> EXCESS CALORIES MAY certainly be the proximate cause of weight gain, but not its ultimate cause. What’s the difference between proximate and ultimate? The proximate cause is immediately responsible, whereas the ultimate cause is what started the chain of events. LOCATION: 233
> Jean Anthelme Brillat-Savarin (1755–1826) wrote the influential textbook The Physiology of Taste in 1825. There he wrote: “The second of the chief causes of obesity is the floury and starchy substances which man makes the prime ingredients of his daily nourishment. As we have said already, all animals that live on farinaceous food grow fat willy-nilly; and man is no exception to the universal law.” LOCATION: 295
> If you were to ask your grandparents what caused obesity, they would not talk about calories. Instead, they would tell you to stop eating sugary and starchy foods. LOCATION: 316
> American Heart Association’s 1995 pamphlet, The American Heart Association Diet: An Eating Plan for Healthy Americans, declared we should eat six or more servings of “breads, cereals, pasta and starchy vegetables (that) are low in fat and cholesterol.” To drink, “Choose . . . fruit punches, carbonated soft drinks.” LOCATION: 375
> Seventy percent of your tendency to gain weight is determined by your parentage. Obesity is overwhelmingly inherited. LOCATION: 454
> The assumption that humans are genetically predisposed to overeat is incorrect. Just as there are hormonal signals of hunger, there are multiple hormones that tell us when we’re full and stop us from overeating. LOCATION: 472
> TRADITIONALLY, OBESITY HAS been seen as a result of how people process calories, that is, that a person’s weight could be predicted by a simple equation: Calories In – Calories Out = Body Fat LOCATION: 501
> Assumption 1: Calories In and Calories Out are independent of each other LOCATION: 506
> Caloric intake and expenditure are intimately dependent variables. Decreasing Calories In triggers a decrease in Calories Out. A 30 percent reduction in caloric intake results in a 30 percent decrease in caloric expenditure. LOCATION: 508
> Assumption 2: Basal metabolic rate is stable LOCATION: 510
> Measuring caloric intake is simple, but measuring the body’s total energy expenditure is complicated. Therefore, the simple but completely erroneous assumption is made that energy expenditure remains constant except for exercise. Total energy expenditure is the sum of basal metabolic rate, thermogenic effect of food, nonexercise activity thermogenesis, excess post-exercise oxygen consumption and exercise. The total energy expenditure can go up or down by as much as 50 percent depending upon the caloric intake as well as other factors. LOCATION: 511
> Assumption 3: We exert conscious control over Calories In LOCATION: 516
> Eating is a deliberate act, so we assume that eating is a conscious decision and that hunger plays only a minor role in it. But numerous overlapping hormonal systems influence the decision of when to eat and when to stop. LOCATION: 516
> Assumption 4: Fat stores are essentially unregulated LOCATION: 525
> Every single system in the body is regulated. LOCATION: 526
> Assumption 5: A calorie is a calorie. LOCATION: 534
> This assumption is the most dangerous of all. It’s obviously true. LOCATION: 534
> In the British experience, neither increased caloric intake nor dietary fat correlated to obesity—which argues against a causal relationship. LOCATION: 564
> But thermodynamics, a law of physics, has minimal relevance to human biology for the simple reason that the human body is not an isolated system. Energy is constantly entering and leaving. LOCATION: 576
> There are an almost infinite number of ways that the body can dissipate excess energy instead of storing it as body fat. LOCATION: 596
> A detailed study of total energy expenditure under conditions of reduced caloric intake was done in 1919 at the Carnegie Institute of Washington.5 Volunteers consumed “semi-starvation” diets of 1400 to 2100 calories per day, an amount calculated to be approximately 30 percent lower than their usual intake. LOCATION: 618
> The participants experienced a whopping 30 percent decrease in total energy expenditure, from an initial caloric expenditure of roughly 3000 calories to approximately 1950 calories. LOCATION: 622
> Several decades later, in 1944 and 1945, Dr. Ancel Keys performed the most complete experiment of starvation ever done—the Minnesota Starvation Experiment, the details of which were published in 1950 in a two-volume publication entitled The Biology of Human Starvation. LOCATION: 626
> Thirty-six young, healthy, normal men were selected with an average height of five foot ten inches (1.78 meters) and an average weight of 153 pounds (69.3 kilograms). For the first three months, subjects received a standard diet of 3200 calories per day. Over the next six months of semi-starvation, only 1570 calories were given to them. LOCATION: 633
> Some men eventually received less than 1000 calories per day. LOCATION: 636
> Resting metabolic rate dropped by 40 percent. Interestingly, this phenomenon is very similar to that of the previous study, which showed a drop of 30 percent. Measurement of the subjects’ strength showed a 21 percent decrease. Heart rate slowed considerably, from an average of fifty-five beats per minute to only thirty-five. Heart stroke volume decreased by 20 percent. Body temperature dropped to an average of 95.8°F.10 Physical endurance dropped by half. Blood pressure dropped. Men became extremely tired and dizzy. They lost hair and their nails grew brittle. LOCATION: 644
> The men in the Minnesota Starvation Experiment should have lost 78 pounds (35.3 kilograms), but the actual weight lost was only 37 pounds (16.8 kilograms)—less than half of what was expected. More and more severe caloric restriction was required to continue losing weight. LOCATION: 678
> In response to caloric reduction, metabolism decreases almost immediately, and that decrease persists more or less indefinitely. LOCATION: 689
> There are two major adaptations to caloric reduction. The first change, as we have seen, is a dramatic reduction in total energy expenditure. The second key change is that the hormonal signals that stimulate hunger increase. LOCATION: 760
> But here’s the dismal truth: whether physical activity increases or decreases, it has virtually no relationship to the prevalence of obesity. Increasing exercise did not reduce obesity. It was irrelevant. Certain states exercised more. Other states exercised less. Obesity increased by the same amount regardless. LOCATION: 861
> Researcher Dr. Herman Pontzer studied a hunter-gatherer society living a primitive lifestyle in the modern day. The Hadza in Tanzania often travel 15 to 20 miles per day to gather food. You might assume that their daily energy expenditure is much higher than a typical office worker. Pontzer discusses the surprising results in a New York Times article: “We found that despite all this physical activity, the number of calories that the Hadza burned per day was indistinguishable from that of typical adults in Europe and the United States.” LOCATION: 871
> Thus, increasing Calories Out becomes equated with Exercise More. One major problem is that the basal metabolic rate does not stay stable. Decreased caloric intake can decrease basal metabolic rate by up to 40 percent. We shall see that increased caloric intake can increase it by 50 percent. LOCATION: 913
> The overfeeding paradox is that excess calories alone are not sufficient for weight gain—in contradiction to the caloric-reduction theory. LOCATION: 988
> YOU CAN TEMPORARILY force your body weight higher than your body wants it to be by consuming excess calories. Over time, the resulting higher metabolism will reduce your weight back to normal. Similarly, you can temporarily force your body weight lower than your body wants it to be by reducing calories. Over time, the resulting lowered metabolism will raise your weight back to normal. LOCATION: 1049
> There appears to be a “set point” for body weight and fatness, as first proposed in 1984 by Keesey and Corbett. LOCATION: 1057
> The problem in obesity is that the set point is too high. LOCATION: 1060
> Obesity is a hormonal dysregulation of fat mass. LOCATION: 1184
> Under normal conditions, high insulin levels encourage sugar and fat storage. Low insulin levels encourage glycogen and fat burning. Sustained levels of excessive insulin will tend to increase fat storage. An imbalance between the feeding and fasting will lead to increased insulin, which causes increased fat, and voilà —obesity. LOCATION: 1257
> Obese patients1 tend to have a higher fasting insulin level, as well as an exaggerated insulin response to food. LOCATION: 1275
> High insulin secretion has long been associated with obesity:1 obese people secrete much higher levels of insulin than do those of normal weight. Also, in lean subjects, insulin levels quickly return to baseline after a meal, but in the obese, these levels remain elevated. LOCATION: 1286
> Metformin decreases the amount of glucose13 produced by the liver and increases glucose uptake by the muscles. LOCATION: 1355
> As the insightful Gary Taubes wrote in his book Why We Get Fat: And What to Do about It, “We do not get fat because we overeat. We overeat because we get fat.” And why do we get fat? We get fat because our body set weight thermostat is set too high. Why? Because our insulin levels are too high. LOCATION: 1430
> Obesity is a hormonal, not a caloric imbalance. LOCATION: 1439
> The question is not how to balance calories; the question is how to balance our hormones. The most crucial question in obesity is how to reduce insulin. LOCATION: 1456
> In a random sample from north Glasgow, Scotland,15 cortisol-excretion rates were strongly correlated to body mass index and waist measurements. Higher cortisol levels were seen in heavier people. Cortisol-related weight gain, particularly abdominal fat deposits, results in an increased waist-to-hip ratio. LOCATION: 1522
> Other measures of cortisol confirm its association with abdominal obesity. People with higher urinary cortisol excretion have higher waist-to-hip ratios.16 People with higher cortisol in their saliva have increased body mass index and waist-to-hip ratio.17 Long-term exposure to cortisol in the body may also be measured by scalp-hair analysis. In a study18 comparing obese patients to those of normal weight, researchers found elevated levels of cortisol in scalp hair of the obese patients. In other words, substantial evidence indicates that chronic cortisol stimulation increases both insulin secretion and obesity. Therefore, the hormonal theory of obesity takes shape: chronically high cortisol raises insulin levels, which in turn leads to obesity. LOCATION: 1525
> Reducing stress is difficult, but vitally important. Contrary to popular belief, sitting in front of the television or computer is a poor way to relieve stress. Instead, stress relief is an active process. There are many time-tested methods of stress relief, including mindfulness meditation, yoga, massage therapy and exercise. Studies on mindfulness intervention found that participants were able to use yoga, guided meditations and group discussion to successfully reduce cortisol and abdominal fat. LOCATION: 1541
> Sleep duration has been steadily declining.21 In 1910, people slept nine hours on average. However, recently, more than 30 percent of adults between thirty and sixty-four years of age report getting fewer than six hours of sleep per night. LOCATION: 1549
> Sleeping five to six hours was associated with a more than 50 percent increased risk of weight gain.26 The more sleep deprivation, the more weight gained. LOCATION: 1555
> SLEEP DEPRIVATION IS a potent psychological stressor and thus stimulates cortisol. LOCATION: 1557
> A single night of sleep deprivation increases cortisol levels by more than 100 percent.27 By the next evening, cortisol is still 37 percent to 45 percent higher. LOCATION: 1559
> Restriction of sleep to four hours in healthy volunteers resulted in a 40 percent decrease in insulin sensitivity,29 even after a single sleep-deprived night. LOCATION: 1561
> After five days of sleep restriction, insulin secretion increased 20 percent and insulin sensitivity decreased by 25 percent. Cortisol increased by 20 percent.31 In another study, shortened sleep duration increased the risk of type 2 diabetes. LOCATION: 1563
> Dr. David Ludwig from Harvard University9 found that the low-fat diet slowed body metabolism the most. LOCATION: 1657
> Highly refined and processed foods somehow do not trigger the release of satiety hormones, and we go ahead and eat that cake. LOCATION: 1669
> However, following the severe food restrictions of Atkins proved no easier for dieters than conventional calorie counting. Compliance was equally low in both groups, with upwards of 40 percent abandoning the diet within one year. LOCATION: 1688
> The notion that carbohydrates are the only driver of insulin is incorrect. LOCATION: 1740
> But the time frame matters a lot. We may try to downplay its effects, but the idea that long-standing obesity is much more difficult to treat has the stench of truth. LOCATION: 1757
> insulin resistance leads to high insulin levels, and as we’ve seen, high insulin levels cause obesity. LOCATION: 1781
> A forty-hour insulin infusion reduced the subjects’ ability to use glucose by a significant 15 percent. Put another way, they developed 15 percent greater insulin resistance. Here’s the implication of this finding: I can make you insulin resistant. I can make anybody insulin resistant. All I need to do is give insulin. LOCATION: 1855
> Men with no previous history of obesity, pre-diabetes or diabetes were given a ninety-six-hour constant intravenous infusion of insulin. By the end, their insulin sensitivity dropped by 20 percent to 40 percent. The implications are simply staggering. LOCATION: 1859
> People who are stuck in this vicious cycle for decades develop significant insulin resistance. That resistance leads to high insulin levels that are independent of that person’s diet. Even if you were to change your diet, the resistance would still keep your insulin levels high. If your insulin levels stay high, then your body set weight stays high. The thermostat is set high, and your weight will be drawn irresistibly upward. LOCATION: 1875
> A long-standing obesity cycle is extremely difficult to break, and dietary changes alone may not be sufficient. LOCATION: 1884
> The main compartments are the brain, liver and muscle. Changing the resistance of one does not change resistance in the others. LOCATION: 1902
> Lack of exercise may lead to insulin resistance in the muscles. Exercise will increase insulin sensitivity there, but has little effect on insulin resistance in the liver or brain. LOCATION: 1905
> The brain is not resistant to insulin. LOCATION: 1908
> High levels alone do not lead to resistance. There are two requirements for resistance—high hormonal levels and constant stimulus. LOCATION: 1927
> In the case of insulin resistance, it comes down to both meal composition and meal timing—the two critical components of insulin resistance. LOCATION: 1937
> Several myths are often perpetuated to convince people that snacking is beneficial. The first myth is that eating frequently will increase your metabolic rate. Your metabolic rate does increase slightly after meals to digest your food—the thermogenic effect of food. However, the overall difference is extremely small. LOCATION: 1975
> The second myth is that eating frequently controls hunger, but evidence is impossible to find. LOCATION: 1981
> The third myth is that eating frequently keeps blood glucose from becoming too low. But unless you have diabetes, your blood sugars are stable whether you eat six times a day or six times a month. LOCATION: 1984
> Your grandmother was right. Snacking will make you fat. LOCATION: 2064
> We are often told that skipping breakfast will shut down our metabolism. The Bath Breakfast Project,13 a randomized controlled trial, found that “contrary to popular belief, there was no metabolic adaptation to breakfast.” Total energy expenditure was the same whether one ate breakfast or not. LOCATION: 2103
> In 2014, researchers gathered all available studies on increased intake of fruit-and-vegetable and weight loss.15 They could not find a single study to support this hypothesis. LOCATION: 2132
> That high insulin levels cause both obesity and type 2 diabetes has profound implications. The treatment for both is to lower insulin levels, yet current treatments focus on increasing insulin levels, which is exactly wrong. Giving insulin for type 2 diabetes will worsen, not improve, the disease. LOCATION: 2143
> The government is subsidizing, with our own tax dollars, the very foods that are making us obese. Obesity is effectively the result of government policy. LOCATION: 2224
> Childhood obesity is a predictor of increased mortality,4 but is, most importantly, a reversible risk factor. Overweight children who became normal weight as adults have the same mortality risk as those who have never been overweight. LOCATION: 2294
> Where would an infant get high insulin levels? From his or her mother. LOCATION: 2315
> Because both the mother and the fetus share the same blood supply, any hormonal imbalances, such as high insulin levels, are automatically and directly transmitted through the placenta from the mother to the growing fetus. LOCATION: 2318
> Calories do not drive weight gain, and thus reducing them will not lead to weight loss. LOCATION: 2371
> It had previously been thought that complex carbohydrates were digested more slowly, causing less of a rise in blood sugar, but this is not true. For example, white bread, which is composed of complex carbohydrates, causes a very quick spike in blood sugar, almost as high as a sugar-sweetened drink. LOCATION: 2501
> The bottom line is that excess fructose is changed into fat in the liver. High levels of fructose will cause fatty liver. Fatty liver is absolutely crucial to the development of insulin resistance in the liver. LOCATION: 2554
> That fructose directly causes insulin resistance was discovered long ago. As far back as 1980, experiments proved that fructose (but not glucose) caused the development of insulin resistance in humans. LOCATION: 2556
> The liver, like an overinflated balloon, will try to expel the sugar back into circulation, so continuously high insulin levels are also required to keep it bottled up in the liver. If insulin levels start to drop, the stored fat and sugar comes whooshing out. To compensate, the body keeps raising its insulin levels. LOCATION: 2579
> Artificial sweeteners are not good. They are bad. Very bad. LOCATION: 2670
> Despite reducing sugar, diet sodas do not reduce the risk of obesity, metabolic syndrome, strokes or heart attacks. But why? Because it is insulin, not calories, that ultimately drives obesity and metabolic syndrome. LOCATION: 2671
> Sucralose13 raises insulin by 20 percent, despite the fact that it contains no calories and no sugar. LOCATION: 2673
> Despite having a minimal effect on blood sugars, both aspartame and stevia raised insulin levels higher even than table sugar. LOCATION: 2675
> People have been eating unrefined carbohydrates for thousands of years without obesity or diabetes. What’s changed, and recently too, is that we now predominantly eat refined grains as our carbohydrate of choice. LOCATION: 2753
> Today, an estimated 99 percent of all wheat grown worldwide is dwarf or semi-dwarf varieties. LOCATION: 2761
> The Broadbalk Wheat Experiment2 documented the change in nutritional content over the last half century. Even as grain yields skyrocketed during the Green Revolution, the micronutrient content plummeted. Today’s wheat is simply not as nutritious as in previous generations. LOCATION: 2764
> Wheat is converted to glucose more efficiently than virtually any other starch. LOCATION: 2782
> Horace Fletcher (1849–1919) believed strongly that chewing every bite of food 100 times would cure obesity and increase muscle strength. LOCATION: 2795
> Soluble fiber reduces carbohydrate absorption, which in turn reduces blood glucose and insulin levels. LOCATION: 2839
> Women who ate a high-glycemic index diet but also ate large amounts of cereal fiber are protected against type 2 diabetes. In essence, this diet is simultaneously high in “poison” and in “antidote.” The two cancel each other out with no net effect. Women who ate a low-glycemic index diet (low “poison”) but also a low-fiber diet (low “antidote”) were also protected. Again the two cancel each other out. LOCATION: 2874
> smaller short-term human studies suggest that vinegar may help reduce insulin resistance. LOCATION: 2902
> Two teaspoons of vinegar taken with a high-carbohydrate meal lowers blood sugar and insulin by as much as 34 percent, and taking it just before the meal was more effective than taking it five hours before meals. LOCATION: 2903
> Potatoes, served cold and dressed with vinegar as a salad, showed considerably lower glycemic index than regular potatoes. The cold storage may favor the development of resistant starch, and the vinegar adds to the benefits. Both glycemic and insulin index were reduced by 43 percent and 31 percent respectively. LOCATION: 2909
> Type 2 diabetics drinking two tablespoons of apple cider vinegar diluted in water at bedtime reduced their fasting morning blood sugars. LOCATION: 2913
> The biggest problem with high-protein diets was that they didn’t really work for weight loss. But why not? The reasoning seems solid. Insulin causes weight gain. LOCATION: 2958
> overall, blood glucose was responsible for only 23 percent of the variability in the insulin response. The vast majority of the insulin response (77 percent) has nothing to do with blood sugars. LOCATION: 2968
> What factors (other than glucose) determine the insulin response? Consider the incretin effect and cephalic phase. LOCATION: 2973
> The incretin effect may account for 50 percent to 70 percent of the insulin secretion after oral glucose intake. LOCATION: 2988
> Fats, amino acids and glucose all stimulate incretin release and thus, increase insulin levels. LOCATION: 2994
> swishing a sucrose or saccharin solution around your mouth and spitting it out will increase your insulin level. LOCATION: 3001
> The incretin effect explains how fatty acids and amino acids also play a role in stimulating insulin. All foods, not just carbohydrates, stimulate insulin. Thus, all foods can cause weight gain. LOCATION: 3004
> Dietary fat, though, tends to have the weakest insulin-stimulating effect. LOCATION: 3008
> PROTEINS DIFFER GREATLY in their capacity to stimulate insulin,8 with dairy products in particular being potent stimuli. LOCATION: 3010
> Dairy also shows the largest discrepancy between the blood glucose and insulin effect. It scores extremely low on the glycemic index (15 to 30), but very high on the insulin index (90 to 98). LOCATION: 3012
> Dairy protein, particularly whey, is responsible for raising insulin levels even higher than whole-wheat bread, due largely to the incretin effect.10 Whey protein supplementation increased GLP-1 by 298 percent. LOCATION: 3017
> The organ meats tend to be the fattiest parts of the animal. By focusing almost exclusively on the muscles of animals for food, we are preferentially eating protein rather than fat. LOCATION: 3074
> Despite the fact that its consumption causes big increases in insulin levels, large observation studies do not link dairy to weight gain. LOCATION: 3077
> In particular, whole milk, sour milk, cheese and butter were associated with less weight gain, but not low-fat milk. LOCATION: 3079
> Blood glucose accounts for only 23 percent of the insulin response. Dietary fats and protein only accounts for another 10 percent. Close to 67 percent of the insulin response is still unknown—which is tantalizingly close to the 70 percent contribution to obesity that is inherited, LOCATION: 3109
> Other suspected factors include presence of dietary fiber, an elevated amylose/amylopectin ratio, preserved botanical integrity (whole foods), presence of organic acids (fermentation), addition of vinegar (acetic acid) and addition of chili peppers (capsaicin). LOCATION: 3111
> There are no intrinsically bad foods, only processed ones. The further you stray from real food, the more danger you are in. Should you eat protein bars? No. Should you eat meal replacements? No. Should you drink meal replacement shakes? Absolutely not. Should you eat processed meats, processed fats or processed carbohydrates? No, no and no. LOCATION: 3135
> There are natural trans fats. Dairy products contain between 3 percent to 6 percent natural trans fats.14 Beef and lamb contain a little less than 10 percent. However, these natural trans fats are not believed to be harmful to human health. LOCATION: 3286
> THE EVIDENCE ON a link between dietary fat and obesity is consistent: there is no association whatsoever. LOCATION: 3332
> Even the National Cholesterol Education Program admits, “The percentage of total fat in the diet, independent of caloric intake, has not been documented to be related to body weight.”29 Translation: despite fifty years of trying to prove that dietary fat causes obesity, we still cannot find any evidence. This data is hard to find because it never existed. LOCATION: 3338
> Eating fat does not make you fat, but may protect you against it. Eating fat together with other foods tends to decrease glucose and insulin spikes.32 If anything, dietary fat would be expected to protect against obesity. LOCATION: 3343
> Permanent weight loss is actually a two-step process. There is a short-term and a long-term (or time-dependent) problem. LOCATION: 3368
> In the short term, we can use various diets to bring our actual body weight down. However, once it falls below the body set weight, the body activates mechanisms to regain that weight—and that’s the long-term problem. LOCATION: 3371
> The truth is that there are multiple overlapping pathways that lead to obesity. The common uniting theme is the hormonal imbalance of hyper-insulinemia. For some patients, sugar or refined carbohydrates are the main problem. Low-carbohydrate diets may work best here. For others, the main problem may be insulin resistance. Changing meal timing or intermittent fasting may be most beneficial. For still others, the cortisol pathway is dominant. Stress reduction techniques or correcting sleep deprivation may be critical. Lack of fiber may be the critical factor for yet others. LOCATION: 3421
> However, moderate consumption of red wine does not raise insulin or impair insulin sensitivity, and therefore may be enjoyed.16 Up to two glasses a day is not associated with major weight gain17 and may improve insulin sensitivity.18 The alcohol itself, even from beer, seems to have minimal effects on insulin secretion or insulin resistance. LOCATION: 3545
> Full-fat dairy is delicious and can be enjoyed without concern of fattening effects. LOCATION: 3663
> Vinegar is also a protective factor. Used in many traditional foods, it may help reduce insulin spikes. LOCATION: 3679
> THERE ARE FIVE basic steps in weight loss: 1. Reduce your consumption of added sugars. 2. Reduce your consumption of refined grains. 3. Moderate your protein intake. 4. Increase your consumption of natural fats. 5. Increase your consumption of fiber and vinegar. LOCATION: 3684
> Insulin resistance keeps our insulin levels high. High insulin maintains our high body set weight. LOCATION: 3709
> To break the insulin-resistance cycle, we must have recurrent periods of very low insulin levels. (Remember that resistance depends on having both persistent and high levels.) LOCATION: 3714
> When we talk about fasting to break insulin resistance and lose weight, we are talking about intermittent fasts of twenty-four to thirty-six hours. LOCATION: 3720
> Hippocrates wrote, “To eat when you are sick, is to feed your illness.” The ancient Greek writer and historian Plutarch (c. AD 46–c. AD 120) also echoed these sentiments. He wrote, “Instead of using medicine, better fast today.” LOCATION: 3734
> Fasting is the most efficient and consistent strategy to decrease insulin levels, LOCATION: 3786
> Regular fasting, by routinely lowering insulin levels, has been shown to significantly improve insulin sensitivity.8 This finding is the missing piece in the weight-loss puzzle. LOCATION: 3791
> Fasting increases adrenalin levels, starting at around twenty-four hours. Forty-eight hours of fasting produces a 3.6 percent increase in metabolic rate,15 not the dreaded metabolic shutdown so often seen in caloric-reduction strategies. In response to a four-day fast,16 resting energy expenditure increased up to 14 percent. LOCATION: 3805