Tips Today A Serious Challenge To The 2012 Low-Carbohydrate Metabolic Payoff Study
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Title : Tips Today A Serious Challenge To The 2012 Low-Carbohydrate Metabolic Payoff Study
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In 2012, David Ludwig's grouping published an interesting RCT that suggested a substantial "metabolic advantage" resulting from a high-protein, very-low-carbohydrate diet (VLC) (2).
This finding has been used past times Ludwig, Gary Taubes, as well as others to back upwards the carbohydrate-insulin hypothesis of obesity, although at that spot is no show that the trial was mediated past times insulin, as well as also no show that it was mediated past times reduced saccharide rather than increased poly peptide (3).
Since I published that post, my confidence inward the finding-- as well as especially the mutual interpretation of it that reducing saccharide intake to a real depression degree increases REE as well as TEE-- has gradually been eroding. This is partially because other studies take away hold to a greater extent than oft than non reported that the carbohydrate:fat ratio of the diet has piffling or no trial on REE, TEE, or fatty storage (4, 5, 6, 7, 8, 9, 10).
My confidence degree dropped fifty-fifty to a greater extent than this week, when I saw a critical comment Kevin Hall added to the study inward PubMed Commons (11). Ludwig as well as colleagues take away hold since responded (12). Here's my perspective on the exchange, organized past times topic:
Inconsistency betwixt reported liberate energy expenditure as well as weight change
Hall pointed out that measured TEE was 200-500 kcal/day higher than reported liberate energy intake for all diets, alongside the largest gap inward the VLC diet. In other words, 200-500 to a greater extent than kilocalories were going out than were going in. Over a four-week period, if the information are correct, the VLC diet should take away hold caused simply over a kilogram of weight loss-- but it didn't-- the VLC diet grouping genuinely gained a pocket-size amount of weight (0.5 kg). This internal inconsistency inward the information may advise that ane or to a greater extent than of their measures is incorrect, either trunk weight (unlikely), liberate energy intake (likely, equally explained below), and/or liberate energy expenditure (possible, equally explained below).
Ludwig responded that trunk weight is an unreliable stair out of liberate energy residue over brusk periods of time-- inward other words, at that spot could take away hold been differential changes inward trunk composition betwixt groups that masked a trunk weight loss effect. I arrive at grip that pocket-size changes inward trunk weight over brusk periods of fourth dimension aren't a real venture stair out of liberate energy balance, but what Ludwig is proposing hither is basically that the VLC grouping was gaining H2O weight and/or thin volume to offset fatty loss that was simultaneously occurring. This hypothesized water/lean mas gain would take away hold to offset to a greater extent than than 1.5 kg of weight modify (just over 1 kg predicted from TEE, + 0.5 kg weight gain on VLC diet). Since nosotros know that VLC diets tend to reduce H2O weight, as well as are unlikely to pack on 1.5+ kg of thin volume inward a calendar month (particularly inward the aspect upwards of a diet that does non run into liberate energy needs), Ludwig's explanation is difficult to believe.
This brings us to what is likely the existent argue for the lack of modify inward weight.
Incomplete diet adherence
When I starting fourth dimension wrote close this study, I don't shout out back I fully appreciated the likelihood that the volunteers would "cheat" as well as eat exterior food. Ludwig's squad provided them alongside all study foods, but since it wasn't a metabolic ward study, volunteers had the might to eat additional nutrient at home. I'll add together that these people had a potent incentive to eat more, because they were maintaining a 10-15% reduced trunk weight throughout the study. This agency they were hungry as well as highly motivated to eat additional nutrient at home.
And they likely did. This may explicate the fact that the volunteers gained a fleck of weight on all diets, despite the fact that their supposed liberate energy intake was hundreds of kilocalories lower than their liberate energy expenditure! Ludwig acknowledges this inward his comment, maxim "it is probable that roughly non-study foods were consumed". He downplays it, but we're talking close 200-500+ kcal/day here, which is non insignificant.
I empathise that this variety of study is challenging to do, as well as the pattern is for sure a lot to a greater extent than rigorous than the type of diet study where yous simply ship people abode alongside diet advice as well as permit them put upwards their ain food. This type of study pattern industrial plant good inward a lot of contexts, but possibly it isn't the best suited for situations where your volunteers are weight-reduced as well as take away hold a potent incentive to eat additional food.
Statistical weaknesses
The study declared REE equally the primary outcome, as well as it establish that the VLC diet had a significantly higher REE than the LF diet. The departure was only 67 kcal/day, but this finding is robust because it was declared inward advance equally the primary outcome. I shout out back nosotros tin endure fairly confident that, nether the atmospheric condition tested, the VLC diet led to an increment inward REE vs. the LF diet. However, the increment is pocket-size plenty that it has piffling clinical or practical significance.
But the large splash made past times this study wasn't the 67 kcal/day increment inward REE-- it was the 300 kcal/day increment inward TEE! Although this finding got all the press, it rests on much less venture ground, equally pointed out past times Hall. The argue is that it's ane of many secondary outcomes (66 possible statistical tests performed on 22 measured variables, to endure exact), as well as when yous take away hold then many possible outcomes, yous destination upwards alongside a high likelihood of a faux positive finding unless yous purpose specific statistical tools to right the problem. This is called the multiple comparisons problem as well as it's real mutual inward science. In fact, it's ane of the leading causes of unreliable findings inward the scientific literature.
As I said, the multiple comparisons occupation tin endure avoided past times using the right statistical tools (essentially, raising the bar for statistical significance inward proportion to the issue of statistical tests yous perform), but inward Ludwig's study, these tools were non sufficiently applied to laissez passer us confidence inward the secondary outcomes. And that's non genuinely equally bad equally it sounds, but it does quest an additional layer of interpretation. Basically, if yous don't adequately right for multiple comparisons, your finding is "exploratory"-- important it's non a statistically robust finding, but it is suggestive as well as tin endure used to guide farther research. Researchers arrive at this all the time, as well as inward my persuasion it's acceptable equally long equally it's clearly labeled equally exploratory. But it also agency that yous can't (or shouldn't) proclaim to the populace that a diet increases TEE past times hundreds of kilocalories per day, because that outcome is non statistically robust.
So to summarize, we're left alongside a pocket-size REE trial that is statistically robust, as well as a large TEE trial that is statistically questionable. And equally nosotros volition see, the REE trial is probable explained past times the higher poly peptide content of the VLC diet.
The confounding trial of protein
The VLC diet was 30% poly peptide past times calories, spell the other ii diets were 20% protein. Since high-protein diets are known to increment liberate energy expenditure, this may furnish a plausible explanation for the observed increment inward REE on the VLC diet.
In Ludwig's answer to Hall's critique, Ludwig states that the higher poly peptide content of the VLC diet can't explicate the higher REE: "A poly peptide departure of this magnitude can’t explicate differences inward REE inward the fasting state, long afterward the thermic effects of nutrient take away hold dissipated". But inward fact, other RCTs demonstrate that it can explicate the increment inward REE.
In 2013, the enquiry grouping of Margriet Westerterp-Plantenga at Maastricht University-- ane of the leading researchers inward this area-- published a study that examined the effects of high-protein vs. normal-protein diets on REE afterward weight loss (13). It's worth noting that poly peptide was increased at the expense of fat, non carbohydrate.
Following a weight loss of close seven kg inward both groups, the normal-protein grouping experienced a reduction of REE, but the high-protein grouping didn't. The between-group departure inward REE during weight maintenance? 81 kcal/day. This is very similar to the 67 kcal/day that Ludwig reported, except that it was produced past times increasing poly peptide alone, non a combination of high poly peptide as well as real depression saccharide equally inward Ludwig's study. In my view, high poly peptide intake likely explains the elevated REE inward the VLC diet group.
Summary
The 2012 study past times David Ludwig's grouping reported that inward subjects maintaining weight loss, a high-protein, very-low-carbohydrate diet increased resting liberate energy expenditure past times a pocket-size amount (67 kcal/day), as well as total liberate energy expenditure past times a large amount ( 300 kcal/day), relative to a normal-protein, low-fat diet. Superficially, this seems to back upwards the thought of a substantial "metabolic advantage" for very-low-carbohydrate diets. However, at that spot are reasons to endure skeptical of roughly of the findings, which Kevin Hall put out inward a comment on NIH Commons. Here's a summary of my electrical current views:
You are now reading the article Tips Today A Serious Challenge To The 2012 Low-Carbohydrate Metabolic Payoff Study with the link address https://makehelathyday.blogspot.com/2018/07/tips-today-serious-challenge-to-2012.html
Title : Tips Today A Serious Challenge To The 2012 Low-Carbohydrate Metabolic Payoff Study
link : Tips Today A Serious Challenge To The 2012 Low-Carbohydrate Metabolic Payoff Study
Tips Today A Serious Challenge To The 2012 Low-Carbohydrate Metabolic Payoff Study
Warning: this post service volition endure a fleck to a greater extent than wonkish than usual, because I demand to larn detailed to brand my points. To read a summary, skip to the end.In 2012, David Ludwig's grouping published an interesting RCT that suggested a substantial "metabolic advantage" resulting from a high-protein, very-low-carbohydrate diet (VLC) (2).
This finding has been used past times Ludwig, Gary Taubes, as well as others to back upwards the carbohydrate-insulin hypothesis of obesity, although at that spot is no show that the trial was mediated past times insulin, as well as also no show that it was mediated past times reduced saccharide rather than increased poly peptide (3).
Since I published that post, my confidence inward the finding-- as well as especially the mutual interpretation of it that reducing saccharide intake to a real depression degree increases REE as well as TEE-- has gradually been eroding. This is partially because other studies take away hold to a greater extent than oft than non reported that the carbohydrate:fat ratio of the diet has piffling or no trial on REE, TEE, or fatty storage (4, 5, 6, 7, 8, 9, 10).
My confidence degree dropped fifty-fifty to a greater extent than this week, when I saw a critical comment Kevin Hall added to the study inward PubMed Commons (11). Ludwig as well as colleagues take away hold since responded (12). Here's my perspective on the exchange, organized past times topic:
Inconsistency betwixt reported liberate energy expenditure as well as weight change
Hall pointed out that measured TEE was 200-500 kcal/day higher than reported liberate energy intake for all diets, alongside the largest gap inward the VLC diet. In other words, 200-500 to a greater extent than kilocalories were going out than were going in. Over a four-week period, if the information are correct, the VLC diet should take away hold caused simply over a kilogram of weight loss-- but it didn't-- the VLC diet grouping genuinely gained a pocket-size amount of weight (0.5 kg). This internal inconsistency inward the information may advise that ane or to a greater extent than of their measures is incorrect, either trunk weight (unlikely), liberate energy intake (likely, equally explained below), and/or liberate energy expenditure (possible, equally explained below).
Ludwig responded that trunk weight is an unreliable stair out of liberate energy residue over brusk periods of time-- inward other words, at that spot could take away hold been differential changes inward trunk composition betwixt groups that masked a trunk weight loss effect. I arrive at grip that pocket-size changes inward trunk weight over brusk periods of fourth dimension aren't a real venture stair out of liberate energy balance, but what Ludwig is proposing hither is basically that the VLC grouping was gaining H2O weight and/or thin volume to offset fatty loss that was simultaneously occurring. This hypothesized water/lean mas gain would take away hold to offset to a greater extent than than 1.5 kg of weight modify (just over 1 kg predicted from TEE, + 0.5 kg weight gain on VLC diet). Since nosotros know that VLC diets tend to reduce H2O weight, as well as are unlikely to pack on 1.5+ kg of thin volume inward a calendar month (particularly inward the aspect upwards of a diet that does non run into liberate energy needs), Ludwig's explanation is difficult to believe.
This brings us to what is likely the existent argue for the lack of modify inward weight.
Incomplete diet adherence
When I starting fourth dimension wrote close this study, I don't shout out back I fully appreciated the likelihood that the volunteers would "cheat" as well as eat exterior food. Ludwig's squad provided them alongside all study foods, but since it wasn't a metabolic ward study, volunteers had the might to eat additional nutrient at home. I'll add together that these people had a potent incentive to eat more, because they were maintaining a 10-15% reduced trunk weight throughout the study. This agency they were hungry as well as highly motivated to eat additional nutrient at home.
And they likely did. This may explicate the fact that the volunteers gained a fleck of weight on all diets, despite the fact that their supposed liberate energy intake was hundreds of kilocalories lower than their liberate energy expenditure! Ludwig acknowledges this inward his comment, maxim "it is probable that roughly non-study foods were consumed". He downplays it, but we're talking close 200-500+ kcal/day here, which is non insignificant.
I empathise that this variety of study is challenging to do, as well as the pattern is for sure a lot to a greater extent than rigorous than the type of diet study where yous simply ship people abode alongside diet advice as well as permit them put upwards their ain food. This type of study pattern industrial plant good inward a lot of contexts, but possibly it isn't the best suited for situations where your volunteers are weight-reduced as well as take away hold a potent incentive to eat additional food.
Statistical weaknesses
The study declared REE equally the primary outcome, as well as it establish that the VLC diet had a significantly higher REE than the LF diet. The departure was only 67 kcal/day, but this finding is robust because it was declared inward advance equally the primary outcome. I shout out back nosotros tin endure fairly confident that, nether the atmospheric condition tested, the VLC diet led to an increment inward REE vs. the LF diet. However, the increment is pocket-size plenty that it has piffling clinical or practical significance.
But the large splash made past times this study wasn't the 67 kcal/day increment inward REE-- it was the 300 kcal/day increment inward TEE! Although this finding got all the press, it rests on much less venture ground, equally pointed out past times Hall. The argue is that it's ane of many secondary outcomes (66 possible statistical tests performed on 22 measured variables, to endure exact), as well as when yous take away hold then many possible outcomes, yous destination upwards alongside a high likelihood of a faux positive finding unless yous purpose specific statistical tools to right the problem. This is called the multiple comparisons problem as well as it's real mutual inward science. In fact, it's ane of the leading causes of unreliable findings inward the scientific literature.
As I said, the multiple comparisons occupation tin endure avoided past times using the right statistical tools (essentially, raising the bar for statistical significance inward proportion to the issue of statistical tests yous perform), but inward Ludwig's study, these tools were non sufficiently applied to laissez passer us confidence inward the secondary outcomes. And that's non genuinely equally bad equally it sounds, but it does quest an additional layer of interpretation. Basically, if yous don't adequately right for multiple comparisons, your finding is "exploratory"-- important it's non a statistically robust finding, but it is suggestive as well as tin endure used to guide farther research. Researchers arrive at this all the time, as well as inward my persuasion it's acceptable equally long equally it's clearly labeled equally exploratory. But it also agency that yous can't (or shouldn't) proclaim to the populace that a diet increases TEE past times hundreds of kilocalories per day, because that outcome is non statistically robust.
So to summarize, we're left alongside a pocket-size REE trial that is statistically robust, as well as a large TEE trial that is statistically questionable. And equally nosotros volition see, the REE trial is probable explained past times the higher poly peptide content of the VLC diet.
The confounding trial of protein
The VLC diet was 30% poly peptide past times calories, spell the other ii diets were 20% protein. Since high-protein diets are known to increment liberate energy expenditure, this may furnish a plausible explanation for the observed increment inward REE on the VLC diet.
In Ludwig's answer to Hall's critique, Ludwig states that the higher poly peptide content of the VLC diet can't explicate the higher REE: "A poly peptide departure of this magnitude can’t explicate differences inward REE inward the fasting state, long afterward the thermic effects of nutrient take away hold dissipated". But inward fact, other RCTs demonstrate that it can explicate the increment inward REE.
In 2013, the enquiry grouping of Margriet Westerterp-Plantenga at Maastricht University-- ane of the leading researchers inward this area-- published a study that examined the effects of high-protein vs. normal-protein diets on REE afterward weight loss (13). It's worth noting that poly peptide was increased at the expense of fat, non carbohydrate.
Following a weight loss of close seven kg inward both groups, the normal-protein grouping experienced a reduction of REE, but the high-protein grouping didn't. The between-group departure inward REE during weight maintenance? 81 kcal/day. This is very similar to the 67 kcal/day that Ludwig reported, except that it was produced past times increasing poly peptide alone, non a combination of high poly peptide as well as real depression saccharide equally inward Ludwig's study. In my view, high poly peptide intake likely explains the elevated REE inward the VLC diet group.
Summary
The 2012 study past times David Ludwig's grouping reported that inward subjects maintaining weight loss, a high-protein, very-low-carbohydrate diet increased resting liberate energy expenditure past times a pocket-size amount (67 kcal/day), as well as total liberate energy expenditure past times a large amount ( 300 kcal/day), relative to a normal-protein, low-fat diet. Superficially, this seems to back upwards the thought of a substantial "metabolic advantage" for very-low-carbohydrate diets. However, at that spot are reasons to endure skeptical of roughly of the findings, which Kevin Hall put out inward a comment on NIH Commons. Here's a summary of my electrical current views:
- There was likely important dietary non-compliance, alongside volunteers eating extra nutrient at abode inward add-on to what they were supplied past times the lab. This likely explains at to the lowest degree business office of why they didn't lose weight, despite the fact that they should take away hold lost weight according to the reported liberate energy intake as well as expenditure figures.
- The finding that resting liberate energy expenditure was elevated on the VLC diet is statistically robust. However, the increment is pocket-size plenty that it has piffling clinical or practical significance.
- The increment inward resting liberate energy expenditure tin endure explained past times the higher poly peptide content of the VLC diet, as well as it likely had piffling to arrive at alongside the fact that the VLC diet was depression inward carbohydrate.
- The finding that total liberate energy expenditure was elevated past times 300 kcal/day on the VLC diet is non statistically robust, as well as it's also difficult to reconcile alongside the results of other studies.
For me, here's the bottom line. Aspects of the study notwithstanding stand upwards equally reliable, but the findings arrive at non back upwards the determination that reducing saccharide intake yields a metabolic advantage. My best interpretation is that the study is consistent alongside other findings suggesting that high-protein diets yield a pocket-size metabolic advantage, but that calorie intake is notwithstanding the cardinal determinant of fatty volume changes.
Thus the article Tips Today A Serious Challenge To The 2012 Low-Carbohydrate Metabolic Payoff Study
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You are now reading the article Tips Today A Serious Challenge To The 2012 Low-Carbohydrate Metabolic Payoff Study with the link address https://makehelathyday.blogspot.com/2018/07/tips-today-serious-challenge-to-2012.html
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