IMS Lecture With Slides And Q&A: 'Why We Get Fat' By Gary Taubes Jimmy Moore has put this up on his site.
I spent last night watching it and although I have heard all the previous online version of his talk I found the more relaxed presentation from home more detailed. As usual he overruns but in doing so provides more examples and analogies to support his case. I particularly like the lecture hall example.
There is also an extended Q&A session with some clearly well informed people asking the questions so this is worth hearing although I think I detected an air of despair or at least resignation underlying some of Taubes replies.
Still it was interesting to hear that his project with Lustig is proceeding. I'm looking forward to seeing to what extent the agree and where they agree to differ.
So I'm sure, even if you've already grasped the key messages from Taubes Good Calories Bad Calories, you will find something interesting in this new version of his talk.
It's split into several sections so you don't have to do it all at once (the talk is 75mins but split into 8 short videos and there are about 5 in the Q&A section so whenever you've 10mins to spare you can do a section.

Thank you for posting this link.

Thanks for posting that. I loved the Q&A. Answered my question about the Japanese.

Thanks again!

Really good. I've heard the lecture several times before, but the Q&A was fascinating.

Agreed. It's the same lecture as before, although I think that it's more accessible to the average layman than his previous lectures. There is very little scientific jargon and his examples are clear and convincing. I'm going to see if I can entice a few people I know to listen to it. I also noticed he has changed a key of the more controversial issues. For example he is quick to point out that exercise is good for you, just that it's not going to make you lose weight.

But the gems are the Q&A for the simple reason it's all new material for us.

I thoroughly enjoyed the lecture and Q/A sessions. Listened to all of it. Thanks for posting the link!

Interesting slides and talk. I wondered, when I saw the Shai, et al., study, what the calories were in the various diets (Mediterranean, low-carb, low-fat). Because a diet does not restrict calories does not mean that more calories were eaten.

I noticed: the 'restricted' vs. 'unrestricted' applies to calories for the low-fat, but low-carb is 'restricting' too. It restricts the amount of carbs you eat instead of calories.

So I went to the NEJM to see if the calories were mentioned.

There have been studies showing that when carbohydrates are restricted, people do tend to eat fewer calories.

This question was brought up by Kirsten Moller, M.D., Ph.D., Rikke Krogh-Madsen, M.D., Ph.D., University Hospital Rigshospitalet, DK-2100 Copenhagen, Denmark (the third letter shown).

http://www.nejm.org/doi/full/10.1056/NEJMc081747

(It's surprising that the low-carb group had the highest drop-out rate, and the low-fat group the lowest... it's usually the other way around.)

Moller and Madsen expressed the question about calories:
'Absolute values for the energy intake before and after the intervention are not given for any of the groups. However, the data provided in the article suggest that the weight loss in the low-carbohydrate group may have been simply a hypocaloric effect, even though the authors state that the energy intake in this group was not restricted. '

Yes, the energy intake in this group was not restricted. Yet they did have less caloric intake than they did before. That's really not so unusual. You might call it a benefit of low-carbing, in fact.

The authors of the study responded:

'In response to the letters from Astrup and Moller and Krogh-Madsen: the diet-recall data confirm that the total caloric deficit was similar among the groups and that the low-fat group maintained a relatively low intake of fat (Table 1Table 1Dietary Intake from 24-Hour Dietary Recall among Participants in the Dietary Intervention Randomized Controlled Trial (DIRECT).). Obviously, with a substantial total caloric deficit, the absolute consumption of fiber was decreased; however, the decrease in the low-fat group was half of that in the low-carbohydrate group.'

The stuff about fiber intake is interesting, but what stands out is that all the groups took in fewer calories.

Yes, the low-carb people lost more. But they were also on what might look to anyone like a calorie-reducing diet, because even inadvertently, they reduced calories. They ate what they wanted, given the restrictions of the diet (restrict carbs), but they ate fewer calories - in fact, the least.

This isn't to say that low-carbing might not be the preferred diet for people who want to 'lose more.'

The numbers are there. Everyone on the diets ate fewer calories (you do lose weight even on the highest number of calories diet, which turned out to be the Mediterranean diet, of all things!)

There's a slide next to the response from the authors. You can see the caloric intake of the three groups.
Low fat 1347 plus or minus 239 calories
Mediterranean 1356 " " 258 calories
Low-carb 1281 " " 380 calories

I'm glad I watched the slides and heard the talk (I've heard Taubes before on Youtube and iTunes podcast). I look forward to the new book - should be interesting.

For those of you who, like me, read the previous message and thought "what new book?", I looked it up.

http://www.amazon.com/Why-We-Get-Fa...id=RXJ6143VDVKW

Not sure how I feel about him writing what looks to be an actual diet book. The fact that he was not promoting a specific diet was, I always felt, a point in GCBC's favor.

(I'll buy it, of course.)

And I think this is the Shai, et al. study:
http://www.ncbi.nlm.nih.gov/pubmed/20115931

all this may be true, but I want the food plan that will help me lose the most fat with the least effort and the least physical and emotional agony...that would be low carb hands down...I really enjoyed the lecture. I'm rather surprised I could follow it all....

See this study:
http://www.proteinpower.com/drmike/...the-mainstream/

The low carb group ate the most calories of the three groups yet did better in all things measured including weight lost. Weight loss can't merely be attributed to caloric deficit, there's something else going on.

It's easy to explain the spontaneous caloric reduction when cutting carbs. We already know that when the brain runs on ketones, it runs 30% more efficiently. In other words, it does 30% more work for the same amount of fuel, or consumes 30% less fuel for the same amount of work. It's no wonder then that when we cut out carbs and go into ketosis for most of the time that we feel less hungry for the simple reason that we have more fuel available. We must also consider that when we lose fat, this fat goes into the total available fuel thereby reducing the intake requirement.

We could use the hedonistic argument but then when we're less hungry, food doesn't taste as good. So really, it's not because food doesn't taste as good, rather it's because we're less hungry.

Heck, I feel fine about it. First, a zillion people complained his 'real' book was too hard, too long, too dense. It was obvious he had an important message but making it more accessible to the mainstream needed to happen -- and so it has. Second, in many ways this has probably done less for his pocketbook or career than almost any topic he could have chosen to write about... he did it as a journalist but it's turned out to be some accidental 'voice in the wilderness'. I hope that the importance of the topic is at least some 'for the moral of it' compensation for him. But 'good intent' doesn't feed anybody, so I hope he might actually make some money from his newer, simpler presentation book!

PJ

I just listened to a new Jimmy Moore podcast talk with Gary and I found it kind of depressing. He sounded discouraged to me and kept talking about scientists/doctors in the past who got the carb thing right and then were forgotten and about people he thinks should know better who ignore his data and ideas.

Maybe it's just me thinking that. I'd be interested in someone else's views on his comments.

Link

Thanks for providing the link to the Eades blog (I already read it). From there, I could pull up the actual study.

http://jama.ama-assn.org/cgi/content/full/297/9/969

The Atkins calorie intake at baseline was 1888
Zone 1975
Learn 1925
Ornish 1850

After 12 months on the diet,
Atkins 1599
Zone 1594
Learn 1654
Ornish 1505

The mean daily intake at the end of the study had changed from the beginning, for each group. They all went down in caloric intake. And anyone would lose weight at the levels they were finally at - not surprisingly, everyone lost weight.

This is what the authors say about calorie restriction:

'The guidelines for the Zone and LEARN diets incorporated specific goals for energy restriction, while for the Atkins and Ornish diets, there were no specific energy restriction goals.'

Just because you are given free rein to take in calories as you wish, that doesn't mean that you will. In fact, everyone, including the Atkins group, reduced calorie intake, whether it was restricted or not. And they didn't differ by all that much.

The Atkins were eating 289 calories less.
Zone 381
Learn 271
Ornish 345

The authors say:

'There were no significant differences in weight loss at any time point among the Zone, LEARN, and Ornish diets. Although the weight loss in the Atkins group was greater than that of other groups, the magnitude of weight loss was modest, with a mean 12-month weight loss of only 4.7 kg.'

(I'm pretty sure the other dieters don't deal with that nice 'water weight' drop at the beginning of Atkins.)

I don't see how the low-carb group ate more calories than other diets. In the study, the Zone diet, which is a lower-carb diet and some may call it low-carb, was included. At most, the Atkins group were eating around 100 more calories than other dieters in the study, less than an large apple's worth of energy.

The weight loss was greater for Atkins but not astounding. Everyone lost weight.

The study answered the question, 'Is a low-carb diet going to be dangerous to recommend to my patient who needs to lose weight, and is it an effective approach' (I'm paraphrasing) and the answer was, 'No, it's fine, go ahead'

The conclusion, from the authors of the study:
'Physicians whose patients initiate a low-carbohydrate diet can be reassured that weight loss is likely to be at least as large as for any other dietary pattern and that the lipid effects are unlikely to be of immediate concern. As with any diet, physicians should caution patients that long-term success requires permanent alterations in energy intake and energy expenditure, regardless of macronutrient content.'

Which is good to know.

The objective of the study was:
'Objective To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables.'

So, when this study - which was only of premenopausal and obese women - is described by Eades as 'showing the low-carb diet brought about greater weight loss and better lab value improvement than the other three diets.' I'm puzzled. The weight loss was greater but modest.

They refer to a similar study that was done, on a larger, more inclusive group:

http://jama.ama-assn.org/cgi/conten...pe2=tf_ipsecsha

Comparing their study of women to that study, which studied the four diets (Atkins, Zone, WW, Ornish) with a larger group, they say:

'Our study and the study by Dansinger et al16 were similar in several design features, including similar number and types of treatment groups and the same duration. Despite the similarities in design, several conclusions differed between the trials. Dansinger et al reported that weight loss at 12 months did not differ by diet group but only by level of adherence, regardless of diet type. In addition, Dansinger et al reported improvements within groups over 12 months for cardiac risk factors but did not report any significant differences between groups. In contrast, we observed statistically significant differences among diet groups for both weight loss and risk factors at 12 months.

These differences are likely attributable to at least 2 factors. One factor concerns the different study populations: our study was restricted to women aged 20 to 50 years who did not have diabetes and were not taking medications for cardiac risk factors, whereas the population in the study by Dansinger et al was much broader in its inclusion criteria. A second likely factor was differences in statistical power; in the study by Dansinger et al, 93 of 160 enrolled participants completed the trial (42% attrition at 12 months; ie, n = 21-26 per treatment group); in the current study, 248 of 311 women completed the trial (20% attrition; ie, n = 58-68 per treatment group).'


Here are the calorie reductions, taken at the same points, in the highly similar study (more inclusive, larger, but using WW instead of LEARN) done by Dansinger et al:

'Dietary intake according to an intent-to-treat analysis of 3-day diet records is shown in Table 2. At baseline, 147 (92%) of the participants submitted food records. Mean total energy intake was 2059 calories daily, with 46.4%, 34.5%, and 17.6% of calories derived, respectively, from carbohydrate, fat, and protein. There were no significant caloric or macronutrient differences between diet groups at baseline. For each group, dietary adherence as assessed by diet records decreased progressively with time, although the specifically targeted dietary parameters for each diet were significantly different from baseline (all P < .01) at each time point, according to both the primary and secondary analyses. At 1 year, the mean caloric reductions from baseline were 138 for Atkins, 251 for Zone, 244 for Weight Watchers, and 192 for Ornish groups (all P<.05, P = .70 between diets).'

Their calorie reductions were less than those reported in the Gardner study. But at most, the difference in their calorie reductions from (essentially) the same groups in the Gardner study were around that of one large apple.


'...all 4 diets resulted in modest statistically significant weight loss at 1 year, with no statistically significant differences between diets (P = .40). In each diet group, approximately 25% of the initial participants sustained a 1-year weight loss of more than 5% of initial body weight and approximately 10% of participants lost more than 10% of body weight. Weight reductions were highly associated with waist size reductions for all diets (Pearson r = 0.86 at 1 year; P<.001), with no significant difference between diets.;'

Here's something:
'In contrast with the absent association between diet type and weight loss (r = 0.07; P = .40), we observed a strong curvilinear association between self-reported dietary adherence and weight loss (r = 0.60; P<.001) that was almost identical for each diet (Figure 3). Participants in the top tertile of adherence lost 7% of body weight on average.'

Hmmm. You stick to a diet, any of the diets, and you lose more weight. Good to know!

Some of the participants in the study took medications, dropped medications, or took a new medication, but the study said this:

'Adjusting for changes in baseline medication use did not materially affect the study outcomes. For example, 4 to 7 participants in each group were initially taking cholesterol-lowering medication, which was discontinued by 1 individual in the Zone group and initiated during the study by primary care physicians for 1 each in the Atkins and Weight Watchers groups and for 3 in the Zone group. When individuals who initiated cholesterol-lowering medication were excluded from the intent-to-treat analysis, the reductions in LDL/HDL cholesterol ratios observed with each diet remained statistically significant, and associations between weight loss and lipid changes were unchanged or slightly stronger.'


'Our results support a growing body of research suggesting that carbohydrate restriction and saturated fat restriction have different effects on cardiovascular risk profiles. Low carbohydrate diets consistently increase HDL cholesterol,17, 20 and low–saturated fat diets consistently decrease LDL cholesterol levels.34 Low carbohydrate diets have typically been more effective for short-term reduction of serum triglycerides, glucose, and/or insulin.17, 19, 22-23,35-36 These findings may suggest to some clinicians that the degree to which a patient exhibits features of the metabolic syndrome might guide the degree of carbohydrate restriction to recommend. In the long run, however, sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in our study.'

In the end, the authors of the Dansinger study highlight adherence:

'In conclusion, poor sustainability and adherence rates resulted in modest weight loss and cardiac risk factor reductions for each diet group as a whole. Cardiac risk factor reductions were associated with weight loss regardless of diet type, underscoring the concept that adherence level rather than diet type was the key determinant of clinical benefits. Cardiovascular outcomes studies would be appropriate to further investigate the potential health effects of these diets. More research is also needed to identify practical techniques to increase dietary adherence, including techniques to match individuals with the diets best suited to their food preferences, lifestyle, and medical conditions.'

'all this may be true, but I want the food plan that will help me lose the most fat with the least effort and the least physical and emotional agony...that would be low carb hands down..'

My criterion for a diet is that it taste good. Low carb wins in that category, for a while. Then it gets boring. Then I eat some carbs.

But then again, low-fat has that problem, too. Whatever works.

In the end, consistency and persistence works. Or, in study parlance, 'adherence.' If you can stick to it, it will work for you.