Weight loss when it's hard 2. Diazoxide

I just thought I'd put this post up as it's fairly topical at the moment.

We all now know that macronutrient ratio is irrelevant, insulin is irrelevant and all that counts is calories. Calories in, calories out, fat people are lazy gluttons. So let's play.

You can simply reduce insulin secretion using diazoxide. Find enough obese people willing to put up with the hunger generating regime supplied by Slimfast and semi starve them for 8 weeks. Half can have a placebo, half get diazoxide in addition to Slimfast starvation. Figure 1 in the results is where you want to look. The idle porkers starving on Slimfast plus diazoxide lost significantly more weight in 8 weeks than the idle porkers starving on Slimfast alone.

It looks to me as if the diazoxide group had lost 10% of bodyweight and were still loosing. The Slimfast alone group were stalled at about 4.5% bodyweight loss. Note also that the diazoxide group lost 9.3kg of fat vs. 3.6kg in the placebo group.

That is, diazoxide produced an excess fat loss of about 5.8kg in eight weeks. That's 100g per day. Or about 900kcal of fat. Every day.

So what's going on. It's pretty obvious really. This is not a metabolic ward study and the subjects cheated. Must have done. Stands to reason. These are free living people. How can any bloke on a 1570kcal per day diet walk past the gym without slipping in and spending an hour doing bench presses? OK, he promised to keep his exercise unchanged but really, no one will ever own up to having a 900kcal/d gym habit like that.

Or maybe the placebo group cheated. It's pretty obvious that 1570kcal of Slimfast will have you pogged out all day, no room for even a teensie weensie little donut, but hell, if they're half price you might force one down or maybe that will be 10 donuts......

But it's funny that the gym sneaks and the donut moonlighters ended up in separate treatment groups.

Or maybe, just maybe, you could just accept that in the real world, outside a meatball ward, sorry, metabolic ward, the level of insulin in your blood stream influences your rate of weight loss, specifically your rate of fat loss.

BTW The folks in this study are clearly pathological liars too. Any trainer being told that a fatty can maintain a BMI >30 on 1900kcal per day will be snorting in their whey protein shake. You know calories in calories out, yawn.

The placebo group lost 64g of fat per day, which is about 600kcal. This was on 1570kcal/day. So, just by arithmetic, they should previously really have been eating 1570 + 600 = 2170kcal/d to have been weight stable. They claimed to have been eating 1953kcal/d. That's not so far out given the accuracy of food tables. Maybe these were the honest ones.

But the diazoxide group lost 1660kcal/d of fat every day while eating 1570kcal/day of "food" (Slimefast). Does this mean that they had originally been eating 1570 + 1660 = 3230kcal/d to maintain their weight pre study? Now these people claimed 1977kcal/day. Lying porkers. You can't trust anyone. Least of all a fatty. But then everyone lies according to Gibney!

Let's get real. I think both groups ate just 1570kcal/d and skipped the gym. The diazoxide group used all of those calories PLUS 1660kcal/d of their own fatty tissue. The placebo group appeared to use that 1570kcal plus 600kcal of their own fat, but this is an average over time. They lost more than this initially per day, but by the end of the study they didn't look to be loosing any weight at all on those 1570kcal. By week eight they USED 1570kcal/d and that was it. They hadn't lost much weight anyway and now they were weight stable on the same energy consumption that had the diazoxide group loosing consistently. And this was at a much lower energy intake than they had possibly "under reported" at enrollment.

To go back to that apparent idiot Taubes, the problem with fat people is that they do not have access to their fatty tissue. It's only "there" as an energy source when insulin levels are low enough to allow HSL (hormone sensitive lipase) to work. Slimfast drops insulin a bit compared to the SAD, in this study from 204pmol/l to 174pmol/l (neither statistically significant nor biologically significant, after a few weeks anyway). Slimfast plus diazoxide dropped insulin from 168pmol/l to 108pmol/l (statistically p<0.01, biologically weight loss continued).

So where did the energy go to in the diazoxide group, and why did the placebo group stop loosing weight on a marked calorie deficit? Thermodynamics rules. No evaporating calories.

Well, a calorie is a calorie is a calorie. You can't burn what you ain't got. On Slimfast alone (I suspect low fat, low protein, some carbs to keep insulin up almost as much as the SAD) stored adipose tissue is just not available. Lugging around a body with BMI of >30 takes calories. If you don't have the calories, you don't do this. No sneaking to gym for this group, and I bet they were dreaming of donuts by week six, if not before.

In the diazoxide group there were significant periods of time when fatty tissue was available to supply calories because insulin was low. Use it AND loose it, calories that is. Lifting a 150kg body takes calories. If they are available, you can do it, you do do it. You don't need a gym when you weigh this much and have found access to all of that energy in your adipose tissue. Just moving around more makes a difference. I weigh 65kg. Putting on a back pack weighing 85kg would cripple me. I'd burn some calories. Heavy people live with this, shifting about takes energy. A lot. You don't have to change your basal metabolic rate. Just how you move.

So just to summarise this paper. Caloric restriction failed in about 7 weeks. Equal caloric restriction plus lowered insulin levels allowed on going weight loss throughout the study period.

Now, imagine the insulin drop without the diazoxide and without the hunger generated by Slimfast. Eating 1570kcal of steak, curly kale, bacon, scrambled eggs, double cream etc etc. The rest of your calories can come from that enormous supply of fat in your abdomen first, then on your bum. Forget about hunger.

You might even have the energy to go to the gym. After all, with all those adipose calories available, you can afford the energy to work out.

Peter