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Are all calories equal part 2 - Kevin's Halls new study
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psuLemon
Posts: 38,401 MFP Moderator
As a follow up to Kevin Halls last study (found in this thread) I wanted to post his more research papers further addressing whether an isocaloric low-carbohydrate ketogenic diet (KD) is associated with changes in EE, respiratory quotient (RQ), and body composition.
Reference: http://sci-hub.cc/10.3945/ajcn.116.133561
Below is from another thread I was involved which brings forward some of the highlights and I found interesting in nature.
"The time course of the unadjusted EEchamber changes is depicted in Figure 3A, illustrating that there was no significant linear trend over time during the BD period (P = 0.76), and introduction of the KD coincided with an increase in EE by ~100 kcal/d in the first week, after which there was a significant linear decrease over time (P = 0.002)."
And further explained:
"The rapid increase in SEE and EEchamber within the first week of the KD may have been caused by increased hepatic oxygen consumption proportional to the rate of ketogenesis (39). For ketogenesis to fully explain the observed early ~200-kcal/d increase in SEE requires ~150 g/d of ketogenesis (16), which is commensurate with both the observed circulating ketone concentrations as well as the urinary excretion rate, and implies a rate of ketogenesis approximately half of that achieved within 1 wk of fasting when ketogenesis reaches a maximum (15). The KD likely also increased the flux through the energy-requiring gluconeogenic pathway as well as the triglyceride fatty acid cycle, both of which would be expected to slightly increase EE (26, 40)."
And here is further discussion in the conclusion:
"This study demonstrated that transitioning from the BD to the KD coincided with a substantial decrease in daily insulin secretion and 24-h RQ, increased circulating FFA and ketones, and marginal increases in EEchamber and SEE. These data, although somewhat confounded by ongoing weight loss, suggest that large isocaloric changes in the proportion of dietary carbohydrate to fat transiently increase EE by only ~100 kcal/d after adjusting for body weight and composition. Furthermore, the body weight and composition adjustments likely overestimated the EE changes during the KD because much of the weight loss was likely from water rather than loss of metabolically active tissues."
And even makes an observation about other studies:
"Several controlled feeding studies have demonstrated significant differences in EE between isocaloric diets with differences in dietary protein (23–25). Unless accompanied by an increase in dietary protein (22, 26), carbohydrate restriction has not previously been observed to increase EE. Rather, studies that use clamped dietary protein and varying carbohydrates from 20% to 75% of total calories have found either small decreases in EE with lower-carbohydrate diets (16, 27–30) or no statistically significant differences (22, 24, 31–38)."
So as KH stated in the video, there was a short increase in EE, but no additional fat loss occurred (in fact, it was temporarily suppressed):
"The carbohydrate–insulin model predicts a greater rate of body fat loss during the KD period. Our data do not support this prediction because body fat loss slowed on transition to the KD, possibly because of augmented utilization of body protein, as indicated by the increased urinary nitrogen excretion that persisted until day 11 of the KD period. The rate of fat loss during the final 2 wk of the KD was similar to that of the baseline period. We suspect that the increased dietary fat resulted in elevated circulating postprandial triglyceride concentrations
throughout the day, which may have stimulated adipose tissue fat uptake (44) and/or inhibited adipocyte lipolysis (45, 46). These mechanistic questions deserve further study, but it is clear that regulation of adipose tissue fat storage is multifaceted and that insulin does not always play a predominant role (16)."[/quote]
TLDR: While there is a temporary increase in EE while switching to a keto diet, it quickly diminished and did not increase fat loss.
Reference: http://sci-hub.cc/10.3945/ajcn.116.133561
Below is from another thread I was involved which brings forward some of the highlights and I found interesting in nature.
"The time course of the unadjusted EEchamber changes is depicted in Figure 3A, illustrating that there was no significant linear trend over time during the BD period (P = 0.76), and introduction of the KD coincided with an increase in EE by ~100 kcal/d in the first week, after which there was a significant linear decrease over time (P = 0.002)."
And further explained:
"The rapid increase in SEE and EEchamber within the first week of the KD may have been caused by increased hepatic oxygen consumption proportional to the rate of ketogenesis (39). For ketogenesis to fully explain the observed early ~200-kcal/d increase in SEE requires ~150 g/d of ketogenesis (16), which is commensurate with both the observed circulating ketone concentrations as well as the urinary excretion rate, and implies a rate of ketogenesis approximately half of that achieved within 1 wk of fasting when ketogenesis reaches a maximum (15). The KD likely also increased the flux through the energy-requiring gluconeogenic pathway as well as the triglyceride fatty acid cycle, both of which would be expected to slightly increase EE (26, 40)."
And here is further discussion in the conclusion:
"This study demonstrated that transitioning from the BD to the KD coincided with a substantial decrease in daily insulin secretion and 24-h RQ, increased circulating FFA and ketones, and marginal increases in EEchamber and SEE. These data, although somewhat confounded by ongoing weight loss, suggest that large isocaloric changes in the proportion of dietary carbohydrate to fat transiently increase EE by only ~100 kcal/d after adjusting for body weight and composition. Furthermore, the body weight and composition adjustments likely overestimated the EE changes during the KD because much of the weight loss was likely from water rather than loss of metabolically active tissues."
And even makes an observation about other studies:
"Several controlled feeding studies have demonstrated significant differences in EE between isocaloric diets with differences in dietary protein (23–25). Unless accompanied by an increase in dietary protein (22, 26), carbohydrate restriction has not previously been observed to increase EE. Rather, studies that use clamped dietary protein and varying carbohydrates from 20% to 75% of total calories have found either small decreases in EE with lower-carbohydrate diets (16, 27–30) or no statistically significant differences (22, 24, 31–38)."
So as KH stated in the video, there was a short increase in EE, but no additional fat loss occurred (in fact, it was temporarily suppressed):
"The carbohydrate–insulin model predicts a greater rate of body fat loss during the KD period. Our data do not support this prediction because body fat loss slowed on transition to the KD, possibly because of augmented utilization of body protein, as indicated by the increased urinary nitrogen excretion that persisted until day 11 of the KD period. The rate of fat loss during the final 2 wk of the KD was similar to that of the baseline period. We suspect that the increased dietary fat resulted in elevated circulating postprandial triglyceride concentrations
throughout the day, which may have stimulated adipose tissue fat uptake (44) and/or inhibited adipocyte lipolysis (45, 46). These mechanistic questions deserve further study, but it is clear that regulation of adipose tissue fat storage is multifaceted and that insulin does not always play a predominant role (16)."[/quote]
TLDR: While there is a temporary increase in EE while switching to a keto diet, it quickly diminished and did not increase fat loss.
6
Replies
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ps - not debating calorie as a unit of measure. Merely discussion macronutrient impacts on EE. And I think it's no surprised that higher protein will increase EE, slightly.0
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I don't think that many low carbers will debate that if there is in fact a metabolic advantage to the fat oxidation of a ketogenic diet, that it is slight. Some low carbers believe there may be no metabolic advantage at all, and that the only advantage is the decrease in appetite and cravings that many experience when they eat very LCHF. Kevin Hall's report seems to suggest that there is a very slight metabolic advantage though. An advantage that appears even larger (around 150 kcal) if you look at the results that he got from the doubly labelled water.
And I think he saw this problematic contradiction between his video and his results (that there was a slight EE increase) because the original abstract was called "Energy Expenditure Increases Following An Isocaloric Ketogenic Diet in Overweight And Obese Men" but then the actual published report was in the end titled "Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men". Oops.
I personally believe that there may be a slight metabolic advantage of a high fat diet over a high carb diet for some people. Not a large advantage, like protein produces, but some. Even if it is just 50-100kcal per day, that works out to 6-12lbs per year. It isn't nothing.
I believe this based on my n=1. I knw. I know. Not very scientific of me. I had my TDEE set up for a loss of 1.5 lbs per week (I believe) at around 1420 kcal per day, but I ate an averge of 1500 kcal because I was hungrier than that. I started at close to 190lbs, at 5'8", and I was completely sedentary. Instead I lost over 30lbs in just over 3 months, and another 10lbs in the next 2 months. That's 2-3 lbs per week in the first few months. I know my caloric deficit was not 1000+ kcal per day. I think there was probably a slight metabolic advantage to the way I was eating. For me - a middle aged woman with (most likely) steroid driven insulin resistance) I seemed to lose more than I should have with a ketogenic diet.
I think Hall's anti-LCHF bias and experimental problems (like not having half of his subjects start with the LCHF diet, ignoring EE from DLW, short test duration when fat adaption - and not just getting into ketosis - may take longer than 4 weeks to achieve, ketone losses not being measured, ignoring the "outlier" during the LCHF diet who did lose a lot, and this not ever actually being an isolcaloric experiment) did not prove, or disprove, much of anything. Who knows, maybe the slight metabolic advantage comes from what Peter Attia calls the "Hall Paradox". LOL
"A few months ago I was discussing this with Kevin Hall at NIH, an expert in metabolism and endocrinology. Kevin pointed out the error in my logic. I failed (in my question) to account for the energetic cost of making the ketones out of fat. Remember, in the experiments described above, the B-OHB is being provided for “free.” But physiologically (i.e., in nutritional ketosis or even starvation), we have to make the B-OHB out of fat. The net energy cost of doing this is actually great. According to Kevin, it is not generally appreciated how making ketones from fatty acids affects overall energy efficiency. Nevertheless, this can be examined by comparing the enthalpy of combustion of 4.5 moles of B-OHB, which is about -2,192 kcal, with the enthalpy of combustion of 1 mole of stearic acid (about -2,710 kcal) that was used to produce the 4.5 moles of ketones. Thus, there is about 20% energy loss in this process. Hence, the energy gain provided by the ketones is actually less than the energy cost of making them, at least in theory.
This suggests that being in nutritional ketosis may require more overall system energy, while still increasing work potential. In other words, a person in nutritional ketosis may increase their overall energy expenditure, while at the same time increasing their muscular efficiency. In honor of Kevin, I refer to this as the Hall Paradox."
It's possible that there is no metabolic advantage to ketosis, but Hall didn't prove that, IMO
More eloquent arguments than mine:
https://medium.com/@davidludwigmd/defense-of-the-insulin-carbohydrate-model-redux-a-response-to-kevin-hall-37ea64907257#.axh59jtvs
https://proteinpower.com/drmike/2016/05/06/contradictions-and-cognitive-dissonance-the-kevin-hall-effect/
And this one is just funny:
https://intensivedietarymanagement.com/heres-5-kevin-hall-go-buy-clue/3 -
I don't think that many low carbers will debate that if there is in fact a metabolic advantage to the fat oxidation of a ketogenic diet, that it is slight. Some low carbers believe there may be no metabolic advantage at all, and that the only advantage is the decrease in appetite and cravings that many experience when they eat very LCHF. Kevin Hall's report seems to suggest that there is a very slight metabolic advantage though. An advantage that appears even larger (around 150 kcal) if you look at the results that he got from the doubly labelled water.
And I think he saw this problematic contradiction between his video and his results (that there was a slight EE increase) because the original abstract was called "Energy Expenditure Increases Following An Isocaloric Ketogenic Diet in Overweight And Obese Men" but then the actual published report was in the end titled "Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men". Oops.
I personally believe that there may be a slight metabolic advantage of a high fat diet over a high carb diet for some people. Not a large advantage, like protein produces, but some. Even if it is just 50-100kcal per day, that works out to 6-12lbs per year. It isn't nothing.
I believe this based on my n=1. I knw. I know. Not very scientific of me. I had my TDEE set up for a loss of 1.5 lbs per week (I believe) at around 1420 kcal per day, but I ate an averge of 1500 kcal because I was hungrier than that. I started at close to 190lbs, at 5'8", and I was completely sedentary. Instead I lost over 30lbs in just over 3 months, and another 10lbs in the next 2 months. That's 2-3 lbs per week in the first few months. I know my caloric deficit was not 1000+ kcal per day. I think there was probably a slight metabolic advantage to the way I was eating. For me - a middle aged woman with (most likely) steroid driven insulin resistance) I seemed to lose more than I should have with a ketogenic diet.
I think Hall's anti-LCHF bias and experimental problems (like not having half of his subjects start with the LCHF diet, ignoring EE from DLW, short test duration when fat adaption - and not just getting into ketosis - may take longer than 4 weeks to achieve, ketone losses not being measured, ignoring the "outlier" during the LCHF diet who did lose a lot, and this not ever actually being an isolcaloric experiment) did not prove, or disprove, much of anything. Who knows, maybe the slight metabolic advantage comes from what Peter Attia calls the "Hall Paradox". LOL
"A few months ago I was discussing this with Kevin Hall at NIH, an expert in metabolism and endocrinology. Kevin pointed out the error in my logic. I failed (in my question) to account for the energetic cost of making the ketones out of fat. Remember, in the experiments described above, the B-OHB is being provided for “free.” But physiologically (i.e., in nutritional ketosis or even starvation), we have to make the B-OHB out of fat. The net energy cost of doing this is actually great. According to Kevin, it is not generally appreciated how making ketones from fatty acids affects overall energy efficiency. Nevertheless, this can be examined by comparing the enthalpy of combustion of 4.5 moles of B-OHB, which is about -2,192 kcal, with the enthalpy of combustion of 1 mole of stearic acid (about -2,710 kcal) that was used to produce the 4.5 moles of ketones. Thus, there is about 20% energy loss in this process. Hence, the energy gain provided by the ketones is actually less than the energy cost of making them, at least in theory.
This suggests that being in nutritional ketosis may require more overall system energy, while still increasing work potential. In other words, a person in nutritional ketosis may increase their overall energy expenditure, while at the same time increasing their muscular efficiency. In honor of Kevin, I refer to this as the Hall Paradox."
It's possible that there is no metabolic advantage to ketosis, but Hall didn't prove that, IMO
More eloquent arguments than mine:
https://medium.com/@davidludwigmd/defense-of-the-insulin-carbohydrate-model-redux-a-response-to-kevin-hall-37ea64907257#.axh59jtvs
https://proteinpower.com/drmike/2016/05/06/contradictions-and-cognitive-dissonance-the-kevin-hall-effect/
And this one is just funny:
https://intensivedietarymanagement.com/heres-5-kevin-hall-go-buy-clue/
To address your n=1; you might find this thread to be vary interesting. At best, there is roughly a 10-20% variation in the BMR formulas. But even outside of that, there is also variation in the inputs. Many people may assume sedentary (based on desk jobs, etc..) but may have a higher than sedentary multiplier by other NEAT increasing activities. IIRC, the sedentary multiplier is only based on a few thousand steps. This may be the case for me. Both MFP (Mifflin–St Jeor equation) and other calculators (Katch McArdle) have my maintenance (post exercise) around 2750-2800. My actual, is 3000. So I have the same experience as you. Also, as I mentioned in other threads, when transitioning to Keto or even LCD (even more so if you are transition into dieting), you should not include the first 2-3 weeks worth a data into your validation of your TDEE. The depletion of glycogen alone would have significant impacts. Heck, I have seen some obese individuals lose 20 or more lbs in the first two weeks.
I must admit, I enjoyed the hall paradox article. It was actually informative as opposed to spending it time with bashing. I read your other articles, but Dr. Fung is a joke who doesn't back up his information with actual studies but rather based upon theory and treatment of his patients, and the pp.com article was written pre-study and admits his biased fairly early into the article.
Dr. Ludwig article at least has some data to support his claim. What I do find a bit ironic or rather interesting is this part of the article:
"But the Calories In, Calories Out model has a sort of Emperor’s New Clothing problem, evidently unseen by its advocates. Without advanced technology, not even the most expert nutritionist could accurately assess an individual’s energy balance to within 350 calories a day by assessment of diet and physical activity level. A daily overestimate 1/10th that magnitude would cause obesity in a decade. For that matter, if conscious control of calorie balance were so critical to weight control, how did humans ever manage to prevent extreme fluctuations in body weight before the very notion of the calorie was embraced a century ago?"
I find it a bit ironic because even his own study falls within the realm of those measurements; especially when you are looking at the low gi moderate approach vs VLC approach. My biggest gripe with this study is the lack of control over protein (which KH addresses in my OP) and the low fat group is highly predicated on high GI foods and drinks (AKA, a low fat version of SAD).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564212/
Its possible that Dr. Attia is correct in stating, there isn't enough data, nor is there an adequate study current, to confirm is there is a metabolic advantage to one particular diet over another. At best, it's highly recognize that protein increase EE, and transitioning to Keto will increase EE, albeit for a short period of time (which fat loss is stopped in that period).2 -
so essentially Keto is not the magical fat burner that we all knew it was not....
interesting read, thanks for posting..
just reinforces what I have been saying - Keto is a tool that you can use to get into a deficit, but is not superior to any other tool in the box.5 -
so essentially Keto is not the magical fat burner that we all knew it was not....
interesting read, thanks for posting..
just reinforces what I have been saying - Keto is a tool that you can use to get into a deficit, but is not superior to any other tool in the box.
At least at this point, there isn't a study or the technology to truly show any difference. If anything, there can be a case made that higher protein diets will increase weight loss since it takes more energy to metabolize.0 -
Bump0
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One consideration for athletes wishing to lose weight is that if they undertake a hypocaloric diet and, as recommended, increase their protein intake, then another macronutrient intake would have to be reduced.
While there are many who propose a higher fat (and presumably higher protein), lower carbohydrate diet, such a diet has not been shown to be effective in allowing exercise performance at the higher exercise intensities.
Thus, it would be prudent for athletes who are aiming to sustain/improve their training intensity that it be lipid energy that is sacrificed in an energy deficit and that protein and carbohydrate are emphasized.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213385/#CR80 -
This forum section had so much great potential.
3 -
nutmegoreo wrote: »
This forum section had so much great potential.
So instead of adding to the debate or discussing the results, you feel that adding gifs provide a contribution to the topic at hand?3 -
nutmegoreo wrote: »
This forum section had so much great potential.
Debates in this environment, on this particular subject is nothing more than a waste of time.0 -
BodyzLanguage wrote: »nutmegoreo wrote: »
This forum section had so much great potential.
Debates in this environment, on this particular subject is nothing more than a waste of time.
For a large part of the community that is probably true but its not universally true. Some of us actually take into consideration of what others are saying and utilize that in practice. I particularly used a lot of the research supporting MUFA and the reduction of added sugars to improve my diet. So not all of us have a myopic view on nutrition. And as i transition to maintenance, the thing i will increase is fat, even though its the first restriction i put in place while cutting.2 -
ps - not debating calorie as a unit of measure. Merely discussion macronutrient impacts on EE. And I think it's no surprised that higher protein will increase EE, slightly.
Was there a difference in protein between diets in Hall's recent study ?
When he says it was "isocaloric" does this mean the two different diets had the same calories despite both diets involving weight loss ? When I read the trial protocol it was not supposed to involve weight loss in the run in phase.
I wonder why all the subjects did the diets in the same order.
0 -
ps - not debating calorie as a unit of measure. Merely discussion macronutrient impacts on EE. And I think it's no surprised that higher protein will increase EE, slightly.
Was there a difference in protein between diets in Hall's recent study ?
When he says it was "isocaloric" does this mean the two different diets had the same calories despite both diets involving weight loss ? When I read the trial protocol it was not supposed to involve weight loss in the run in phase.
I wonder why all the subjects did the diets in the same order.
Protein held constant at 91 calories and ~2400 calories (2398 for BD, KD at 2394).
"Seventeen overweight and obese men were confined to metabolic wards where they consumed a BD designed to represent a habitual high-carbohydrate intake for a 28-d run-in period followed by an isocaloric KD for an additional 28 d. Dietary protein was kept constant throughout, and the subjects were prescribed 90 min of low-intensity daily aerobic exercise. Every week, subjects spent 2 consecutive days residing in metabolic chambers to measure total daily energy expenditure, respiratory quotient, and sleeping energy expenditure. Body composition was measured by DXA, and the average energy expenditure during the last 2 wk of each diet period was measured by the DLW method. BD, high-carbohydrate baseline diet; DLW, doubly labeled water; DXA, dual-energy X-ray absorptiometry; KD, low-carbohydrate ketogenic diet."
And IIRC, the main purpose to do things in the same order was to minimize the amount of variables (I believe KH discussed this as part of an interview after his last study).0 -
https://sigmanutrition.com/episode165/
Hello_Its_Dan posted this in another thread. Its an interview with Kevin Hall about the study. Very interesting and insightful stuff; even addresses some of the comments that Taubes made at a low carb conference.1 -
https://sigmanutrition.com/episode165/
Hello_Its_Dan posted this in another thread. Its an interview with Kevin Hall about the study. Very interesting and insightful stuff; even addresses some of the comments that Taubes made at a low carb conference.
If you haven't, go back and listen to all of the Sigma podcasts when you have free time. It's probably one of the best I have encountered. Dude's had everyone from Lyle McDonald, to Layne Norton, to Jose Antonio on his show.0
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