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[Paper] Effect of a plant-based, low-fat diet versus an animal-based, ketogenic diet on ad libitum energy intake - 2021 [Junk]

10d 23h ago by hackertalks.com/u/jet in ketogenic@discuss.online from hackertalks.com

The carbohydrate–insulin model of obesity posits that high-carbohydrate diets lead to excess insulin secretion, thereby promoting fat accumulation and increasing energy intake. Thus, low-carbohydrate diets are predicted to reduce ad libitum energy intake as compared to low-fat, high-carbohydrate diets. To test this hypothesis, 20 adults aged 29.9 ± 1.4 (mean ± s.e.m.) years with body mass index of 27.8 ± 1.3 kg m−2 were admitted as inpatients to the National Institutes of Health Clinical Center and randomized to consume ad libitum either a minimally processed, plant-based, low-fat diet (10.3% fat, 75.2% carbohydrate) with high glycemic load (85 g 1,000 kcal−1) or a minimally processed, animal-based, ketogenic, low-carbohydrate diet (75.8% fat, 10.0% carbohydrate) with low glycemic load (6 g 1,000 kcal−1) for 2 weeks followed immediately by the alternate diet for 2 weeks. One participant withdrew due to hypoglycemia during the low-carbohydrate diet. The primary outcomes compared mean daily ad libitum energy intake between each 2-week diet period as well as between the final week of each diet. We found that the low-fat diet led to 689 ± 73 kcal d−1 less energy intake than the low-carbohydrate diet over 2 weeks (P < 0.0001) and 544 ± 68 kcal d−1 less over the final week (P < 0.0001). Therefore, the predictions of the carbohydrate–insulin model were inconsistent with our observations. This study was registered on ClinicalTrials.gov as NCT03878108.

Paywall - https://doi.org/10.1038/s41591-020-01209-1

Full paper is on the pirate academic sites.

Evaluating weight loss for only the first 14 days shows absolutely nothing.
Yes, low carb will lead to more weight loss while consuming more calories than low fat during the first 2 weeks.

Because you lose water weight when you consume fewer carbs.
Bottom center and bottom right graphs show this: You lose almost no fat with the low carb diet, all the weight loss is fat-free mass.

Generally, body fat is what you want to get rid of, and what's hard to get rid of.
Water weight drops in a few days without carbs, and will all be back after one cheat meal.

My other gripe is that the low fat diet was specifically one with high glycemic load. That's not what anyone trying to lose weight would do on purpose. And finally, why are they comparing diets with different caloric intakes?

why are they comparing diets with different caloric intakes

The premise is to let subjects eat as much as they want and see what happens.

You lose almost no fat with the low carb diet, all the weight loss is fat-free mass.

N=1, but this is entirely inconsistent with my personal experience doing low carb. I lost significant amounts of fat (fatty liver gone, also stopped snoring) and water retention.

Edit: since you added more questions

the low fat diet was specifically one with high glycemic load.

To be as charitable as I can to Hall, it's very hard to design a diet that's both low in fat and carbohydrates. Aren't we only left with protein, at that point?

why are they comparing diets with different caloric intakes?

Again, to give Hall as much credit as I possibly can, this is perhaps because Hall understands that nutrients are what drives metabolism and weight loss, and not calories, which are a measure of heat energy and quite reductionist.

Yeah, I was only talking about what's in the graph.
And what that shows (low carb consuming more calories while losing weight faster) isn't possible for longer than a few weeks.
In my opinion, the reason why low carb works as a diet is that most people are addicted to simple carbs before they start a diet.
Cutting those out breaks the addiction, you stop getting those hunger cravings, which makes it easy to eat less calories overall.
But replacing simple carbs with whole grains and lots of fiber has the same effect.

Ah, I see, you mean glycemic index also, in terms of how quickly the blood glucose will spike post-prandially. In that case I share your doubts.

And what that shows (low carb consuming more calories while losing weight faster) isn’t possible for longer than a few weeks.

Actually it is sustainable - I think there is a implicit assumption that the CICO model is controlling fat gain/loss, but humans are hormonal machines.

In fact you might really enjoy this case study - https://discuss.online/post/25062313- [Paper] A case study of overfeeding 3 different diets - 2021

Basically someone overfed themselves on different diets and looked at their body composition changes, on lchf they lost fat even eating 5300 calories a day.

OK, that actually makes sense.
It's possible to lose fat while overeating, since calories on labels just show how much heat energy is created when you burn the food.
Hormones and a lot of other factors influence how much of that energy the body actually takes in and uses or converts to fat.

So I retract my statement. It's possible to lose weight while overeating.
It's just impossible to gain weight while eating less than you expend.

It’s just impossible to gain weight while eating less than you expend.

Yes, I think that statement is 100% correct

My other gripe is that the low fat diet was specifically one with high glycemic load. That’s not what anyone trying to lose weight would do on purpose.

Unfortunately when you remove fat from a diet you have to replace it with something, and that is either protein or carbohydrates. A low fat diet IS a high carb diet

Doesn't keto look worse in these charts?

The weight keto dieters lost was due to loss of muscle and water (fat free mass). Low fat dieters lost the most fat and started catching up in weight loss at around 2 weeks.

Interesting paper. I'll read it.

it takes more then 2 weeks to adapt to fat metabolism. I do not recommend reading this paper, it is junk and not worth your time. A 2 week study on the effects of a diet is too short to be useful, its less then useless, its misleading. You can't evaluate any diet realistically in two weeks.

Low fat dieters lost the most fat and started catching up in weight loss at around 2 weeks.

Look at the update paper from hall on the cross over effect, after 2 weeks those who started with low carb were eating 2000 calories less per day then those who started on low fat.

Here is the graph from halls cross over paper (same dataset as this paper)

The red line is the people who did low carb first, they lost more fat mass. This is exactly why a 2 week study is misleading. Notice how this data separating out the diet order shows a totally different study then the initial graphs in the paper? That is how you can engineer misleading headlines and outcomes. I think it was intentional.

Thanks. I'll check out the updated paper.

That is the problem with Hall, he refuses to update or retract his initial paper... We only see the update graphs in the above message (i may have added them after you responded) in a paper talking about cross over effect.... that is stubborn bias in there. I think Hall is too biased to spend your time reading, and I wouldn't recommend reading any paper about a 2 week intervention.

This is the result of the updated paper.

Current diet – circles are LC, square is LF. Color represents transition. Red is LC-> LF

I kind of see the same pattern here. Loss of more muscle and water on Keto and fat on low fat. So low fat seem better at least in the short term.

I agree fat adaptation takes a few months. So it may not represent what happens to long term LC dieters.

edit: confused the labels lol

You will notice the Blue bar had NO reduction in fat mass. Only the red bad (lc first) had any reduction in fat mass. So clearly 2 weeks isn't enough to say anything about anything, but it is interesting.

Which category does water get put into? fat mass, or fat free mass? We know low carb significantly reduces water retention.

I agree fat adaptation takes a few months. So it may not represent what happens to long term LC dieters.

100% it does not!

Look at the 2000 calorie day difference in intake in weeks 3/4. That does say something!

Blue bar had NO reduction in fat mass Look at the 2000 calorie day difference in intake in weeks 3/4

What I saw in the blue bar was a reduction of body fat during the LF diet and then 2 weeks of keto undid that benefit.

Even in the original paper the energy intake of keto dieters was high. Now it's even higher because you trained the brain that fats are becoming scarce. (Due to fat loss from the LF diet and lack of fat in the diet itself)

And now the brain wants to gobble up as much fat as possible.

Even in the original paper the energy intake of keto dieters was high. Now it's even higher because you trained the brain that fats are becoming scarce. (Due to fat loss from the LF diet and lack of fat in the diet itself)

The original paper doesn't separate out the diet order, so we can't rely on that analysis to tell us anything.

We see from the separated graph that energy intake is the same during the first two weeks on both LC and LF.

The confusion here is exactly why you need to isolate and reset between diet trials, this is the crossover effect.

You have a interesting theory on fat scarcity and fat reuptake, it would be interesting to see it tested, but this paper does not match your theory.

And now the brain wants to gobble up as much fat as possible. (Red line)

We can't say what the brain wants, this is science we shouldn't attribute motivations we haven't observed.

The red line does not gobble up fat according to energy intake or fat mass.

it would be interesting to see it tested

Same! It was a guess based on a well established principle that we crave the nutrients we lack or start losing rapidly.

The confusion here is exactly why you need to isolate and reset between diet trials

agree

this paper does not match your theory

Sorry I wrote the wrong line color again :( I will be extra careful from now on. I was explaining only the blue line the entire time.

In the blue line people didn't eat fat for 14 days and lost body fat. So in the next 14 days they overate and stored it back during the keto phase. (Due to increased cravings)

edit: (more explanation) And in the red line, the subjects ate LC at the start and then switched to LF. They would have craved carbs after 14 days but they couldn't overeat because the LF diet has a low calorie density. Fiber stretches your gut and makes you feel full.

This paper is a EXCELLENT demonstration of why you can't trust abstracts or opinions and you have to look at the data directly. 

First kudos to the paper for actually using a ketogenic diet, monitoring ketones! That is rare. Now, on to the bullshit -

  • Animal Based in title, but not in reality, this is nowhere near a carnivore diet

From the supplementary material the animal menu was

  • Veggie scramble egg
  • Green Salad with beef
  • Zucchini Pasta with meat sauce
  • Green Salad with Tuna
  • Cauliflower soup
  • etc,etc

so this is closer to omnivore keto, with at least 75% plant based energy, AND LOTS OF SEED OILS (fried chicken for goodness sake). Calling this animal based is dishonest. This is plant based with some animal protein thrown in.

  • Paper claims to be contradictory to CIM (carbohydrate insulin model)

Yet the data shows weight going down on low carb, even while energy intake increases.

  • Paper has serious methodological flaws 2 weeks on each eating pattern is insufficient to adapt to a metabolic change, it takes up to 12 weeks to become fully fat adapted.

No run-in period to the diets (no standard baseline).

Diets switched at 2 weeks, no wash out period.... You can't see it in this paper directly, but that means many of the low carb benefits that take time to manifest get demonstrated in the high carb diet due to this rapid switching. This is not a clean demarcation.

Responses to this paper, including data reanalysis

This paper uses the first's paper data and separates out the cross over groups by diet order. When that is done the first paper's conclusion of CIM energy difference not being demonstrated disappear... in a 2 week : 2 week back to back cross over - ORDER MATTERS. LCD reduced energy intake in ad libitum eating, that PERSISTED into high carb diet, and the reverse as well. High carb diet increased energy intake, crossing over into the low carb diet. IT TAKES TIME TO ADAPT TO A NEW METABOLISM.

What I think is demonstrated here is that CICO has not been proven by Hall, and the Carbohydrate Insulin Model still stands viable. Clean studies will be most welcome here.

This was a VERY expensive study. Why Hall, a well funded plant based researcher, is wasting his time on a tiny fringe theory like the carbohydrate insulin model? What made him spend the time and money making these very poorly constructed, yet very expensive, studies? and why compare against plant based and not SAD like he does every other time?

Hall clearly has a bias, and I suspect he engineered his study in such a way he could have the conclusion he wanted. The paper title is more important than the data.

WALTER WILLET, the man himself, called this study “worse then useless because its misleading”… If Walter Willet the king of weak epidemiology is against you… man… you got problems. https://youtu.be/tIPX_TnUAWQ

In the willet video that make the cross over energy difference even more clear. After 2 weeks of low carb energy intake decreased on the low carb eating pattern.

Hall even made a new paper - https://doi.org/10.1016/j.ajcnut.2024.08.013- Diet order significantly affects energy balance for diets varying in macronutrients but not ultraprocessing in crossover studies without a washout period

But, he doesn't fix or retract his initial paper. So he acknowledges the issue, but not his conclusions.

[Squares are low carb first, circles are high carb first] Look at that! a 2,000 calorie change in eating! that is HUGE.

If you eat low carb for 2 weeks you eat 2,000 calories LESS PER DAY then if you eat low fat for two weeks - FROM HALLS OWN DATA AND GRAPHS - This is exactly inline with the CIM.

TLDR - This is a junk paper engineered to push a headline. The data doesn't support the abstract or discussion section findings. Most people will never read the paper, they will just hear from influencer, blogger, etc that keto is bad and there is a study that proves it.

CIM was kinda proven in 197x and 1983 with the in vivo tests demonstrating anti-lipolytic effects of insulin, and in 2000 in vitro. The fact somebody is trying to kill CIM now in 2019 is crazy... you can't mobilize fat with elevated insulin... hence Carbohydrate Insulin Model is just a direct consequence of what we know about insulin and fat cells.

What should be clear from this paper, the responses, the response re-analysis is that very involved people well read on the literature disagree and that CIM isn't disproven or dead by any measure.

Bret Schur did a interview with Taubes and Ludwig on this paper, as well - https://www.youtube.com/watch?v=L39nTrxhBeo

And Hall did a interview about this too: https://youtu.be/zOAapJo9cE0

my (barely educated) guess is the fiber in the LFPB diet is what causes participants' energy intake to be lower

This study doesn't cover it! both diets were mostly plant based, the paper title is a political device. The animal base low carb diet had tons of fiber and plants. If you look at the actual data of the paper, ad libitum energy is HIGHER on the high carb diet.

did they mangle the data analysis that badly? it looks like there was a pretty clear difference in energy intake between the two diets unless I'm reading the charts wrong

the use of "animal/plant" based in the text does come off as odd and vaguely political. though so vague I can't tell if the authors are pro- or anti- animal-based foods

Hall is very deep in the pro-plant camp.

They didn't mangle the data-analysis, they did gymnastics to prove their thesis - hence the need for other researchers to do a re-analysis of their own data but separating out the groups by diet order.

But even if restrict yourself to Halls paper, even with a higher energy intake on low carb, people lost more fat mass - That does not contradict the carbohydrate insulin model. The fact they are saying this isn't CIM is by implicitly assuming CICO drives fat mass is pre-supposing their conclusion in the analysis, which their own graphs contradict!

I sure as hell wouldn't use any study with a 14 day duration to inform my understanding of weight loss dieting lol

Just for fun, from the supplementary material, here is a real photo of the ANIMAL BASED snacks supplied to the low carb group - this is what the ad libitum is talking about, they could eat as many snacks as they wanted.

Ah yes that famous animal the peanut

Sure as hell looks like plants to me...