NuSi's metabolic ward study.
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AlabasterVerve
Posts: 3,171 Member
I posted this on the Nutrition forums but I thought people here might be particularly interested in the results as well.
The first results from NuSi's metabolic ward study were shared at ICO 2016 by Kevin Hall. In a nut shell his findings were there's no metabolic advantage to a ketogenic diet; there may be something interesting going on with appetite.
Here's a short 13 minute interview of Kevin Hall at the conference by Yoni Freedhoff:
Dr. Kevin Hall on NuSi first public presentation of their metabolic ears work.
Conclusions:
1. An inpatient controlled isocaloric low carbohydrate ketogenic diet was
followed by small increases in energy expenditure that waned over time.
2. Despite rapid, substantial and persistent reductions in insulin
secretion (as assessed by 24hr C-peptide excretion) and RQ, no
augmentation of body fat loss was observed.
3. Our data do not support the carbohydrate insulin model predictions of
physiologically significant increases in energy expenditure or body fat
loss in response to an isocaloric low carbohydrate ketogenic diet.
Some of the Q&A with Yoni Freedhoff and Kevin Hall:
Q: I take it this has not increased your buy in for the insulin hypothesis?
A: I think the combination of these two studies - on the metabolic side of things - basically falsify the carbohydrate insulin hypothesis.
Q: When's the paper coming out?
A: It was just resubmitted to the American Journal of Clinical Nutrition after a round of relatively positive reviews. So I would anticipate probably hearing something positive within the next few weeks.
Q: Does this mean the hypothesis is now over? I suspect you would say yes.
A: I still think there might be something interesting to say about appetite. [Appetite] was something that was measured very indirectly in this study which I'm not presenting the data yet.
The first results from NuSi's metabolic ward study were shared at ICO 2016 by Kevin Hall. In a nut shell his findings were there's no metabolic advantage to a ketogenic diet; there may be something interesting going on with appetite.
Here's a short 13 minute interview of Kevin Hall at the conference by Yoni Freedhoff:
Dr. Kevin Hall on NuSi first public presentation of their metabolic ears work.
Conclusions:
1. An inpatient controlled isocaloric low carbohydrate ketogenic diet was
followed by small increases in energy expenditure that waned over time.
2. Despite rapid, substantial and persistent reductions in insulin
secretion (as assessed by 24hr C-peptide excretion) and RQ, no
augmentation of body fat loss was observed.
3. Our data do not support the carbohydrate insulin model predictions of
physiologically significant increases in energy expenditure or body fat
loss in response to an isocaloric low carbohydrate ketogenic diet.
Some of the Q&A with Yoni Freedhoff and Kevin Hall:
Q: I take it this has not increased your buy in for the insulin hypothesis?
A: I think the combination of these two studies - on the metabolic side of things - basically falsify the carbohydrate insulin hypothesis.
Q: When's the paper coming out?
A: It was just resubmitted to the American Journal of Clinical Nutrition after a round of relatively positive reviews. So I would anticipate probably hearing something positive within the next few weeks.
Q: Does this mean the hypothesis is now over? I suspect you would say yes.
A: I still think there might be something interesting to say about appetite. [Appetite] was something that was measured very indirectly in this study which I'm not presenting the data yet.
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AlabasterVerve wrote: »Q: Does this mean the hypothesis is now over? I suspect you would say yes.
A: I still think there might be something interesting to say about appetite. [Appetite] was something that was measured very indirectly in this study which I'm not presenting the data yet.
Great study. Very minor increase in BMR. No increase in fat loss rate. That means if it works (and we know it does), it's nearly 100% about the decrease in appetite!
(As I've said all along.
)
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It is interesting. I am somewhat surprised by the results. I figured there would be a minor increase in BMR, but I thought it would be more than 100kcal based only on my own experiences. When I started to lose weight I was 190lbs and I set my calories to 1420 to lose 1 or 1.5 lbs per week - I can't remember which. I ended up eating an average of almost 100kcals more per day but I lost a good 2 lbs, and often more, each week. I thought the insulin weight hypothesis would explain this, especially since I was starting with a slightly raised insulin level.
With thoe results I can't explain why a sedentary, 5'8" middle aged woman lost weight so easily. I can't explain why I can eat so much now and not gain weight either. I often eat 2500 kcal per day, often more, but I gain nothing. Today was a pretty light day for me with no large meals yet I ate two pepperoni sticks, a 1/3c pistachios, about 3 oz of cheese (mozzerella binge), one egg, 3 travelmugs of BPC (with a teaspoon coconut oil, 2-3 Tbs whipping cream, and 1/4 serving of protein powder each), a cup of macadamia nuts with cacao nibs, celery with about a 1/4 c of asiago cheese dip, salmon patty with a Tbs mayo, a few cooked carrots, and then I just had 4-5 Tbs of coconut oil with cocoa in fat bombs- I will probably eat again since I am still hungry. That's a maintenance day, and a light one (at the moment) at that. I should be gaining weight.... I am not. In fact, I am not losing weight but my clothes are still very slowly getting loser.
I wonder if they had done the experiment in the reverse order if there would have been a slight differece? I wonder if there would have been more fat loss in keto and then slowed loss on the higher carb diet? It would have been an interesting comparison.4 -
AlabasterVerve wrote: »Q: Does this mean the hypothesis is now over? I suspect you would say yes.
A: I still think there might be something interesting to say about appetite. [Appetite] was something that was measured very indirectly in this study which I'm not presenting the data yet.
Great study. Very minor increase in BMR. No increase in fat loss rate. That means if it works (and we know it does), it's nearly 100% about the decrease in appetite!
(As I've said all along.)
Yes, I agree.
I hope the research continues in this area for those like me who respond particularly well to a low carb diet. Something is happening. It sounds like such a small thing - reduced appetite - but I've used the word miraculous to describe the effect even a low level of ketosis has for me (going from an insatiable appetite and drive to eat even if I was physically full to having a normal appetite again).5 -
And the first blog post is out:
http://www.thenutritionwonk.com/#!Is-the-Insulin-Theory-of-Obesity-Over/cmbz/5726e6810cf26b6d6848a8f8
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Appetite supression is a big deal. 365 days x amount of years. It's why "diets" don't work for longterm adherence.
From what I read, about 30% of gen pop do not respond very much to lowcarb diets, due to many factors.
I do however believe that the act of overeating is in itself detrimental to health. Especially if it becomes a habit. I notice I get hungrier the more I eat. Interestingly I get less hungrier if I can fast. Maybe it's the higher BHB levels?
After lots of experimenting for 1,5 years lowcarbing +IF + exercise is the system that works best for my body. A 1 month metabolic chamber study with 17 men...won't change how MY middleaged female body reacts to certain types of food.
I think Mr. Hall is a bit vain, going for big headlines. The 300 kcal deficit is well within the margin of error for the nutrient count. Nutrient count can vary up to 10% from the labels. Which goes to show CICO as a "science" is questionable. Keto macros for 1 month? That's barely enough time for the enzyme regulation. They were only in the chamber for the first 2 weeks on each diet before crossover. Was there a washout period? How long were these men obese and how old?
...so many questions. I'm not on keto macros, but I do think Nutritional Ketosis is a state that finds it's true stride and strength over minimum 6 months or longer.
It's strange why did NuSi even agree to finance this?4 -
Foamroller wrote: »Keto macros for 1 month? That's barely enough time for the enzyme regulation. ...
I do think Nutritional Ketosis is a state that finds it's true stride and strength over minimum 6 months or longer.
Lots of good points (head spinning) - thanks!
A couple Qs -
Enzyme regulation?
Why min 6 months?
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Foamroller wrote: »It's strange why did NuSi even agree to finance this?
A metabolic chamber is the best way to figure out what's really happening, and Hall is well recognized for this type of experiment. I assume NuSi wants to improve the quality of nutritional science, and this is how it's done.
Hopefully, this will allow us to move past the unsupported idea of a "metabolic advantage" and look at the things that really matter: appetite regulation, long-term compliance, and health benefits (independent of weight loss).
Edit: So far, all of the studies that support the idea of "fat adaptation" and increased fat oxidation have been only in the context of intense exercise. This study tested that idea without exercise, and there was no increase in fat oxidation. The exercise studies show this as well -- no difference between fat burners and sugar burners at rest.
So the other aspect of low-carb that this study supports is that the only "metabolic advantage" comes with exercise!3 -
Foamroller wrote: »Keto macros for 1 month? That's barely enough time for the enzyme regulation. ...
I do think Nutritional Ketosis is a state that finds it's true stride and strength over minimum 6 months or longer.
Lots of good points (head spinning) - thanks!
A couple Qs -
Enzyme regulation?
Why min 6 months?
Calling @wabmester! You always seem to find the best sources and explain things succinctly. Can you help me?
From what I know there's no clinical definition of what keto adaptation actually is. It seems more like a bunch of symptoms.
I could be wrong, so please correct me: Enzymes are protein molecules that are like boosters for chemical signals. When the body is forced to use more fatty acids, the enzymes that help the mitochondria max out on fat oxidation to create energy (ATP), will increase. This may take up to several weeks. So being "in ketosis" is not the same as getting the full benefit of having mitochondria that are primed to burn fat for fuel due to the enzyme levels.
If you create more mitochondria, through for example exercise, you get even more fat burners per cell. This is called mitochondrial density. Mitochondria are made per demand and they can also move!
Re 6 months. It takes time and effort to adapt. Anecdotally from reading r/keto the body really likes to be a fat burner. In my own experience, the longer I go, the more forgiving it is after a detour into carb land. It tells me when I'm above carb threshold. But I do LCHF also for metabolic flexibility.
Like any relationship, the longer we get used to each other, the harder it is to separate? The mitochondria doesn't reprogram back to sugarburning instantly if you're having one bad day. It's a lot about consistency. That's maybe where the enzymes play a big role ?
Phinney says several places that keto adaptation comes in different stages. But he's awfully vague about it. So I think it's something they haven't been able to quantify other than the ability to burn over 1.5g fat/minute for an athlete in the FASTER study.
Re 6 months. What happens after the diet is over? We all know what happens...
Longterm maintenance is more about changing mindset and lifestyle. The body can shed weight fast. But the mind and how we comfort ourselves in hard times may never change unless conscious effort to do so. This is why I'm a proponent of building good habits. Lowcarb is more satiating than high carb. I feel bad for my frds IRL who keep suffering dieting with high carb. This is just my opinion.
Rambling over.1 -
Yeah, enzymes are protein-based catalysts for a zillion different metabolic reactions. Some up-regulation of enzymes involved in fat metabolism is usually proposed as part of "fat adaptation," but I've never seen any evidence.
But here's the thing. People talk about becoming a "fat burning machine" and about "eating fat to burn fat."
This study shows no evidence of that. And the FASTER study showed very little evidence of any difference at REST.
So that strongly suggests that the main metabolic adaptation to fat occurs in muscle tissue, and you only benefit at higher levels of exertion.
So simply sitting on your butt for 6 months in ketosis probably does virtually nothing. Exercise will lead to oxidative stress, and that stress will lead to mitochondrial biogenesis.
If fat oxidation rates double during exercise, that means that either mitrochondrial density doubled, or the bandwidth for the fat oxidation pathways doubled (enzymes), or some combination of the two.
I've only seen evidence for an increase in number and size of the mitochondria. So any increase in enzyme activity is probably directly proportional to the increase in mitochondrial size and density.3 -
Interesting. I wish it didn't skate over and discount the many other benefits of a low carb Keto diet, though kudos for bringing up the appetite suppression. (Having stable blood sugar FEELS amazing! ) I never really thought that a low-carb or keto diet worked by *raising* our BMR. That would be great, of course, but I don't think the BMR can be directly connected to just one hormone in our body. And insulin is just one hormone. For me being on keto is part of the process of achieving whole health, not a short cut to it. I always assumed our BMR is set based on our overall health, and how well our body works as a whole based on how well we take care of it. Avoiding deficiencies in vitamin and nutrients are key too, as well as getting regular exercise. Removing toxins from our diet, and anything else that can improve how our body functions. I also never believed all carbs are created equal. What he only proved, IMO, is that there isn't a *simple fix* with low-carb. Keto diets are being observed for a host of other benefits too at the cellular level, such as AMPK production and autophagy. I still believe whole heartedly that our bodies were never meant to have high carbs all day long, nor were we meant to avoid fats.
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I think any study < 24 months concerning LCHF will not show a clear picture.
I am thankful for the short story. I never thought LCHF as a weight loss plan in my case even though I lost some weight.
In just 30 days I got a marked pain reduction. In 6 months I got total resolution of 40 years if serious IBS, less of a *kitten* than in a long time, etc, etc.
For me LCHF is an eating lifestyle that is giving this old man a chance at a better quality of life at all levels. My family appreciates my new way of eating/moving/acting.2 -
So simply sitting on your butt for 6 months in ketosis probably does virtually nothing.
Hmmm. However, we have plenty of (admittedly anecdotal) evidence on sites and boards dedicated to keto/low carb for people doing exactly that, with calorie restriction (or without!) and losing weight.
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So simply sitting on your butt for 6 months in ketosis probably does virtually nothing.
Hmmm. However, we have plenty of (admittedly anecdotal) evidence on sites and boards dedicated to keto/low carb for people doing exactly that, with calorie restriction (or without!) and losing weight.
Exactly. This study showed weight loss, just no additional fat loss due to being low carb. So in one sense, it's just a validation of CICO. But combined with ALL the other studies showing that low-carb works for weight loss even with "ad lib" eating, it strongly suggests that the results are nearly 100% due to appetite regulation. Not due to "fat adaptation" or "keto adaptation" or a "metabolic advantage" or to a decrease in insulin or an increase in energy expenditure.0 -
There was only one reason my pain level dropped like a rock that I can think of and that is my body level of inflammation dropped like a rock.
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Right, this is not an invalidation of the health benefits. But it would still be interesting to know which health benefits come from being low carb and which come from weight loss. Personally, I think high insulin levels cause lots of problems.4
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@wabmester , I think it's interesting that you mentioned appetite regulation. That in itself is a huge bonus of a low carb diet. This is like saying, your car can run on 20 gallons, but at 10 gallons of regular gas (sugar) your car will sputter and turn on the gas light, but with premium (ketones) your car can go almost until 19 gallons are gone without decrease in speed or turning the light on. Are there any studies on keto effects on leptin? If there is a possibility that keto suppresses appetite by regulating leptin, maybe we have solved the problem in the other thread (the one about Biggest Loser contestants) of weight re-gain.2
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Yes, there are some low-carb studies that suggest:
- leptin sensitivity improves on low-carb
- leptin levels don't fall as much as on low-fat
- other hunger hormones (such as ghrelin) are suppressed by ketones
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Yes, there are some low-carb studies that suggest:
- leptin sensitivity improves on low-carb
- leptin levels don't fall as much as on low-fat
- other hunger hormones (such as ghrelin) are suppressed by ketones
So, let me postulate... a low fat diet will screw with your hormones (maybe even permanently). A high-fat low carb diet may be leptin sparing, so all of us may retain our BMR as we lose weight, which would be a whopping advantage of LCHF.3 -
I expect since this way of eating is becoming more and more popular we will have more better or long-term studies in the near future2
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@Lillith32, I think you're right. And it's probably a combination of screwed-up hormones and screwed-up sensitivity to those hormones. The biggest change we experience on low-carb, IMO, is improved sensitivity. Normal hunger. Normal metabolism. And for some of us, normal sleep, normal skin, normal digestion, etc. It's just a better normal. 7
