Biggest Loser Study – They are gainers now

From (Fothergill E1, Guo J1, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M, Walter PJ, Hall KD.  Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity (Silver Spring). 2016 Aug;24(8):1612-9.):

Of the 16 “Biggest Loser” competitors originally investigated, 14 participated in this follow-up study. Weight loss at the end of the competition was (mean ± SD) 58.3 ± 24.9 kg (P < 0.0001), and RMR decreased by 610 ± 483 kcal/day (P = 0.0004).

After 6 years, 41.0 ± 31.3 kg of the lost weight was regained (P = 0.0002), while RMR was 704 ± 427 kcal/day below baseline (P < 0.0001) and metabolic adaptation was -499 ± 207 kcal/day (P < 0.0001).

Weight regain was not significantly correlated with metabolic adaptation at the competition’s end (r = -0.1, P = 0.75), but those subjects maintaining greater weight loss at 6 years also experienced greater concurrent metabolic slowing (r = 0.59, P = 0.025).

Not a very good result.

Revisiting the “Alpert” Number

I think that the Alpert number may not be right if you are on a Low Carbohydrate diet.

The Alpert number is the maximum rate of fat oxidation from a relatively moderately active person (Hypophagia – How much fat can I lose in a day?). It occurred to me that I can check this number from my own VO2max test.

  • Looking at the REE at rest (REE from VO2max) it shows 2.16 kCal/min.
  • From my Bod Pod results (Overshot My Recomp Goals – Part 1) my fat mass is 12.3 lbs.
  • Multiplying my fat mass times the Alpert number is 381.3 kCals/day. That’s 15.88 kCal/hr or 0.26 kCal/min.

Yet, my REE was 2.1 kCal/min  at and RER of 0.73 (90% fat) which is 1.9 kCal/min from fat oxidation. Flipping the number around that’s 1.9 times 60 times 24 = 2736 kCal per day from fat.

The smallest number I saw in the resting period was 1.209 kCal/min or 1740 kCal/day. dividing 1740 number by my fat weight in lbs is 141 kCal per lb of fat mass. That’s quite a bit more than the Alpert number.

The Minnesota Starvation (Ancel Keys) data was the basis of the Alpert number. Perhaps the difference is in the idea that I am not actually in starvation? And the Minnesota Starvation subjects were fed carbohydrates in their diet.

The Alpert number pretty closely matches my own experiences in Protein Sparing dieting.

Is the Magic in Low Carb, High Fat?

How about neither? How about if the magic is in the increased protein content of LCHF diets? That was the question that this study sought to unravel (Stijn Soenen, Alberto G. Bonomi, Sofie G. T. Lemmens, Jolande Scholte, Myriam A. M. A. Thijssen, Frank van Berkum, Margriet S. Westerterp-Plantengaab. Relatively high-protein or ‘low-carb’ energy-restricted diets for body weight loss and body weight maintenance? Physiology & Behavior. Volume 107, Issue 3, 10 October 2012, Pages 374-380.).

Design

Body-weight (BW), fat mass (FM), blood- and urine-parameters of 132 participants (age = 50 ± 12 yr; BW = 107 ± 20 kg; BMI = 37 ± 6 kg/m2; FM = 47.5 ± 11.9 kg) were compared after 3 and 12 months between four energy-restricted diets with 33% of energy requirement for the first 3 months, and 67% for the last 9 months: normal-protein normal-carbohydrate (NPNC), normal-protein low-carbohydrate (NPLC); high-protein normal-carbohydrate (HPNC), high-protein low-carbohydrate (HPLC); 24 h N-analyses confirmed daily protein intakes for the normal-protein diets of 0.7 ± 0.1 and for the high-protein diets of 1.1 ± 0.2 g/kg BW (p < 0.01).

Results

BW and FM decreased over 3 months (p < 0.001): HP (− 14.1 ± 4 kg; − 11.9 ± 1.7 kg) vs. NP (− 11.5 ± 4 kg; − 9.3 ± 0.7 kg) (p < 0.001); LC (− 13.5 ± 4 kg; − 11.0 ± 1.2 kg) vs. NC (− 12.3 ± 3 kg; − 10.3 ± 1.1 kg) (ns). Diet × time interaction showed HPLC (− 14.7 ± 5 kg; − 11.9 ± 1.6 kg) vs. HPNC (− 13.8 ± 3 kg; − 11.9 ± 1.8 kg) (ns); NPLC (− 12.2 ± 4 kg; − 10.0 ± 0.8 kg) vs. NPNC (− 10.7 ± 4 kg; − 8.6 ± 0.7 kg) (ns); HPLC vs. NPLC (p < 0.001); HPNC vs. NPNC (p < 0.001). Decreases over 12 months (p < 0.001) showed HP (− 12.8 ± 4 kg; − 9.1 ± 0.8 kg) vs. NP (− 8.9 ± 3 kg; − 7.7 ± 0.6 kg) (p < 0.001); LC (− 10.6 ± 4 kg; − 8.3 ± 0.7 kg) vs. NC (11.1 ± 3 kg; 9.3 ± 0.7 kg) (ns). Diet × time interaction showed HPLC (− 11.6 ± 5 kg ; − 8.2 ± 0.7 kg) vs. HPNC (− 14.1 ± 4 kg; − 10.0 ± 0.9 kg) (ns); NPNC (− 8.2 ± 3 kg; − 6.7 ± 0.6 kg) vs. NPLC (− 9.7 ± 3 kg; − 8.5 ± 0.7 kg) (ns); HPLC vs. NPLC (p < 0.01); HPNC vs. NPNC (p < 0.01). HPNC vs. all other diets reduced diastolic blood pressure more. Relationships between changes in BW, FM, FFM or metabolic parameters and energy percentage of fat in the diet were not statistically significant. Metabolic profile and fat-free-mass were improved following weight-loss.

Also (A. K. Gosby A. D. Conigrave D. Raubenheimer S. J. Simpson. Protein leverage and energy intake. Etiology and Pathophysiology, 28 October 2013).

…these trials encompassed considerable variation in percent protein (spanning 8–54% of total energy), carbohydrate (1.6–72%) and fat (11–66%). The data provide an opportunity to describe the individual and interactive effects of dietary protein, carbohydrate and fat on the control of total energy intake. Percent dietary protein was negatively associated with total energy intake (F = 6.9, P < 0.0001) irrespective of whether carbohydrate (F = 0, P = 0.7) or fat (F = 0, P = 0.5) were the diluents of protein. The analysis strongly supports a role for protein leverage in lean, overweight and obese humans.

Keto for the Win – Again

Here is another cross-over study showing the advantage of the keto diet over a medium carbohydrate diet (Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am J Clin Nutr. 2008 Jan;87(1):44-55.).

Ad libitum energy intakes were lower with the LC diet than with the MC diet [P=0.02; SE of the difference (SED): 0.27] at 7.25 and 7.95 MJ/d, respectively. Over the 4-wk period, hunger was significantly lower (P=0.014; SED: 1.76) and weight loss was significantly greater (P=0.006; SED: 0.62) with the LC diet (6.34 kg) than with the MC diet (4.35 kg). The LC diet induced ketosis with mean 3-hydroxybutyrate concentrations of 1.52 mmol/L in plasma (P=0.036 from baseline; SED: 0.62) and 2.99 mmol/L in urine (P<0.001 from baseline; SED: 0.36).

These men were allowed to eat as much as they wanted but chose to eat less when they were given Low Carb food.

 

Am I Keto or Low Carb?

Someone in a Fakebook group posted that keto is:

eating in such a way that about 80% of your calories in come from healthy fats, about 15% from protein and 5% or less from carbs

My median actual maintenance macros for the past 3 months (Maintenance Macros – 2018-07-20) were:

  • Protein: 181g
  • Carbs: 28.52g
  • Fat: 159.6

In terms of percent of calories by macronutrient, that is:

Macro g kcal/g kcal Percent
P 181 4 724 31.8%
C 28.5 4 114 5.0%
F 159.6 9 1436.4 63.2%
2274.4

So I am not keto by this gentleman’s definition since my protein is twice his listed amount and my fat is much lower. My protein number is twice his and my fat number is lower than his.

However, my blood ketone meter shows that I am in ketosis. Here’s the number from yesterday:

And that is nutritional ketosis with a “high” protein intake.

 

Maintenance Macros – 2018-07-20

I started on maintenance macros back on 2018-05-04 using Ted Naiman’s formula based on Protein to Non-Protein Energy ratio of 1:1 (grams:grams).

Macro Numbers (From Our BurnSugarNotFat calculator)

Current Weight: 167 lbs
P:NPE Ratio: 1
Protein: 167g
Carbs: 20g
Fat: 147g

Actual Macros

The median actual macros were:

  • Protein: 181g
  • Carbs: 28.52g
  • Fat: 159.6

This is a ratio of 181:(159.6+28.5) = 181:188 which is pretty close to the 1:1 ratio for maintenance. I have been at higher macro numbers than my goals but my activity level has been enough to support the higher macros.

Weight

My weight has been stable over the time period with some normal fluctuations.

 

PSMF – March 2018 – 2nd Edition

I did a short Protein Sparing Modified Fast (PSMF) back in March (PSMF March 2018). This is a summary of the results.

Maximum Fat Loss Dietary Macros (From KetoCalc)

Protein: 115.0 g (459.9 cals), 36.8% of calories
Carbs: 20 g (80 cals), 6.4% of calories (from leafy green vegetables)
Fat: 78.9 g (710 cals), 56.8% of calories
Initial Maximum Fat Loss: 0.30 lbs per day
At this limit you will use 1063 calories from your body fat per day.

Weight Loss on PSMF

Macros on PSMF

Blood Glucose on PSMF

Some Typical Day’s Foods on PSMF

3-15-2018

3-16-2018

3-19-2018

3-20-2018

3-21-2018

3-22-2018

3-23-2018

 

Carbs, Not Saturated Fats, Increase Fat in Blood

Interesting study that gradually increased carbs and decreased fats shows that fats don’t increase fat in the blood, but carbs do (Volk BM, Kunces LJ, Freidenreich DJ, Kupchak BR, Saenz C, et al. (2014) Effects of Step-Wise Increases in Dietary Carbohydrate on Circulating Saturated Fatty Acids and Palmitoleic Acid in Adults with Metabolic Syndrome. PLOS ONE 9(11): e113605.).

Sixteen adults with metabolic syndrome (age 44.9±9.9 yr, BMI 37.9±6.3 kg/m2) were fed six 3-wk diets that progressively increased carbohydrate (from 47 to 346 g/day) with concomitant decreases in total and saturated fat. Despite a distinct increase in saturated fat intake from baseline to the low-carbohydrate diet (46 to 84 g/day), and then a gradual decrease in saturated fat to 32 g/day at the highest carbohydrate phase, there were no significant changes in the proportion of total SFA in any plasma lipid fractions. Whereas plasma saturated fat remained relatively stable, the proportion of palmitoleic acid in plasma triglyceride and cholesteryl ester was significantly and uniformly reduced as carbohydrate intake decreased, and then gradually increased as dietary carbohydrate was re-introduced.

Blood Sugar and Fasting

A while back, I noticed that my Blood Sugar peaks around the second day of extended fasting. George Cahill did the seminal work measuring blood markers during starvation (Cahill, George. Fuel Metabolism in Starvation.). Here’s an interesting chart from that study that explains the sources of glucose during starvation.

This demonstrates the increase in blood sugar around day 2-3. Diabetics are particularly adept at GNG. Eventually though, even that reduces as the body becomes physiologically Insulin Resistant.

The chart can provide some idea of what happens in a ketogenic diet. Although someone on a ketogenic diet is eating enough food, their exogenous glucose is greatly reduced due to the low carbohydrate content of the diet. Glycogen stores lower next. When the glycogen stores get low the body then upregulates Glyconeogenesis (GNG).

This could also explain why when I see an increase in blood sugars on one morning I often see a drop in weight the following morning. The body is signalling that it is switching fuel to up-regulated GNG due to dropped Glycogen stores. Although these two sources are of the same magnitude in Cahill’s chart above they could well be less equally matched in a diabetic. It is possible that GNG in a diabetic outpaces the ability to pull from Glycogen stores.