia's three levers.

The other two levers - macro restriction and time restriction - also help to mitigate the negative effects of insulin, potentially far more so than a more typical/literal CICO approach, where one grazes lightly but constantly on low-fat nibbles during the day.

IMO, both the CIM and the EBM are useful. The mistake is perhaps in assuming that they directly contradict each other, which I don't necessary believe to be the case. Yes, it may ultimately be about calories (hence the denominator in SPC), but that's not the same thing as it being exclusively about calories (hence the numerator in SPC).

My only problem with SPC is that the "S" is such a grey term, open to such subjective interpretation. Diet Doctor's current algorithm for example, concludes quite differently from my own experience. Fibre does nothing special for me at all, while their "hedonic" factor basically translates for me to just "carbs".

I wonder if, in order to properly reconcile the CIM and EBM, we need something that integrates the negative effects of excess calories and the negative effects of excess insulin together? Something like that would align well with Ben Bikman's mantra of "control carbs, prioritise protein, fill with fat" for example.

The macros involved have different purposes in the body. Protein satisfies first, then fat, while carbs never satisfy. The first two have rebuilding properties to them, while carbs have the lowest requirement in the body, and can only be burned or stored.

I think that's the point of tracking macros since they are individual. Now that I'm not overweight anymore, I crave fat, not carbs. There's much less in storage for me to draw upon. Also, healing takes energy, and makes me want to move more.

I think the real answer lies in the two systems, the sugar burning one and the fat burning one, and the way our body reacts when it tries to change gears. By keeping my carb intake low, I stay in ketosis, and burn fat instead of storing it.

What our body considers "low" can vary. I'm now convinced the other half of this equation is bioavailability. And all of us, unless raised like Jeremiah Johnson, are dealing with various levels of metabolic damage that will require further customization.

They've been trying for over four or five decades to make the artificial diet work, and it's not. That's what the most recent research on UPF has shown to my satisfaction.

I now think UPF is the confounder in these theories that don't quite fit together. It looks like UPF confuses our complex body chemistry. Maybe that, more than anything else, is what actually deranges our metabolism.

Because some of these artificial foods are also pretty old. Like Crisco.

I agree wholeheartedly. It was focusing on calories which got me hooked on carbs. I'd wind up eating lots of "fluffy" ones 🤣 which did the opposite of satisfying my hunger.

Hey Grav, great to see you here.
The ultimate goal of Marty's Satiety formulas, and I believe Hava's too, is to Personalize Satiety.

https://optimisingnutrition.com/sat...nalised-satiety

I do find fiber filling, welcoming back carrots, other raw veggies and hummus was a helpful change to my afternoon routine. But UPF…anything with artificial sweeteners, would lead to cravings, not satiety.

This is my experience and observation. While I don’t consider carbs from healthy whole foods to be bad, I must limit my consumption of them and focus on eating foods enabling me to achieve satiety. In following this practice for years, I’m able to maintain a healthy weight and a healthy metabolism. Attia isn’t necessarily wrong regarding the lower calorie observation, as highly satiating foods with emphasis on protein enable me to consume fewer calories. While that’s not my primary objective, my nutrition choices result in this. Like Jean, I like emphasizing lowering carbs, as it’s a simple way for me to achieve health. Simple is key for people wanting to transition to a healthy lifestyle without having to secure a PHd in nutrition. Sometimes our valued experts confuse more than clarify, and that discourages many by being too complex to make an easy transition.

Yes, and this is key. Bikman’s research directly addresses this dynamic. Following Bikman’s research by adapting one’s lifestyle accordingly makes it very easy for me to emphasize protein over carbs and achieve the results I want.