Calorie counting and eating disorders

January 6 2013 by in Calorie counting

Needing to count calories means something is wrong (the appetite regulation is disturbed) or the body weight goal is unnatural. We should try to fix what’s wrong and try to have healthy goals, if possible. Then there will be no need to starve.

Calorie counting is an eating disorder.

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jake
January 6 2013 15
let me ask you something, is measuring your blood ketones every day an eating disorder? how about counting carbs? how about wondering if an apple is going to make you fat?

get real.

Replies: #37, #67

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Galina L.
January 6 2013 12
A lot of people managed to stop yo-yo cycle with LCarbing because they don't have to be in a semi- starved state all the time.

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51
Reply to comment #48 by grinch
nostents4me!
January 9 2013 2
Thank you, good point!
This study: http://www.nutritionandmetabolism.com/content/pdf/1743-7075-3-7.pdf
compared three isocaloric diets, with same weight loss in all arms.
The study is easy to read, scroll to tables!
The low fat group increased fasting insulin 15%
The medium fat reduced fasting insulin 18%
The high fat (50%) reduced fasting insulin 33%
I guess it is can be dose proportional to the insulin-driving
macro nutrients, i.e. carbs and protein.
But remember weight loss same in all 3 groups, which means
weight loss with too high carbs isn't working to correct the metabolic syndrome!

The max carb group ate 67% carbs, which is even over USDA recommendation (45-65).
The LC group 9% carbs.

Will check the other study later when I get time!
52
FrankG
January 9 2013
I notice you also like to keep focusing on weight-loss as the measure of success grinch... it must make your straw men easier to construct.

I am so much healthier in so many ways that: my body having established an healthy weight seems almost incidental. AND I dare suggest that for many of those "stalls" you keep harping on about -- as if these point to an overwhelming failure of LCHF -- they are likely healthier too.
53
Reply to comment #48 by grinch
nostents4me!
January 9 2013 1
Here link to the 2nd study:
http://jn.nutrition.org/content/132/7/1879.full#ref-23
Two arms low carb (8%) and high carb (55%).2002.
No weight loss intended for these normal weight men, but -2.2 kg average over 6 weeks was recorded.
I cannot see if it is for the LCHF group or both.
Over the 6 week trial fasting insulin in the LFHC group rose 14%, i.e the high carb diet made these subjects less insulin sensitive quickly, although it is mean of what USDA and Swedish SLV recommend for carbs.
In the LCHF group fasting insulin reduced by 34%.

As I wrote before the insulin is for me the variable of interest, although this study also shows improved lipid profile for LCHF versus high carb diet.

The earlier study I referred to showing insulin being the main biomarker for CVD, again:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pm...
54
grinch
January 9 2013
nostents4me, interesting study. I love how the LF group lost almost as much fat-derived weight as the LCHF group despite an increase in fasting insulin! Maybe insulin isn't really the determinant of weight status after all.

Reply: #60
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FrankG
January 9 2013 1
Here's a question... hands up anyone who has experienced a weight-loss stall on a calorie-restricted diet?

Uh oh... if we are using this as a measure of validity for a diet, then I guess that's another nail in the coffin for ELMM :-(
56
grinch
January 9 2013
Frank,

Does your use of a LCHF diet to treat diabetes somehow relate to me with only modest weight loss goals and the rest of the non-diabetic population?
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FrankG
January 9 2013
As I see it that "rest of the non-diabetic population" is a rapidly shrinking percentage of humanity... or maybe you don't look around you much?
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Galina L.
January 10 2013 1
@grinch,
weight loss explains stalls on a LC forums, what else? Human body fights weight loss resulted from any diet or illness or a forced starvation, but on a LC diet people at least don't have a tortures level of hunger. For that reason I didn't gained weight during stalls, but some people do. Fighting own body intentions is very hard.
59
Galina L.
January 10 2013 2
A lot of people who are not diabetics react with abnormal blood sugar levels on carbohydrates in their meals. Probably, people who have only 20 lb to loose do not have any metabolism abnormalities (yet?), and need only limit or eliminate junk food.
60
Reply to comment #54 by grinch
nostents4me!
January 10 2013 1
With 30% energy restriction at the high BMI levels, average 33, the missing calories must come from somewhere! After all even weight watchers lose weight, but usually with considerable pain and massive fallouts and retrials. Called Jojo-calorie-counting in Sweden, now offered with 40% discounts and numbers drop.
The problem is the hunger that sets in between meals and after each work out, although of course not for all, and some others can steel themselves.
But most successful high/low carb trials have usually been carried out with inmates in jails to eliminate "adherence" factors. And these trials have always proven that once calories are down enough from the normal, the calories alone make the difference, irrespective of human suffering! Here the calorie in-calorie out dogma stems from. It is obvious but provides no help!

Insulin: It was the relative differences that went up or down.
The values went as per table here:
group start end diff %diff mean insulin % carbs
VLCARB 10.7 7.1 -3.6 -33.6 8.9 8.8
VLF 8.6 9.9 +1.3 +15.6 8.75 67

I could now be the devils advocate and reply to you saying that well,
average insulin was lower in the high carb group, so that is why theY lost weight...
But I don't. I like you want to find out the reasons. For now I note that the phrase "high insulin stops weight loss" is obviously undefined, fuzzy at best!

The main take for me is still that the LC group were able to drop insulin and that the LF group did not, with both on -30% energy diets. It has been said before that weight loss per se causes fasting insulin to drop, which is not shown here, or in the other study.
When it comes to CVD, the clear detriment of a calorie restricted high carb diet stands out to anyone. Even with reduced calorie intake, the diet increases the risk for heart disease due to its fasting insulin augmenting effects if the values are correct.

Another interesting observation is that the fasting insulin reduction is inversely proportional to the carb intake crosses zero at some point near 50% CH.
A rough estimate gives zero effect just around 49% carbs, fasting insulin
increasing (daily) on diets above 49%. The USDA official CH target is 45 -65 and the Swedish 50-60, both centering at 55%, a bit over estimated(!!) threshold for development of metabolic syndrome.
Cheers!
61
bill
January 10 2013 1
This will forever more be considered the famous "smackdown at minute 47"

Dr Robert Lustig on the radio:

http://thedianerehmshow.org/audio-player?nid=16890

Reply: #62
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Reply to comment #61 by bill
FrankG
January 10 2013
Great find bill... thanks! I just fast-forwarded to that spot and it was well worth listening to... I'll find time later today to listen to the whole thing.
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shell
January 10 2013
Thanks for the link Bill, I loved it. I agree with him so much it actually hurts not to tell everyone I know about it. :)
64
Reply to comment #50 by FrankG
nostents4me!
January 10 2013 1
Frank, your recovery is a great achievement and the more people who read about it, the sooner we will get out of this carbs-in-sane era where excess carbs and medications replaces common sense, common sense being just less of the stuff that causes the pain; less carbs.

At the end of your post you write about the "dawn phenomen".
I didn't know the name of it but that is just the very reason I got a blood ketone meter.
You possibly know all this, but just to get the context right for others:
Initially on low carbs the body is not used to convert proteins to blood sugar although the "untrained" ability is there. Going low carb therefore works very good for around 3 months, also with a lot of proteins due to the this "shortcoming"! Sometime later, the conversion in the liver (of excess proteins to glucose, glucogenesis) comes into gear resulting in more glucose produced, day and night , if still on the initial diet with excess protein.
The increased glucose production then starts to show in raised dawn glucose, as the production exceeds consumption only at rest in the night!

With a keto meter this shows up immediately: Only 0.2 in dawn readings, rising slowly to maybe just one in the afternoon, 1.5 after a walk. (My current morning readings are 2 - 2.5), 3.5 in the afternoon.
The remedy is simple, reduce the proteins!
In excess of ~ 1g/kg body weight they do two things: 1/ causes the dawn phenomena, 2/ excess protein raises insulin which long term works against a reduced fasting insulin, which logically must be part of a the ticket to take us out of the metabolic syndrome, since its elevation put us into it.

One can of course spare the expense of ketone sticks by reducing evening proteins and then just compare dawn BS . I had to cut out extra cheese at (most) nights to get back into weight loss and regain long term health, as I see it.

Else get blood ketone sticks to the glucose meter. Most new meters can read both.
Since you are registered diabetic these things may not cost you much if anything.

One only need to measure ketones daily for a few days, until the suspected foods are found and reduced. Then maybe weekly to see that things keep on track , Then it "feels" !
Check out Jimmy Moore's blog about his renewed weight loss through his ketone meter!

High fasting insulin has also been shown to be the strongest correlator to heart disease, so it is a very good idea to keep these levels very low!
I now aim to have mine measured for the first time and to target 3.5, despite my age of 66 and being a recent recoveree from angina!
My fasting insulin may have been in the 20's before LCHF and anything I did was what I had been told to do but things never got better, just like you. It went on for over 6 years, and when they started to get worse I finally dared to try LCHF as a last straw!

See what I wrote earlier in #37 about fasting insulin and references to some clear study evidence.

Reply: #66
65
greensleeves
January 11 2013 1
Hi Frank

"stalls"

Oh you can't dispute this, you really can't. The Atkins forum and the other long-time famous ones are in fact packed with women aged 50 who can't lose a pound no matter what they do. When you go in depth with them you usually discover it's hormonal - they need to take replacement hormones and/or metformin, but they refuse to admit that. They insist they can get themselves to weigh 140 while eating 200g of protein a day, upping their carbs 5g a week to 70, and eating the low-carb junk food and breads. Low-carb ice cream - awesome!

The reality is that these ladies need a slap of common sense. Of course calories count. No one, even Taubes, disputes that. The question is whether anyone needs to bother counting them. Some people do. If you're a 5'6" 50 year old women, and you want to weigh 140, you're looking at 1339 calories a day, base. If you walk everyday, you can boost that up to 1600. Max. Ever. For the rest of your life.

But they don't want to give up the low-carb ice cream, no way. You can talk to people like this on the Atkins forum, absolutely. But this is not a well-formulated LCHF diet. This is fantasy. I absolutely agree those in fantasy land need to count a couple of times to see reality.

With a well-formulated reasonable LCHF diet and metformin, almost all the stalled women can start to lose again. The problem is getting them there emotionally. :)
66
Reply to comment #64 by nostents4me!
FrankG
January 11 2013 1
Thanks nostents4me!

Yes Dawn Phenomenon is one of the first things many folks ask on diabetes forums, "I am not eating overnight so how come my BG is higher when I wake up than when I went to bed?"

It can be a difficult issue to handle with solutions including those you suggested, or having a snack before bed in order to discourage the liver from "dumping" extra sugar due to a falling BG, or a glass of alcohol in the evening... using the logic that detoxing this keeps the liver otherwise engaged.

I had it well controlled when using an insulin pump that gives timed "trickle" doses which can vary all day and night but that seemed like [expensive] overkill after I started LCHF; where it turns out that my waking BG is the highest of the day for me.. and only just above normal. In fact my BGs are now so incredibly stable that I can easily miss meals without trouble, I can hike all day with plenty of energy and I rarely need to check my BGs.

Not cured but very well controlled and overall in the best shape I have been in many years

As I think you suggest: Dawn Phenomenon is not limited to folks with Diabetes but of course so long as the Pancreas (beta cells) can keep up with insulin requirements, the BG does not stay high for long -- unfortunately, by the time of diagnosis most Type 2 D's have lost up to 80% of beta cell capacity. Some Doctors are waling up to the idea of earlier detection but the policy is still very much to wait until really, it is already too late.

I think Dawn Phenomenon makes evolutionary sense in terms of preparation to either go find something for breakfast, or to avoid being something else's breakfast.

The other thing that you'd quickly learn on Diabetes forums (or from frequent BG testing) is that the tolerance for carbohydrate varies through the day; with first thing in the morning being commonly the worst time... exactly when most of the western world is sitting down to their cereal, skimmed milk, toast, jam, muffins, porridge, OJ etc... etc...

I did see your links, thank-you. I was already aware of the health concerns that go along with chronic high insulin levels... quite apart from any excess fat mass. It's essential to life but in high doses causes harm... I am glad see more and more recognition of LCHF not just for "weight" loss but also these other health benefits.
67
Reply to comment #10 by jake
Kate
January 16 2013
Jake, you are awesome!
68
Calin
January 18 2013
I agree completely with this statement.

Don't let the naysayers that defend the current dogma get to you Dr. Eenfeldt! You are spot-on!

Chances are we evolved with well-honed hunger/satiety mechanism that simply has gone wrong due to eating foods that make us fat (carbs, fructose).

The idea that the majority of us are all extremely greedy pigs predisposed to gaining fat and eating as much as possible and that we should count calories to prevent this is less plausible to me than the idea that our appetites should work correctly, and when they don't, we should figure out what's breaking them (usually carbs and fructose).
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Laura
January 30 2013
Being obese is an eating disorder. The desire to be a healthy weight is a life changing endeavor. Counseling to manage the psychological factors that influence out-of-control eating is a big part of the puzzle, however counting calories is just a tool to assist obese people to understand what healthy eating is - both portions and quality of the foods based on the calories it has. Not all people who count calories are anorexic. I think it's a gross assumption to say that counting calories in and of itself is an eating disorder. I would encourage obese people to find a tool that works for them to learn the habits of healthy eating - and utilize any kind of food tracker, whether it be a point system like Weight Watchers, or just a calorie diary like ChooseMyPlate - doesn't matter what you use - it's a support element in addition to counseling if that is a step a person is willing to take. Lost 90 pounds this way. I'm not skinny. I'm healthy.

Reply: #70
70
Reply to comment #69 by Laura
nostent4me
January 30 2013
I agree that being obese is an eating disorder. The call is to find what causes it, not to compensate for it. Compensate = run more, keep down all calories, go to (diet-) jail, voluntarily or not. Nearly all studies that proved only calories count for weightloss were conducted on prisoners, without choiches !

When we just cut down on all foods across the board we must also address the increased hunger feelings that naturally follows, when not locked up.
LCHF says: cut bloodsugar jo-joing by cutting the carbs, which helps for most if not for all!
By also cutting out fructose through cutting refined sugar foods, the hunger sensed by the brain may also reduce, as pointed out in a very recent study that compared effects of fructose and glucose on brain sensors. Glucose intake shut off the hunger sensors while similar amounts of fructose didn't...
So fructose must be a real supercharger in starvation times when a little more food every time it is thee can make the difference between death or survival in a months time. Truly evolutionary stuff, with its best before date gone, or put back into the future, for now. Hope it isn't worth remembering!

But even if we manage to cut down our insulin levels to rock bottom with low carb, which is a very healthy thing in itself, eating more calories than we burn will increase weight, not reduce it, if on low carb or not!
If we have a "greedy fat tissue" (some of the visceral stuff ?) that snatches calories as soon as they arrive in the bloodstream due either to high insulin or other metabolic disorders, the calories may have to be reduced near starvation levels to stop the pattern. Through progressive insulin reduction it should pass, I believe, to come back over the near starvation level.

By removing the hunger causing foods LCHF is a great help but voluntary further reductions can often be needed for some, although they are so much easier to implement with LCHF.

On the other end of the scale, with very low insulin and little hunger, if calories are not reduced weight will go up. But for the vast majority the overeating without carbs in the food is hard! No hunger!
Yet starting a nibblingspree with tasty fat cheeses every evening or rolled ham or salami with (garlic-) butter inside could cause even the best system to pack in : Cheese alone can have over 20% proteins and insulin response from proteins can be half that of carbs, at the same time as the liver is delighted to make more overnight blood sugar from excess proteins, then managing to deliver high blood sugars the mornings after, which can re-trigger the old jo-jo bonanza ! The (cheap part) of the ketometer reveals this quickly. Take a morning walk to drop the BS quickly for damage limiting.

Question to you: When it comes to the calorie tables in Weight watchers and ChooseMyplate software, please fill me in:
Do they handle high fat low carb diets or are most "plates" designed around 55% carbs instead of the 5-15% carbs that many here would regard as the healthy choice?
Can one set desired ratios of macronutrients freely?
Can one exclude crertain fats, like most PUFAs ?

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