Archives for June 2012

It’s been nearly two years now since we took a trip internationally. Far too long. It’s not in the making this summer—so far, anyway—so I thought I’d review the last trip, July 2010. It’s for myself to relive it a bit, but also for those readers who weren’t around at that time, perhaps to inspire and encourage to get out there and see the world a bit.

The story of how this particular trip came about starts in the summer of 2006, when Beatrice and I headed off for a 3-week tour of Europe by car, no hotel reservations. We touched down in Paris, got the car, stayed the night, then headed south towards Barcelona. From there, we hugged the Med all the way up through Spain, across France, down into Italy, all the way to Pizza. After a couple of days in Firenze (Florence), we headed north, passed through Switzerland and just a bit of Germany, then west back to Paris for the flight home. In all, about 6,000 km. Each afternoon, we’d stop in a place we couldn’t not stop at, I’d drop Beatrice on the waterfront, and she’d go from hotel to hotel until someone could show her a nice room with a view she liked; she’d ring me on the phone, and we’d have a place.

I’ve travelled this way—no reservations—a number of times and it’s my preferred method of vacation/touring travel. So much better when you can see the whole context and decide accordingly. Those wanting to follow along with our Eurotrek 2006, posts begin July 3, 2006 in the archives, and run through July 26.

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This is actually my favorite sort of post to do; more so, even, than the rants here and there. I find it interesting to get two or more perspectives on some issue or controversy, then synthesize them into what I always hope will be a broader context of understanding and in particular, highly accessible to those less interested in the nitty-gritty of the science.

It’s a dialectic of sorts, but in this case, doesn’t involve any material antithesis. Here, it’s actually two pretty compatible theses: one put forth by Anthony Colpo (quantitative); the other by Dr. Stephan Guyenet (quantitative and qualitative). This is a follow-on to my post of yesterday, JAMA: Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance (access the full text of the study here).

I do find this study highly fascinating. I suppose because it has a number of elements that are ripe for debate, and open debate tends to get more people more closer to more truth. I read the thing from start to finish a couple of times, including all the figures and tables. Something just didn’t add up for me. I quote from the Comment section (emphasis mine):

The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective. During isocaloric feeding following weight loss, REE was 67 kcal/d higher with the very low-carbohydrate diet compared with the low-fat diet. TEE differed by approximately 300 kcal/d between these 2 diets, an effect corresponding with the amount of energy typically expended in 1 hour of moderate-intensity physical activity.

OK, but then there’s this from the Results section (emphasis mine):

Body weight did not differ significantly among the 3 diets.

So I popped off an email to David Ludwig, MD, PhD, one of the researchers. Here’s the relevant part:

I was interested in the study just published yesterday […]

However, I have a glaring question I have been unable to answer after reading the study and looking at the figures and tables:

Where did the 300 calories go LC vs. LF? As I understand it, participants ate isocalorically in crossover fashion, so the only change was the macro ratios. It’s also stated that physical activity did not change. So if they ate the same calories, had the same physical activity, maintained the same weight loss throughout, then how are the 300 daily calories accounted for if not in additional weight loss beyond the initial loss?

Perhaps I could learn more from the eMethods supplement as cited in the article. However, the link to the PDF is broken. If you have that PDF I’d appreciate it, and of course any light you could shed on my question so I can pass it on to my readers and commenters.

Anticipating that the answer might be something like: increased bodily metabolism (higher heart rate, respiration, etc, etc), then my follow on question might be what’s the point, the advantage?

I got back a very quick response.

The point is that 4 weeks isn’t long enough to translate a 300 kcal/d difference into statistically significant weight change, especially when one considers that body weight normally fluctuates by a kilogram or two through the course of a week, based on differences in hydration status, the time of the last bowel movement, etc. We’d need 6 months to reliably see this effect. Nevertheless, there was a slight, and not statistically significant difference in the hypothesized direction, with body weight highest on the low fat diet (data included in the results section).

I’ve informed the journal about the web site problem with the eMethods. Hopefully they will correct that soon.

OK, now here’s the two posts by Guyenet and Colpo.

• New Study: Is a Calorie a Calorie? (Guyenet)
• Finally, a Study that Proves a Low-Carb Metabolic Advantage? Yeah, Right… (Colpo)

Hmmm…now comes the hard part, which is where to begin, what to highlight, what to say about it (actually, I worked that latter part all out in the shower this morning). Suffice to say that I like both of these posts for their mutual injection of sanity into what seemed initially to be a lot of attaboys, high-fives, etc., amongst ardent fans of carbohydrate restriction (I count myself a circumspect fan of LC) leading to metabolic advantage (eat as much as you want LC, no problem—I’m not a fan).

Let’s begin with what I’d characterize as a strictly quantitative analysis from Anthony. In the first part of his post, Anthony takes time to review the fact that every single metabolic ward study going back to 1935—every single one—fails to find a statistically significant difference in weight loss amongst different sorts of diet compositions (including LC). In other words, weight loss always comes from caloric restriction. He goes into great detail on every single one of these studies in his book, The Fat Loss Bible. He then goes on to address this particular study; kinda doing so with one arm tied behind his back, because he doesn’t make a lot of fuss about it not being a metabolic ward study, and thus tightly controlled (for my take, the team did appear to use an impressive array of state of art methods and incentives to motivate decent compliance and record data). An excerpt from the post.

Bodyweight was virtually identical during all three isocaloric diet phases which to me, as a rational indvidual whose head has never been embedded in his culo, quickly refutes the famous low-carb claim that greater weight loss will occur on a low-carb diet at a given caloric intake. At the caloric level calculated by the researchers to maintain weight, the low-carb diet did exactly what the other diets did – it maintained weight. It did not magically produce further weight loss while the other diets simply maintained the status quo.

I could by all rights end the discussion there, but the interesting thing about this study is that the lack of difference in weight status during the 3 diets is being roundly ignored by the very same low-carb advocates who are parading this study as proof of a metabolic weight loss advantage.

Instead, they are wanking on and on about an allegedly greater increase in resting energy expenditure and total energy expenditure experienced by the participants during the low-carb phase. This increase in REE and TEE, they are claiming, is proof that low-carb diets produce greater weight loss – even though the low-carb diet didn’t produce any weight loss at all.

Got that?

Let me attempt a different way of conveying the essential point Anthony is making in hopes of getting just one or two more otherwise breathless LC metabolic advantage fans to take a breath.

Here goes, y’ready? …

All 21 participants did lose a significant 13% average body weight over 12 weeks on a calorie restricted diet equal to 60% of daily energy requirements.

Did that escape everyone’s attention, or only the fact that everybody didn’t lose any weight regardless of dietary composition over a separate 12 weeks? And just as the first 12 weeks was designed to lose weight (via caloric/energy imbalance), the second 12 weeks was designed to maintain weight (via caloric/energy balance). Everything went according to plan, so is there really any meaningful news here beyond a curiosity that may merit further investigation?

Let me put it a different way, hopefully getting a few more breathless to take a breath:

Researchers gave 12 people free food, prepared it for them, and promised to pay them $500 if they could stand a 40% caloric deficit for 12 weeks. Additionally, they gave them another 12 weeks of free, prepared food, and promised to pay them another $2,000 if they would eat it and come to the hospital for 9 days of tests.

Again, everything went according to plan.

Another thing Anthony points out is important especially on the basis of what has already happened in the media and some blogs: ‘300 calorie per day metabolic advantage for low carb; step right up and get your metabolic advantage.’

On the TEE graph, 8 of 21 subjects experienced greater declines in TEE on the low-carb diet when compared to the low-GI diet, and four of these folks experienced similar or greater declines in TEE than they did on the low-fat diet.

So you can see that the true story is a little more complicated and somewhat different to the one low-carb shills are trying to portray. Rather than a clear-cut case of reduced drops in REE and TEE during a low-carb diet, the indvidual results are in fact much more haphazard, with some subjects in fact showing markedly greater drops in REE and TEE during the low-carb diet.

Meaning that if you adopt a low-carb diet expecting an increase in metabolism, based on the results of this study, there’s a very strong possibility you’ll be sorely disappointed.

Colpo goes on to address some of the hormonal markers and such, but I’ll set that aside and focus just on the weight loss.

So let’s move on to Stephan Guyenet who, while addressing some of these quantitative weight loss issues, also includes a qualitative angle, and it’s just this sort of thing that makes for a good synthesis. Stephan summarizes the entire dispute in three points.

1. Calories don’t matter at all, only diet composition matters.
2. Calories are the only thing that matters, and diet composition is irrelevant.
3. Calories matter, but diet composition may also play a role.

The first one is an odd position that is not very well populated. The second one has a lot of adherents in the research world, and there’s enough evidence to make a good case for it. It’s represented by the phrase ‘a calorie is a calorie’, i.e. all calories are equally fattening. #1 and #2 are both extreme positions, and as such they get a lot of attention. But the third group, although less vocal, may be closest to the truth.

Sounds like he might be talking about real food, eh? He continues. You can check the post for his references.

Some people have suggested that the type of food we eat, not just the amount, influences energy expenditure, and in particular that this is related to the diet’s carbohydrate content. In people who are not trying to lose weight (4, 5), or who are being overfed (6, 7), the carbohydrate:fat ratio in the diet has little or no detectable impact on energy expenditure, and if anything it favors carbohydrate, but could this be different during fat loss in people who start off overweight? This idea has been called the ‘metabolic advantage’, most notably attributed to the low-carbohydrate diet. The idea here is that you can lose fat eating the same number of calories if carbohydrate is kept low.

I’ve never really weighed in on this because it’s a topic of heated debate, and in any case it’s a fairly academic question. Why is it academic? Because previous weight loss studies have shown that if a metabolic advantage exists at all, it’s quite small, because the effect is undetectable in most studies (8, 9, 10). People who are not associated with the low-carbohydrate community tend to conclude that there’s no metabolic advantage when they review the literature (11), although I haven’t reviewed it closely myself. It’s clear that where fat loss is concerned, calorie intake is much more important than the amount of fat or carbohydrate in the diet. What previous studies have suggested is that low-carbohydrate diets suppress appetite — often resulting in lower calorie intake (12, 13). The reason for this remains a topic of speculation.

So we begin to come full circle with what Anthony said. To put my take on it, Anthony says it’s dumb to believe in any metabolic advantage, while Stephan says it’s pointless, because either it doesn’t exist or is too small to matter.

At which point, I remind you:

All 21 participants did lose a significant 13% average body weight over 12 weeks on a calorie restricted diet equal to 60% of daily energy requirements.

Now enter the qualitative angle. Stephan again.

That being said, I’m actually quite open to the idea that food quality in addition to quantity can influence body fatness, and I would encourage people to think outside the macronutrient box: there are probably many different dietary factors that can have such an effect. Although this idea hasn’t received much support in the human literature so far, there’s quite a bit of evidence for it in the animal literature.

…Like, real food: meat, fish, fowl, vegetables and fruit, like we evolved to eat? Animals? You mean like all those animals in the wild that maintain body compositions exactly as they’re supposed to, when able to eat what they’re supposed to eat? And we’re not even talking about health, yet. Is an animal going to generally fair healthier on a diet provided by nature, or industrial crap in a bag/box?

OK, so if there’s anything that could be termed an antithesis from Guyenet contra Colpo’s thesis in this regard, here it is—but it’s certainly on no such level that all you have to do is eat zero carbs and you’ll lose weight:

Does this support the idea that there is a ‘metabolic advantage’ to low-carbohydrate diets? Well, sort of. It doesn’t change the previous findings that the carbohydrate:fat ratio has little or no impact on energy expenditure during overfeeding, in weight stable people, or during weight loss, but it does suggest that a VLC dietary pattern has a metabolic advantage over a LF diet specifically in the context of weight maintenance after weight loss. It also suggests that a LGI diet has a smaller but still meaningful metabolic advantage in this setting, and that a LF diet are not very effective in this regard. It also opens a whole new can of worms for the research world, investigating the effects of diet quality on energy expenditure.

…It’s that last phrase I’m most interested in: “investigating the effects of diet quality on energy expenditure.” If that were actually to happen, what would that mean for fans of Paleo and WAPF, allied most specifically because of their advocacy of real, whole foods from all the available sources (sorry, veg*ns, no soup for you!)?

Here’s an idea: eat real food first. If I can play loose with the term “metabolic advantage,” I’d say that in the end, I think calories count, but that food quality matters. Low to moderate carbohydrate diets—when done right—tend to push out crap food for much better food. Much better food means improved satisfaction, satiation…a greater chance of being in control of appetite, cravings, and so on. Inasmuch as appetite, hunger and satiation are related to metabolism, loosely stated, there’s your metabolic advantage, right there.

If this was recognized above all, perhaps we could get off macronutrient ratios and focus on real, quality food. In so doing—unless you’re just going to eat tubers all day—you’re likely going to be eating a pretty moderate carbohydrate load anyway, and even if that includes potatoes, a pretty low glycemic load (that’s index, with over time thrown in because, y’know, time passes by).

The takeaway: Eat. Real. Food. Move. Around. If you need to lose weight: Eat. Less. Real. Food. Move. Around. More.

[As an endnote, I was already well into this post when I learned that Evelyn at Carb Sane also weighed in. We’ve had our differences, but fair is fair and she raises some of the same questions and issues: A Modest Proposal for Peer Review Research. Check it out.]

Well I’d intended to get up this morning and write a run of the mill rant about the stupid article accompanying an interview the other day on NPR Morning Edition with my buddy John Durant. Here’s the link to the thing, along with 7 minutes of audio that’s substantially better than the article. There’s now 441 comments. When last I scanned through them, around 360 of them or something, it was about the most idiotic comment thread I’ve ever seen.

OK, so no rant this time.

I got wind of this study this morning via a link to Glenn Reynlds from a friend of mine, then chasing down rabbit holes. This appears to be the full text: Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. I haven’t scrupulously picked through it but figured why not let everyone who want to go through it just like I will.

Here’s a couple of media reports for those wanting just a summary.

• USA Today: Low-carb diet burns the most calories in small study
• The New York Times: Which Diet Works?

And from the Abstract of the actual study:

Objective To examine the effects of 3 diets differing widely in macronutrient composition and glycemic load on energy expenditure following weight loss.

Design, Setting, and Participants A controlled 3-way crossover design involving 21 overweight and obese young adults conducted at Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, Massachusetts, between June 16, 2006, and June 21, 2010, with recruitment by newspaper advertisements and postings.

Intervention After achieving 10% to 15% weight loss while consuming a run-in diet, participants consumed an isocaloric low-fat diet (60% of energy from carbohydrate, 20% from fat, 20% from protein; high glycemic load), low–glycemic index diet (40% from carbohydrate, 40% from fat, and 20% from protein; moderate glycemic load), and very low-carbohydrate diet (10% from carbohydrate, 60% from fat, and 30% from protein; low glycemic load) in random order, each for 4 weeks.

Main Outcome Measures Primary outcome was resting energy expenditure (REE), with secondary outcomes of total energy expenditure (TEE), hormone levels, and metabolic syndrome components.

[…]

Conclusion Among overweight and obese young adults compared with pre–weight-loss energy expenditure, isocaloric feeding following 10% to 15% weight loss resulted in decreases in REE and TEE that were greatest with the low-fat diet, intermediate with the low–glycemic index diet, and least with the very low-carbohydrate diet.

~~~

Alright, here’s some of my initial, off the cuff thoughts having just skimmed through. I believe I saw somewhere that the participants were eating food prepared for them by the research team; if so, that does add a bit of credibility. Also, if REE and TEE (resting and total energy expenditure) was less with the LF diet compared to the LC diet it seems more plausible to me that the LF, high-carb diet would generally be prone to more cheating, hence more caloric intake, hence an even more curious result if that were the case.

Here’s a blurb from the comments I found interesting:

The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective. During isocaloric feeding following weight loss, REE was 67 kcal/d higher with the very low-carbohydrate diet compared with the low-fat diet. TEE differed by approximately 300 kcal/d between these 2 diets, an effect corresponding with the amount of energy typically expended in 1 hour of moderate-intensity physical activity.

The physiological basis for the differences in REE and TEE remains subject to speculation. Triiodothyronine was lowest with the very low-carbohydrate diet, consistent with previously reported effects of carbohydrate restriction23 ; thus, changes in thyroid hormone concentration cannot account for the higher energy expenditure on this diet. The thermic effect of food (the increase in energy expenditure arising from digestive and metabolic processes) dissipates in the late postprandial period and would not affect REE measured in the fasting state. Because the thermic effect of food tends to be greater for carbohydrate than fat,24 – 25 it would also not explain the lower TEE on the low-fat diet. Although protein has a high thermic effect of food,16 the content of this macronutrient was the same for the low-fat and low–glycemic index diets and contributed only 10% more to total energy intake with the very low-carbohydrate diet compared with the other 2 diets. Furthermore, physical activity as assessed by accelerometry did not change throughout the study. Alternative explanations for the observed differences in REE and TEE may involve intrinsic effects of dietary composition on the availability of metabolic fuels13 – 14 or metabolic efficiency, changes in hormones (other than thyroid) or autonomic tone affecting catabolic or anabolic pathways, and (for TEE) skeletal muscle efficiency as regulated by leptin.26 – 29 Regarding the last possibility, the ratio of energy expenditure to leptin concentration has been proposed as a measure of leptin sensitivity,30 and this ratio varied as expected in our study among the 3 diets (very low carbohydrate>low glycemic index>low fat).

Maybe I’m missing something here, but if the participants were eating isocaloric diets (just the different macro ratios), they were in weight maintenance (no participants gaining or losing), yet the LC participants had total energy expenditure 300 kcal per day greater than the LF participants, and…“Furthermore, physical activity as assessed by accelerometry did not change throughout the study”...then what’s the point?

What am I missing?

OK, perhaps I’ll put up an addendum or another post once I’ve gone through this more, but don’t let that stop any of your science, metabolism or science geeks in comments.

Update: Synthesis: Guyenet, Colpo, Calories Count, Food Quality Matters, Macronutrient Ratios are Qualitative (my extensive follow-up post on the matter)

How do I love thee? Let me count the ways.
I love thee to the depth and breadth and height
My soul can reach, when feeling out of sight
For the ends of Being and ideal Grace.
I love thee to the level of everyday’s
Most quiet need, by sun and candle-light.
I love thee freely, as men strive for Right;
I love thee purely, as they turn from Praise.
I love thee with a passion put to use
In my old griefs, and with my childhood’s faith.
I love thee with a love I seemed to lose
With my lost saints, — I love thee with the breath,
Smiles, tears, of all my life! — and, if God choose,
I shall but love thee better after death.
— Elizabeth Barret Browning.

Who amoung you who really cares, can’t relate a good set of deadlifts to all of that?

…It’s a long history but I eventually worked myself up to 325# for 5 reps, back almost a year and a half ago. Here’s a video of 305# for 4. Somewhere along the way, I got an injury—a cervical herniation—that put me down like nothing else, ever. Here’s the this and that of all of that:

• This is One Big Ass Pain in the Neck!
• Tension Myositis Syndrome (TMS): Can Your Mind Really Heal Your Back, Neck, Shoulder, Butt, and Leg Pain?

I must mention both Dr. Kurt Harris and Dr. Doug McGuff. Early on, they both tuned me into Dr. John Sarno. Essentially, if the pain is so intense, chronic and constant, 24×7, for weeks and months…to the point you begin plotting suicide—and how not to make a display or show of it for family members—then perhaps it’s time to look at the mind. Additionally, Kurt (a radiologist) graciously looked at my MRI imaging and confirmed the physical side of things.

Interesting thing is, it worked—and totally without fucking woo bullshit. It’s physiological. For whatever reason you should not care about, your mind decides to fuck with you by restricting oxygen at a cellular/muscular level to isolated places, and it causes oxygen deprivation and excruciating pain, which can persist for years—while a broken femur heals from pain in two weeks (hint hint). The solution? Tell your brain to fuck off. Seriously. Explicitly. In the mirror. You don’t need to “work out your problems.” Tell yourself to fuck off. Mean it. Done. It does take some weeks of such self therapy, so’s that you know you really mean it: in the mirror. Face to same face.

More direct: laugh at the pain and the pain becomes a laughing stock.

All that was a while back. I laid off heavy workouts for a good while, gained fat, bla bla bla. About this time last year I went back to the gym and dived into DLs once again. On the first day I pulled 255 for reps with no problem. I did that a few times in a few weeks. Then, we took a trip to the cabin and in getting ready to turn our vacation home into a vacation rental, I worked for a solid day with my arms above my head cleaning ceilings, light fixtures, etc….and the very next day the same pain was back with a vengeance.

What was the real cause???

It was just as powerful and debilitating as before. I had no idea what was in store and at the time, I was slated for both The 21 Convention in Orlando and AHS at UCLA. I contemplated canceling both. I continued to nurse my woulds, gain fat, and wax miserable. Then, I took note of something. The pain went away, and it did so without me doing much in the way of Sarno-esque, “Fuck you, Richard,” affirmations in the mirror. It was about 2-3 weeks. Gone. I suspect it had something to do with no longer having any fear or trepidation in the matter and I kinda just dismissed the pain much of the time in spite of the intensity.

So, I ended up doing my deals: The 21 Conv and AHS. I didn’t look good at all, but made the best of it and was well received.

Since then, I have been very gun-shy about the whole thing in terms of heavy lifting. I essentially didn’t work out for months. A few months back, I got kettlebells. I really didn’t treat them as formal workouts. Rather, it was 5 minutes here, 5 there, maybe a couple of times per day, or none at all some days. I really like that informality and it will continue. However, whatever it was I did—probably with the 45 pounder—the whole deal came back. But and but: way, way less than before. It was only annoying, and it didn’t really affect sleep and such. Zero suicidal thoughts. It went away in a couple of weeks or so, and it’s been a couple of weeks since I haven’t had a single symptom.

…And so, yesterday was: how-do-I-love-thee-let-me-count-the-ways day. It wasn’t planned. Beatrice and I just decided to head to the swim club around 4:30 and I said to myself: I’m going to fucking do dead lifts.

135# x 10. Kittens could do that, and so did the kitten in me. OK, let’s load 25 per side, for 185# total. Whoa. That’s easy. I took it to 5 reps, rested a bit, did another 5. There’s no wind in the gym, so caution sticks around. After a good rest, I thought that 205# would be doable. So I loaded it up and did 5 more reps; pretty damn easy. I put a cherry on top with 400# on the leg press. Two sets for 10 reps each. Piece of cake. Then I went in the pool, the 13ft side for 40 minutes, legs crossed, treading water, arms only (very easy for me: all my life).

Here’s the thing: all reps were done double overhand grip. This, I owe to Clifton Harski. I had a great steak and salad lunch with him in Los Gatos after AHS last fall…talked about my troubles, my injury, and he immediately nodded his head. He’d seen this before. His advice was something that would likely have not dawned on me ever, because I’m simply not deep into the details of physical training. He said: do only double overhand on deadlifts, and lock your arms “outwards.”

When you think of it, the evolutionary logic makes sense. We’re a system. We evolved in such a way that muscle groups are in concert. Or: our arms can do things our legs can’t; our feet can do things our hands can’t…and all which ways around the mulberry bush.

It seemed like a sensible thing to me, since my forearms and hands, and arms, ultimately, are the endpoint on the bar: to not let the far more massive muscles of my glutes, back and legs injure my far more tender assets—but also far more brainy assets.

It’s a simple concept:

The weakest link in your system is your limit.

In deadlift, that’s your grip. Yea, a reverse grip gets the job done, but it’s interesting to see where all competitors in this deal lift comp failed. Many got into the 400s, some into the 500s, but every single one failed eventually on grip, not on what their butt, back and legs could do.

And so, with an abundance of caution I go forth. I still want to pull a 500# deadlift in my lifetime. I’m 51, and I want to be able to pull 500# when I’m 60, and I’m willing to take it slow and easy. But, when, and if, I do, it will be double overhand.

The way I look at it, my ability to grip is the weakest link, and as such, is what just might keep the rest of my body safe to progress for as long as it takes for my grip to strengthen over time. Moreover, I think that realization has a lot of application in the entire workout and lifting industry.

Don’t shortcut the weak link.

I almost wrote a post last evening just so I could write something for fun. But I was a bit sapped—which continues into today—so I ate a big bowl of my father-in-law’s caldo de res instead. Now, finally, the editors get it back for a couple days before it reverts to me.

What’s Version 2.0? Well, first of all I’m trying to beef it up quite a bit at the level of each chapter—just make it a bit better in my eyes, but still simple and basic for the beginner. A quick summary:

• Deemphasis of low carbohydrate as necessarily any part of Paleo, while acknowledging its usefulness to many for weight loss an certain health issues.
• Calories count.
• Potatoes are nutritious.
• Lots of additional sections in a number of chapters, but one I recall explicitly (my brain is in a fog) is a section on the ethics of eating animals.
• New Chapter: Cold Water Therapy or “Thermogenesis” (though I’m not sure I care for that term).
• New Chapter: Moderate Carbs.
• New Chapter: Paleo Kids.
• New Chapter: Barefooting

Well, that’s about it for now. Should be out around the end of the month.