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Wellness Wednesday for November 22, 2023

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

  • Requests for advice and / or encouragement. On basically any topic and for any scale of problem.

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Protein Restriction In?

In the 1930s, Walter Kempner treated over 18,000 patients with obesity, diabetes, heart disease, and renal failure by changing their diet. At the time, treatments for malignant hypertension were few, and those with the disease had a life expectancy of months. With Kempner's magic diet, many patients saw their conditions improved or reversed.

What was the magic diet?

  • White rice
  • Fruit
  • Fruit juice
  • Refined table sugar
  • In some cases, vitamin supplements (A, D, thiamine, riboflavin, and niacin)

And nothing else. The diet macros come out to about 4% to 5% protein (<20 g per day), 2% to 3% fat, and the rest was carbohydrates.

The diet was hard to follow. The alternative was death, and it was the 1930s, so Kempner famously whipped his patients to keep them on the diet (double blind study pending to see if whipping patients also improves renal function.)

But it worked. It fell out of fashion once people had literally any other option than eating rice and being whipped, but it kept many people alive who otherwise would have been dead. Kempner's studies also contributed to the body of work that Ancel Keys drew from when he declared Saturated Fat the enemy.

Cut to the Year of our Lord 2023.

Brad Marshal (pig farmer, French-trained chef, occasional Molecular Biologist,) has kicked off a craze in alternative nutrition. He has lost 14 lbs in 28 days by lowering his Branch Chain Amino Acids (BCAAs) to 8g or less a day. BCAAs are a group of protein that are especially high in muscle meat and low in gelatin.

Big deal, he cuts out a food group, eats less, loses weight, right?

He is eating "2800-3000 calories per day on average, some days more." Given his age, weight, and height, his Total Daily Energy Expenditure (TDEE) should be around 2,360. Yet, he claims to be eating more, and therefore his TDEE must be much higher if he is losing weight. If it's all water weight, then how is he depleting glycogen while eating 500g of carbs a day?

Another prominent case study and blogger is ExFatLoss, who has been tracking his weight and food intake for years. He has been running a series of diet experiments and has noticed that the more protein he restricts, the more weight he loses. He has also dived into the literature and discovered that protein restriction seems to improve metabolism in mice and human studies. The specific culprit is Isoleucine, which researchers are able to completely restrict in mice diets (less able to do so with humans without really intrusive studies.) When isoleucine goes down, fat stores go down and calories go up. Some mice are able to eat 80% more than controls and still lose weight.

This is Wellness Wednesday, not culture war, so I think I'll end the comment here.

In the 1930s, Walter Kempner treated over 18,000 patients with obesity, diabetes, heart disease, and renal failure by changing their diet. At the time, treatments for malignant hypertension were few, and those with the disease had a life expectancy of months. With Kempner's magic diet, many patients saw their conditions improved or reversed.

I thought the prevailing twitter-narrative is that obesity and related conditions like diabetes and hypertension were non-existent or unheard of until the 80s--and then boom! So much for that. it goes to show how narratives are popular because they confirm our preexisting beliefs about how society is or ought to be, not what is actually true. 18,000 is hardly rare or unheard of , especially for a single doctor, so we're easily talking millions of obese people. Obesity must have been widespread but massively underreported, particularly among middle aged people and older people in the '30s , not some rarity as commonly assumed by the internet-experts.

As for the diet itself , yes, consuming rice or any macro or food in a calorie deficit will cause weight loss. AFIK, there is nothing in particular special about rice. As for it 'working', it's way easier to treat diabetes and hypertension than reverse obesity, as shown by the dearth of effective drugs to treat the latter and the very low success rates of diets. If it worked it would be widely reproducible and 'common knowledge', but it only seemed to work for select patients for weight loss.

There's a huge difference between 1-2% of kids being obese and 20% of kids being obese. Even if less than 10% of people were overweight, that would still provide doctors with millions of patients in the 30s. There is plenty of evidence that the overweight population has increased dramatically, even just in our lifetimes it is obvious.

One thing that could effect the obesity rate in the past is that many people with diabetes or heart disease just died. If someone dies, they aren't counted in the population obesity statistics.

But the Twitter Bros have their own explanation - by the 1930s many people in the American South were eating shortening, peanut butter, and other foods laden with Poly-Unsaturated Fats. We can actually see a difference in metabolic rates between Northerners and Southerners in the 1930s.

For the diet part, I don't think that rice has a "thinning" quality like opium has a "soporific" quality (sorry if you don't get the reference, that's a philosophy joke.) But one of the more interesting things about the Kempner Rice Diet is that even people who did not eat at a calorie deficit and did not lose weight still saw diabetes reverse and insulin sensitivity go up:

As Kempner pointed out, any obese patients were indeed encouraged to lose weight—but the improvements in blood sugar levels and insulin requirements occurred “both in patients who lost weight and in those who did not have a significant weight change” (his words). Kempner’s data, both in this paper and in the massive collection of his work filed away at Duke University, showed that the diet could benefit diabetics even when their weight and energy intake didn’t budge.

I'm always up for a good fad diet!

That said, my first instinct is to not to trust a guy who weighs 230 pounds with 32% BF. Especially when the same guy also lost weight on a croissant diet (that apparently didn't stick).

If he sticks with it for a year and gets down to 15% BF, I'd love to hear more about it. In the mean time, Penn Jillette's potato diet has much better results.

That said, my first instinct is to not to trust a guy who weighs 230 pounds with 32% BF. Especially when the same guy also lost weight on a croissant diet (that apparently didn't stick).

if any diet worked it would be common knowledge. we would not need to be berated about it (like with keto), nor would there need to be huge discussion and communities around it (more discussion generally means less effective). The problem with the potato diet is it's hard to stick with it...people become ravenous for non-potato foods even if stuffed with potatoes. Also, it has to be plain pototatoes..no mashed, fries ,etc.

That said, my first instinct is to not to trust a guy who weighs 230 pounds with 32% BF. Especially when the same guy also lost weight on a croissant diet (that apparently didn't stick).

He's way fat.. if someone espouses diet advice but cannot apply the diet themselves to not be fat, loses credibility in my book, but I think he has some good info anyway .

I started giving this high-carb, low-fat, low-protein diet a go. I started losing weight almost immediately, but found myself feeling anxious/depressed after a couple of weeks (I think from lack of fat). At the moment I'm trying to up my fat intake but keep BCAAs (specifically isoleucine and valine) low to see if I can keep losing the weight.

agree. I find this 'fats are good' mantra to be overrated. i was able to lose a lot of weight and keep most of it off by limiting fats to close to zero as possible.

Well upping my fat didn't actually help in the end. I think the issue was a lack of tryptophan caused by the low protein diet.

That's great! I hope the low-protein swamp diet works. You could also try a heavy cream fast like ex150.

According to webMD, these foods have BCAAs:

Whey, milk, and soy proteins. Corn. Beef, chicken, fish, and eggs. Baked beans and lima beans. Chickpeas. Lentils. Whole wheat. Brown rice.

Yes, in order to get the BCAAs so low, they are eating Glass Noodles, Dextrose Powder, and Cream. Some fruit and veggies, limited amounts of meat (3 oz) and gelatin. Those who eat rice/wheat avoid meat.