High protein magic

Remission of pre-diabetes to normal glucose tolerance in obese adults with high protein versus high carbohydrate diet: randomized control trial (Stentz et al., 2016)

n=12/group

Duration = 6 months

Diet: all food provided.  Mucho gusto!

 

Critique #1: if my calculations are correct, we’re comparing low protein (0.675 g/kg) to adequate (1.35 g/kg) (not “high”).

The diets were decent:

 

 

Results:

 

 

Author’s conclusion was that this was due to high protein alone, but I’d say it was at least partially due to weight loss.  BOTH groups lost weight and improved insulin sensitivity.  Statistically significant in both groups.

 




 

Glucose (A) and insulin (B) in response to a 75g OGTT (red is high protein, blue high carb):

 

 

I still say weight loss was the primary driver, but must concede, however, that protein did have a little magical effect: high carb group actually lost slightly more weight, but insulin sensitivity improved more in the high protein group.  The high protein magic: reduced insulin secretion yet still greater reduction in glycemia.

 




 

Well, maybe not magic…

 

 

Despite having more insulin, high carbers lost slightly more fat mass but way more muscle.  THAT’s high protein magic lol

 

However, the meal tolerance tests show a slightly different trend:

 

 

We expect glucose and insulin excursions to be greater in HC (blue), because they had a high carb meal whereas the HP group had a high protein meal.  From this perspective, if we graphed the results as “change from time zero,” I think the reduction in glycemia from baseline to 6 months would be similar in both groups suggesting weight loss as bigger factor.  We’d still give some props to high protein because it lowered glucose just as much despite having less insulin.  High protein magic.

 

Note to self: gotta stop saying this was “high protein.”  1.35 g/kg is not “high,” seriously.  But still, High protein magic haha

 

Oh and one other thing, high protein usually induces greater weight loss:

Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity (Skov et al., 1999)

High protein vs high carbohydrate hypoenergetic diet for the treatment of obese hyperinsulinemic subjects (Baba et al., 1999) (not ad lib)

Comparison of high-fat and high-proein diets with a high-carbohydrate diet in insulin-resistant obese women (McAuley et al., 2005)

The effect of a low-fat, high-protein or high-carbohydrate ad libitum diiet on weight loss maintenance and metabolic risk factors (Claessens et al., 2009)

 

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Light and food in the morning

Suggested pre-reading: Metabolism at night

Recently, when the topic of breakfast came up, I got something like this: “correlation isn’t causation, and anyway, it’s because people aren’t eating bacon & eggs at night, they’re having cake & alcohol.”

OK, you can’t say “correlation isn’t causation” and then suggest a cause, literally, in the same sentence.

But anyway, yeah, that actually is a plausible cause. Cake & alcohol are mainly consumed at night.

Also, metabolism is gimped in the evening: 1) skeletal muscle insulin resistance; 2) adipose tissue insulin sensitivity; and 3) impaired diet-induced thermogenesis.

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Conserved lean body mass? O_o

Alternative title: keto isn’t muscle-sparing if you compare it to any remotely sensible control group.

Exhibit A. Resistance training in overweight women on a ketogenic diet conserved lean body mass while reducing body fat (Jabekk et al., 2010)

The exercise intervention was resistance and progressive.  The diet was ketogenic, confirmed by urinary ketones… of note, presence of urinary ketones is a better indicator of ketosis than any information about diet (although they were advised to start at <20g carb/d).

 

 

As per usual, the LC diet was higher in protein… but that wasn’t enough to induce skeletal muscle growth, even when combined with resistance exercise… worded another way, resistance exercise and more protein prevented ketogenic diet-induced muscle loss:

 

 

Neither group was instructed to restrict energy intake, but from the above graph it’s relatively safe to assume the LC diet counteracted exercise-induced hunger.

Confirmed:

 

 

However, exercise-induced hunger isn’t conducive to fattening because the cause is exercise.  I think.

Ketones may spare muscle during starvation, but not in the context of regular people eating a ketogenic diet.  Otherwise, muscle mass would’ve increased in that study relative to the control group.  Confounded by negative energy balance?  Perhaps, but from where I’m standing, the LC diet did almost exactly what we expected: reduced food intake and induced a selective loss of fat mass.  And exercise also performed as expected: increased muscle mass.  In other words, if you want to gain muscle, you need calories, protein, and exercise.  Keto provides no advantages in this context.

 




 

Exhibit B. The effect of weight loss by ketogenic diet on the body composition, performance-related physical fitness factors, and cytokines of Taekwondo athletes (Rhyu and Cho, 2014)

Keto dieters got 33% more protein (40% vs. 30%), and still managed to lose almost twice as much lean mass as non-ketogenic dieters.

 

(figure from Suppversity)

 

The participants were physically active, and thus likely fairly insulin sensitive, so this may be why those assigned to a ketogenic diet lost less body fat…

 




 

Exhibit C. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women (Volek et al., 2004)

And in this study on sedentary insulin resistant folk, keto still wasted muscle (NS) despite more protein and calories:

 

 

If you’ve been paying attention, this wasn’t unexpected.

Sedentary and overweight: more fat loss on keto.

Keto and sedentary: muscle loss.

Sleep well, get your circadian rhythms entrained proper — otherwise these efforts will give you a mere fraction of the benefits.

 




 

Other~

Protein + exercise works: Interactive effects of an isocaloric high-protein diet and resistance exercise on body composition, ghrelin, and metabolic and hormonal parameters in untrained young men: A randomized clinical trial (Kim et al., 2014)

Simply replacing carbs with fat, or resisting food for as long as possible after waking up and staring at your smart phone all night: doesn’t work.

#context

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Cyclical ketogenic diet and carb refeeds

Potential conclusion (pending full texts): “if you’re gonna keto, no need to carb”

I think these three abstracts are all referring to the same studies.  I haven’t seen the full texts.  My takes are in italics, after each abstract.

Exhibit A. The Effects of an Eight Week Ketogenic Diet vs. a Cyclical Ketogenic Diet on Performance and Testosterone in a Resistance Training Program (Lane, Lowery, Volek, D’Agostino, Wilson, et al., 2015)

Introduction: Our lab recently examined the effects of the ketogenic diet (KD) compared to a western diet regarding strength related performance; additionally, free and total testosterone was evaluated. Individuals on the KD saw similar adaptations in strength and similar changes testosterone. Comparisons of the KD against a cyclic (CKD) in strength, endurance, and testosterone have not been previously demonstrated in literature.

Purpose: Therefore the purpose of this study was to investigate the effects of the KD versus a CKD on performance and testosterone in resistance-trained males.

Methods: Sixteen resistance trained males participated in the study (age: 23.5 ± 3.3; weight: 187.6 ± 32.6). Participants on the KD consumed 5% carbohydrate, 25% protein, and 70% fat for 8 weeks. The CKD group applied the same macronutrient ratio to their diet Monday through Friday, while altering the ratio on weekends (50% carbohydrate, 25% protein, 25% fat). A periodized resistance training program was strictly followed 3 days per week throughout the duration of the study with high intensity interval training implemented on intermittent days 2 times per week by all participants. Participants were placed on a 500 kcal deficit derived from basal metabolic rate determined by the Mifflin St. Jeor equation. One repetition maximum (1RM) strength was assessed on deadlift, bench press, and leg press at baseline with a repeat assessment performed Week 8. Strength endurance was assessed on the leg press at baseline and re-assessed at Week 8. Free and total testosterone was evaluated at baseline and at Week 8. An ANOVA with repeated-measures was used to scrutinize the effects of KD and CKD on dependent variables assuming group (KD and CKD) and time (pre and post) as fixed factors. The significance level was set at p ? 0.05.

Results: There were no differences between groups in the performance tests or testosterone levels detected at baseline (p > 0.05). A time effect was observed for bench press and deadlift 1RM (p < 0.01). There was a trend towards a group by time interaction (p = 0.07) which favored an increase in the leg press 1RM in the KD group. There were no significant differences for leg press strength endurance in both groups. For free testosterone, there were no group or group × time interactions (p > 0.05). For total testosterone, there was a group × time interaction following the diet treatment (p < 0.02). The pairwise comparisons revealed that only the cyclic group decreased in total testosterone (10.3%, p < 0.02).

Conclusions: In regards to performance, a strict KD seems to augment positive strength related adaptations when compared to a CKD. These responses may be explained by sustained total testosterone levels seen in the KD group compared to reductions in total testosterone as a result of the fluctuations in macronutrient intake.

Practical Applications: Individuals attempting to optimize adaptations in strength performance while maintaining testosterone levels should perform a KD compared to a CKD.

My take: no difference between KD & CKD, despite testosterone declining in CKD.  This isn’t surprising because small fluctuations within the physiological range are not expected to affect these outcomes.

When protein and calories are controlled, and the #context is a 500 kcal deficit, not really sure what they were expecting.  Because of the constant deficit, insulin will be low even on the carb-up days, and those carbs are more likely to be burned off than replenish glycogen.

 

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Ice age fairy tales

Trigger warning: potentially offensive.

Trying to pinpoint an Ice Age Diet is about as complicated as defining a Paleo or Mediterranean diet… it would’ve been completely different depending on when & where, season, family/tribe, etc., etc.  And while the interwebz are full of anecdotes & guesses (educated & otherwise), there seems to be little reliable information and a lot of contradictions.

And anyway, is this really relevant for us today?

#context

Here’s what I came up with, and why I feel like ranting.

I don’t doubt that humans went through periods of low & high plant consumption, but if someone argues that passing through times of low plant consumption is what “elevated” our species or fostered brain growth or whatever; LOGIC: it can be just as easily argued that passing through times of high plant consumption did the same.  Saying “don’t eat plants because #IceAge” is just as flawed an argument.

Alternatively, considering the importance of #context in our modern environment, couldn’t you also argue that low-plant diets are only evolutionarily appropriate during an ice age (where the Earth is theoretically a giant snow ball LOL)?  Also, if plants are somehow unhealthy, how did we survive periods when hunting was poor?  All of the arguments can go both ways.




I mean, if I lived 10 thousand years ago, I would eat anything I could get my hands on — which would probably look something like a plant-based diet with seafood and whatever else could be hunted, scavenged, etc.  Gotta eat, but why handicap yourself by intentionally avoiding plants – shouldn’t the goal be to spend as little time worrying about this as possible?

If you didn’t have to hunt 24/7, you’d have more time to do other things like acculturation, play, sex, music, story-telling, building traditions, etc., etc.

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High Meat, Low Carb During Pregnancy

The Motherwell Studies

Around 50 years ago a group of expecting mothers were asked to increase their meat intake to about a pound a day and cut out the carbs (Campbell et al., 1996). They assessed a variety of traits of the infants and again when they were all grown up.

The babies were healthy, but as adults they tended to have higher blood pressure (Shiell et al., 2001), higher cortisol response to stress especially if the diet was also low in green vegetables (Reynolds et al., 2007), and modestly worsened glucose tolerance (Reynolds et al., 2007).

 

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Steak Fam and the Wild Mustard Plant

There are many different types of beef cattle which have been selectively bred for specific qualities or properties.

A lot of info here, “Knowing It: Beef Cattle

 

 

Scottish Angus x Longhorn = Black Angus.  Apparently, Longhorn beef was unpleasant and tough but they bred well.  Scottish Angus beef was tender but they didn’t breed well.  Cross ’em and problems solved.

Hereford cattle are inexpensive and were bred for feed efficiency.

 




 

Piedmontese cattle are double-muscled and less marbled than Angus, and they’re often crossed because it’s hard to give birth to a fully double-muscled babe.  Seems like it would help if momma was the Piedmontese, too.

 

 

Wagyu: main breeds are Japanese Black, Japanese Red, Kobi, and Sandai.  Allegedly fed beer and given regular massages LOL

Angus vs. Wagyu: look at that marbling –>

 

 

More info from American Cowboy and Steak Perfection.  And a comprehensive list of breeds here.

 

Needless to say, we aren’t eating the same animals as our ancestors: all of this selective breeding… it’s kind-of-like GMO.  Also, we would’ve been domesticating the slow and less intelligent animals because the fast and smart ones would’ve gotten away.  I’m not saying this is a bad thing, just that it’s not what the hunters were a’huntin way back when.

If an animal has been bred for a trait that increases growth hormone (GH); is it really that different from an animal treated with GH to induce that trait?  [rhetorical]

 




 

Same goes for plants.  Check out this awesome infographic:

 

Thank you for all you’ve given us, Wild Mustard Plant.

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Clara Davis: Babies Know Best

“The nurses’ orders were to sit quietly by, spoon in hand, and make no motion…”

The babies never had anything other than breast milk prior to starting the experiment.  Fully ad lib, they could have as much of whatever food they wanted.  Every morsel was weighed and quantified.

Setting: orphanage.

 

“Armed with growing evidence from the newly emerging field of nutrition, doctors began prescribing with bank teller–like precision what and when and how much a child should eat in order to be healthy.”  #fakenews LOL

Results: “Every diet differed from every other diet, 15 different patterns of taste being presented, and not one diet was the predominantly cereal-and-milk diet, with smaller supplements of fruit, eggs and meat, that is commonly thought proper for this age.”

“15 uniformly well-nourished, healthy children”

 

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The DietFits Study

Preliminary results from Chris Gardner’s follow-up to this study suggest insulin resistance may not be as big an influence on the success of LC/LF diets as prior studies have shown.  Maybe I was wrong.

We aren’t given many details in the abstract or interviews, and there are still some good studies showing otherwise (eg, those by Cornier, Pittas, Ebbeling, and Gardner himself), although this one is bigger (n = 609) and longer (1 year).  However, the range of weight change was huge, something like +20 lbs to -80 lbs, so the devil might be in the details… time will tell.  Might be subtle yet important changes in body comp or other metabolic indicators.

If it turns out to be true, my best guess: they were all following Hunger-Free Diet(s)… which work regardless of whether low fat or low carb.

 

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Whole grains aren’t all they’re cracked up to be

WUUUT *rimshot*

A new study on whole grains demonstrates how nuanced & complicated nutritional science can be.

Substituting whole grains for refined grains in a 6-wk randomized trial favorably affects energy-balance metrics in healthy men and postmenopausal women (Karl et al., 2017)

Sounds simple enough…

Study design: adequate to address the questions being asked.  Isocaloric, weight-maintenance diets.  Biggest differences between the two diets were whole grains (0 vs. 200 g/d) and insoluble fibre (15 vs. 30 g/d).

Disclaimer: I’m not a huge fan of cereal fibre, but that’s irrelevant for the point of this post.

 

 

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