Depression isn’t a Real Thing

Depression isn’t *a* real thing. I am not saying depression doesn’t exist, I’m just saying that it is actually many things, and that what we tend to call “depression” is really just a mash up of lots of different types of human suffering, with different causes, courses and manifestations.

depression

Depression is best known as a specific diagnosis, the criteria for which are set forth in the latest volume of the Diagnostic and Statistical Manual for Psychiatric Disorders (DSM). So, according to the American Psychiatric Association, the group that publishes the DSM, depression is pretty clearly defined- it is a thing! However, even when it is most strictly defined, it still has many, many variations. First off, there many major diagnoses that are relevant to depression.  Is it a unipolar depression, meaning the symptoms are all ones indicating a general depression, or is it bipolar, in which depressive episodes are punctuated by periods of mania? Does it reach the level of major depressive disorder, or is it better explained by stressful acute life events; such as an adjustment disorder? Perhaps it is more long term but less severe, like dysthymia. Also, it might be depression that is induced by the use of substances. Or maybe it is depression due to a medical condition.

So then, lets say that it seems like Major Depressive disorder. That is *a* thing, right? In order to qualify for this diagnosis, you must have at least 5 symptoms from a list of 9 possible symptoms. I did the math, and according to my back-of-the-napkin calculations, there are about 256 possible ways in which these symptoms could combine to qualify for a diagnosis.

We’re not done yet! The Depression could be classified as mild, moderate or severe. If we take a detailed history, we can see if it is chronic, episodic, or a single isolated episode.

This is what I mean when I say that depression is not a *thing*. The term is so broad that, functionally speaking, it is basically useless. But, you may argue, these are just symptoms! Certainly there are many possible ways in which a disease can manifest, and these are just various permutations of the same disease.

We are now at the root of the problem. There is no evidence of any single underlying cause of what we generally refer to as “depression”, by which I mean the ridiculously broad spectrum of symptoms that are assigned the name “depression”.

What we refer to as “depression” should really be “depressions”, various, multi-causal, functionally distinct forms of human suffering.

But what about the chemical imbalance theory? Doesn’t that explain depression? Given the commercials for pharmacological fixes on TV and the amount of attention the theory has gotten, one might expect that there exists a pile of evidence in support of it. Sadly, the term “chemical imbalance” is not really much more than a “figure of speech”, a kinda-sorta way of trying to say that depression might kinda-sorta have something to do with the brain, and the brain operates in large part on the interactions of various biological neurotransmitters.

To put it mildly, the folks studying the “biological roots” of depression have their work cut out for them. There are currently no biomarkers associated with the ridiculously broad umbrella term “depression”, so there is no way to test for a disease that may or may not exist.

There are lots of other theories. One that is gaining prominence is the idea that depression results from systemic inflammation. This is known as the “Immune Cytokine Model of Depression”. This theory has its significant merits, but it is still treats depression as if it is a thing, when, not to belabor the point, it really isn’t. Two people can have the same diagnosis and can function completely differently. Why assume that these two people are struggling with the same underlying causes?

Still other theories point to lifestyle factors such as sleep, diet, exercise and stress. There are relational models of depression, cognitive models of depression, behavioral models of depression. It is quite possible that all of the models have merit, but may be more relevant than others depending on the individual circumstance of the particular depressed person.

Someone who is homeless, an overburdened working parent, a directionless college student and an apathetic farmer may all, according to the current definition of depression, qualify for the same diagnosis. Of course, if they all have the same diagnosis, it should follow that they should receive the same treatment.

This is about like treating everyone who comes in with chest pain as if they are having a heart attack. MAYBE the person with chest pain symptoms is having a heart attack, but maybe they have a variety of other heart conditions, or lung problems, or digestive problems, or muscle sprains, or panic attacks. Further assessment, including taking vitals and other biometric data, is required in order to arrive at the cause of the problem.

Currently, we don’t have the knowledge or tools to determine the biological causes for depression, if they even exist, which is at the moment still an unproven assumption. At this point, I think that the most prudent course of action is to assume that depressions are caused by many, many different things, including biological, genetic, relational, lifestyle, psychological, environmental, occupational, and financial causes, among others.

In my view, the most successful way to start treatment is with the clear assumption that we don’t really know what is going on. Then, rather than point to “a solution” to “a problem”, perhaps it would be more effective to start by assessing the exact ways in which the problematic symptoms function in the context of a person’s life. Then slowly, methodically, try to experiment by making changes bases on this assessment, and see which changes seem to be the most effective.

When dealing with problems of a psychological nature, trial and error is likely to take you a whole lot further than the proverbial “magic bullet.”

 

 

Reflections on the Death of Robin Williams

I am not a person who pays attention to celebrity news. Partially that is because I have two small children and never get to watch movies, and partially it is because I’m just not that interested. Now and again some tragic something flies through my Facebook feed in a flurry of heartfelt and emotive reactions, but I usually just tune them out.

Not so with the recent suicide death of Robin Williams.

williams

Even though it has been a week, I have not been able to shake a feeling of sadness. In some ways, this seems silly, as this is not a person who I really know. True, as a 36 year old, I grew up with his movies, a number of which I’d list as among my favorites. Like many others, I can’t help but find his spasmodic humor and warmth compelling. He was a great entertainer, and seemed to be  a genuinely kind person.

But the death of Robin Williams isn’t what I’ve found so impactful. It is the suicide of Robin Williams that carries such an emotional weight. That is because, simply, suicide is so very, very sad. Everything about it drips with sadness. I am a counselor, and among other things, part of my job is to be with people who are, to varying degrees, contemplating suicide. The pain and suffering that precede the act itself can only really be described as a sort of internal torture. The late David Foster Wallace, celebrated author of “Infinite Jest” and victim of suicide was quoted as saying the following:

“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”

This may or may not be a universal feeling for people who attempt or complete suicide; my experience tells me that different people have different reasons, different “flames” and differing levels of fear of falling to the sidewalk. Why I quote this passage here is that I think it conveys the desperation of the act.

Coverage of William’s death has included a great deal of discussion of depression, mental illness and compassion for those who are suffering from all sorts of mental anguish. This is very good. It also causes us to look back over his life, view the instances of drug abuse and depression and assume that those things finally killed him. It is almost as if his life now takes a dramatic arc: his genius mixed with suffering, compounded over time with mental illness and fatigue, culminating in the finality of self-inflicted death. We may look at his laughter as a mask that was covering an abyss all along, one that finally caught up with him. This narrative suggests that his suicide was inevitable, that the entirety of his lived experience led up to an inescapable conclusion.

But suicide is never inevitable. It is not so tidy as to fit a narrative. It is far more capricious and volatile than that. Another very important aspect of suicide is the impulsiveness of it. Details from the scene of William’s death appear to convey a sense of impulsiveness. The ad hoc, improvised nature of the the scene doesn’t suggest a great deal of premeditation. I am speculating, of course, but while it doesn’t seem premeditated, it does sounds desperate and impulsive.

We also now know, via his widow, that he was suffering from the early stages of Parkinson’s. She also maintains that he had remained clean and sober in the time leading up to his death. His death, his motives and his actions are very hard to explain. Impossible, actually, as we will never know his experience of those last moments. Was he freighted by a long history of depression, of a life filled with emotional hardship? Was he afraid of what was to come from his disease? Did he find himself lost in a moment of overwhelm and misery, betrayed by his own mind and a victim of an impulsive choice? All of the above? None of the above?

The saddest thing is that, had he not completed the act, he would have likely felt better at some point. He may have made more movies. He would likely have experienced joy. He would, given his history, have gone beneath the surface again, but, again given his history, he would have likely resurfaced. When he was down, he was under the illusion that this was it, that it would never quit. In other moments of his life, it probably looked very different.

In order to stave off suicide, you don’t have to reverse a lifetime of painful struggle, or solve the deepest, darkest questions in your psyche. You don’t even necessarily need hope, as counter-intuitive as that may sound. You simply need to make it through this moment right now.

I use the word simple very intentionally. In the depths of suicidal feelings, nothing seems simple- thought and emotion weave together a complex tapestry of internal torture. You cannot think your way out of it. Every thought has a counter-thought, every hope has a reason to be snuffed out. It’s a rigged game, and the harder you fight, the more tightly you are trapped. But you don’t need to win the struggle. You simply need to stay alive, today, right now.  And that probably means reaching out to another person- a friend, family member, a clinical professional, or a helpline operator which, by the way, you can reach at 1-800-235-8255.

This video is one I remember coming across a few months ago. It is a brief statement by Jennifer Michael Hecht, author of the book Stay: A History of Suicide and the Philosophies Against it, and it’s the best plea for staying alive that I’ve seen:

How to Be Compassionate

Last week I contrasted the prevalent aphorism to “let go” of difficult experiences, as exemplified by the hit song from Frozen “Let it Go”, with the similar but fundamentally different approach of “Letting it Be”. This process is best represented, obviously, by the Beatles song “Let it Be.” I called it the wisest song in the history of pop music, which it absolutely is. Let’s listen to the song again, and I’ll spend a few words breaking down the wisdom and the psychological utility of the Beatles sage advice.

The most notable aspect of the song is its beauty. In their years of making innovative, world-changing music, the Beatles never produced a more beautiful song. I won’t try to get into the psychology of beauty and why we find things beautiful- mostly because I am not that well-informed on that front- but you know it when you see it, or, more to the point, hear it.

The song is also soaked with a poignant sadness. There are references to “times of trouble”, loss, and broken-heartedness scattered throughout. The lyrics convey this, but not so clearly as the accompanying music. That the emotional tone of the piece is so heavily shaded by sadness is a mark of its wisdom. It isn’t possible to let something be without deeply acknowledging its presence. The song achieves such emotional weight by artfully acknowledging the presence of pain associated with loss, uncertainty and fear.

Letting something be, as the Beatles portray it, is not a way to get away from pain, it is a way to live with pain.

Acknowledging that emotional pain is an integral part of being human shift the focus from whether to have pain to how to hold it. John, Paul & Co have some good advice here. Firstly- it isn’t a battle. You will find no struggle in the song, no fight at all. This is nearly the opposite of how most of us react to pain most of the time. A more typical reaction is to resist unwanted emotion and feeling, attempting to push it away through act of will or resolve. This has the unwanted effect of introducing tension and stress into an already un-winnable battle.

This openness and receptivity to the reality of suffering gives rise to the possibility of something other than tension and strife, it creates the conditions necessary for the expression of compassion.

It is compassion that is at the heart of this song, and “Let it Be” is one of the most perfect expressions of compassion that you’ll ever find. The genius of the song isn’t that it tells us how to express compassion, it is that it demonstrates compassion for us. Indeed, when taken out of context, the lyrics aren’t that helpful. But the spareness of the message- presence, acceptance, caring- combined with the reassuring and ultimately hopeful beauty of the song and the gentle, persistent reminder to “let it be” create a nearly perfect practical example for how to put compassion into practice. Ultimately, compassion is a practice, not an idea. It is very hard to put into words. It requires an active willingness to be passive in the face of a powerful desire to turn away- a skill to be practiced, never mastered.

I will almost certainly be posting more on compassion in the near future, as it is something that has really caught my attention lately. A few weeks ago at a professional conference I learned of the presence of a type of treatment known as “Compassion Focused Therapy” and was able to attend a workshop about it. I’ve also been inspired to pick up Dr. Dan Gilbert’s book on the subject, The Compassionate Mind, which neatly summarizes much of the recent science on the topic and how compassion towards one’s self and others can be such a helpful approach to living.

No matter what anyone else says on the matter, however- it’s unlikely than anyone else will ever say it better than John, Paul, George and Ringo.

beatles

Letting Go of Difficult Emotions

Have you ever been told that you really need to “let go” of something? Have you ever given that advice to anyone else?

letitgo

The idea of letting a painful thought, emotion or memory go is a very appealing one. Painful emotional experiences such as regret and resentment tend to have a “sticking around” kind of quality to them, recurring again and again over time. Anger, hurt, and fear can stick around long after the initial incident, sometimes even for years. Who in their right mind wants to carry that stuff around? Yeah, listen to the Disney princess and Let It Go.

Weeeelllllll, that might be one of those things that are more easily said than done. I believe that in most (not all) cases, most of us would rather let our frustrating and painful emotions and memories go whizzing away. The problem is that just because we let something go, it does not mean that IT lets go of us.

Let me use a metaphor to explain what I mean. This is not a metaphor I made up, by the way, but I have been using it for so long I have no idea who to credit for it.

Let’s say you and I are sitting and chatting about this or that. We notice that for some reason, a beautiful butterfly finds its way into the room we’re in. I see it, and, realizing that it belongs inside rather than outside, I quickly yet gently grab it out of the air, trapping it between my hands. I excuse myself from the conversation so that I may take the butterfly outside.

I then proceed to open my hands and let it go.

Something funny happens, however. Instead of flying up in the air and off into the distance as I’d expected, it stays right where it is. Irritated, I shake my hand, trying to rid myself of the butterfly. It hangs on. I’d really like to go back inside and finish the conversation, but I feel obligated to let this pesky insect go. I try to knock it off with my hand, and it starts to fly away, but then turns around and lands on my nose.

After five minutes of letting the butterfly go, I realize that I have in no way let the butterfly go. To the contrary, the butterfly is now completely controlling my behavior. In an effort to let go, I have in fact become more engaged with it.

If I were to really let go, I’d allow the butterfly to sit upon my nose and flap its wings, while I return upstairs to the conversation we were in the middle of.

The key point is this: when we “let go” of something, to be truly psychologically useful, we must let go not of the experience itself, but of our own drive to control the experience.

This is a subtle but extraordinarily important difference.

Painful memories, emotions and thoughts aren’t voluntary. We don’t choose them- they just show up. So it stands to reason, and more importantly, it is generally borne out by experience, that if we don’t choose them, we can’t really un-choose them. That’s simply not how brains work.

Very often the phrase “let it go” is used as a stand in for “get over it” or “get rid of it”.  Truly letting go of something, however, requires a very different attitude. In order to truly let go of something, we’ve got to be willing to accept it. If we can’t stand the butterfly on our nose, we’ve got no hope of letting go of it- we’ll be constantly fighting it. If we let go of control over it, though, we might be able to get on with our lives.

A better phrase might be “let it be”. Since we began this post by referencing a pop song, let’s end by playing one. This one, of course, is the Beatles song “Let it Be”, which I think is almost certainly the wisest song in the history of popular music:

Exercise, Psychological Well-Being and Willingness

Its pretty much common knowledge at this point that physical activity is likely to confer psychological benefits. I just wrote last week about how to take advantage of this effect by adopting a particularly convenient strength training program. This week, I want to focus a bit on how exactly adopting a strength and conditioning program might be psychologically helpful.

Woman Resting on Exercise Bike

There are two main ways to think about the benefits of physical exercise on psychological health. They are distinct, but not necessarily in conflict with one another. Lets call one way the direct pathway, the other we’ll call the behavioral pathway. The direct pathway refers to the direct effect of exercise upon the body and mind. Physical activity mobilizes energy, lifts mood, and increases physical health in a wide variety of ways. Psychological benefits are a direct result of the activity.  Many of us can relate to feeling better after a walk, or invigorated by a quick dip in the pool (or lake, ocean, pond, or other swimming hole). It also is intuitively easy to understand that if one feels an increase in health and fitness, they are likely to experience and increased psychological sense of well-being as well.

The behavioral pathway is the one I’d like to spend a bit more time on. In this way of looking at the impact of activity on psychological health, increased psychological well being is not directly a result of the activity. Rather, the activity is itself the result of utilizing particularly valuable psychological skills. In other words, in this way of looking at things, we aren’t specifically interested in the downstream effects of activity on psychological well-being. We are instead interested in the psychological skills required to get you and keep you moving, and building on those.

Another way of saying this is that the outcome, a state of psychological well-being, is less useful than the process of getting there. Master the process, and you won’t need to obsess about the outcome. So, what is required to engage in the process of making exercise a regular habit? There are many things, but the thing I’d most like to focus on is something that is often called willingness.

If you are currently inactive, there are probably a number of reasons why. Perhaps you work in a setting in which you are very sedentary, and don’t feel as though you have enough time once you go home. Maybe you’ve gotten out of shape, and the idea of intense movement is overwhelming. Maybe you just strongly dislike the physiological feeling associated with exertion.

I’m sure there’s more. “I’m embarrassed I am so out of shape”. “I’ll start tomorrow.” “I can’t believe how weak I’ve gotten.” Yada Yada Yada. And those are just the things that go through my mind. I’m sure many of you have your own.

Underneath under all those reasons and all of that chatter lies a simple, basic stance: an unwillingness to experience a particular type of discomfort. In this case, it might be physical discomfort, or the type that comes from embarrassment, or perhaps even shame.

I’d like to take a minute and point out how this is a problem that is far more general than dislike of exercise. If it is common for something as vital and important as exercise to be blocked by an unwillingness to experience unwanted feelings, is it common for that same stance to cause problems in other areas?

You bet it is. What if you become anxious whenever encountering new people? You might start avoiding situations in which you are likely to meet someone new. What if you feel uncomfortable when someone you care about is upset? You might be less likely to show them compassion and support during difficult times.

Living well requires being willing to do things that are uncomfortable and unpleasant. Often, we become so focused on changing how we think and feel that we forget that the formula for making positive changes is really much more simple than that: it involves being willing to make those positive changes, even when that provokes discomfort. It is a both/and, not an either or.

Exercise, then, can be viewed as intensive willingness practice. It could be willing to keep running for just one minute longer that you did last time. It could be starting small and getting up a few minutes earlier to stretch or take a brief walk. It doesn’t necessarily mean jumping straight into high intensity interval training, it just means being willing to jump into something that supports your health.

Opening up to and embracing discomfort is a fairly counter-intuitive strategy. But in many cases, it is just what the doctor ordered.

 

 

 

 

Strength Training for Mental Health?

What do you think of when you think of strength training? Do you think of benefits to cognitive and mental health?

child-muscle-chest-shirt

Probably not. You probably think of big weights, barbells and lots of grunting. You might think of “gym rats”, overly-muscled guys with tight shirts and biceps like softballs. You might think of crossfit-training obsessives, dedicated to pushing well beyond the point of pain into the land of frequent injury.

That may be true in some cases, but it needn’t be true in all. First, let’s talk about why strength training is important. The benefits of increased muscle are plentiful and varied.  It improves cognitive performance in elderly participants. Strength training can increase bone strength, relieve symptoms of arthritis, and increase balance. It aids in the management of chronic diseases such as diabetes, osteoporosis, back pain, and obesity. Additionally, it can help sleep and improve mood.  Muscle mass is also “metabolically expensive tissue”; in other words, it requires lots of calories.  I don’t know about you, but I can use all the calorie-burning help I can get.

So, it has benefits that extend far, far beyond the aesthetics of having big, bulging muscles. In fact, strength training does not need to be oriented towards bulky size, strength gains can produce significant health benefits without being taken to extremes.

Just because there are benefits to strength training doesn’t mean there are not risks.  Certainly, any time you put a great deal of stress on your body we are exposing ourselves to forces that are potentially damaging.  Both chronic and acute injuries happen when strength training; I’ve personally experienced a few.

So, how does one reap the benefits of strength training, including mental health and cognitive benefits, while minimizing the risks? Further, how does one find this balance while maintaining a busy schedule, one that doesn’t allow for multiple 1-2 hour trips to the gym per week?

One approach that seeks to maximize the benefits of increased muscle while minimizing the exposure to health risks is something known as High Intensity Training (HIT).  My understanding of HIT comes from Doug McGuff’s excellent book on the subject, Body by Science.   I am not knowledgeable enough on the topic of exercise physiology to review the work, but in my personal experience, I have found it to be very helpful. For an introduction to the workout, you can read an article summary of the approach by the author at the website Mark’s Daily Apple. Here is an excerpt describing how to get started:

Your 12 minutes of exercise should be composed of 4 or 5 movements. These movements should be basic compound movements that require very little skill to perform. You should aim for low skill movements because all of your attention needs to be focused on effort and rapid fatigue not performing a complex movement that requires a lot of concentration. If you have access to a commercial gym, performing these movements on quality machines will allow you even more focus on effort as opposed to the movement…

…Each of these exercises should be done until you cannot produce any further movement of the weight. You should perform them in a way that keeps the muscle under constant stress. Here are some tips: Start the movement very slowly. Take at least 3 seconds to crack the weight stack and 3 seconds to move the first inch. After moving the first inch, just try to keep the movement going along smoothly. Done properly the cadence from that point should take you 5-10 seconds to complete the lifting phase of the repetition. On a pulling movement, hold the contracted position for 2-3 seconds if it feels harder to do so, if it feels easier to hold, simply begin the lowering portion smoothly….When you reach the point of 15 degrees before your joints lock, smoothly reverse direction and lower the weight at about the same speed you lifted it or slightly faster. As you approach the end of the lowering phase…slow down. If the weight stack touches at the bottom of your movement, you should allow the weights to barely touch without completely setting them down. Once you barely touch, you should barely start the next repetition, allowing 3 seconds to cover the first inch, then just try keeping the movement going. By about the third repetition you will be pushing as hard and as fast as you can, but you will only be able to go fast enough to move the weight through the positive in about 7-12 seconds. Once you fail or get stuck, do not heave or jerk in order to get another repetition, simply keep trying to produce movement (even though no movement occurs) for another 5 seconds or so. A properly selected resistance will allow between 4 and 8 repetitions. Once you have gone through this procedure on the first exercise, move briskly to the next exercise.

The premise of this type of training is to supply maximum stimulus to your musculature as safely as possible.  In this model, recovery is critical.  To my astonishment and delight, Dr. McGuff argues that the optimal workout  time is one twelve minute workout, one time per week.  Any more than that starts to have counterproductive effects, decreasing your body’s ability to recover and adapt. For a busy parent like me, this is music to my ears.

I’ve taken this approach off and on for a couple of years, and I have found certain strengths and limitations. If you want to get really, really strong, I think there are better approaches. I’ve been a fairly serious lifter in the past, and using a more typical workout program with a higher volume of exercise produced more significant gains. Of course, I was a younger man then, so everything was physically easier.

However, when I have used this approach, I have always improved. I’ve made slow, but steady and measurable gains. I’ve felt different, and better. Perhaps most importantly, I’ve exposed myself to the myriad benefits of strength training without exposing myself to the increased risk of injury that typically comes with it (very important for someone like me, approaching middle age and self-employed with no sick leave). Not bad for something I can squeeze in on a lunch hour once per week.

 

 

Does it Really Make A Difference WHAT you Eat?

This question of what comprises the optimum human diet is one that has been absolutely beaten to death in recent years. It is a puzzle that never seems to be quite solvable. In fact, it isn’t that the answers seem just out of reach, much research actively contradicts other established research. This is quite fortunate for the gigantic industry of people who want to make money by selling us their own branded approach, which likely enjoys *some* empirical support.

hungry

We’ve heard the litany of possibilities before: low fat, low carb, Mediterranean, Adkins, South Beach, Paleo, Ornish, yada yada yada.

Of course, while it is very far from clear what we should eat, there are a few things that we should very clearly not eat. For instance, it is at this point nearly perfectly evident that we should generally avoid added sugar. This is difficult for two reasons- 1) it is delicious and 2) nearly every processed food contains it in some degree. Also, trans fats, such as what we were fed en masse when we were advised to avoid saturated fat, are now viewed as irredeemable.

So, lets just leave it at this- one thing we know for sure about what to eat is that we know at least two things we should not eat- sugar and trans fat.

That doesn’t give us a lot to go on. But one interesting angle to consider is the possibility that what we eat might not be the most important variable in determining the link between food and health. How we eat, at what intervals and in what quantity might have a lot more to do with how our body reacts to food than does the precise nutritional makeup of the individual items we’re eating.

This is all a long prelude to linking to a very interesting study which was written up by the New York Times last week. From the article:

Researchers in Spain and Sweden had 15 healthy but overweight Swedish men restrict their calories to about 360 a day, a reduction of approximately 1,800 calories. What calories they did ingest came in liquid form: Some men drank mostly sugary carbohydrates, others a high-protein drink. The men also exercised — a lot. Their days began with 45 minutes of cranking an arm-pedaling machine for an upper-body workout. Then, as a group, the men strolled foreight hours across the Swedish countryside, with only a 10-minute break every hour. They were allowed as much of a low-calorie, sports-type beverage as they wanted during their walks.

More:

After four days, the men had each lost almost 11 pounds, with nearly half of that coming from body fat; the rest of the loss came primarily from muscle mass. The researchers had anticipated that the high-protein drink would protect people against muscle-mass loss. In fact, the losses were the same, whether the men had been given sugar or protein.

More surprising, the men did not immediately put the weight back on after the study ended. “We thought they would overeat and regain the weight lost,” Dr. Calbet says. Instead, when the volunteers returned a month later, most had lost another two pounds of fat. And a year after the experiment, they were still down five pounds, mostly in lost body fat.

What is interesting here is that the variables that are being explored are not the ones that are normally tested in weight loss experiments. It does look at carbs vs protein for the minimal calories involved (and finds no difference), but it is really looking at variables such as frequency and volume of eating, and volume and intensity of exercise. There is not enough data here to make any sure conclusions, but it may indicate that we should be considering options beyond the “eat this, not that” mentality that has come to predominate discussions about weight loss.  As long as we don’t eat much sugar or trans fat, of course.

Now, if you are still very concerned about what you should eat, check out this idea from The Atlantic: eat lots of ice. Your body will have to burn calories heating it up, and you won’t be simultaneously filling your mouth with something else. My big question is this: does this theory make ice cream calorie-neutral?