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Dr. David Ludwig: Some Fine Dot Connecting

Woke up this morning to notification of yet another blog post by Mike Eades. In it, he points to a relatively short presentation (30 minutes) by Dr. David Ludwig of Harvard University at the Ambition Nutrition Conference.

Mike goes on to provide his notes on the presentation with time stamps. I found them intriguing enough to watch the presentation which I think is a good one, and jot off a bit of a post of my own. I’ll limit it to two high points of disagreement as I understand it from the presentation, and one point of solid euphoric enthusiasm.

On the issue of insulin driving fat storage, I think the gaping hole in the idea is that even if true, per se, it’s not asking the right question or making the correct identification, per se. Everyone is familiar with the phrase the dose makes the poison, but everyone also seems to disregard timeframe, or, time under dosing. In other words, we’re not fully taking into account that dose has two components: volume and time…v/t. And they are directly proportional. The higher the volume, the greater must be the time under administration; or, the lower the time interval, the smaller must be the volume of the dose.

Relating the analogy to insulin, I think there is far too much emphasis placed on the the dose one might get from a food, a meal, or even a few meals, and not enough on the frequency or periods of no dosing.

In specific terms, we were probably not “munching hunter-gatherers.” So, for example, you can show that Hadza eat about 18% of their annual calories in the form of honey. But, they tend to do so in a gorging fashion. When they find it, they eat it all, and we’re talking pints. So, they hit the “poison,” but then have extensive periods were there is little or none.

But how does this resolve to modern society with easy food at fingertips 27/7? Well, rather than CICO—and Ludwig makes an excellent case against that, with good data—how about self-imposed eating-windows? Rather than eating and snacking from 6-7am until 9-10pm every day, impose a 12/12 on yourself. Take note of the time you ate your last calorie every night, don’t eat another unit for a full 12 hours. I suspect that would go a long way towards solving obesity in America. Want to lose weight, then go 14, 16, or 18 hours.

Now, note that this raises another question: are the generally good results obtained in fat loss, weight maintenance, and health markers due to a likely slight reduction in average calories (say, measured over a month), or the fact that you are getting a zero food-induced dose of insulin for at least 12 hours per day?

Well, wouldn’t it be nice if folks on both sides of that debate were at least doing so in the face of actual proven results? So, then, let the debate rage on. Benefits everyone, no matter their bias.

In large part, one way to view this presentation is as one of making a valid distinction between kinds of carbohydrate in the diet. It’s almost the theme of it and while I don’t know how much Ludwig is, or not, a proponent of low-carb diets…then if so, this makes for good progress in terms of valid distinctions.

The original Atkins was pretty much agnostic in terms of food quality (it was the 70’s). You want your protein to come from Slim Jims and your fat, from soy-oil mayonnaise? Or, later, do you just want an Atkins shake with a 3″ list of “ingredients?” No problem. One value of paleo is that it got many low-carbers to pay attention to food quality. So, everyone now knows the difference between the mystery meat in a Hot Pocket, and a pot roast. They know the difference between Mazola, and grass fed butter and lard.

And now, they need to continue on the path, recognizing the difference between a Coca-Cola and a baked potato. Ludwig cites the data in a number of studies to suggest just that: that while all protein and fat is not created equal, neither are all forms of carbohydrate.

I’m in league with Mike on the 16 ounce steak, though perhaps not for the same reason. Given his fondness for insulin playing a large role—which I’ve already mentioned—and knowing that protein can be insulinogenic, it smacks as though he seems to think moderate protein is the way to go, and then talk about fat (no impact on insulin) vs. carb (big impact), though with the nouvelles distinctions just mentioned.

But what if people focussed far more on protein from quality food sources and were more ambivalent about fat vs. carbs, but minimally cognizant enough to understand that perhaps an inverse relationship is in order?

There’s controversy over Kevin Hall’s NuSi funded study that showed no particular advantage to high-fat-low-carb diets, within the study design. BUT, the study design controlled for protein. I think it’s hugely important and may be a critical aspect that has been overlooked or regarded as inconvenient by some of Hall’s critics.

…A footnote here is that Ludwig spent good minutes talking about the neurological aspects inherent in chowing down on the junk food. Well, I’ve recently read and will review soon Stephan Guyenet’s The Hungry Brain: Outsmarting the Instincts That Make Us Overeat. There, you get about 10 solid chapters covering the neurological science of overeating. It’s cool that Mike saw this aspect in Ludwig’s presentation and highlighted it, “how palatability is not inherent in food.”

Serendipitously, I recently had a comment exchange on Shephan’s blog that’s apropos, here.

Hey Stephan:

In your book which I blew through in four sittings over 2 days, I seem to get the impression that you are at least considering the possibility that higher intakes of protein might be key.

Is that a correct impression?

I’ve been dabbling with higher protein lately, about 30%, trading off carb and fat willy nilly as preferred, usually a few days at a time alternating. The higher protein seems to be so uniquely satiating that I wonder if the fat vs. carb war is rather pointless in that paradigm. This is in the context of mostly whole, “frugal” food.

Stephan’s response:

Hi Richard,

I do think protein has a major impact on satiety and possibly the setpoint. I think this controlled feeding study was the most striking demonstration of the effect:

http://ajcn.nutrition.org/content/82/1/41.full

In the book, I argue that higher protein may actually be an “active ingredient” in low-carb diets, rather than lower carbohydrate itself– at least for moderate LC (as opposed to ketogenic diets). I don’t think the evidence is definitive, but it is suggestive. And yes, I do think that goes some way toward undermining the fat vs. carb war. Still, I recognize the possibility that people may respond differently to fat or carb such that they don’t respond in an “average” way.

I also think that diets at the extremes of macro composition, such as very-low-carb and very-low-fat (e.g., McDougall), may have certain advantages for metabolism and weight control that are not seen in more moderate versions.

Well, I must say that after hundreds of books and presentations over the years of almost everyone saying the same thing because everyone else is saying it—via lectures and books—I sense a lot more integration and synthesis, indeed honesty, in dealing with all the elements coalescing.

Richard Nikoley

I'm Richard Nikoley. Free The Animal began in 2003 and as of 2021, contains 5,000 posts. I blog what I wish...from health, diet, and food to travel and lifestyle; to politics, social antagonism, expat-living location and time independent—while you sleep—income. I celebrate the audacity and hubris to live by your own exclusive authority and take your own chances. Read More

11 Comments

  1. thhq on March 12, 2017 at 06:42

    I pay more attention to Willett than Ludwig….and more attention to Keys and early Yudkin than either of those. Ludwig/Taubes/Lustig are what the older Yudkin was during his sugar craze.

    Conviction nutritionists.

    http://www.bmj.com/content/346/bmj.e7800/rr/626611

    • Richard Nikoley on March 13, 2017 at 12:51

      “I pay more attention to Willett than Ludwig….and more attention to Keys and early Yudkin than either of those.”

      You do seem to have quite an affinity of paying attention,

      I pay little, minimal attention to anyone, think, and then synthesize.

  2. thhq on March 12, 2017 at 07:48

    This thread on honey is interesting

    http://www.rawpaleodietforum.com/general-discussion/raw-paleo-honeyhoneycombgrubcomb/25/?PHPSESSID=i301av5ecn113710tk5obl27r1

    Paleos ate the whole thing. Comb, larva and honey all together. You get your daily carbs, protein, wax and exercise all in one event.

    • thhq on March 12, 2017 at 11:35

      And beeswax isn’t paraffin, but esterified natural fats like palmitic. It’s at least partially digestable, and probably breaks down the way fats do.

    • thhq on March 14, 2017 at 09:08

      Very unlikely that beeswax produces food fat calories. Like paraffin and carnauba, stomach acid doesn’t dissolve it.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745513/#!po=0.877193

  3. pzo on March 12, 2017 at 17:14

    You forgot, I think it’s called TEF, Thermal Effect of Food. That digesting protein uses 20-25% of its calories to digest protein. You might say one out of four or five calories are free. And protein is highly satiating, both in the mouth and due to its long digestion time.

    Window eating is, of course, not new. (What is?) If the not-eating window is long enough, 15+ hours I’ve read, you can reap the benefits of fasting without doing it for days. If avoiding insulin is your goal, you can further achieve long, low insulin by packing your volitile carbs into one meal or two.

    Mi dos centavos

  4. thhq on March 13, 2017 at 08:47

    I made it through the first five minutes. No wonder Truswell calls these guys conviction nutritionists. When I reached the part about “sugar and starch” with no mention of the fat ALWAYS associated with processed foods like cookies and Doritos I shut it off. Ludwig had gone off the 14th century deep end into a world of devils and angels. Pedantic theology.

    I’m thinking that the obesity crisis is a result of our modern indulgent victim culture. Keys and Yudkin firmly believed in CICO. That means keeping food and exercise diaries. Living the Biggest Loser life forever. If you want automatic weight loss get bypass surgery. Otherwise it takes motivation to make the right conscious decisions every day. People do not automatically do the potato hack, or live like Jack Lalanne.

  5. Evolutionarily on March 14, 2017 at 00:22

    I do believe Taleb has written about this also, IIRC he thinks (type 2) diabetes is an issue of meal frequency rather than composition.

  6. Justin Owings on March 17, 2017 at 06:30

    I was surprised that Eades hadn’t made the connection to palatbility before. That seems like a pretty key ingredient. It’s not like we instinctively know what food is “good.” It’s all learned behavior though even sayhing that simplifies what’s going on behind the scenes. The quick analogy I make when I talk about this is, “Did you like the taste of beer/wine/alcohol the first time you tried it? What about coffee?” Our brains make the connection between the effects of the foods (or drugs) and the taste. Post ergo hoc propter hoc. We don’t have to make the connection on a conscious level for it to be real and a driving force in our behavior.

    Perhaps high protein diets work so well because they take the longest route from taste->hitting our brains with nutrients. The PEHPC connection is weakly formed. Importantly, though, if you’re accompanying high protein with high-fat or high-carbs, you’re going to still be piling on the calories.

    I maintain that Martin Berkhan continues to be the most on-point practitioner of nutrition around — and most importantly, his methodology is vetted out by hundreds if not thousands of actual results. And what’s Martin recommend? High protein every day. Cycle carbs to working out. And even when you boost carbs, we’re still only talking about 200-250g (maybe more if you’re bulking). Even Martin’s bulking advice is still _very_ high-protein.

    • Richard Nikoley on March 17, 2017 at 07:30

      Hey Justin:

      Long time. Yep, LOTS of protein in Martin’s deal, plus he controls for fat and carb inversely (more carb less fat workout days, inverse rest days, with slightly less protein but still a lot).

      Hey, what’s Friedman up to these days?

    • Justin Owings on March 27, 2017 at 07:24

      Patri? He’s at Google these days but looks like he’s been promoting the Seasteading book.

      The last 1.5 I was at Google (just left) and the busy-ness of the work, which was not great, left my RSS in shambles.

      At a new place, a start-up, and wouldn’t you know? My job is actually built around blogging and content creation.

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