This post first appeared on Mark's Daily Apple.
---After two years, we at the Ancestral Weight Loss Registry (AWLR) are proud of what we’ve become. Over 3,100 people from all 50 states and over 55 countries have registered and shared the tribulations and triumphs populating their noble journey towards health, fueled by fatty meats with a side of buttered broccoli. A physician’s recommended eating strategy that, but for a few years ago, would at the very best be viewed as a data-less void of speculation, and at the worst, labeled utter quackery. Asking an overweight patient to eat foods high in calories does not pass the proverbial eyeball test, defying all common wisdom characterizing weight loss advice to date.
Coming up with a testable hypothesis for why we gain weight and how to lose it undoubtedly involves logic, intuition and researcher experience. As Nobel laureate Richard Feynman describes scientific discovery and hypothesis testing:
“First we guess it…then we compute the consequences of the guess to see what it would imply. And then we compare those computation results directly to observation to see if it works. If it disagrees with the experiment, it’s wrong. In the simple statement is the key to science”
But what if we didn’t have to guess it? What if we had the capabilities to crowd-source hypothesis creation instead of relying on bias-confounded researcher intuition? This is the motivation for AWLR, and central to its success is you. Primal Blueprint (PB) followers make up 40% of registry members and from the bottom of my heart, I thank those who have registered thus far and urge those who have not to register here today to help make AWLR the largest weight loss registry the world has ever seen.
PB eaters have contributed a tremendous amount of data. The common experiences and behaviors that materialize by straining your conglomerate information through an algorithmic sieve become hypotheses that spawn a reverse engineering problem, beginning with clinical findings and searching for mechanisms of action. One of the most interesting such trends was that related to hunger.
“After going primal, I just didn't get so hungry any more. And when I did feel hunger, it wasn't so pressing, and I could easily ignore it and it would go away for a while.”
“The ease of Primal Blueprint has surprised me the most. Fat tastes delicious, so I eat better-tasting food. I don't go hungry because I simply eat until I'm full instead of counting calories.”
See our testimonials page for hundreds of similar quotes. 95.8% of PB eaters report feeling “rarely or never hungry between meals” and of those who have tried a low fat diet in the past, 91% report feeling less hungry while eating PB. This satiety has led to an average of 33 pounds lost and over 31,000 pounds dropped total.
Could these findings be real? Or are they simply a function of the non-randomized, self-selected data that has accrued? Taking a journey through the medical literature may offer some insight.
They Starved, We Forgot
In 1944, Ancel Keys recruited 36 men into what would be known as the Minnesota starvation experiment, to study the physiologic and psychological effects of prolonged and severe dietary restriction. He documented his findings in a 1400 page tome, and shortly after the experiment began, the men quickly realized how difficult it might be. The predictable signs and symptoms quickly crept in: constant hunger, low body temperature, decreased libido and a total inability to think of anything but food. One subject offered a particularly chilling exposé of what it is like to eat such little food:
"How does it feel to starve? It is something like this: I'm hungry. I'm always hungry - not like the hunger that comes when you miss lunch but a continual cry from the body for food. At times I can almost forget about it but there is nothing that can hold my interest for long. I wait for mealtime. When it comes I eat slowly and make the food last as long as possible. The menu never gets monotonous even if it is the same each day or is of poor quality. It is food and all food tastes good. Even dirty crusts of bread in the street look appetizing and I envy the fat pigeons picking at them.”
So what were they eating? “The major food items served,” described Dr Keys “were whole wheat bread, potatoes, cereals, and considerable amounts of turnips and cabbage. Only token amounts of meats and dairy products were provided,” with an average daily intake of 1570 calories, including about 50 grams of protein and 30 grams of fat.
Fast-forward 70 years
The director of Boston Medical Center’s weight management clinic and obesity consultant for Dr. Oz, Dr. Caroline Apovian describes in an interview how she treats her patients’ weight troubles.
“If somebody came into my clinic who had a BMI of 30—female—I would put them on a 1,200- to 1,500-calorie-a-day diet, and they usually would be eating 2,500. A normal, moderately active female eats 2,000 calories a day, and a male, 2,500.” But wouldn’t this “produce a chronic hunger?” the reporter aptly counters. “It does,” replies Apovian, “and it’s usually a hunger that people cannot tolerate. That is the reason most diet programs fail.”
So how did the ‘starvation diet’ of 1944 become the standard of care today?
Protein, Hunger & Weight Loss
The Fat Trap, a popular New York Times article from 2011 profiles a study by Dr. Joseph Proietto, highlighting the difficulty in losing weight on a low calorie diet. Proietto recruited 50 obese men and women, studying the biological state of the body after weight loss. The patients were given 500 calories of a low fat Optifast shake each day for eight weeks. But after a year, the weight slowly came back and the subjects were haunted by their diet-induced hormonal changes, feeling “far more hungry and preoccupied with food than before they lost the weight.” Researchers also noticed that ghrelin, often dubbed the ‘hunger hormone,’ was about 20 percent higher than at the start of the study. “What we see here is a coordinated defense mechanism with multiple components all directed toward making us put on weight,” Proietto says. “This, I think, explains the high failure rate in obesity treatment.”
However, this weight-loss-induced ghrelin rise is only observed when ketosis is absent. These same researchers three years later sung to a different tune:
“Ketogenic low-carbohydrate diets are a popular means of weight loss, and in the short-term, often result in greater weight loss than low-fat diets…it is commonly proposed that ketones suppress appetite, and it has been observed that study participants on ad libitum ketogenic diets spontaneously restrict their energy intake.”
And their randomized trial in the European journal of clinical nutrition confirmed this observation, demonstrating that “in mildly ketotic participants, the increase in the circulating concentration of ghrelin, a potent stimulator of appetite, which otherwise occurs as a result of diet-induced weight loss, was suppressed.”
This anorexic effect secondary to a high protein, high fat diet likely explains why PB eaters are so successful and happy with their new way of eating. It could also explain why in the majority of randomized clinical trials testing such diets, those highest in protein and fat systematically lead to more weight loss. There are at least 14 randomized clinical trials in which the people assigned to a calorie unlimited high protein, high fat diet lose more weight than their low fat, calorie restricted counterparts.
Which begs the question: Where are the randomized clinical trials supporting low fat diets as the standard of care? The studies where a low fat, calorie restricted diet results in more weight loss than a calorie unlimited high fat diet. In fact, we at AWLR were so bewildered by the lack of evidence that we are running the ‘Low Fat Challenge’ for anyone in the world to find such a trial, incentivized by a crowd-funded pot of cash. After nearly a year, hundreds of dollars have been raised with no winner to accept.
My wildest dream would be to make AWLR the largest weight loss registry in the world within the next year, overtaking the National Weight Control Registry that has a 15-year head start. They boast around 10,000 members after approximately 17 years of existence. At 3,100+ after two years, it is an ambitious but attainable goal; A dream that can only be achieved with your help. It would make a tremendously unbelievable statement to the dietary research community if Paleo and PB was so prominent and demonstrated such incredible improvements in health. If you have not registered yet, please take 10 minutes to do so here. And if you have, sharing this post with the world would make all the difference.
As you are reading these words, there is someone out there who is depressed, unhealthy and overweight. A poor soul being shunned by the medical community due to their “lack of willpower,” who struggles to get by on their 1400 calorie low-fat diet. A beautiful human being with boundless happiness trapped underneath the overwhelming heaviness of constant hunger and a label of ‘BMI > 30’, desperately searching for a real solution. With your help, I hope we can reach them and offer a gentle, heart-felt helping hand.