Richard Morris

@MacroFour 10 years on April 20th. Which means statistically none of my fat cells will remember being type 2 diabetic fat cells, as adipocyte residence time is evidently 10 years.

I'm well into my 8th year of T2 diabetes remission staying LCHF. Technically (as I had 6 yrs Dx before remission) it should have never happened at all. Next, like most of the 'easier' DiRECT remission cases (put back on the EATWELL diet) I should have lost remission...1of2

@nicknorwitz @washingtonpost It is also true that humans can become shorter by maintaining a permanent crouching posture. I suspect if you locked subjects in a ward with a lowered ceiling, they would be able to sustain that almost indefinitely.

🚨I just read the new @washingtonpost article entitled, "Yes, calories in/calories out really is the key to weight loss" In my opinion, it was rife with misunderstanding and misdirection. Let's dig in! The author first establishes that energy balance is a “fundamental weight loss truth,” i.e. that the energy balance equation "Energy in - Energy out = Weight gain," being a recapitulation of the law of energy conservation, is not up for debate. For the sake of argument, I can certainly except this premise, highlighting - however - that the energy balance equation is a DESCRIPTION and NOT a pathogenic model of #obesity. The core of the author's argument is that the non-caloric properties of food and food products -- factors like the "thermic effect of food," microbiome digestibility, etc. -- have such a small magnitude effect as to be nearly clinically meaningless. Her exact words are "all those ways [factors] are small. So small that, in trial after trial, no diet, based on any of these things, significantly outperforms any other diet in the long term." That's the thesis. It's not subtle. Basically, focusing on Calories in food (Calories in) is the highest yield target for controlling weight. Everything else is "small [near meaningless] details." That’s a nice punch-line… one that may appears to debunk the “CICO deniers,” especially when the argument is dressed in big words like "oligosaccharides" and "thermic effect of food." It sounds authoritative and convincing. The only problem is... it's wrong and based on a what appears to be a fragile understanding of the literature, limitations of study design, and selective citing. A keystone of the authors argument is reference to metabolic ward studies in which caloric control tends to have the dominant effect on weight. However, a major limitation of such studies is they are necessarily short term. This handicaps their relevance because: (1) Negates the important effects of human behavior variable and sustainability (2) Short-term trials don't provide time for dietary adaptation (3) And they deemphasize what is, IMO, the most important variable of “energy balance” -- fuel PARTITIONING Let's remember weight gain is an insidious process that happens over years. You don't gain 50 lbs in a month. So, a key factor that's often disregarded - especially in short-term studies - is WHERE the 'delta energy' is put. Is it stored in fat, or muscle, or expended on non-exercise activity thermogenesis etc. Over the long-term fuel partitioning can have a dominant effect on weight management, as it establishes a positive feedback loop: e.g. energy stored in muscles increases basal metabolic rate, increasing "Eout" progressively as compared to fuel partitioning in fat. That's just one example The author disregards this critical truth of weight management entirely. I’ll also note the author challenges her reader to “to pop on over to PubMed and look around. Look at the meta-analyses, which try to make sense of the body of evidence, and find one where a particular kind of diet outperforms others long-term” It would be my pleasure! Here's one meta-analysis of 29 studies that proves my point. In longer-term, but not shorter term studies, varying the macronutrient content of diet increases energy expenditure - providing a metabolic benefit that, over the long term, can lead to weight management success! pubmed.ncbi.nlm.nih.gov/33274750/ There's certainly more I could dig into about this article, such as the choice of the author to lump "The Häagen-Dazs Diet. The Pepsi Diet. The Bacon Diet," as if Bacon is metabolically similar to rich ice cream and soda. Hehe. But for now, I'll cap it by quoting the final lines of the article: “If you’re not losing weight, you have to find a way to rejigger the equation. It’s the calories, people. It’s the calories.” Without beating around the bush, I have to say "It’s the calories, people. It’s the calories” is such a useless statement that I'd simply call it nutritional advice pollution Video breakdown: youtu.be/86nEejQXld0?si…

@nicknorwitz Delay answering the question, while sampling each to make up my mind, until there is no more cheese ... then ask "What was the question again?"

Roquefort, Brie, Manchego, or Cheddar. You only get 1… Which? (There is a right answer)

@richcollins @lowcarbGP @AbilitiesB @realDaveFeldman Most lipid draws are 10 hours fasted ie: empty buffers. But a lot of empty buffers. Suggesting upregulated capacity to adequately fuel a fat adapted lean subject between meals when adipose is not enough

@khiron @lowcarbGP @AbilitiesB @realDaveFeldman But they’re mostly empty (low trigs)? Are more particles in circulation just in case they’re needed?

Or just go low carb and actually lose that belly without the elastic pants!!

@lowcarbGP @AbilitiesB @realDaveFeldman Adipose has a rate limit Leanness is not evolutionarily conserved for a reason - so your lineage could survive a day of bad hunting An adaptation to insufficient buffer is more buffers - and circulation is a buffer of FAs via APO-B particles

@AbilitiesB In my patient cohort of people with T2D mostly the lipid profiles improve on low carb I have had a few lean hyper responders but their CAC scans were perfect so not so worrying @realDaveFeldman is the expert on this

@FrogHarmless @MacroFour @KetoCarnivore @DrFeinman Baseline RQ of non MS cohort Induce transitory insulin resistant with several hours of infusion of 20% TAG emulsion with heparin (per Shulman ncbi.nlm.nih.gov/pmc/articles/P…) Re-measure RQ If they are burning more FAs than at baseline the alternative hypothesis can be rejected

@MacroFour @KetoCarnivore @DrFeinman @khiron OK. How would you measure this, and what would you compare it against?

"We don’t take in calories. We take in grams. Calories-in-calories-out is colloquial." —@DrFeinman

@HugoMacdermott @MeganLOMara Congrats Dr :)

@MeganLOMara Thanks Megan! It’s been an amazing ride and I’ve learned so much. Proud of everything we’ve achieved together. 😁🎓📚

@BelindaFettke @Leafiehealth @FructoseNo @zoeharcombe 4 legs good ... 2 legs bad.

@Leafiehealth What????? Fruit beer counts as part of your 5 a day??? Now I've heard everything @Leafiehealth @FructoseNo @zoeharcombe 😳😳😳

Alcoholic drink ad banned for suggesting its fruit-flavoured beers counted as "one of your five-a-day".

@MarikaSboros In person he emitted creepy vibes. I wrote those off as maybe just cultural differences I should be more tolerant of ... should've trusted my 1st instinct What a creep

Eina! This is a shocker!

@KenDBerryMD GLP-1's physiological role is to prime the gut for digestion by releasing a little insulin till the pancreas can get an accurate read on expected glucose, and switching off hunger till the gut can get a read on expected calories. Not convinced being in that state 24/7 is ideal

This is a great profit model! This is an awful health model... insider.com/semaglutide-ta…

@nicknorwitz GLP-1's physiological role is to prime the gut for digestion by releasing a little insulin till the pancreas can get an accurate read on expected glucose, and switching off hunger till the gut can get a read on expected calories. Not convinced being in that state 24/7 is ideal

5/ Point (2) -- The data for GLP-1s are strong. Need to give credit where it's due. Data are impressive. These are data from a 68w double blind RCT with once/w Semaglutide at 2.4mg Mean change in weight was −14.9% in the semaglutide group as compared with −2.4% with placebo

1/ At Thanksgiving dinner, a relative who struggles with #obesity -- like too many in this world -- asked my opinion on the Ozempic (Semaglutide), the GLP-1 receptor agonist that's being prescribed more and more for weight loss My 4-point reply... 🧵👇

@Drlipid Inhibiting transport of fatty acids "the last mile" across the mitochondrial membrane might do it. They are lipids, right?

I am going to stick to lipids but wondering if anyone, including the experts, know "What causes Obesity?" ow.ly/bgLF50LLbiv?

@robertlufkinmd @Sam_Apple1 Is there an online source for this clipping?

@HeatherMAitken @ourANU Ok Doc :)

You may absolutely call me doctor! @ourANU #grad #phd

@live_intheflesh @KetoCarnivore @FrogHarmless @DrFeinman Fair enough. Mind you I'm not sure that nutritional scientists contributed much to the definition of how much energy raises 1g of water from 14.5C to 15.5C by determining that 1 Calorie is also precisely equal to 1000 calories

@khiron @KetoCarnivore @FrogHarmless @DrFeinman Technically work can't be defined any better than energy can. I think hammering on the point that physicists can't define their own terms without vicious circularity can break biologists of the obsession with calories wrt human health. That's my preferred gimmick.

@Alundra @KingManninen @raphaels7 @DietDoctor Insulin signalling increases transcription of and activation of the rate limiting enzyme (Acetyl-CoA) Lowering insulin potentiates fatty acid mitochondrial transport and oxidation Between meals in mild cases, chronically in severe cases

@khiron @KingManninen @raphaels7 @DietDoctor How do you uninhibit fat oxidation?

Putting myself in the shoes of a new @DietDoctor user: “Before you pushed the most energy dense diet possible (#keto), and now you emphasize diets that primarily⬇️energy density - why?” Long-term, sustainable eating doesn’t need to always be the same, but it needs coherence…

@FrogHarmless @KetoCarnivore @DrFeinman Potential value ... if you can get the fuel into the furnace If not and you have a disposal pathway (glucose->urine) it's just inefficient conversion. If you don't have a disposal pathway (eg: fatty acids) then it's an episode of "Hoarders"

@KetoCarnivore @DrFeinman I hope he's not implying you can get fat on water. 🤨 The caloric model is a useful abstraction of the metabolic value of foodstuff, not just a colloquialism.

@cancerclasses @FrogHarmless @KetoCarnivore @DrFeinman Water is a product of metabolism not a factor

@FrogHarmless @KetoCarnivore @DrFeinman Water and minerals have mass but NO calories & thus give NO energy, they are both just co-factors for metabolic processes.

@live_intheflesh @KetoCarnivore @FrogHarmless @DrFeinman Technically calories are work, not potential work. Metabolic fuel (glucose,fatty acids) can be turned into metabolic work if they can be metabolized into ATP Hyperinsulinaemia inhibits mitochondroal membrane transport of fatty acids, and plasma membrane transport of glucose

@KetoCarnivore @FrogHarmless @DrFeinman @khiron I've seen this floating around lately. I really think "isocaloric is not isometabolic" captures what we're getting at here much better and that we should stick with it.

@raphaels7 IOW if you want to weigh less go for a run - your body will soon work out this animal needs to be lighter to hunt and set the buffer it defends lower. Nothing to do with calories out, more like information in

@raphaels7 Define "works" - keto reversed my type 2 diabetes, and hasn't stopped keeping it reversed 8 years later

At this stage, i’m more interested in why keto doesn’t work for some folk, or why it stops working for them, than why it works in the first place