Jason Phillips: Talk at Google

Set Point and Metabolic Downregulation

From the above – Jason Phillips @10:00

Say your set point is burning 2500 calories per day. And all of a sudden you are consuming 1500 calories [a day] — because that is a common dietary prescription. What do you think your body is actually doing in this area? It’s downregulating its metabolic response.

Jason goes on

As your consuming less and less calories you are convincing your body to be a fat storage machine not a fat burning machine.

From the article (Metabolic downregulation doesn’t explain dieters’ weight regain):

The theory that adaptive changes in the resting metabolic rate (RMR) of weight-reduced persons predispose them to regain weight is challenged by new evidence published in The American Journal of Clinical Nutrition. The set point theory holds that the body has a homeostatic feedback system which causes an adaptation in the energy efficiency of metabolic processes during calorie restriction, with the aim of maintaining fixed fat stores and body weight. In a study of 24 overweight postmenopausal women, Weinsier et al. found no significant differences in RMR between the subjects once they had stabilized after weight loss and a control group of never-overweight women. Four years after their weight loss, the overweight subjects had regained an average of 10.9 kg, and their RMR’s were not significantly different than they had been previously.

Jason Phillips quotes Lyle McDonald for this theory but he is misunderstanding Lyle’s view. Lyle disagrees with this “metabolic damage/set-point theory” in his article (Another Look at Metabolic Damage, April 17, 2014):

Because in no study that i have ever seen or ever been aware of has the drop in metabolic rate (whether due to the drop in weight or adaptive component) EVER exceeded the actual deficit whether in men or women. Fine, yes, it may offset things, it may slow fat loss (i.e. if you set up a 30% caloric deficit and metabolic rate drops by 20%, your deficit is only 10% so fat loss is a lot slower than expected or predicted) but it has never been sufficient to either stop fat loss completely (or, even to address the even stupider claim being made about this, to cause actual fat gain).

Also from the same article, Lyle wrote:

Perhaps the classic study in this regard was the oft-quoted (and oft- misunderstood) Minnesota Semi-Starvation Study. In it, a dozen or so war objectors got to avoid going to war and arguably got into something worse. That is, researchers wanted to study long- term starvation as might occur during war or famine or being held in a prisoner camp.

Specifically the men were put on 50% of their maintenance calories, subject to forced daily activity (walking, NO weight training) and basically had their lives controlled and managed for 6 months. And in various sub-analyses, it was found that, by the end of the study the total drop in metabolic rate was nearly 40%. That is, of the original 50% deficit in calories, 80% of it had been offset. Of that 40%, a full 25% was simply due to the reduced bodyweight. Again, lighter bodies burn less calories and there’s no getting around it. But that also means that the adaptive component of metabolic rate reduction was only 15%.  Which is about the largest drop ever measured (most studies measure less).

Why Do I Care?

My problem with this notion of metabolic damage is very personal. I didn’t diet for over ten years believing that it would mess up my metabolism even worse. And I was 250-280 lbs in that time-frame. I was wrong. I had plenty of body fat to diet from and was at no risk of any metabolic damage. Nobody with 100 lbs of body fat is at any actual risk of metabolic damage.

At the Extremes

Angus Barbieri is the most extreme evidence of the point. He was 450+ lbs and went on a water only fast for 282 days. He lost weight down to 185 lbs and five years later his weight was just 195 lbs.

The Key is Getting to the “Ideal” Weight

The key for Angus and others is reaching the “ideal” body weight. Often people diet and regain over and over again through their lives. But they never reach their ideal body weight. They might drop from 250 to 220 and they feel great about it. They then regain the weight and probably some more weight – ever ratcheting up.


What are Macros?

Macros are macronutrients. There are four macronutrients:

  1. Protein
  2. Fat
  3. Carbohydrates

There’s also alcohol.


We need dietary protein to replace the constant tearing down of dietary protein that happens in our bodies. There’s a lower limit on the amount of protein that we should eat every day. There’s probably not an upper limit since protein tends to self limit.

For some reason, women seem to have a more difficult time consuming adequate amounts of protein than men.

There are:

nine amino acids that your body cannot create on its own, and that you must obtain by eating various foods. (Link).

Complete proteins are food which have all all of the essential amino acids present. Meat is a source of complete protein. Vegetarians often have to combine vegetable proteins (such as hispanics with beans and rise) to get a complete protein source from vegetables. (Link).


Although we are accustomed to thinking of fat as bad it does serve important functions in our bodies and in our diets. Our body will consume it’s own fat in the absence of enough calories from our diets. That’s what any diet is based on.

There are essential fats:

The body can synthesize most of the fats it needs from the diet. However, two essential fatty acids, linoleic and alpha-linolenic, cannot be synthesized in the body and must be obtained from food. (Link).

Sources of the essential fats can be certain types of plant oil and meat. (Link).


Carbohydrates provide energy but it may surprise you that there are no essential carbohydrates. Here’s some of the reasons that we don’t need carbohydrates:


Carbohydrates drive blood sugar levels and controlling blood sugar requires controlling carbohydrate consumption. Type 2 Diabetics, like myself, when eating very low carbohydrate diets can experience a total remission of their diabetes. As long as they don’t return to carbohydrate eating patterns that got them sick they can stay non-diabetic indefinitely (This BLOG has many posts about Type 2 Diabetes and Carbohydrates).

Carbohydrates can range from complex carbohydrates (typically found along with fiber) and simple carbohydrates (such as sugars).


Fiber is considered indigestible although the microbiome (the little bugs that fill us up) can digest fiber and we can digest the result of their digestion.

MacroNutrients and Calorie Counting

Macronutrients are measured in grams. There’s a simple conversion from grams of a macronutrient to calories.

  • Fat has 9 calories per gram
  • Protein has 4 calories per gram
  • Carbohydrates have 4 calories per gram

And for the sake of this discussion fiber can be considered to have around 1.5 calories per gram.

Macronutrient Mixes

There are few foods found in nature which are purely one thing or the other. Most unprocessed meat has nearly zero carbohydrates although fresh (meat that has not undergone rigormortis may have glycogen (form of carbs) in it.

Very lean meats, like lean turkey breasts, have almost no fat as well and are widely available sources of protein. Another source of “concentrated” proteins are Protein Powders.

Dietary Approaches

Every diet out there has a specific mix of macronutrients.

In this chart they are represented as the percent of calories of each macronutrient.

I’d like to contrast two of these diets. One is to eat whatever you want (ad lib dieting), but with restricted food groups. The other involves monitoring consumption and limiting food based on tracking (not ad lib).

Ad Lib Keto, AKA Lazy Keto

For most people cutting out carbohydrates, particularly simple sugars and reducing the amount of starches will result in a lot of weight loss. I went from 285 to about 225 that way and I could have stayed at 225 forever using Lazy Keto. All I had to do was keep my carbohydrate intake to less than 20 or 30 grams a day. Combined with Intermittent Fasting (eating in the evening only in my case) made this easy to comply.

For most people keto means Very Low Carbohydrates, Moderate Protein and very high fat.

The problem is that I didn’t want to be 225 and found that I needed to adjust my strategies.

Tracking Macros

This leads to the idea of Tracking Macros.

I use a phone/computer app called cronometer to track my macros. (My review of Cronometer). Another popular app is MyFitnessPal (MFP). The free version of MFP doesn’t allow as direct control of macros as the free version of Cronometer which is why Cronometer seems to have more of a market hold on low-carb dieters.

My Particular Goals

I have goals for my macros and adjust the macros as needed to match those goals. My goals are very particular to my situation. As a former diabetic I don’t want to do anything that might lead me to becoming a diabetic again. For me this means:

  • Carbohydrates low (less than 20 or 30 grams a day)
  • Protein at a higher level to support exercising and my age (1 gram per pound of lean body mass) or about 145 grams a day.
  • Fat at the right level to gain, lose or maintain weight

Your Goals


Your macros should be set to meet your own goals. If are one of the 40% of the population who has the symptoms of Metabolic Syndrome (if you are reading this BLOG you probably fit this) then Ketogenic Macros might make the most sense. I know it did for me. Although it helped, Low Carb levels of carbohydrates weren’t low enough for me to not be a diabetic.

If you are an athlete who works out 6 hours a day you may be able to tolerate a lot more carbohydrates. Or, like Stephen Phinney who was an endurance runner, those years of eating too many carbs may result in you becoming a diabetic. You can only do so much damage to your body before it will fight back.

“CrossFit Macros”

If you are at a Crossfit box (gym) they may recommend you eat Zone macros which is a significant improvement over the standard American diet (Here are my thoughts on the Zone Diet versus the Standard American Diet). The Zone macros (as a percentage of total calories) are:



Stalls and Historical Weights

My pet theory, which I can’t find in the science, is that historical weights are often stall points. I was 208 lbs for a while in college and it was tough for me to get lower than that in my 50’s. Even though it had been 30+ years since I was last at that weight it seemed to me that my body “liked” that weight.  I also remember that I tried to diet at that weight and didn’t lose much weight. I also took up running thinking that would help. It didn’t.

My particular theory is that stalls are a function of things like-

  1. Weight you were stable at.
  2. How long you were stable at that weight.
  3. How many years ago you were at that weight.
  4. Whether or not you previous dieted to/from that weight.

2018-05-3 Added this study (F1000 Med Rep. 2010; 2: 59. Is there evidence for a set point that regulates human body weight? Manfred J Müller, Anja Bosy-Westphal, and Steven B Heymsfield).



Ran across an older study (The American Journal of Clinical Nutrition, Volume 83, Issue 5, 1 May 2006, Pages 1055–1061. Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets. Carol S Johnston Sherrie L Tjonn Pamela D Swan Andrea White Heather Hutchins Barry Sears) which indicates that LDL is directly tied to BHB levels:

LDL cholesterol was directly correlated with blood β-hydroxybutyrate (r = 0.297, P = 0.025)

The study was only six weeks so it was too short a term to provide much of value in the critique of ketogenic low-carbohydrate diets. The main criticism was that people had a lack of energy on low carb during what we now know is the adaptation phase.

More details:

Compared with baseline, the 6-wk LDL concentrations increased in 5 KLC dieters (0.08, 0.13, 0.41, 0.44, and 0.52 mmol/L, respectively) and decreased in the remaining 4 KLC dieters (0.57 ± 0.18 mmol/L)

Another interesting point:

 Weight-adjusted REE increased in both diet groups over the 6-wk trial, but blood β-hydroxybutyrate concentrations were not correlated with REE (r = −0.014, P = 0.921), which indicates that the protein content of the diet, rather than the severity of the carbohydrate restriction, likely contributed to the elevations in REE.  These data support the contention that calorie-reduced diets high in protein facilitate weight loss, in part, by preserving the metabolic rate.


Low-ish Carb Diet and Diabetes

A five week long study was conducted to determine the effect of a non-ketogenic but still low-ish carb diet on blood sugar numbers in diabetes (Diabetes 2004 Sep; 53(9): 2375-2382. Effect of a High-Protein, Low-Carbohydrate Diet on Blood Glucose Control in People With Type 2 Diabetes. Mary C. Gannon and Frank Q. Nuttall).

The study compared diets with two different macros. The carbohydrate:protein:fat ratio of the Low Carb diet was 55:15:30. The test diet ratio was 20:30:50. Again, note this was not ketogenic levels of carbohydrates. The diet was “weight-maintaining”.  Assuming this is a 2000 calories a day diet that would be 2000 * 0.2 = 400 calories or 100 grams of carbohydrates a day.

The subjects were tested and their Plasma and urinary β-hydroxybutyrate were similar on both diets indicating that the lower carb group was not in nutritional ketosis.

The results were favorable for the Low Carb group.

The percentage of glycohemoglobin (HbA1c) was 9.8 ± 0.5 on the control diet and 7.6 ± 0.3 on the Low Carb diet. It was still decreasing at the end of the Low Carb diet. Thus, the final calculated glycohemoglobin was estimated to be ∼6.3–5.4%.

The reason they estimated the final HbA1c numbers would be lower was that:

The mean 24-h integrated serum glucose at the end of the control and LoBAG diets was 198 and 126 mg/dl, respectively.

Carbohydrate Control is the Key to Blood Sugar Control

As the study noted:

Data obtained in our laboratory (1–3) as well as from others (reviewed in 4) indicate that glucose that is absorbed after the digestion of glucose-containing foods (carbohyrates) is largely responsible for the rise in the circulating glucose concentration after ingestion of mixed meals. Dietary proteins, fats, and absorbed fructose and galactose resulting from the digestion of sucrose and lactose, respectively, have little effect on blood glucose concentration.

The study did increase protein by 2x but a previous study had isolated the protein affects on HbA1c:

We previously reported that a diet in which the protein content was increased from 15 to 30% of total food energy, with a corresponding decrease in carbohydrate content, resulted in a moderate but highly statistically significant mean decrease in glycohemoglobin (8.1–7.3%) after 5 weeks on the diet. This was the consequence of smaller postmeal glucose increases. The fasting glucose concentration was unchanged (12).

Thus, the increase in Protein did help the HbA1C due to the decrease in carbohydrates that came along with that increase.

The conclusion was unavoidable given the data:

Thus, the dietary modification that we refer to as the LoBAG diet has the potential for normalizing or nearly normalizing the blood glucose in people with mild to moderately severe type 2 diabetes.

Not as well as the ketogenic diet, but pretty good nevertheless. I did low carb some time back and get my HbA1C to 6.4 (with other meds). But I like my 5.2 number better now.


Protein does not turn into chocolate cake

From (The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 3, 1 March 2001, Pages 1040–1047, Effect of Protein Ingestion on the Glucose Appearance Rate in People with Type 2 Diabetes. M. C. Gannon J. A. Nuttall G. Damberg V. Gupta F. Q. Nuttall.):

Amino acids derived from ingested protein are potential substrates for gluconeogenesis. However, several laboratories have reported that protein ingestion does not result in an increase in the circulating glucose concentration in people with or without type 2 diabetes. The reason for this has remained unclear. In people without diabetes it seems to be due to less glucose being produced and entering the circulation than the calculated theoretical amount. Therefore, we were interested in determining whether this also was the case in people with type 2 diabetes. Ten male subjects with untreated type 2 diabetes were given, in random sequence, 50 g protein in the form of very lean beef or only water at 0800 h and studied over the subsequent 8 h.

Protein ingestion resulted in an increase in circulating insulin, C-peptide, glucagon, α amino and urea nitrogen, and triglycerides; a decrease in nonesterified fatty acids; and a modest increase in respiratory quotient.

The total amount of protein deaminated and the amino groups incorporated into urea was calculated to be ∼20–23 g. The net amount of glucose estimated to be produced, based on the quantity of amino acids deaminated, was ∼11–13 g. However, the amount of glucose appearing in the circulation was only ∼2 g. The peripheral plasma glucose concentration decreased by ∼1 mM after ingestion of either protein or water, confirming that ingested protein does not result in a net increase in glucose concentration, and results in only a modest increase in the rate of glucose disappearance.


Is this Keto?

A very common question for those of us who eat a keto diet is “Is this [whatever] keto?”. Along with it comes comments like “you mean you can’t eat bread [or whatever]”.

You can google almost any food with the phrase Nutrition Facts to get the carb values. For instance “google banana nutrition facts” returns:

The total carbohydrates for a medium banana is 27g. I subtract off fiber because your body doesn’t digest fiber (although the microbiom in you does) so the next carbs is 23.9g. That’s more than a day’s worth of carbs in one medium banana. So no, bananas don’t fit in keto numbers.

It’s down to carbs

In the end, it’s as simple as the number of grams of carbohydrates. There are no hard and fast definitions of what constitutes Low Carb and what constitutes ketogenic. The technical answer is what amount of carbohydrates you can eat in a day/meal that keep you in ketosis.

What is Ketosis?

But that begs the question of what constitutes being in ketosis. There’s also no accepted range of numbers or measurement methods. But the idea is that your body is using ketones for fuel. Even that is not an absolute since everyone uses some mixture of ketones and glucose. If you do an extended fast your body will generate glucose from your liver which converts fat to glucose in a process called Gluconeogenesis (GNG).

The easiest thing to measure and track are carbohydrates using a scale and an app like Cronometer which can show you the total number of carbs in your day.

Measuring Ketones

Ketones can be tested by three methods; blood, urine and breath. Each of these tests measure chemicals produced as a byproduct of ketosis. There’s some correlation between these three measurements but even that is not absolute.

Nutritional Ketosis Measures Blood Ketones

A widely accepted method is to use blood ketones and measure them against a standard. Except that there is no standard. Often cited is Stephen Phinney’s definition of “nutritional ketosis” illustrated below:


This says that blood ketones in the range of 0.5 to 3.0 mmol are optimal for brain and muscles.

Is this Food Keto?

Using this definition any food which you eat over a meal/day that drops your blood ketones below 0.5 mmol is not keto. But there’s no easy mapping of how many carbohydrates it takes to push someone to below that number. A commonly asserted amount is 20 grams of carbohydrates per day will take a person out of nutritional ketosis. For most people this number will be adequate. For others it may be too high and for others it may be too low.

The Only Way to Know is to Measure

The only way to know for sure is to measure the effect of a particular food or activity on your ketone levels. And testing isn’t cheap at around $5 a test strip. I’ve used the Precision Xtra meter for my measurements but I never actually mapped carb amounts to ketone levels. I mostly tracked the ketone levels vs days of fasting.

Cheaper Way to Measure

A cheaper way to measure is urine test strips. They are around $5 for 50 strips. You pee on a strip and compare the color of the strip to a scale. They work well for most people (at least at the beginning) but are affected by urine concentrations (which is a function of your level of hydration). They are also slow to react to diet changes. They can indicate what your level of ketosis was hours ago.

Another Expensive Way to Measure

I also bought a breath ketone measurement device, the ketonix. It is fairly expensive but can be reused.

The trouble is there’s a messy mapping from breath to blood ketones. Here’s the scatter diagram from breath to blood ketones with the best fit curce. Going up from 0.5 mMol to the line shows that that’s something like 2.0 PPM.


The ketonix has a USB interface and the data can be downloaded to your computer. Here’s a screen shot of one capture showing the level at 5.4 ppm which would be around 1 mMol.


In the end, the best way to be in ketosis is to eat a very limited amount of carbohydrates such as less than 20 grams a day.


CrossFit and Nutrition – Part 5 – Greg Glassman’s Offensive Tweet

CrossFit’s Greg Glassman posted a Tweet which was taken as offensive by some diabetics. Here’s the Tweet:

The criticism came largely from people who were Type 1 Diabetics since this tweet implies that diabetes is a choice of whether or not to drink sugary drinks. And it is true that for Type 1 Diabetes it’s not a lifestyle choice that leads to the Type 1 Diabetes.

But it’s true for both Type 1 and Type 2 diabetics that sugar isn’t their friend.  This is a helpful graphic that makes the point. Which diabetic can take that much sugar without affecting their blood sugar? More importantly what value does that sugar bring to anyone’s life – diabetic or not.

At the risk of offending a Type 1 diabetic sugar is your enemy. Same for a Type 2 Diabetic. Yes, the type 1 diabetic can’t cure their diabetes by eating a low sugar diet. But your diabetes can be controlled much more easily with less sugar. You will take in less Insulin. Even Type 1 Diabetics can become Insulin Resistant.

And I have zero doubt as a former Type 2 Diabetic that the vast majority of Type 2 Diabetics have no business drinking any sugary drink. Yes, those drinks are killing you by raising your blood sugar.

Diabetes professionals know better, though. From (Diabetes Care 2004 Feb; 27(2): 538-546. Carbohydrate Nutrition, Insulin Resistance, and the Prevalence of the Metabolic Syndrome in the Framingham Offspring Cohort. Nicola M. McKeown, PHD, James B. Meigs, MD, MPH, Simin Liu, MD, SCD, Edward Saltzman, MD1, Peter W.F. Wilson, MD4 and Paul F. Jacques, SCD)

the prevalence of the metabolic syndrome was significantly higher among individuals in the highest relative to the lowest quintile category of glycemic index (1.41; 1.04–1.91).

And shame on the Diabetic community for not recognizing the role of sugar in both Type 1 and Type 2 diabetes.

Yes, Glassman is right. #SugarKills


Calories In Calories Out – Revisited Again

Here’s some thoughts I have on the Calories In/Calories Out (CICO) model.

The CICO perspective has value but I think where Fung’s contribution worked for me and others was the role of Insulin in weight gain and carbs being the driving force in Insulin Resistance. Combining Low Carb with Intermittent Fasting made for easy compliance. The reduction of Insulin levels over extended periods of time frees the body to release body fat. The release of body fat reduces the need for calories from the diet since part of the fuel that body needs comes from the body rather than meals.

I see Fung’s advice as focused on his patient population which as a kidney doctors is many older diabetic patients. He found that his patients were compliant with Intermittent Fasting and Low Carbohydrate diets. Probably much more so than the standard population because they were seeing a kidney doctor to begin with. Faced with the possibility of failing kidneys or eating OMAD/Low Carb the alternative seems pretty bad.

Also, there are differences in body composition between various diets. Some are more effective than others at shifting the lean mass/fat mass proportions. http://www.ergo-log.com/paleo-diet-makes-fat-cells-lazy.html

I think they do matter but not so much at the start of the diet. Eventually we have to pay attention to them when we stall with lazy keto. But I got from 285 to around 220 with being completely lazy keto. Never would have reached goal weight, though.

Put another way when we have 100 lbs of body fat that’s 3100 calories a day of fat we can easily pull from our fat stores. Easy to do a caloric “deficit” since we have plenty of surplus to draw from in our bodies.

I’ve been looking into the three compartment theory of diabetes and it seems to have legs to me. First our body’s fat cells fill up. Then our liver fills up with fat. Last our pancreas gets choked with fat which keeps us from making enough Insulin. When that happens our fat backs up into our blood in the form of very high triglycerides. When I was Dx with T2D my triglycerides were over 5000. In fact, they couldn’t get an assay on the number since it was too high. Putting someone on Insulin gets them over that by allowing the fat cells to get even fatter. I gained 50 lbs when the doctor put me on Insulin and my diet was not any different.

This has application in this situation since the fat cells stay locked closed due to high Insulin. There are studies which show CICO doesn’t exactly apply in these cases. Diabetics take more Insulin and eat less calories but still gain weight. There’s a strong relationship with Insulin and body fat.

Intermittent fasting and Low Carb break that relationship by lowering basal Insulin levels and allow the liver to begin dumping the fat. That only takes about a week. The pancreas gets less fatty within 2 weeks and the body’s fat cells drop thereafter.

To me the key is the role of Insulin and that’s Fung’s “contribution”. He’s not a researcher but applied what he learned in the clinical setting.

Bottom line is that if someone is Type 2 Diabetic they can get off meds very quickly by following Fung’s approach of Intermittent Fasting and Low Carb. They can learn to count calories/macros later on when they stall if they want to get lower in weight (and some of them may not care about their weight, they just want to be no longer diabetic).

The reason I think CICO matters later on is that our hormones, particularly Insulin, get in order and then the standard model applies.

There are studies which also show CICO is not matched by the data. For example: https://academic.oup.com/jcem/article/88/4/1617/2845298

The mechanism of the enhanced weight loss in the very low carbohydrate diet group relative to the low fat diet group is not clear. Based on dietary records, the reduction in daily caloric intake was similar in the two groups. For the greater weight loss in the very low carbohydrate group to be strictly a result of decreased caloric consumption, they would have had to consume approximately 300 fewer calories/d over the first 3 months relative to the low fat diet group.

I think Protein is the power multiplier between Low Carb and SAD. In part it has something to do with the Thermic Effect of Food with Protein using about 25% of the calories to process and fat and carbs being much less. So Calories in and Calories out need to take into account the source of the calories.

I’m eating about 2800 calories a day now on Carnivore diet with around 280g of Protein a day. Far in excess of my “Needs”. Some of that we just eliminate as Urea – again outside of the CICO model.

Or maybe the CICO model is just really, really complicated compared to what we see on the standard calculators?

My guess is that the standard calculations for BMR and TDEE are inherently based on the SAD macro ratios. They don’t correct for overconsumption of protein nor do they correct for underconsumption of carbohydrates. They don’t take into account hormonal factors either nor medications such as Insulin.

They are good first order approximations. Eat and track macros and by extension calories. Watch the scale. If you are gaining you need to cut back. If you are maintaining then things are set pretty close. If you want to lose you need to cut.

In my case my methodology is:
Less than 20 g of carbs
At least 1 gram of protein per lb of Lean Body Mass
Enough fat to fill the gap between the first 2 and what I want to lose.

Here’s the calculator I wrote to calculate macros.