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Nutrition Past and Future

The Drivers of the Herd, Part 8

Malhotra’s Major Issues, Part 2 (The Kekwick-Pawan Phenomenon)

Slide 3                   Malhotra, Aseem. "Saturated fat is not the major issue." BMJ: British Medical Journal 347 (2013).


Let’s resume our discussion of Aseem Malhotra’s defense of saturated fat in the BMJ.



Slide 4                   Malhotra’s article drifted away from the topics of saturated fat and cardiovascular disease and into the bizarre notion of a “metabolic advantage” for low-carb diets. Evidently, he’s been reading the low-carb blogosphere. He cited a study in JAMA as evidence of the superiority of low-carb and low-glycemic diets over low-fat diets. A low-carb diet induced the highest resting energy expenditure, and this is taken by Malhotra to mean low-carb diets are a good choice for weight loss.



Slide 5                   Ebbeling, Cara B., et al. "Effects of Dietary Composition During Weight Loss Maintenance: A Controlled Feeding Study." JAMA: the journal of the American Medical Association 307.24 (2012): 2627.


One should be cautious in using this study to reach a general conclusion about low-fat diets. Notice that the low-glycemic group ate about one third less carbohydrate, yet they still consumed more fiber than the low-fat group. The advocates of low-fat diets argue for whole plant foods, not refined plant foods. This low-fat diet was a bit of a straw man, just like the low-fat diet we just saw compared to an oily version of the Mediterranean diet.



Slide 6                   Moreover, the authors noted the higher cortisol levels that accompanied the low-carb diet.



Slide 7                   Manenschijn, L., et al. "High Long-Term Cortisol Levels, Measured in Scalp Hair, Are Associated With a History of Cardiovascular Disease." Journal of Clinical Endocrinology & Metabolism 98.5 (2013): 2078-2083.


Malhotra is a cardiologist and he should be concerned about any diet that increases cortisol. As this paper states, “elevated long-term cortisol levels are associated with a history of cardiovascular disease.”



Slide 8                   Mittelsteadt, Alison L., et al. "Effects of HIV and antiretroviral therapy on resting energy expenditure in adult HIV-infected women—a matched, prospective, cross-sectional study." Journal of the Academy of Nutrition and Dietetics(2013).


If the goal is to have a higher resting energy expenditure, one could contract HIV, too. I wouldn’t be so quick to interpret this study as an indication of a healthy metabolism on low-carb.



Slide 9                   Malhotra implies that fat’s extreme energy density doesn’t matter because a biochemist and a physicist said that low-carb diets have a so-called “metabolic advantage.” Let’s look at what those guys actually said and see if they really demonstrated the existence of a “metabolic advantage” for saturated fat.



Slide 10                 Feinman, Richard D., and Eugene J. Fine. "A calorie is a calorie" violates the second law of thermodynamics." Nutr J 3.9 (2004).


First, recognize that their premise in all this is that some foods are very inefficient fuels. We are to accept that the wasting of energy is a good thing.



Slide 11                 Next, their argument doesn’t apply to fats. According to the biochemist and the physicist, fats are the most metabolically disadvantaged macronutrient. Their argument applies to protein, not fat. Malhotra’s article is about fat, not protein.



Slide 12                 Read this quotation again. Once more, he seems to be confused and grasping at anything.




Slide 13       


There is no metabolic advantage that can overcome the vast differences in energy density between common fatty foods and common carbohydrate foods. Butter is more than 7 times more energy dense than potatoes and more than 14 times more energy dense than oranges. To imagine a metabolic advantage for fats despite their extreme energy density is simply delusional.



Slide 14                 Next, Malhotra references a very strange study to continue his claims of metabolic advantage for fatty foods. He cites a paper by two researchers named Kekwick and Pawan from 1956. This is an old favorite among low carbers.



Slide 15                 p.22. Bowden, Jonny. Living the Low Carb Life: Controlled Carbohydrate Eating for Long-Term Weight Loss. New York: Sterling Pub, 2005. Google Books.


For example, here is a Jonny Bowden, whom you saw in my videos about Catalyst, calling this experiment “visionary.”



Slide 16                 You see Malhotra wrote that the diets were either 90% fat, 90% protein, or 90% carbohydrate. He says these people lost the most weight on the high-fat diet.



Slide 17                 Feinman, Richard D., and Eugene J. Fine. "Thermodynamics and metabolic advantage of weight loss diets." Metabolic Syndrome and Related Disorders 1.3 (2003): 209-219.


Notice that the biochemist and the physicist referenced this study, too. They say it’s been ignored rather than disproved. Well then, let’s disprove it now. This is one of the worst studies in the low-carb library.



Slide 18                 Kekwick, A., and G. L. S. Pawan. "Calorie intake in relation to body-weight changes in the obese." The Lancet 268.6935 (1956): 155-161.


Here’s an excerpt from the paper. “If these observations are correct,” they wrote, “there seems to be only one reasonable explanation.” They say that fatty foods increased energy expenditure. Now you just saw that the metabolic advantage argument from Malhotra and the biochemist and the physicist pertained to protein, not fat, so again we are seeing low-carb advocates whose arguments lack coherence. Low-carbers just ignore these things. So were their observations correct? Almost certainly not.



Slide 19                 Kekwick, A., and G. L. S. Pawan. "Calorie intake in relation to body-weight changes in the obese." The Lancet 268.6935 (1956): 155-161.


This is their handy graphic explaining their diets. You can see that all three diets only permitted 3000 ml of water, which is represented by the column on the left in each set. You can also see that they were all limited to 1000 calories. That’s some pretty tough calorie restriction for obese people. If we stop to understand this graphic, we will understand why this study is garbage.



Slide 20                 Byrom, F. B. "A Study of the Total Exchange of Water, Sodium, Potassium, and Nitrogen in Epilepsy." QJM 1.2 (1932): 289-302.


It was known back in 1932 that ketogenic diets are dehydrating. They drain the body of water, protein, and electrolytes.



Slide 21                 p.18. Westman, Eric C, Stephen D. Phinney, and Jeff Volek. The New Atkins for a New You: The Ultimate Diet for Shedding Weight and Feeling Great Forever. New York: Simon & Schuster, 2010. Google Books.


Atkins promoters today know this. This is why they all say you need multivitamins and broths.



Slide 22                 So if we look at our graphic and see that water was kept constant, we can easily understand that the low-carb groups were just dehydrated. They must have been completely miserable. It’s incredible to me that low-carb advocates haven’t figured this out in all these years.



Slide 23       


By the way, considering that these were obese individuals, it’s possible that 3 liters of water might not have been sufficient regardless of the diet.




Slide 24                 Next, look at this graphic from the Kekwick/Pawan paper. Remember, the high-carb dieters were restricted to only 4% of energy from protein out of only 1000 calories.



Slide 25                 Rand, William M., Peter L. Pellett, and Vernon R. Young. "Meta-analysis of nitrogen balance studies for estimating protein requirements in healthy adults."The American journal of clinical nutrition 77.1 (2003): 109-127.


Realize that the most-referenced modern study used to calculate adequate protein intake says that humans need at least 0.65 g of protein each day for every kilogram of body weight.



Slide 26                 Look at the top left set of bars. It shows someone starting their high-carb phase at 124 kg. He or she then proceeded to gain weight even though the diet was limited to 1000 calories! Does that even seem possible to you? Right there we know something strange is going on. Then look at my math. A 124 kg person would weigh about 273 pounds. According to the meta-analysis you just saw, that person would need about 81 grams of protein. But because of the diet these nutty researchers imposed, this person got only half of that!



Slide 27                 p.251. Wadden, Thomas A, and Albert J. Stunkard. Handbook of Obesity Treatment. New York: Guilford Press, 2004. Google Books.


Their situation may have been even worse than that. Experts today say that obese individuals on very low calorie diets require much more protein than those figures indicate. So you can see that these people would have been miserable on the high-carb diets, too, so miserable they likely cheated on their diets.




Slide 28                 And that’s exactly what happened. These knuckle-head researchers actually commented in their paper about the “inadequate personalities” of their subjects, who would lie and cheat and surreptitiously scrounge the hospital for extra food. Malhotra thinks this is good science? And then, considering what terrible judgment these researchers displayed, we are supposed to ignore the potential bias introduced when they allowed themselves to only report the results they selected? This study is laughable and it should not be considered a reference by any modern researcher except as an example of what bad research looked like in the old days.



Slide 29                 Passmore, R. "The relation between the metabolic mixture and the water content of the body in man." Annals of Nutrition and Metabolism 3.1 (1961): 1-16.


I investigated references to this study to see if anyone else saw these flaws. It’s true, this study was mostly ignored, and for good reason. But one researcher did comment on it and it’s from him that I’ve taken the title of this video. Reginald Passmore addressed this one in 1961. Fifty years ago he noted that some gullible people were taking it seriously. The low-carb diet is evergreen fad diet material.



Slide 30                 Passmore pointed out that Kekwick and Pawan weren’t able to demonstrate an increase in basal metabolism on the high-fat diet, and we’ve seen that the low-carbers’ own evidence argues against that. Their hypothesis never gained support.



Slide 31                 Passmore’s judgment was that any differences in weight on the diets were probably explained by differences in body water.



Slide 32                 p.60. Atkins, Robert C. Dr. Atkins' New Diet Revolution: Completely Updated. New York: M. Evans and Co, 2002. Google Books.


Despite all this, Robert Atkins took this sloppy experiment seriously. He didn’t comment on the likelihood of dehydration. He didn’t comment on the protein undernourishment. He didn’t mention the cheating and the arbitrary exclusion of data. Instead, he bought into a later interpretation of the study from Kekwick and Pawan – that the ketogenic diets caused the production of something they called Fat-Mobilizing Substance. Atkins promised to continue research on Fat-Mobilizing Substance with his foundation. Do your own research and you’ll see this notion never went anywhere and hardly anyone is chasing after this Fat-Mobilizing Substance today.



Slide 33                 Kekwick, A., and G. L. S. Pawan. "Effect of fat-mobilising substance in man."The Lancet 292.7561 (1968): 198-199.


Kekwick and Pawan said they isolated this substance from mice and injected it into obese mice, inducing weight loss. They then issued a very short report about a very informal and brief experiment they conducted injecting this substance into obese people. They claimed it induced weight loss. Search the citations of this article and you’ll see this revelation went nowhere in the research community.



Slide 34                 Todorov, Penio T., et al. "Purification and characterization of a tumor lipid-mobilizing factor." Cancer Research 58.11 (1998): 2353-2358.


I was curious what this substance really was. This reference gave the best answer I could find. It was likely an adipokine called Zinc-Alpha 2-Glycoprotein.



Slide 35       


This substance is now available from suppliers to medical laboratories. You can see it is associated with the severe wasting suffered by cancer patients.



Slide 36                 Russell, S. T., and M. J. Tisdale. "Studies on the anti-obesity activity of zinc-α2-glycoprotein in the rat." International journal of obesity 35.5 (2010): 658-665.


There have been a couple researchers looking at this substance as a treatment for obesity in recent years. But we have wandered far from the claims in Malhotra’s article. This article was about saturated fat, not miraculous chemicals from cancer tumors for the treatment of obesity.



Slide 37                 Let’s review. Malhotra used a very dubious reference to support the idea of a trivial metabolic advantage that is purported to work in ways that don’t support his thesis about fat. His use of it in this way is an indicator of the lack of research he put into this topic before using his credentials to promote some very harmful advice.



Slide 38                 Malhotra also cited what may be the single most popular study in the low-carb, pro-cholesterol literature today, a meta-analysis by Patty Siri-Tarino and others that is taken to exculpate saturated fat from any role in heart disease. I’ve talked about this before in past videos but I’d like to present a closer look at it now. We’ll pick this up in the next video.