Treatment of obesity with calorically unrestricted diets (1953) [pdf] | Hacker News Reader

Treatment of obesity with calorically unrestricted diets (1953) [pdf]

ajcn.nutrition.org

23 pointsDiabloD329 comments

Having quite a few years of experience treating obesity it's interesting how often this topic comes up here. As several posters say, the "paleo" diet in some form is not a recent idea. Despite paleo's apparent merit, the "standard" high-CHO diet continues to predominate. But why?

I can only speculate. Much has been written about "carbohydrate addiction", an idea that remains controversial, yet there's some evidence for it. We know about the huge amounts of sugars in processed convenience foods, disrupting the body's energy-handling mechanisms, shunting calories into fat deposition.

Industrialization plays a role, it's cheaper to produce and distribute pleasing sugar-rich items vs. fresh farm-grown vegetables. Healthful food is expensive and less available, especially for economically stressed populations. For others, the problem is exacerbated by a demanding, tech-driven lifestyle. Under pressure, taking time to consider what's truly beneficial for health is less likely. Just grab the Starbucks and let's go.

While obesity is in part a behavioral issue, it's a fallacy to assume it's only a subset of the "mental health" domain. I assert obesity is the most complex medical condition we face. All body systems, down to each and every cell has a stake in the intake and distribution of energy, and plays some role in these processes.

Metabolic illness is among the most prevalent and costly to our economy, and also among the most intertwined with psychiatric, medical, cultural, and political phenomena. As pointed out, Banting's fish diet of 1863 worked, but also roundly criticized. The insight keeps reemerging, which seems to mean it's a pointer to solutions, not itself a solution.

Comments like this are why I love this site.

The real problem with diet and obesity research is that they are trying to identify "universal truths". Unfortunately, an individual's response to nutrient intake is highly specific, and depends on genetics, activity level, adiposity and gut flora. This is why controlled studies don't show a significant difference between low carb and high carb diets. Researchers tend to view the intra-group differences are just random variation, when in actuality different diets are better for different people.

There is no such a thing as "carbohydrate addiction", our body is built to live off carbohydrates, there is no reason why you should be able get addicted to carbohydrates any more than you can get addicted to water.

Obesity is a real illness. Overeating is one of its symptoms and not its cause. Obese people gain weight because they feel hungry too much and too often. In fact, some people's caloric intake doesn't even seem to be limited by their appetite, but by the volume of food they're able to consume. There is no way you could blame people's neglience or a lack of self control anymore, people simply shouldn't WANT to eat that much. There is either something wrong with our food (like some unrecognized vital nutirents missing) or there is some other thing that breaks our metabolism.

Keto's been around for a long, long time.

In my own experience with keto, the biggest reason why it works is that it's very difficult to eat at a surplus. I can eat a pound of pasta in one sitting. In contrast, eating that same amount of calories in meat and vegetables is much more difficult. You can get fat very easily by eating pizza and drinking beer. It is significantly harder to do so by drinking water and eating lentils and chicken.

Don't lentils contain too many carbs for keto? One friend of mine started doing it a few months ago, he has lost a lot of weight. He eats less than 25g of carbs a day, and lentil servings usually surpass that.

Lentils are popular in the "slow carb" diets, as they are a moderately low-carb legume. People doing full-on keto would probably avoid them.

> eating that same amount of calories in meat and vegetables is much more difficult

Only if it's lean meat, though.

Fatty meat with a creamy, cheesy dressing on those veggies on the other hand ...

My experience has been that I can lose weight if I eat all I want of bacon, nice marbled chuck steaks, broccoli with (flour-less) cream sauce, cottage cheese, fried eggs and bullet-proof coffee.

God save you if you are trying to do low-fat keto, that sounds almost as awful as being a gluten-free vegan.

Fat is not the devil, and one calorie does not equal one calorie metabolically.

> Fat is not the devil

The devil may be the definition of "all I want" based on what foods it is restricted to.

Convenience is a factor. It's easier to reach for another bagel and put peanut butter and jam on it, then to fry up more eggs or grill another steak. Not to mention cheaper.

If additional servings of meat are readily available, you might suddenly find that "all you want" actually more closely corresponds to "all that is there".

I've eaten leftover meat from a company BBQ like it's potato chips!

Put ten "nice marbled chuck steaks" in front of me and they are gone.

Some ten years ago, I tried the "low carb, eat meats without restriction" approach and I started gaining (and so pulled the brakes on that experiment). The thing is, I was very lean at that time from a regime of diet and endurance exercise.

For someone who is obese and eats uncontrollably due to the abundance of easily prepared carby snacks, it is easy to see how switching to satisfying food that contains protein, requires preparation, and is more of an actual meal, is helpful.

I don't see how it makes sense to focus on a single study in 1953. Most of the comments here imply that this study found the truth, which has been ignored or forgotten since then. On the other hand, the mainstream claims to have come to a different conclusion on diet based on a huge number of other studies [0][1]. If you're going to use this study as evidence for low carb diets, you have to explain why this particular study is so important, why it was better designed or otherwise more conclusive that studies that came before/after it, etc. Otherwise this is just cherry picking.

[0] https://en.wikipedia.org/wiki/Low-carbohydrate_diet#Opinions...

[1] https://en.wikipedia.org/wiki/Medical_research_related_to_lo...

It's fun reading papers from the 1950s because this would never be published today.

I had an interesting thought reading this. It's well-known that caloric restriction extends lifespan. People who are obese but lose weight have metabolic changes similar to those induced by caloric restriction (lower BMR among others). I wonder if those who were formerly obese but are able to keep off weight have longer lifespans.

this is very well known in the scientific community (which is one of the reasons it's unlikely to be published today). one of the key challenges in diet science is that what works for individuals may not be an ideal public health or clinical recommendation.

re your hypothesis, i don't know of any studies on your specific question (there aren't many people who keep the weight off -- the national weight control registry is following several thousand), but there are studies showing that people who weight cycle minimally (1-4 times) have lower all-cause mortality: http://aje.oxfordjournals.org/content/early/2012/02/01/aje.k...

My model of the obesity crisis is that it's fundamentally a mental-health issue, not a nutritional one. Food and eating is connected to your motivational and emotional centers on a deep and fundamental level. The actual mechanics of losing weight is fairly straightforward, but turning an over-eater into a healthy-eater isn't.

The problem is do you consider the minds reactions to hormones mental or nutritional? You can have plenty of 'willpower' but if your chemistry craves balance then you have blurred boundaries into saying its both, neither and that they are broken abstractions.

"Willpower" isn't the answer, either. Like, long-term expenditure of willpower isn't a good solution to any problem. I hope I didn't imply that that was my proposed solution.

Like, what I'm saying is that if you replaced the decision-making process for eating with an algorithm designed to bring someone to a specific body weight, that would basically solve the obesity problem.

To answer your question more directly, there may be nutritional solutions to the mental problems that lead to over-eating.

Seems like the discovered the effects of low-carb diets sixty years ago?

How did you find this paper, out of curiosity? Makes you wonder how many other discoveries were made and ignored.

From a doctor I'm friends with who introduced me to Paleo years ago. He thought this was pretty funny that we keep rediscovering the truth and keep ignoring it.

Possibly because the optimal diet is a highly individual thing that depends on someone's activity level, body fat, genetics and gut bacteria? Paleo/keto diets tend to work very well for people who are overweight and sedentary, that doesn't mean everyone should be on that type of diet.

Just as a simple example, I'm extremely lean/muscular, and I typically get ~2 hours a day of exercise. I kick ass and take names on a high carb low fat diet, while I get flat and lose strength when I switch to a high fat low carb diet.

Not just 60. https://en.wikipedia.org/wiki/William_Banting

Actually this made me wonder how far back you could go, and a little searching turned up a vaguely-decent match from antiquity: "Obese people and those desiring to lose weight should perform hard work before food . . . Their meals should be of a fatty nature as people get thus satiated with little food. They should, moreover, eat only once a day and take no baths and sleep on a hard bed and walk naked as long as possible. —Hippocrates (Hippocrates on Diet and Hygiene, Zeno, London, 1952)" at http://forum.lowcarber.org/archive/index.php/t-464645.html which was ironically hard to find among all the hits for a vegetarian Hippocrates Diet.

>sleep on a hard bed and walk naked as long as possible

That's the problem , huh. I'll have to let my co-workers know that they're in for a few weeks of naked walking around the office.

I wonder if the walking naked "as long as possible" is about the seasons? That is, subjecting yourself to colder temperatures -- which is also a modern recommendation (cold showers) in some of the same circles as recommend a high-fat diet with intermittent fasting ("eat only once a day", "hard work before food").

If so, the hard bed's the only part that been dropped.

Almost definitely not. Vitamin D deficiency is fairly common today, even with good food sources like fortified dairy products and eggs. The ancient Greeks didn't have fortified dairy and the chicken hadn't been domesticated yet, so the only readily available food source of vitamin D was liver. Luckily, the body can produce vitamin D; half an hour of naked sun exposure is more than sufficient to meet your daily requirements.

That sounds like a better idea. I've seen a couple claims that higher vitamin-D levels go with lower weight, e.g. https://www.fredhutch.org/en/news/releases/2014/04/vitamin-d...

The Yellow Emperor's Classic, which is over 2,000 years old and possibly the most important fundamental text in Chinese Medicine, advocates avoiding grains in many situations ... but there is much debate on exactly what was meant.

https://en.wikipedia.org/wiki/Huangdi_Neijing

https://en.wikipedia.org/wiki/Bigu_(avoiding_grains)

Interesting, what kind of debate?

Possibly something to keep in mind, but when ancient Chinese authors are talking about grain, they are probably talking about wheat, barley, millet or sorghum, rather than rice. The nucleus of Chinese civilization was in the Yellow river region, in northern China, where rice was not a native plant - as opposed to the Yangtze and Cantonese regions of China, which were colonized later.

Galen mentioned low carb diets as a treatment for epilepsy, and for certain kinds of athletes. It works very well as a treatment of epilepsy, and doctors who have prescribed it have noticed it helps people lose fat as well.

Pretty much this was common knowledge until the 80s when people started suggesting pasta and cornflakes diets.

Here are some videos that convinced me to try low-carbs a few years ago:

https://www.youtube.com/watch?v=dBnniua6-oM Sugar: The Bitter Truth

1h29 - One of the best information (as in biology) video around about sugar.

----

https://www.youtube.com/watch?v=lDneyrETR2o Why We Get Fat

1h10 - A little less technical (IIRC), but still a great insight on what's going on.

----

https://www.youtube.com/watch?v=_vfK5U9qKaI TWiT Live Specials 124: The Sugar Hill

55min - Steve Gibson on his discovery of low-carbs, how and why it works.

----

https://www.youtube.com/watch?v=dSLf4bzAyOM - Dr Eric Westman - Duke University New Atkins Ketogenic Diet for Weight Loss and Health

38min - Dr Eric Westman guide patients through what they can eat and what will be transition 'symptoms'.

Eat what you can shows the ancestors https://youtu.be/BMOjVYgYaG8

Reply on news.ycombinator.com