Obesity Journal study: It's not just CICO

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  • Crisseyda
    Crisseyda Posts: 532 Member
    edited June 2016
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    Crisseyda wrote: »
    Dr. Fung's explanation of the 2 compartment model is still basic, but far more realistic than the CICO model.

    https://www.youtube.com/watch?v=tIuj-oMN-Fk&feature=youtu.be

    What a silly video. That's not how any of this works. If you want to get technical the body is a multi compartment storage not only liver and subcutaneous fat. CICO does not claim a single compartment storage. Adaptation has nothing to do with insulin or the type of diet you are on. It's brought about strictly by certain biological and behavioral responses to caloric restriction (like decreased spontaneous non-exercise activity without being aware of it) .

    The biggest loser contestants were not eating nearly enough to have a high insulin response and the grueling exercise routine likely burned through any liver glycogen. They were essentially fasting, exactly what this video is advocating. They also utilized dehydration and dropping water weight, so it's likely their diet was actually low carb since carbs tend to be stored along with water.

    Nah, anyone who has actually completed a prolonged fast vs a prolonged calorie restricted diet knows there is a huge difference. During a fast, after about a day or two, you don't really feel hungry at all. During calorie restriction, it's basically all you can think about not to eat.
  • CattOfTheGarage
    CattOfTheGarage Posts: 2,750 Member
    edited June 2016
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    Another thing that strikes me is that people - including the doctor being quoted - always talk about "calorie restriction" as if it was all the same, but there's a big difference between a very low calorie diet and a moderate deficit, at least it terms of how it feels.

    @Crisseyda says above "During calorie restriction, it's basically all you can think about not to eat." - I don't identify with that from my experience of a 500 calorie deficit. Yes, I get hungrier than I do at maintenance, but not obsessionally so, provided I'm careful to eat filling foods. At a higher deficit, I think you probably will start to get obsessional hunger and other unpleasant effects. It's not the same experience.

    Can we assume the body sees these two situations in the same way, or is it reasonable to hypothesise that they are not the same, and that from the metabolic point of view, not all "calorie restriction" is created equal?

    And that makes me wonder if, even at low deficits, you could diet in a way that, as well as leaving you hungrier and less happy, could also have a bigger impact on metabolism?

    "More research needed ".
  • Crisseyda
    Crisseyda Posts: 532 Member
    edited June 2016
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    Crisseyda wrote: »
    Crisseyda wrote: »
    Dr. Fung's explanation of the 2 compartment model is still basic, but far more realistic than the CICO model.

    https://www.youtube.com/watch?v=tIuj-oMN-Fk&feature=youtu.be

    What a silly video. That's not how any of this works. If you want to get technical the body is a multi compartment storage not only liver and subcutaneous fat. CICO does not claim a single compartment storage. Adaptation has nothing to do with insulin or the type of diet you are on. It's brought about strictly by certain biological and behavioral responses to caloric restriction (like decreased spontaneous non-exercise activity without being aware of it) .

    The biggest loser contestants were not eating nearly enough to have a high insulin response and the grueling exercise routine likely burned through any liver glycogen. They were essentially fasting, exactly what this video is advocating. They also utilized dehydration and dropping water weight, so it's likely their diet was actually low carb since carbs tend to be stored along with water.

    Nah, anyone who has actually completed a prolonged fast vs a prolonged calorie restricted diet knows there is a huge difference. During a fast, after about a day or two, you don't really feel hungry at all. During calorie restriction, it's basically all you can think about not to eat.

    The video was touting the benefits of pseudo fasts in that regard as well, lumping them with a true fast. Some people on keto stop feeling hungry after a few days. Hunger has nothing to do with it. I did complete a prolonged fast by the way (and landed in the hospital for it) and the weight gain right afterwards came in astronomical numbers, part water part compensatory appetite. That has nothing to do with what was being said in the video anyway. That's not how any of this works.

    @amusedmonkey You say, "that's not how any of this works," but you're not really connecting the dots between keto and fasting. Both create almost identical metabolic and hormonal changes through the state of ketosis. That was basically his point. The body's cells need to switch between the "2 compartments," and the presence of insulin inhibits the breakdown of fat. If the body can't have access to its fat stores, it does feel deprivation and starvation... and it is smart enough to match output with available energy, resulting in a lowering of BMR--which can happen in as little as a few weeks.

    @CattoftheGarage

    To quote you:
    Can we assume the body sees these two situations in the same way, or is it reasonable to hypothesise that they are not the same, and that from the metabolic point of view, not all "calorie restriction" is created equal?

    And that makes me wonder if, even at low deficits, you could diet in a way that, as well as leaving you hungrier and less happy, could also have a bigger impact on metabolism?

    Yes, and yes. I absolutely think Dr. Fung's research and work support those ideas. Definitely, not all "calorie restriction" is created equal. While Dr. Fung is a big proponent of intermittent fasting, if you listen closely, he says both carbohydrate restricted diets and fasting have the positive effect of 1. granting easy access to the second compartment and 2. protecting BMR.

    EDIT: if you read more of his work, he goes into much greater detail into the multi-factorial etiology of obesity (and diabetes), and how the cure can be approached in a way that prevents being "hungrier and less happy." And there is a whole lot more that goes into it--ketosis is just a very big piece of the puzzle.
  • amusedmonkey
    amusedmonkey Posts: 10,330 Member
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    @Crisseyda that's exactly the point.

    The insulin hypothesis of obesity doesn't hold up well against scientific evidence and his overly simplistic explanations sound more like extrapolations, taking a basic mechanism and drawing unrelated conclusions from it that I don't find particularly pertinent.

    Low carb is not particularly any more or less muscle sparing than any other diet if you control for protein and I have yet to see any consistent evidence that people with higher carb intake/insulin are particularly more prone to gaining fat than those on a lower carb/with lower insulin.

    TBL contestants were most likely low carb, in addition to being effectively in a ketogenic state due to their 4-6 hours a day exercise routine which would leave anyone on a 800ish calorie diet in a ketogenic state, even if every single one of these calories came from carbs.
  • Crisseyda
    Crisseyda Posts: 532 Member
    edited June 2016
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    @Crisseyda that's exactly the point.

    The insulin hypothesis of obesity doesn't hold up well against scientific evidence and his overly simplistic explanations sound more like extrapolations, taking a basic mechanism and drawing unrelated conclusions from it that I don't find particularly pertinent.

    Low carb is not particularly any more or less muscle sparing than any other diet if you control for protein and I have yet to see any consistent evidence that people with higher carb intake/insulin are particularly more prone to gaining fat than those on a lower carb/with lower insulin.

    TBL contestants were most likely low carb, in addition to being effectively in a ketogenic state due to their 4-6 hours a day exercise routine which would leave anyone on a 800ish calorie diet in a ketogenic state, even if every single one of these calories came from carbs.

    Do you have any access to this evidence?

    Dr. Fung shares clear scientific evidence that calorie restricted diets lower BMR and that fasting does not. He then explains the science behind it, which you can find in any physiology textbook. Insulin does in fact inhibit lypolysis--known fact.
  • amusedmonkey
    amusedmonkey Posts: 10,330 Member
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    Crisseyda wrote: »
    @Crisseyda that's exactly the point.

    The insulin hypothesis of obesity doesn't hold up well against scientific evidence and his overly simplistic explanations sound more like extrapolations, taking a basic mechanism and drawing unrelated conclusions from it that I don't find particularly pertinent.

    Low carb is not particularly any more or less muscle sparing than any other diet if you control for protein and I have yet to see any consistent evidence that people with higher carb intake/insulin are particularly more prone to gaining fat than those on a lower carb/with lower insulin.

    TBL contestants were most likely low carb, in addition to being effectively in a ketogenic state due to their 4-6 hours a day exercise routine which would leave anyone on a 800ish calorie diet in a ketogenic state, even if every single one of these calories came from carbs.

    Do you have any access to this evidence?

    Dr. Fung shares clear scientific evidence that calorie restricted diets lower BMR and that fasting does not. He then explains the science behind it, which you can find in any physiology textbook. Insulin does in fact inhibit lypolysis--known fact.

    http://www.ncbi.nlm.nih.gov/pubmed/17130851 is one (if you have access to the full text) as well as the overall body of the current research
    Practical evidence is another, high carb intake in countries (like Japan) and populations (like high carb vegans) does not predict obesity, while high calorie intake coupled with a low calorie expenditure does.
    And then there is the use of calories, not insulin levels, in most weight related studies as a fairly predictable measure for weight loss/gain showing which model is more widely accepted in the scientific community.
  • Zella_11
    Zella_11 Posts: 161 Member
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    Gamliela wrote: »
    gebeziseva wrote: »
    What does this have to do with CICO?
    CICO means that you lose weight if you eat less than you burn and you gain weight if you eat more than you burn. How much you're going to burn has nothing to do with this principle.

    Also this is the only way a person can lose weight - eat less than you burn - more out than in. This is not disputable. So it is just CICO.

    ETA: Now if you want to lose them pounds super fast and decide to eat like a mouse and then screw your metabolism as a result, well then I guess we always have natural selection at work :)

    To your question - how do we get our TDEE/BMR tested - EASY :)
    I do that for the last few month. I put all my data - the calories in, the calories out through exercise if any, and my weight in excel tables and calculate what my TDEE is as a result of that. This is my actual TDEE and it can't lie :) Fortunately for me it is very close to what the online formulas suggest it is (my calculation is experimental fitting of data, theirs is based on thermodynamics). This method can only work though if you are extra careful with your food measuring and logging.

    One doctor associated with this study is quoted as saying that calorie rstricting diets just don't work. I thought it was a bit deprssing myself, I mean the whole thing was, for obese people and sortof hopeless.

    A calorie restrictive diet is the only thing that works--restricting calories so that one is in a daily caloric deficit, consuming fewer calories than one burns. Not sure what that doctor is trying to say...
  • Crisseyda
    Crisseyda Posts: 532 Member
    edited June 2016
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    Crisseyda wrote: »
    @Crisseyda that's exactly the point.

    The insulin hypothesis of obesity doesn't hold up well against scientific evidence and his overly simplistic explanations sound more like extrapolations, taking a basic mechanism and drawing unrelated conclusions from it that I don't find particularly pertinent.

    Low carb is not particularly any more or less muscle sparing than any other diet if you control for protein and I have yet to see any consistent evidence that people with higher carb intake/insulin are particularly more prone to gaining fat than those on a lower carb/with lower insulin.

    TBL contestants were most likely low carb, in addition to being effectively in a ketogenic state due to their 4-6 hours a day exercise routine which would leave anyone on a 800ish calorie diet in a ketogenic state, even if every single one of these calories came from carbs.

    Do you have any access to this evidence?

    Dr. Fung shares clear scientific evidence that calorie restricted diets lower BMR and that fasting does not. He then explains the science behind it, which you can find in any physiology textbook. Insulin does in fact inhibit lypolysis--known fact.

    http://www.ncbi.nlm.nih.gov/pubmed/17130851 is one (if you have access to the full text) as well as the overall body of the current research
    Practical evidence is another, high carb intake in countries (like Japan) and populations (like high carb vegans) does not predict obesity, while high calorie intake coupled with a low calorie expenditure does.
    And then there is the use of calories, not insulin levels, in most weight related studies as a fairly predictable measure for weight loss/gain showing which model is more widely accepted in the scientific community.

    This 2006 review you shared doesn't refute the insulin theory at all. It just reviews some of the available data. The conclusion to the first section on Insulin level and insulin sensitivity in adult populations states:

    The authors failed to find a correlation between fasting insulin and weight gain (similar to the results from many other cohorts, as mentioned above), but did show that high acute insulin response during an intravenous glucose challenge was a predictor of higher weight gain, especially in insulin-sensitive subjects. This is actually not in complete discordance with earlier findings. Indeed, the predictive effect of high acute insulin response on weight gain was diminished in insulin-resistant subjects. Thus, it is possible that at the onset of the weight gain process, insulin may act as an anabolic hormone and conceivably induce fat accumulation. As adiposity increases, insulin resistance develops and may eventually protect the individual against further weight gain.

    Nothing about this refutes what Dr. Fung is saying here about the 2 compartment model. And what's really funny to me is that Dr. Fung makes the same exact observation in one of his blog posts(see 1). Insulin resistance is a protective mechanism for cells--the cells defend themselves against excess insulin at the cost of rising extracellular glucose levels to the host (to its detriment). (EDIT: if you think about what this really means, it's saying that an obese, insulin-resistant person is not going to gain as much fat from a doughnut as an insulin-sensitive person--that's in direct contradiction to the CICO model, where calories in predict weight gain exactly). And the statement here about insulin-sensitive subjects being more prone to weight gain also does nothing but support the insulin theory.

    @Zella_11
    Yes, calorie restriction is essential to weight loss-agreed. However, the process is far more complex, and limiting to that simplistic model can be detrimental to our health (the Biggest Losers' case in point). The "2 compartment model" helps explain why not all types of calorie restriction diets and eating patterns are created equal. If you want to know more, I'm happy to explain :)

    (1) https://intensivedietarymanagement.com/insulin-resistance-good-t2d-7/
  • AnnPT77
    AnnPT77 Posts: 32,419 Member
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    Another thing that strikes me is that people - including the doctor being quoted - always talk about "calorie restriction" as if it was all the same, but there's a big difference between a very low calorie diet and a moderate deficit, at least it terms of how it feels.

    @Crisseyda says above "During calorie restriction, it's basically all you can think about not to eat." - I don't identify with that from my experience of a 500 calorie deficit. Yes, I get hungrier than I do at maintenance, but not obsessionally so, provided I'm careful to eat filling foods. At a higher deficit, I think you probably will start to get obsessional hunger and other unpleasant effects. It's not the same experience.

    Can we assume the body sees these two situations in the same way, or is it reasonable to hypothesise that they are not the same, and that from the metabolic point of view, not all "calorie restriction" is created equal?

    And that makes me wonder if, even at low deficits, you could diet in a way that, as well as leaving you hungrier and less happy, could also have a bigger impact on metabolism?

    "More research needed ".

    To the bolded:

    Satiety seems to be very individual . . . it seems iffy to try to generalize about it. Personally, even when at 750-1000 daily calorie deficit rates, I rarely felt hungry (and if I did, I ate), and certainly not "obsessionally hungry" or that it was "basically all you can think about not to eat" (don't really relate to the latter at all - and I'm not saying that I never overate/overeat . . . but I think that's not the reason).

    I know this is tangent to the main trajectory of the thread.

    Certainly, there are at least some suggestions that how you lose weight matters in how your metabolism reacts, like journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0004377 .
  • Crisseyda
    Crisseyda Posts: 532 Member
    edited June 2016
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    AnnPT77 wrote: »
    Another thing that strikes me is that people - including the doctor being quoted - always talk about "calorie restriction" as if it was all the same, but there's a big difference between a very low calorie diet and a moderate deficit, at least it terms of how it feels.

    @Crisseyda says above "During calorie restriction, it's basically all you can think about not to eat." - I don't identify with that from my experience of a 500 calorie deficit. Yes, I get hungrier than I do at maintenance, but not obsessionally so, provided I'm careful to eat filling foods. At a higher deficit, I think you probably will start to get obsessional hunger and other unpleasant effects. It's not the same experience.

    Can we assume the body sees these two situations in the same way, or is it reasonable to hypothesise that they are not the same, and that from the metabolic point of view, not all "calorie restriction" is created equal?

    And that makes me wonder if, even at low deficits, you could diet in a way that, as well as leaving you hungrier and less happy, could also have a bigger impact on metabolism?

    "More research needed ".

    To the bolded:

    Satiety seems to be very individual . . . it seems iffy to try to generalize about it. Personally, even when at 750-1000 daily calorie deficit rates, I rarely felt hungry (and if I did, I ate), and certainly not "obsessionally hungry" or that it was "basically all you can think about not to eat" (don't really relate to the latter at all - and I'm not saying that I never overate/overeat . . . but I think that's not the reason).

    I know this is tangent to the main trajectory of the thread.

    Certainly, there are at least some suggestions that how you lose weight matters in how your metabolism reacts, like journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0004377 .

    Yup, and it gets even more tricky for people who have insulin resistance at baseline. When they go on a calorie restricted diet, they have an even greater hurdle to overcome in unlocking that "second compartment." They feel hungrier than that person who can more readily and easily switch to fat metabolism for energy--which is why fasting and LCHF diets can be such a powerfully effective tool for them, while others seem to do fine without it. Like @cattofthegarage who just needs to be careful to eat "filling foods."
  • xtina315
    xtina315 Posts: 218 Member
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    That show is just so unhealthy. People's of accounts of taking drugs to make weight etc. No one should lose that amt of weight in a short time, you learn nothing and you cannot continue with that lifestyle
  • Crisseyda
    Crisseyda Posts: 532 Member
    edited June 2016
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    Crisseyda wrote: »
    @Crisseyda that's exactly the point.

    The insulin hypothesis of obesity doesn't hold up well against scientific evidence and his overly simplistic explanations sound more like extrapolations, taking a basic mechanism and drawing unrelated conclusions from it that I don't find particularly pertinent.

    Low carb is not particularly any more or less muscle sparing than any other diet if you control for protein and I have yet to see any consistent evidence that people with higher carb intake/insulin are particularly more prone to gaining fat than those on a lower carb/with lower insulin.

    TBL contestants were most likely low carb, in addition to being effectively in a ketogenic state due to their 4-6 hours a day exercise routine which would leave anyone on a 800ish calorie diet in a ketogenic state, even if every single one of these calories came from carbs.

    Do you have any access to this evidence?

    Dr. Fung shares clear scientific evidence that calorie restricted diets lower BMR and that fasting does not. He then explains the science behind it, which you can find in any physiology textbook. Insulin does in fact inhibit lypolysis--known fact.

    It is also a known fact that perpetuum mobiles don't exist, so every living organism needs a steady supply of energy, so stopping lipolysis because insulin (which you ALWAYS have some amount of in your blood btw) is not a thing that exists in this universe. You wouldn't be able to live.

    @stevencloser

    Here's a nice physiology e-textbook I found for you from the Department of Biomedical Sciences at Colorado State University.

    http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/pancreas/insulin_phys.html

    Insulin and Lipid Metabolism

    The metabolic pathways for utilization of fats and carbohydrates are deeply and intricately intertwined. Considering insulin's profound effects on carbohydrate metabolism, it stands to reason that insulin also has important effects on lipid metabolism, including the following:

    Insulin promotes synthesis of fatty acids in the liver. As discussed above, insulin is stimulatory to synthesis of glycogen in the liver. However, as glycogen accumulates to high levels (roughly 5% of liver mass), further synthesis is strongly suppressed.

    When the liver is saturated with glycogen, any additional glucose taken up by hepatocytes is shunted into pathways leading to synthesis of fatty acids, which are exported from the liver as lipoproteins. The lipoproteins are ripped apart in the circulation, providing free fatty acids for use in other tissues, including adipocytes, which use them to synthesize triglyceride.

    Insulin inhibits breakdown of fat in adipose tissue by inhibiting the intracellular lipase that hydrolyzes triglycerides to release fatty acids.

    Insulin facilitates entry of glucose into adipocytes, and within those cells, glucose can be used to synthesize glycerol. This glycerol, along with the fatty acids delivered from the liver, are used to synthesize triglyceride within the adipocyte. By these mechanisms, insulin is involved in further accumulation of triglyceride in fat cells.

    From a whole body perspective, insulin has a fat-sparing effect. Not only does it drive most cells to preferentially oxidize carbohydrates instead of fatty acids for energy, insulin indirectly stimulates accumulation of fat in adipose tissue.


    So...
    In terms of fat metabolism, Insulin 1. promotes fat storage in the liver, 2. promotes the creation of new fat, and 3. inhibits the breakdown of stored fat. Sounds to me like Dr. Fung is onto something when he says control of insulin is the key to unlocking the second compartment of stored fat!
  • gothchiq
    gothchiq Posts: 4,598 Member
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    A nutritionist can test it for you. You sit still for a period of time and breathe into a machine. From your exhalations they measure your metabolism and basal metabolic rate. This way your true caloric needs can be ascertained. I had this done. It's a very valuable tool.
  • Crisseyda
    Crisseyda Posts: 532 Member
    edited June 2016
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    @Crisseyda It's easy to pick a single point out of a whole post and throw around studies and theoretical ideation at it picked out carefully to support your point (any point has at least a handful of supporting theories if you look carefully enough), but how do you marry your theories with practice? How do you explain TBL contestants slowed metabolism when they were effectively in a ketogenic state if being in a ketogenic state prevents slowed metabolism somehow due to some silly compartment theory?

    It takes a single case to disprove a theory. How do you explain me, insulin resistant, previously pre-diabetic, losing 90 lb comfortably with barely any hunger on a moderate calorie moderate carb diet with quite a few high glycemic foods (which happen to be the most filling for me)? How do you explain 80/10/10 vegans? How do you explain calorie consumption, but not carb consumption, being predictive of obesity? How do you explain high protein diets preserving more muscle mass, reducing hunger and helping fat loss regardless of carb levels when protein is pretty insulinemic?

    @amusedmonkey

    Nah, it's actually a lot easier to take no position and have no answers.

    And, we disagree on whether or not they were in ketosis. Insulin inhibits the breakdown of fat as well as ketone production (see http://www.ncbi.nlm.nih.gov/pubmed?term=3287950 ). In case of these contestants, who are already obese and most likely insulin resistant, their insulin levels are already higher at baseline--it is a greater challenge for them to enter ketosis. A calorie restricted diet is unlikely to be very effective. If you disagree with the theory, fine; but don't pretend the science isn't there--and you have yet to offer any direct counter evidence.

    And as far as all your other questions, did you have any specific scientific evidence to share? About vegans, protein, or the obesity epidemic? I really don't understand why you think all these concepts are mutually exclusive. Obesity and diabetes are multi-factorial diseases, and the role of insulin is one major piece of the puzzle for many people. Each individual person who suffers from obesity likely has unique combination of contributing factors from stress to addiction to culture to history to genetics to food environment and so on.
  • DebSozo
    DebSozo Posts: 2,578 Member
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    annaskiski wrote: »
    People on long term weight loss journeys typically do 'refeeds' for this very reason. (Restoke their metabolism).

    This is not new information. There's a lot of good info from people who regularly cut and bulk (i.e. body builders) on how to protect your metabolism. One good book I've read is "Burn the fat, Feed the Muscle". I'm sure there are others.

    The silly show doesn't allow people time to stop and restoke their metabolism. They'd get kicked off.

    This is true. Bodybuilders know that they need to alternate bulking and cutting and do manage to restore their metabolisms. The show BL is extreme.