MY CYBER CHAT WITH TOM NAUGHTON OF THE MOVIE "FAT HEAD"

--> A couple of years ago, in response to watching the movie Super Size Me, I completely stopped eating at fast food restaurants and I've never looked back.  Tom Naughton's response to watching the movie was a little more extreme:  He set out to make his own documentary, exposing the obvious (to him) inaccuracies, inconsistencies and downright deceptions in that movie.

The result was Fat Head, a factual and comic look at Super Size Me, written by, produced by and starring Tom Naughton, a stand up comedian, sit down writer and first time film-maker.  Not only does Tom rip Super Size Me to shreds, but he also shines a very informative spotlight on the whole low carb nutritional movement.  I just got my copy a week ago, after watching all the teasers for the same on youtube, and I loved it.  However, because of the way I am "wired", I wanted to know more about what Tom thought on a few low carb confusions of mine.

I contacted Tom, asking if I could grill him a little, and he graciously told me to fire away.  In pretty short order, I got some very interesting and thought-provoking answers and observations from Tom, which helped me fine tune my own understanding of the way I have chosen to eat - high fat, moderate protein and low carb.

Following are some Q & A from Tom and me. 

Rebecca:  How is fat stored in the absence of insulin?  Most of the things I have read talk about how the over-release of insulin causes glucose to be stored as fat.  I have also read that protein that is not needed by the body is converted to glucose and stored as fat.  But what happens when a person eats overeats fat?  I asked that question of Gary Taubes in his recent interview with Jimmy Moore.  Gary answered by saying he has a problem with the word “overeat” and then he really didn’t answer the question.  He said that what is enough for one person might not be enough for another person.   

So I am trying to rephrase the question so that it is clear:  Say a person is eating a certain amount of fat, protein and carbs (very low carb), and they are maintaining their weight on these amounts of each macronutrient.  Then, they suddenly increase their fat intake only by a large amount.  Do they begin to gain weight?  And if so, why?  If fat storage is driven by insulin, and fat does not provoke an insulin response, then how does that fat get stored?  

I have heard some say that excess fat beyond what the body needs will just cause the body to raise the metabolism to burn it off.  I have heard some say that the body does not use the excess fat, but just excretes it.  I have heard some say that the excess fat is a “calorie bomb” and will be stored as fat, but they do not say by what biological mechanism this happens.  

Dr. Atkins said that we can eat as much fat as we want, because it will not cause insulin to be produced and there will be no way for the fat to be stored.  But then he says that if we eat way too much, it will cause weight gain.  How? 

Tom:  Unless you’re a type I diabetic, your body will always produce some insulin in response to food, and good thing too, or you’d waste away and die.  Carbohydrates generally provoke the greatest insulin response, but protein provokes an insulin response too.  I’m not aware of any experiments in which subjects lived on a diet of 100% fat, so I can’t say whether or not it’s possible to gain weight on fat alone, but we don’t eat fat alone; we eat fat with protein. 

So my guess is that while you’re less likely to store calories as fat if you’re eating nothing but fat and protein, it’s still possible to gain weight if you eat enough, because the protein could provoke an insulin response sufficient to store some fat.   

Rebecca:  What is the difference between “Calories In Calories Out” and “Creating a Calorie Deficit”?  I have heard many people talk about how 3500 calories equals a pound, and that to lose a pound per week, all you have to do is cut 500 calories from your daily food.  Or cut 250 calories per day and increase your activity by 250 calories each day for the same result. 

Many low carb people will say that this theory is wrong, because a calorie is not a calorie is not a calorie.  The body will react to 100 calories of high glycemic index carbs differently than it will react to 100 calories of butter.  I know that I, personally, will maintain my weight on 1100 calories of high carb, low fat food, and I will also maintain my weight on 1800 calories of low carb, high fat food.  So I do believe that there is a “metabolic advantage” to eating low carb and high fat.   

Also, many will say it is wrong because the body can adapt through homeostasis or thermogenesis, and keep the body from losing weight.  I heard this analogy recently:  It's kind of like the Borg on Star Trek, where a phaser weapon works against the alien Borg creatures once, but then they adapt, and soon the same phaser blast no longer does anything. 

I started a thread on the Atkins Forum called “My Body is Not a Piggy Bank!  (Do Calories Matter?)” and I posted information that I got off of Adam Kosloff's website Why Low Carb Diets Work.  On that website, Adam attempts (and does a great job, I think) of crystallizing Gary Taubes’ ­Good Calories Bad Calories into an easily read and understood form.  Gary told Adam that he thought it was good. 

If anyone can prove that homeostasis and/or thermogenesis are real,  it is me!  Without changing my activity, I have both gained and lost weight eating 1400 calories and 2000 calories and everything in between.  And all of this high fat, moderate protein and very low carb (never more than 40 total carbs and as low as 20 total carbs). 

Tom:  To lose weight, you still have to create a calorie deficit. The idea behind low-carb is that the fat cells are open for business, so if you create the need to tap them, you can. Otherwise, simply eating less can encourage your body to slow your metabolism.   

Calories In Calories Out assumes the number of calories you burn stays more or less constant. It ignores adaptive thermogenesis, the process by which your body can dramatically raise or lower your metabolism in response to the foods you eat, hormones, etc.  So according to the Calories In Calories out crowd, if you simply eat less, you’ll automatically lose weight matching the equation 3,500 calories = 1 pound of fat. However, if your fat cells aren’t open for business and you simply eat less, your body will respond to starvation at the cellular level by slowing your metabolism. That’s part of the reason so many diets fail, and also the reason some people who try to grit it out end up losing muscle instead of fat. Likewise, people who literally can’t seem to gain weight (my son, for one) have metabolisms that ramp up if they eat more. 

If your fat cells are open for business, your body can make up for a fuel shortage by burning body fat, so it won’t experience cellular starvation and won’t slow your metabolism. But any way you slice it, you need to give your body a reason to tap those fat cells. I’ve seen people accuse the low-carb doctors of either denying the need for a calorie deficit or just now admitting to it, but Drs. Eades & Eades wrote about the need to create a calorie deficit way back with their first Protein Power book, which was published in 1997.  

Research has shown that people who go on low-carb diets often end up eating less spontaneously. There’s a reason for that: once the fat cells are opened up, they supply a bigger share of your energy, so you don’t feel the need to eat as much. 

Rebecca:  It seems like you are saying that Calories In Calories Out does not work if the fat cells are “closed” but it does­ work if the fat cells are “open”.  Or maybe it works when the fat cells are “open” but you make sure not to drop your calories too low and cause the body to “shut” the fat cells again.

But doesn’t “creating a calorie deficit” also ignore adaptive thermogenesis?  If the fat cells are “open” does that turn off adaptive thermogenesis, or is it still possible? 

If I am understanding this correctly, the difference between Calories In Calories Out and Creating a Calorie Deficit is really only a matter of semantics.  You could basically say that if you are eating high carb and low fat, Calories In Calories Out will not work.  But if you are eating low carb and high fat, Calories In Calories Out will work.  Isn’t Creating a Calorie Deficit really the same thing as Calories In Calories Out, provided, of course, that you are acknowledging that all calories are not created equal? 

Just eating less and exercising more (Calories In Calories Out) will not make a person lose weight IF they are eating wrong.  But if they are eating right, eating less and exercising more will make them lose weight (Calorie Deficit).  Please help me to understand this better!   

Tom:  Well, it’s a big, complex subject, but I’ll try to make it as clear as possible.  The Calories In  Calories Out crowd believes that 1) Body fat is passive and 2) All calories count the same.  Therefore, they make goofy statements such as “If you just cut 100 calories per day from your diet, you’ll lose 10 pounds per year.”

They see the body as a bank which has a set number of daily expenses (your basal metabolism).  Every calorie consumed is a deposit, and every calorie burned through activity is a withdrawal.  So in their view, if your basal metabolism is 1500 calories and you burn an extra 500 calories through activity, eating more than 2000 calories will always cause weight gain, and eating fewer than 2000 calories will always cause weight loss. 

We know this is poppycock because people like my wife and son weigh exactly the same year in and year out.  They can’t possibly be consuming EXACTLY the right number of calories every year.  My son easily consumes more than a million calories in a year.  According to simple calorie math, if he over-ate by a mere 7,000 calories, he’d gain two pounds – yet that never happens.  So unless he’s eating exactly the right number of calories every year – with 99.3% accuracy – his body must be adjusting his metabolism up and down in response to his diet to maintain his weight. 

In fact, my son twice tried to gain weight by eating quite a bit more, but it didn’t work.  Other people have tried to starve themselves thin but couldn’t lose anything close to what the simple Calories In  Calories Out math says they should have lost. 

That’s what Taubes explained in his book. It’s important to understand that despite what some of his critics have said, Taubes does not believe calories can magically disappear or that the laws of thermodynamics don’t apply to the human body.  (We’re talking about a guy with a degree in physics, after all.)  In any system, the body included, the inputs and outputs must match.  However, Taubes believes that 1) Body fat is an active driver of your metabolism, 2) the amount of fat your body wants to maintain is determined by hormones, and 3) the body responds to different sources of calories in different ways. 

Body fat drives metabolism by providing you with a supply of fatty acids for fuel.  To keep your blood sugar level, your body needs to alternately store and retrieve fat – storing fat when blood sugar is high so the blood sugar will be consumed first and brought down to a safe level, retrieving fat as blood sugar drops so blood sugar isn’t over-consumed and pushed too low.  The amount of body fat you need for this system to work depends on how efficiently your fat cells can release fatty acids, which in turn is a function of several hormones.  Insulin, of course, is a prime mover in this system because high levels of insulin can slow down or block the release of fatty acids.  If your fat cells are slow to release fat, your body will work to make them bigger, because bigger fat cells can release more fatty acids, thus allowing you to keep your blood sugar stable. 

So if hormones are telling your body to maintain a certain level of body fat, it will fight your efforts to gain or lose.  It fights by adjusting your metabolism up or down.  So you cut 100 calories per day from you diet, just like the experts suggest, and nothing happens.  Why?  Because if hormones are telling your body to remain fat, your body will respond by making adjustment to the calories it expends. 

The Calories In  Calories Out crowd doesn’t account for those adjustments.  They also don’t account for the fact (despite plenty of clinical research) that the body tends to raise its metabolism in response to certain nutrients, such as proteins and medium-chain triglycerides – the fat found in coconut oil. 

Here’s an analogy:  To the Calories In  Calories Out crowd, the gas I put in my car is calories in, the gas my car burns while idling is basal metabolism, and the gas my car burns while moving is calories expended through activity.  In their minds, this equation never changes.  But of course, we all know you can buy a car that gets 35 mpg, and three years later it’s only getting 28 mpg.  That doesn’t violate the laws of thermodynamics, and it doesn’t mean the energy in no longer matches the energy out.  It means something has changed inside the car’s system and it’s no longer using the energy in exactly the same way.   

There is no getting around the fact that to burn away body fat, you need to create a need for your body to consume the fat – an energy deficit.  But merely cutting calories may not do the trick, because your body can adjust your metabolism down, thus reducing or eliminating the deficit.  That’s what Taubes was trying to explain:  The calories in can cause adjustments in the calories out.  If you don’t solve the hormonal issues first, shrinking your fat cells will simply produce a situation where your body can’t retrieve fatty acids quickly enough to feed your cells and keep your blood sugar level.  Then your body will fight like crazy to avoid shrinking the fat cells any more – again by slowing your metabolism. 

So for the calorie deficit to work in the long term, it must be combined with a hormonal environment that allows your body to efficiently retrieve fatty acids from your fat cells.  That’s where keeping your insulin levels low comes in. 

Rebecca:  If I am Creating a Calorie Deficit, why am I still 36% body fat, even though I eat high fat, moderate protein and very low carb? 

Even though it makes sense, in theory, that I need to “burn” more calories than I take in, I have not been able to make that theory a reality in my body.  It seems that every time I either increase or decrease fat and protein (carbs always staying very low in all cases), there is no rhyme or reason to why I either stay the same weight, or lose weight or gain weight.  

Remember my "Borg" analogy? Well, my body is the Borg, and it wants to weigh 143.4 pounds and Resistance is Futile!  When I decrease my intake of food in order to create a calorie deficit, it will sometimes give up a little fat, but then adapts and starts storing fat again, bringing me back to 143.4 pounds or more.  There was one time that I increased my food intake from 1600 calories to 2000 calories, and dropped several pounds in a week, but then my body adjusted my metabolism (I’m assuming) and all the weight came right back, with a little more just for good measure, to teach me a lesson. 

In your Jimmy Moore interview,Tom, you said that people can look up exactly what you ate and how it caused you to lose a certain amount of weight.  If you were to look at my food diary, you would see no rhyme or reason to the weight I have lost, gained or maintained relative to the food I happened to be eating at the time or the amount of exercise I was getting or not getting.   

I recently just gave up and ate 1800 calories per day for a few months without a change.  My weight stayed the same.  I then dropped down to 1400 calories, and did not lose weight.  I have been doing this now for two weeks, with no change in my weight.  But didn’t I create a calorie deficit?  And 1400 calories for a 5’3” woman is certainly not starving, I would think… 

How can a person (me!) create a calorie deficit when thermogenesis is at work, it seems, to keep my body at a certain weight?   What is the likelihood that a person has no control over their weight, and no matter what they eat or how much they exercise, they will not lose weight? 

Tom:  Okay, this is the answer nobody wants to hear, but here goes:  Short of starvation that would ruin your health, it may not be possible for you to be as thin as you would like to be.  As I explained above, your body needs to be able to store and retrieve fatty acids to keep your cells fed and your blood sugar level.  The amount of body fat required to do that job depends on how quickly and efficiently your fat cells release fatty acids.  Think of it this way:  if you’ve got weak batteries, you need more of them to produce the same charge.  So unless you can make your fat cells more efficient, your body is going to fight you tooth and nail to maintain your current level of body fat – because it NEEDS that body fat to avoid cellular starvation between meals, especially when you’re sleeping. 

You may be able to make your fat cells more efficient through changes in hormones – thyroid recovery, adrenal recovery, insulin sensitivity recovery, etc. – but if you’ve suffered irreversible damage to any of those, there’s a limit to how much body fat you can or should lose. 

I once managed to semi-starve myself down to 165 pounds, but the love handles and bit of belly fat in the front still didn’t go away.  I started burning up my own muscles instead.  My arms, legs and chest got skinnier, the belly didn’t.  At some point, my body refused to sacrifice the body fat it needed.  I just didn’t realize at the time that it did, in fact, need the fat.   

So I can only suggest looking into possible fixes for hormone problems, keeping your carbs low (which you apparently already do), and engaging in hard exercise to improve your insulin sensitivity a bit.  Beyond that, I believe the smartest thing to do is to accept that what matters is health, not body size.  As Dr. Mary Vernon said in a lecture I attended, “From a health standpoint, I don’t care how fat you are.  I care about what you’re burning for fuel.” 

Rebecca:  What do you think of the BodyBugg?  I have a friend who uses one, and he says it accurately tells him how many calories he is burning off each day so that he can create a 20% calorie deficit and lose weight consistently.  He eats high fat, moderate protein and low carb.  I feel that if I got one (out of desperation!), it would tell me that I am burning calories, but I still would not lose weight. 

Tom:  Never seen one.  Since the body will adjust your metabolism to keep you fat if you don’t solve the hormonal issues first, I don’t see the point of counting every calorie. 

Rebecca:  What other processes are at work in the body to store fat due to hormonal imbalances other than insulin? 

Estrogen dominance, low progesterone, low testosterone, low thyroid, high cortisol and low melatonin will all cause weight gain.  Why?  (By the way, I have all of these, and having my hormones balanced with natural, bio-identical hormone replacement has not helped me lose weight.)  Do people with these imbalances gain weight because the imbalances cause excess insulin to be produced?  And if that is so, and a person is eating very low carb, what the heck is the insulin driving into the fat cells?  Fat and protein? 

Tom:  I don’t believe they all work directly through raising insulin.  From what I’ve read, they all have an effect on how efficiently your body can release fatty acids for fuel.  Testosterone, for example, aids in lipolysis – the release and burning of fatty acids. Insulin, however, can block the actions of hormones that aid in lipolysis.  If you can’t release fatty acids quickly, your body doesn’t want to give up the body fat it needs.  

Rebecca:  It's disappointing to me that I am actually a success story in the new Atkins book, A New Atkins for a New You.   

Tom:  I take it you don’t feel successful at the moment?

Rebecca:  The answer to that is resounding NO!  I have done everything right.  I have exercised, I have lifted weights, I have eaten low carb, I have had my hormones naturally balanced with bio-identical hormone replacement.  I am one of the top three contributors on the Atkins Community Forum, where some of my articles are used in the forum “stickies” so that newcomers will see them.  I am profiled in The New Atkins For a New You.  I was interviewed by Jimmy Moore for his podcast this past September.  I have this health and nutrition blog. 

And sometimes I feel like a hypocrite.  I spend all my time telling everyone I know that low carb is the way that human beings were designed to eat, but eating this way is not causing me to lose more than just a few initial pounds of fat.  I started out at 46% body fat and now I am 36% or so, and I am stuck.  I did get down to around 33% over a year ago, but it has steadily been going back up since then.  

Tom:  I hear you.  I’d love to have arms with veins that pop and six-pack abs, like my son.  But it’ll never happen.  I stopped a life-long weight gain and reversed it to a significant degree, but I know I damaged my metabolism as a young man, and it will apparently only recover so far.  I have to focus on the fact that at age 52, I’m stronger than when I was at 25, I can walk for miles in hilly terrain without getting fatigued, I kick my wife’s behind in racquetball even though she’s 14 years younger, my blood pressure is low, my triglycerides are low, my HDL is high, and I’m the only one of my friends in my age bracket who isn’t taking some awful prescription drug. 

You are NOT a hypocrite, Rebecca.  You cannot compare yourself to people whose bodies are happy to be thin.  (If I compared myself to my wife and son all the time, I’d go bonkers.)  You can only compare who you are now with who you would’ve been if you hadn’t taken steps to improve your health.  So I don’t compare myself to my son.  The only person I compare myself to is the one I used to be.

Rebecca:  Can fat tissue be damaged beyond repair?  I have heard some say that the basic problem is that fat tissue function is damaged.  Do you think that there is a possibility that, in some cases, adipose tissue has been damaged beyond total repair?  Is there a chance, when there are no other possible issues at play, that a person cannot be capable of creating a calorie deficit in order to lose weight?  Gary Taubes said something to that effect in his recent interview with Jimmy Moore.  He said that, in some people, there will be excess fat that will not go away, no matter how well they eat. 

Tom:  I think Gary’s right, for the reasons I have already talked about here.

Rebecca:  So you think that a person can be fat and healthy?  In your Jimmy Moore interview, you talked about the difference between being overweight and being unhealthy, using members of your family and yourself as examples:  You are a little overweight and yet you have normal blood sugar, and others in your family are normal weight and yet have Type 2 Diabetes.  Do you believe that being overweight causes disease, or that disease ­leads to overweight?  My father’s doctor has always told him to avoid gaining weight in order to avoid Type 2 Diabetes.  His mother, my grandmother, was overweight most of her life and developed Type 2 Diabetes in her 60s.   

I think of myself, and realize that I have low triglycerides, good HDL and slightly high LDL, but normal blood sugar, and low inflammation markers, like C-Reactive Protein and Homocysteine,  and yet I am 36% body fat.  If I stay this fat, will that lead to developing Diabetes and Coronary Heart Disease, or can I stay fat and remain healthy, as long as I eat right (low carb) and exercise?  Should I only care about my health, and not try to lose weight, and if I do that, will this fat, healthy body of mine lead me down the road to ill health? 

Tom:  My father-in-law is lean, athletic, and a type 2 diabetic.  My maternal grandmother is on the skinny side, but also became a type 2 diabetic.  Clearly, body fat is not the cause of type 2 diabetes, or we wouldn’t see lean type 2 diabetics.  It’s far more likely that many people eat diets that both make them fat and create insulin resistance at the same time.  Others can eat the same diet and become insulin resistant without becoming fat.  

Having said that, there is some evidence that the fat that accumulates in your liver may accelerate insulin resistance through the production of inflammatory cytokines. 

Rebecca:  So basically, does staying slim keep you healthy, or does staying healthy keep you slim (chicken/egg)?   

Tom:  Proper diet can aid in keeping you both slim and healthy.  Losing weight may assist in keeping you healthy by removing inflammation-producing visceral fat from your liver. 

Rebecca:  Tom, why do people get fat?  I know that Gary has a book coming out about this, but I am interested to hear your take on it.  I have heard it said (maybe by Gary) that we don’t get fat because we sit on the couch and eat too much – we sit on the couch and eat too much because we are fat.   

In other words, we aren’t fat because we eat too much and don’t get enough exercise. We’re not just lazy gluttons.  It’s not just Calories In Calories Out.  There is actually something wrong in the adipose tissue that is driving us to eat (specifically carbs) and causing us to stay inactive and keeping our metabolism slow. 

I know that I did not change the way I was eating or exercising, but when I hit thirty, I just started gaining weight.  I now blame hormonal imbalances, of which I’m sure insulin was one.  I was also eating a high carb and high fat diet, except when I was trying to lose weight, and then it was high carb and low fat. 

What do you think? 

Tom:  Metabolic derangement happens first.  The result is weight gain and lethargy.  When Dr. Robert Lustig treated kids for cancer, they nearly all become fat and lazy soon after.  Realizing something hormonal must’ve happened, he tested them and ended up giving them a drug to suppress excess insulin production.  Bingo; they lost weight and became active again, without anyone harping on them to eat less and exercise more. 

Rebecca:  I've been doing a lot of reading lately about cholesterol, because my husband's is high.  Based on what I've been learning, I am beginning to wonder:  Does serum cholesterol even matter? 

Since starting low carb 20 months ago, my cholesterol has gone from around 200 to around 220.  I’m sure it would not surprise you to know that my doctor wants me on statins.  I refused.  I did agree to start supplementing with red rice yeast, but now I am wondering if I should even be trying to lower my LDL.  I have been reading a lot of things in books and on the internet that say that as long as triglycerides are low, and inflammation is low, you could have a high LDL and it doesn't matter.  Some doctors believe that, ten years into the future, cholesterol will not even be considered a marker for heart disease.  What do you think? 

Tom:  Don’t try to lower your LDL.  High LDL protects you against infections and cancer.  It’s only a problem if you’re producing small, dense LDL, which is unlikely if you have low triglycerides and high HDL.  Also, LDL isn’t usually measured; it’s calculated.  If you have low triglycerides (below 100), that calculation will nearly always overestimate how much LDL you have.  Your doctor probably doesn’t know this, but there’s never, ever been an association shown between high cholesterol and heart disease in women.  In senior citizens, those with high cholesterol have the longest average lifespans, primarily because they have a lower rate of cancer.

Rebecca:  Thanks, Tom!  I really appreciate you taking the time to answer my questions!   I know that we all hope that low carb wisdom will prevail - and hopefully in our lifetimes!

To visit Tom Naughton's blog, click here.