Weight of the Evidence

Yes, I am Doing Something on the Blog

2011-06-03T21:59:00.003-05:00

Okay, some may have noticed I've migrated (sans links) back some posts made after I moved the blog to wordpress. I'm consolidating the posts back to Blogger. You'll know why soon!

Sugared Beverages

2008-12-26T21:57:00.000-06:00

Commentary from Governor David Patterson, New York on CNN.com:

Today, we find ourselves in the midst of a new public health epidemic: childhood obesity.

What smoking was to my parents’ generation, obesity is to my children’s generation. Nearly one out of every four New Yorkers under the age of 18 is obese. In many high-poverty areas, the rate is closer to one out of three.

That is why, in the state budget I presented last Tuesday, I proposed a tax on sugared beverages like soda. Research has demonstrated that soft-drink consumption is one of the main drivers of childhood obesity.

These days I’m no longer surprised when something like an “obesity tax” is foisted upon the masses without so much as a whimper – afterall it is your fault if you’re fat, right? You should pay more, right?

Several commentators in the media applauded the move by Governor Patterson – Nicolas Kristof opined the hope that other states will follow suit because “if other states follow, [it] could help make us healthier.”

He even ties it up neatly with a bow, repeating Patterson’s parallel to smoking and cigarettes, “These days, sugary drinks are to American health roughly what tobacco was a generation ago. A tax would shift some consumers, especially kids, to diet drinks or water.”

No one likes taxes, but by golly, we must do this for the children! We must save ourselves from ourselves with this tax – save the children, save the world, reduce consumption of sugared beverages and all will be well.

What’s maddening isn’t so much the propsed tax on sugared beverages, it is what government does if they can get away with it….what’s maddening is that no one seems to notice that we are already paying taxes that enable the flood of cheap soda, fruit drinks and sugared beverages into our markets. It’s paid by our taxes in the Farm Bill, with corn being king amongst the crops subsidized by our tax dollars.

This new tax represents a double taxation to New Yorkers – taxed first from their income to subsidize corn in the Farm Bill; and now to add insult to injury, when they dare to consume products made from the corn products their tax dollars helped make cheap at the consumer level – namely high-fructose corn syrup….beverages produced that are artificially low in price at the consumer level and often cheaper than buying a bottle of water!

If the government truly wants to tackle the obesity epidemic, perhaps it’s time to revisit the Farm Bill and how it is directly creating a market flooded with cheap corn calories at the consumer level for things like high-fructose corn syrup which is used in thousands of food products in our markets!

Banning Bottled Water

2008-12-09T21:56:00.000-06:00

They say the road to hell is paved by good intentions.

The Toronto Star recently noted the political battlelines drawn around the debate to ban bottled water in Toronto, “Environmentalists claim bottled water commercializes a public resource, undermines faith in Canadian water systems, and sends plastic bottles to the landfills. The bottled water industry counters that environmental groups rig recycling rate numbers and vilify a product that helps combat obesity.”

Last week the vote was cast and the Toronto city council voted to immediately ban the sale and/or distribution of bottled water in City Hall and the city’s civic centres where contracts permit, and ban the sale and/or distribution of bottled water in other city-owned facilities such as arenas and theatres by the end of 2011.

While it’s now illegal to not only sell bottled water, but also illegal to distribute bottled water in city-owned facilities in Toronto, it’s still perfectly legal and acceptable to sell and distribute sweetened waters (translation – soda and fruit drinks).

Afterall, isn’t that really what soda and fruit drinks are – simply sweetened water?

Let me see if I understand this.

Bottled water = bad-illegal

Bottled soda & fruit drinks = good-legal

This vote after Statistics Canada released data that found Canadians consumed more than 95 litres of soft drinks in 2007!

How much more soda and fruit drinks do you think folks will drink now that bottled water is banned?

So We Begin the Food Stamp Challenge

2008-10-17T21:55:00.000-05:00

When I posted about this year’s Food Stamp Challenge yesterday, underway in various locations in the US, I assumed it was going to be much harder this year to stay within the allotted budget despite an almost double amount of money last year. My regular readers may recall, last year I reviewed the sales circulars online to get the best bargains, planned the week of meals before I went shopping, had to include a fairly high level of canned goods (especially beans) and barely made the budget. We did well nutritionally – with the exception of Vitamin D, we met all nutrient requirement RDA’s and managed to keep carbohydrate intake at an average 97g per day for the week; 73g net if you deduct fiber. But, as I noted, it wasn’t easy to do on a budget of just $3.00 per person per day, or $63 for the week for my family.

This year, with a nearly double budget – $123.27 for the week ($5.87 per person per day) – I changed the rules I’d follow in response to comments last year. Unlike last year, this year I’d shop in only one store, no pre-planning; instead I’d grab a sales circular on my way into the closest grocery store to my home and do my shopping for the week without any menus planned ahead of time.

Now I don’t shop for many routine items at the grocery store – most meats for us are usually ordered from a local farm, I buy a lot of produce at the local Farmer’s Market, and some things, like cheese, I usually buy at a specialty shop in town. But I do shop enough in the grocery stores to note that prices have definitely risen over the last year, with some items nearly double what I remember from last year.

When I did our grocery shopping yesterday, at HyVee (closest to my house) I was surprised that I wasn’t just within budget, but that I didn’t spend the entire budget. And, I included a number of items that were “maybe” items, held back until I could see the running total for the “must have” foods; “maybe” things like crumbled blue cheese, roasted red pepper hummus, name-brand coffee, a small container of heavy cream, a fancy brand of fajita wraps and a small pumpkin my son asked for that we aren’t going to actually eat.

That isn’t to say I didn’t make any compromises – I did buy canned green beans over the fresh, they were much less expensive in the can; I chose frozen whole strawberries over the fresh for the same reason; and frozen broccoli won over the fresh too. My cuts of meat, poultry and fish were all selected by price rather than higher priced selections. For the most part, organic foods were out….one compromise I would not make was the organic, grass-fed, VAT pasturized, non-homogenized milk for my son; that was one thing that would be included no matter how much it cost. Luck had it though that it was on sale this week!

I also decided once I saw the sale circular for the week, that I’d see if I could do a week with low-carb – basically keep carbohydrate (for my husband and I only) at or below 60g a day on average and not have to include much in the way of beans or starchy foods, although I did buy two bread items (wraps and pita) when I saw they were possible within the budget. My goal again this year is that in the week we are able to eat well and meet our nutrient requirements. I think I did fairly well too!
When all was totaled, I spent $115.55 before tax, $120.91 with tax.

What did I get for my money?

*Items with a star were “maybe” items included when I saw the total was still within budget, listed in order placed into the final order.

1-pound butter
3-quarts half & half
2 dozen large eggs
1/2 gallon organic whole milk
1 8-ounce brick store-brand mozzarella
1 8-ounce brick store-brand cheddar
1 container sour cream
1 container cottage cheese
1 package cream cheese
10 8-ounce containers assorted store-brand yogurt (including plain)

1-pound deli ham (it was a steal at $1.99 a pound!)

1-pound bag frozen broccoli
1-pound bag frozen spinach
1-pound bag frozen whole strawberries

Box of tea bags
1 can bean sprouts
2 cans green beans
Small Hellmann’s mayonnaise
2 Bottles store-brand salad dressing
1 small bottle soy sauce
2 cans mandarin oranges
1 bag dried split peas
1 packet taco seasoning
1 can tomato paste
1 can diced tomatoes
1 bag sauerkraut

5 bananas bunch
2 pears
1 head cauliflower
2 cucumbers
2 bags of store-brand mixed salad
1 head iceberg lettuce
2 kiwi fruit
1 yellow pepper
2 red peppers
2 green peppers
Yellow and green squash
1 spaghetti squash
2.5-pounds carrots
1 package Wholly guacamole
4 lemons
5 onions
1/2 cantaloupe
5 apples
2 plums

1 package Johnsonville sausage patties
1 package Oscar Mayer bacon
1 whole chicken
1 package chicken leg/thigh quarters
1 package split chicken breasts
2 pounds ground beef
1 large pork roast
1 package coconut crusted fish filets (store made; raw; frozen)
1 package eye-of-round steak
Folgers coffee* (I had a smaller, less expensive container, but added this instead)

1 package boneless skinless chicken breasts*
1/2 pint heavy cream*
1 small bottle olive oil*
1 small jar minced garlic*
Assorted bags, very small amounts, open/loose spices sold by the ounce*
1 container blue cheese crumbles*
3 small sample size cheese (butterkase, gouda, gruyere)*
1 container roasted red pepper hummus*
1 5-pack Toufayan tomato wraps*
1 package pita*
1 small pumpkin*

You’ll notice that above I don’t have any tomatoes or tomato sauce. That’s because we have a garden and right now, an excess of tomatoes that have to be eaten or made into sauce, so I’ll be using those tomatoes in some dishes this week.

As you can see, I wasn’t left with little choice – I didn’t have to buy boxes of macaroni & cheese or ramen noodles. In fact, with the higher budget this year, I was able to buy much more fresh produce and meat, along with some “goodies” to enhance the meals I’ll make, like blue cheese to top salads, assorted cheeses for snacks, and decent coffee for our morning brew.

Last night we kicked off our week with a delicious chicken & beef fajitas, complete with tomato wraps, sour cream, guacamole and cheddar cheese that I shredded from the block of cheese. Since our son isn’t too keen on spicy food, I made him some plain chicken and onion sautéed in a little butter, and with that he had some broccoli and a blueberry yogurt, and then a plum for dessert.

Food Stamp Challenge 2008

2008-10-16T21:54:00.000-05:00

In May 2007, I decided to step up to a challenge getting a lot of press as the Congress was readying to pass a new farm bill – it was to feed my family with a budget those recieving food stamps must stay within each week.

At that time, the average per day was just $3.00 per person each day, which translated to $21 per week per person, or $63 total for all three of us to eat for one week. I chronicled my shopping, meals and my thoughts afterward between May 25 and June 5, which are still available on my blog.

Making the news this week is a new challenge as we near the holiday season and more individuals and families find themselves in need of assistance. Yesterday kicked-off the Grand Rapids for the Michigan Food Stamp Challenge where those participating try to live on $5.87 per day per person (the new, higher maximum level provided to recipients).

From news reports, “300 state and local leaders who have pledged to live on the equivalent of food stamps for five days.”

Apparently the governor of Michigan, Jennifer Granholm, is participating in the challenge. As reported by mlive.com, “The governor says she took her son shopping Sunday at a Meijer grocery store. They could only spend $5.87 per day per person. She says she bought a lot of macaroni and cheese.”

Like last year, I’m not surprised by the belief perpetuated in the media that one must eat poor quality, high carbohydrate, cheap foods to survive on a limited budget. Last year I showed that was untrue as I fed my family a high-quality, nutrient dense diet for the week on just $3.00 a day per person. This year recipients receive even more money and I have to wonder, given the current economic situation, is the increase enough or not?

So this year, once again, I’m going to see what a food stamp budget, $5.87 per person per day, buys us since food prices have steadily increased in the last year.

Can we eat as well as we did last year?

Will I need to make compromises?

Will we eat better?

Last year a number of comments criticized that I shopped in three different stores, had access to the internet to review sales circulars and plan based on sales, and had time to plan our meals before I shopped. For this challenge, I will shop in the closest grocery store to our house, will pick-up the circular when I enter the store and do my best without pre-planning the week since it was pretty clear that time and ability to plan ahead are both issues for many.

Like last year, I invite readers to step up to the challenge too and share your experience in the comments as we move forward for the week, starting tomorrow.

Here’s our rules for the October 2008 Food Stamp Challenge:

1. Maximum per person is $5.87 per person per day. For us, a family of three, this means I have to feed us with just $123.27 in the coming week. Your total budget does not include any sales tax since recipient purchases are not subject to sales tax.

2. Salt and pepper are considered in your pantry, so you do not need to buy either. But any other spices, condiments or cooking fats/oils do need to be purchased or you need to deduct a portion of your cost when you did buy the item that is in your pantry since it’s difficult to have a stocked pantry when you’re on food stamps. For example, if you do have chopped garlic in your house, you don’t have to buy another jar for the week, but should – if you use some – deduct a part of the cost. If the jar cost $5.00 and you use one serving from a 10-serving jar, take 50-cents off your budget to account for the garlic you used.

3. It’s best to plan ahead, so if you have mailed or newspaper ad circulars, review what’s on sale and make a list before you shop. This time around, I’ll personally not plan ahead like I did last year and I’ll shop in only one grocery store. You don’t have to unless you want to also.

4. If you have a child in school and they receive or buy lunch, do not deduct this from your budget. Any foods you pack for lunch or snacks does have to be part of your budget however.

5. The budget does not include paper products, cleaning supplies, over-the-counter medicines, prescription medication, or non-food items not covered by food stamps. If you do need to buy these while you’re shopping, just make them a separate order, paid for separately, so you can accurately add up what you’re spending on food only.

6. We can shop for, prepare and cook whatever we want to eat, and can eat free food at business functions, meetings, work, or other places just like anyone else; in addition we can sample from tasting stations in grocery stores, and eat at parties we attend, hosted by friends or family. We cannot take home leftovers to stretch our budget though.

7. We can also eat out – but do need to include any meals we pay for and include the tax and tip since food stamp recipients cannot pay for meals out with their debit card, but also do have the expectation that the food stamps are assistance, not their sole source of buying food…we’ll include any meals out in our total budget.

Basically, the challenge includes preparing and eating what you are able to purchase throughout the coming week, and any meals eaten out, since it’s one thing to have to shop with a limited budget and another to live with it for a week.

Who will join me this week?

Again this year, those participating in the challenge are encouraged to email me photos of their groceries for the week, along with recipes and meal ideas and insights about your experiences during the week. I’ll highlight them here on my blog next week and open discussion about the various challenges we all faced, and the things we learned along the way! As always your comments are welcome as the challenge gets underway!

A Picture Worth 1000 Words

2008-09-25T21:51:00.000-05:00

Public Comment Open at USDA

2008-08-27T21:49:00.000-05:00

Last week, in the Atlanta Journal Constitution, an article revealed some
shocking school breakfast and lunch options: "Pop-Tarts and doughnuts
for breakfast for 2-year-olds. Rolls, chicken nuggets and French fries for
school lunches. Brownies given the same nutritional value as a slice of
whole-wheat bread."

This struck a chord with me since I recently posted on my blog about
the dismal lunches served in the Columbia Public Schools in Missouri.
One particularly disturbing lunch option - Smucker’s PBJ Uncrustable,
Pepperidge Farms Goldfish Pretzels, Rice Krispie Treat, 1% cholocate
milk, baby carrots and a fruit - is offered daily to students throughout the
district!

With 789-calories, the school's website highlights that the lunch contains
23g of protein (92-calories) and just 24% fat (189-calories; 21g); no
mention that this means the lunch also contains 508-calories from
carbohydrate (127g), or the equivalent of 32-teaspoons of sugar in a child's metabolism...not to mention if a parent packed such a lunch for their
child each day, they'd be branded as irresponsible and lending a hand
to the epidemic of childhood obesity!

With school back in session across many states, it seems we have a
pattern that shows school lunches are not as healthful as we're led to
believe!

Senatobia, Mississippi: Chicken Nuggets or BBQ Rib Sandwich, Mashed
Potatoes w/Gravy, Cheesy Broccoli, Hot Cinnamon Apples, Fruit Juice,
Yeast Roll, Gelatin. (assorted milk)

Randolph, Massachusetts: Nachos with cheese, beef, onion, tomato and
sour cream and fruit. (assorted milk)

Roff, Oklahoma: Corndog, tator tots, black-eyed peas, chocolate pudding
and milk.

Whittier, Massachusetts: Choice of Domino's of french bread pizza, small
salad, pretzel, assorted fruit. (assorted milk)

Folsom, New Jersey: Nachos with cheese or Smucker's PB&J, vegetable,
fruit and milk.

Ada, Oklahoma: Frito chili pie with cheese, green beans, garden salad,
rosy applesauce, salad bar and milk.

Benton, Arkansas: Pizza, corn, salad, half an orange, milk

Nachos, pizza, chicken nuggets, corndogs, frito chili pie....what is frito
chili pie anyway? And why are we not disturbed by these school lunches
offered to our kids each day?

Amazingly, each and every one of these lunches meet the minimum
standards for school lunches established by the USDA.

Which begs the question - how do we go about improving the minimum
standards for school lunches?

It turns out the Child Nutrition and WIC Reauthorization Act of 2004 is
up for review and revision in 2009, and you can provide comments about
ways to improve the school lunch program by either testifying at an
upcoming USDA Listening Session, or submit written comments online
or via mail.

If you'd like to submit comments online, you may at the Public Comment and Submission page.

If for some reason the above link fails to take you to the page for public
comment, the Docket ID is FNS-2008-0011 and the Docket Title is
Request for Public Comments for Use in Preparing for 2009
Reauthorization of the Child Nutrition Programs and WIC.

Investigate the Alternate Hypothesis

2008-08-25T21:53:00.000-05:00

Ever since the publication of Gary’s Taubes’ Good Calories, Bad Calories, folks within the low-carb community have suggested and discussed various study designs to investigate the alternate hypothesis, the “Carbohydrate Hypothesis”, explored in the book. The biggest issue isn’t so much designing a study, but funding a study large enough and controlled enough to reach valid conclusions.

With obesity considered one of the most pressing health issues of our time, wouldn’t it be great if we could find the resources necessary to investigate, in a really well done trial, that alternate hypothesis?

Enter Project 10100 - a call for ideas to change the world by helping as many people as possible.

Project 10100 is accepting submissions of ideas for projects until October 20, 2008. One hundred ideas will be selected for public review and voting to narrow the field to twenty semi-finalists. An advisory board will then select five projects to fund from a commitment by Google of $10-million dollars.

One category is “Health” and the critera provided to help those submitting ideas includes:

Criteria:

Reach: How many people would this idea affect?
Depth: How deeply are people impacted? How urgent is the need?
Attainability: Can this idea be implemented within a year or two?
Efficiency: How simple and cost-effective is your idea?
Longevity: How long will the idea’s impact last?
Project 10100 may be a way to fund a study to investigate the Carbohydrate Hypothesis!

If you’d like to submit your ideas, you can go to the Project 10100 website, or directly to the submission page.

Gary Taubes - Columbia, MO - November 2008

2008-08-15T21:50:00.000-05:00

Gary Taubes, author of Good Calories, Bad Calories and three time winner of the National Association of Science Writers’ Science in Society award, is scheduled to present his lecture, The Quality of Calories: Big Fat Lies: The Truth About Diet, Exercise and Obesity, on November 13, 2008 in Columbia, Missouri.

The event is sponsored by the Boone County Medical Society and the Department of Nutritional Sciences at the University of Missouri. It is free and open to the public. Registration is strongly recommended as seating is limited.

The presenation will take place at the Monsanto Auditorium (University of Missouri) at 2:30pm and will be followed by a reception in the McQuinn Atrium. More details are on the flyer below. To register online, click here.

Feeding Infants Fructose

2008-08-08T21:47:00.000-05:00

Discussion: Consuming fructose during suckling may result in lifelong changes in body weight, insulin secretion, and fatty acid transport involving CD36 in muscle and ultimately promote insulin resistance.

That was the conclusion reached by researchers who published Dietary Fructose During the Suckling Period Increases Body Weight and Fatty Acid Uptake Into Skeletal Muscle in Adult Rats, in the journal Obesity.

While the study was on rats, it’s interesting to look at the ingredients in baby formula sold in the United States (all of the below are the first few ingredients listed from peapod.com and do not include the brand name):

INGREDIENTS: Nonfat Milk, Whey Protein Concentrate, Corn Syrup Solids…

INGREDIENTS: Corn Syrup Solids, Partially Hydrolyzed Nonfat Milk and Whey Protein Concentrate Solids, Vegetable Oil…

INGREDIENTS: Corn Syrup Solids, Vegetable Oil (Palm Olein, Soy, Coconut, and High Oleic Sunflower Oils), Casein Hydrolysate …

INGREDIENTS: Corn Syrup Solids (43.2%), Soy Protein Isolate (11.5%), High-Oleic Safflower Oil (10.3%), Sugar (Sucrose) (8.4%), Soy Oil (7.7%), Coconut Oil (7.7%)….
Is there a connection with rising prevalence of childhood obesity and feeding infants corn syrup solids? Things that make you go ‘hmmmm’

Moving On...

2008-08-02T09:19:00.002-05:00

Call me a "once burned, twice shy" kinda gal....I am not going to risk being locked out of my blog again, so I'm moving to my own host for this blog in the future!

Please update your links - my blog address is now

http://www.WeightoftheEvidence.com

The full migration of all posts and comments will be complete by Monday, August 4, 2008.

No additional posts will be added here.....if you've reached here via a link in Google or other search engine, please go here for all new posts: Weight of the Evidence.

Thanks!

My New Blog Home

2008-08-01T21:45:00.000-05:00

Well, I decided to migrate my blog, Weight of the Evidence, to WordPress. This was due to Blogger locking my blog under the mistaken belief it was a “spam blog”. I have some minor work to do on the posts that migrated to get them properly tagged – but should have that complete by the end of next week.

For anyone who has my old blog address in their links (weightoftheevidence.blogspot.com) – please change the link to www.WeightoftheEvidence.com – Thank you!

Chew on this...

2008-07-25T09:41:00.005-05:00

The Cochrane Database of Systematic Reviews recently withdrew a document within its collection - Advice on low-fat diets for obesity.

As we learn on The Cochrane Collection website, the editorial group responsible for this previously published document have withdrawn it from publication.

The reason cited for the withdrawal?

This review is withdrawn because it is very much out of date, as authors stated. None of the authors has any plans to update it.

Happy Trails to you....

2008-07-19T08:17:00.002-05:00

http://www.youtube.com/watch?v=4IGtDPG4UfI

Two Year Dietary Trial Results: Low-Carb Better than Low-Fat

2008-07-17T16:50:00.006-05:00

The study just published in the New England Journal of Medicine, Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet (free full-text), is quite a read, with lots of data and lots of findings to explore and look at!

First things first - the objective of the study was to compare the effectiveness and safety of weight loss diets over a two year period.

The dietary approaches included in the study:

a low-carb diet, loosely based upon the Atkins diet, no calorie restriction
a Mediterranean diet, calorie restricted, based on the recommendations of Dr. Willett & Dr. Skerrett (Eat, Drink & Be Healthy)
a low-fat diet, calorie restricted, based on the American Heart Association guidelines

In addition to weighing participants each month and measuring waist circumference, the researchers measured at reporting invervals (6-months, 12-months and 24-months) total cholesterol, LDL, HDL, triglycerides, fasting blood glucose, fasting insulin, HbA1C, blood pressure, HOMA-IR, C-reactive protein, leptin, adiponectin, bilirubin, alkaline phosphatase, alanine aminotransferase and urinary ketones.

Enrolled in the study were 322 volunteers; they were provided their largest meal each day (lunch) at work, and given support and guideance about their diet throughout the study period. Of the 322 who started the trial, 95.4% completed one year, and 84.6% (272 participants) completed the 24-months - making this perhaps, the best adherence level in a dietary trial lasting two years!

So what happened? Let's look at the various outcome measures to see.

Weight Loss

The mean weight changes among the 272 participants who completed 24 months of intervention were:

–3.3 ±4.1 kg in the low-fat group (7.3-pounds)
–4.6 ±6.0 kg in the Mediterranean-diet group (10.1-pounds)
–5.5 ±7.0 kg in the low-carbohydrate group (12.1-pounds)
(p=0.03)

Overall, in the intent to treat data (which includes even those subjects that did not complete the study) the weight loss was reported as:

–2.9 ±4.2 kg for the low-fat group (6.4-pounds)
–4.4 ±6.0 kg for the Mediterranean-diet group (9.7-pounds)
–4.7 ±6.5 kg for the low-carbohydrate group (10.3-pounds)

The reason I note the two findings is that in the media reports, the trend appears they're reporting the intent-to-treat numbers, which are lower because they include the 50 subjects that dropped out. Those who actually completed the study are the data I prefer to look at for weight loss since it accurately presents how effective the dietary approaches are when continued for two years!

Waist Circumference

-2.8 ±4.3 cm in the low-fat group
-3.5 ±5.1 cm in the Mediterranean-diet group
-3.8 ±5.2 cm in the low-carbohydrate group

Lipid Profiles

The graph itself speaks volumes:

High-Sensitivity C-Reactive Protein, High-Molecular-Weight Adiponectin, and Leptin

The level of high-sensitivity C-reactive protein decreased significantly only in the Mediterranean-diet group (21%) and the low-carbohydrate group (29%), during both the weight-loss and the maintenance phases, with no significant differences among the groups in the amount of decrease.

During both the weight-loss and the maintenance phases, the level of high-molecular-weight adiponectin increased significantly in all diet groups, with no significant differences among the groups in the amount of increase.

Circulating leptin, which reflects body-fat mass, decreased significantly in all diet groups, with no significant differences among the groups in the amount of decrease; the decrease in leptin paralleled the decrease in body weight during the two phases.

Fasting Plasma Glucose, HOMA-IR, and Glycated Hemoglobin

Among the 36 participants with diabetes, only those in the Mediterranean-diet group had a decrease in fasting plasma glucose levels (32.8 mg per deciliter); this change was significantly different from the increase in plasma glucose levels among participants with diabetes in the low-fat group.

This is critically important to note - the low-fat group experienced a rise in fasting blood glucose over the course of the two years; this despite a greater calorie deficit than the other two diets, and a greater increase in physical activity! Yet, this type of diet is exactly how the ADA recommends people at risk for or diagnosed with diabetes eat, while expecting ever increasing doses of medication to cover their progressive decline in glycemic control.

It is also noteworthy that, "there was no significant change in plasma glucose level among the participants without diabetes." Basically those who did not have diabetes did not experience any change in their values over the period of the study.

What the researchers did not note in their written text of the results was this - the low-carb dieters had similar declines in their fasting blood glucose levels through month 12, followed by a progressive decline through month 24.

If we look at the data provided, we can see something important changed - the quality of the carbohydrate they consumed seems to have declined. If you look at the table providing details of the dietary intakes, one major change in the low-carb group between moth 12 and month 24 pops out - as the study progressed, the consumed less and less fiber on average, compared with their baseline intake. Now early on, that's to be expected. Later, as carbohydrate is increased - if quality whole foods are the choice - fiber typically increases!

In contrast, insulin levels decreased significantly in participants with diabetes and in those without diabetes in all diet groups, with no significant differences among groups in the amount of decrease.

Among the participants with diabetes, the decrease in HOMA-IR at 24 months was significantly greater in those assigned to the Mediterranean diet than in those assigned to the low-fat diet.

Again, in the text, the researchers do not note if there were changes in HOMA-IR in the low-carb group. There was - over the 24-month period, the HOMA-IR in those with diabetes, following the low-carb diet, declined by 1.0; in those with diabetes following the low-fat diet the decline was 0.3; and in those with diabetes following the Mediterranean diet the decline was 2.3.

The last item reported in the section was the HbA1C levels. Among the participants with diabetes, the proportion of glycated hemoglobin at 24 months decreased by:

0.4 ±1.3% in the low-fat group
0.5 ±1.1% in the Mediterranean-diet group
0.9 ±0.8% in the low-carbohydrate group

The changes were significant only in the low-carbohydrate group.

The lower HbA1C is perhaps one of the most important outcomes of this study. The diabetics, in the low-carb group, were able to lower their levels by 0.9 over the 24 months and this was significantly greater than those in the two other diets. Unfortunately the researchers did not include the baseline HbA1C for participants, so we do not know what the reduction really means.

Liver-Function

Tests Changes in bilirubin, alkaline phosphatase, and alanine aminotransferase levels were similar among the diet groups

Alanine aminotransferase levels were significantly reduced from baseline to 24 months in the Mediterranean-diet and the low-carbohydrate groups.

The Good, Bad, and Why oh Why?

Overall, most reporting on the study today, feel the research team did a good job designing the study and executing it, many applauding the high rate of retention in the study for two years. I too am impressed that the participants remained committed to the trial, their assigned diets, and the longer-term outcome measures!

I personally would have liked more information than was published.

Key information regarding the baseline diet was not included in the data - not published items include how many calories were consumed, on average, at baseline; nor do we know how much protein, carbohydrate, fat or fiber was in the baseline dietary habits of those participating. While obviously not critical, it is 'nice to know' data.

I also would have liked to see the researchers have the courage to actually follow the Atkins dietary approach, and not make changes based on a number of assumptions.

We do not, for example, know what the outcome would be if the participants on the low-carb dietary arm had not been told to specifically choose vegetable based fats over animal fats. Atkins does not specifically state you must eat butter, but the diet allows butter. In addition, encouraging the consumption of plant-based proteins over animal proteins is another tweak that may not have had any effect, or may have had a positive or negative one. We simply do not know because the researchers encouraged plant-based protein consumption rather than leave the dietary recommendations as they are - meats, eggs, poultry, fish, tofu and such are allowed, ad libitum. [please see update below!]

The reporting in the media, as my earlier post highlights, has been quite an eye-opener. I'm not sure if those quoted realize it or not, but their reaction to the study is quite telling, especially those with the strongest vested-interests in maintaining the status quo.

In the Wall Street Journal, Robert Eckle, the past president of the American Heart Association and a professor of medicine at the University of Colorado Health Sciences Center, said he was not ready to recommend an Atkins-type low-carb diet based on the results. People on a low-carb diet increased their consumption of saturated fat, he said, which could not be good for them in the long run.

Did he even bother to read the findings?

Or maybe he was just disappointed the AHA's recommended diet - the diet recommendations the low-fat group were instructed to follow - did so poorly compared to the other two?

Did he know that the study author, Dr. Meir Stampfer of Harvard Medical School, in the same article, said "It is time to reconsider the low-fat diet as the first choice for weight loss and for cardiovascular health, it is not the best."

I think tomorrow, we'll take a fun ride through many of the quotes and opinions offered on this study!

In the meantime, what are your thoughts? Feel free to leave comments!

UPDATE 7/18/08

I received an email today from a friend who asked one of the researchers about the reference to plant-based (vegetable) fats and proteins. Dr. Shai assured him that the low carbohydrate group was not advised to consume a vegetarian low-carb diet, nor were they specifically restricted from eggs, cheese, red meat, poultry or fish. Due to dietary restriction (religious) the group would not, for instance have a cheeseburger or butter on top of their steak. Olive oil featured prominently. The participants did read the Atkins diet book. And the examples provided of the types of meals was "For example, a plate could include : fish or fried/not bread coated chicken/or red meet, broccoli and mushrooms coated with eggs, roasted eggplants, vegetable salad (peppers, cucumber, green leaves, notlettuce) with olive oil dressing.

One Study, A Myriad of Opinions

2008-07-17T07:24:00.002-05:00

The buzz across the internet today is the findings from the paper, Weight loss with a Low Carbohydrate, Mediterranean, or low fat diet, published in the New England Journal of Medicine.

The headlines are all over the place regarding what the results mean:

Low-Carb and Low-Fat Diets Face Off

Dr. Meir Stampfer, the study's senior author and professor of epidemiology and
nutrition at Harvard School of Public Health, told ABC News: "The low-carb diet
was the clear winner in providing the most weight loss."

The Never-Ending Diet Wars: Why Atkins Still Doesn't Beat Low-Fat Diet

"An optimal diet is one that is low in fat (because fat, whatever the type, has
9 calories per gram versus only 4 calories per gram for protein and
carbohydrates). When you eat less fat, you consume fewer calories without
having to eat less food, because the food is less dense in calories, as well as
low in refined carbohydrates."

Healthy Diets Shown to Have Benefit Despite Modest Weight Losses

In a tightly controlled dieting experiment, obese people lost an average of just
6 to 10 pounds over two years. The study, published Thursday in The New
England Journal of Medicine, was supposed to determine which of three types of
diets works best. Instead, the results highlight the difficulty of weight loss
and the fact that most diets do not work well.

More Evidence that Diets Don't Work

After two years of effort the dieters lost, on average, 6 to 10 pounds. The
study, funded in part by the Atkins Research Foundation, seemed designed to
prove that low-carb diets trump low-fat diets. But in the end, all it really
showed is that dieters can put forth tremendous effort and reap very little
benefit.

Diet Study: Hold the Carbs, Not the Fats

Low-carbohydrate and so-called Mediterranean diets may be more effective than
low-fat diets, according to a major new study published in tomorrow’s New
England Journal of Medicine.

Against the Grains

Carbohydrates have taken another hit. A new study finds that a low-carb diet
results in greater weight loss and better cholesterol readings than a low-fat
regimen that promotes a lot of grains and fruits.

Diet Plans Produce Similar Results

New research shows that Mediterranean and low-carb diets are just as good and
just as safe as the low-fat diet often prescribed by doctors, a revelation that
should give people more choices in eating well.

Unrestricted Low-Carb Diet Wins Hands Down

The similar caloric deficit achieved in all diet groups suggests that a
low-carbohydrate, non–restricted-calorie diet may be optimal for those who will
not follow a restricted-calorie dietary regimen.

Atkins Diet is Safe and Far More Effective Than a Low-Fat One, Study Says

The controversial Atkins diet is just as effective and safe as a conventional
low-fat diet, a two-year study has found. Researchers found that
overweight volunteers shed more pounds on the low carbohydrate regime than they
did on an orthodox calorie-controlled diet.

Low-Carb and Mediterranean Diets May Equal Watching Fat Intake

Explain to interested patients that the study suggested low-carbohydrate and
Mediterranean diets could be as effective as the traditionally recommended
low-fat diet for weight loss.

It's amusing that each of the above headlines are all reporting on the same study!

Later today, in another post, we'll set aside the headlines and simply look at the study itself and the results.

Shame on Missouri!

2008-07-09T15:27:00.002-05:00

Yes this is going to be a rant!

Yesterday I was alerted to the newly proposed changes, open for public comment, in the Missouri Eat Smart Guidelines - standards for school lunches (and breakfast) in my state. When I first opened the document, I was not surprised by the incremental reduction of dietary fat and the push for more fiber, especially with whole grains.

What did surprise me was the absolute lack of attention to nutrient-density at each category level. Oh, there is a minimum which applies to each category - the minimums established by the USDA that establish minimum calories, fat not to exceed 30%, acceptable levels of protein, cholesterol, sodium and fiber, along with target minimums for calcium, iron, and vitamins A and C.

So the committee drafting the newly proposed "expemplary" category didn't think it wise to perhaps set the bar higher - ya know, establish benchmark minimum for other micronutrients...maybe the same ones identified as deficient in our children in Missouri?

Hey, the starting document to consider this could be the Missouri Department of Health & Senior Services (DHSS) recently published Dietary Intake Summary Report for school year 2000-2001 - in it the DHSS reported finding the vast majority (greater than 50%) of all children in the state fail to meet RDA requirements for vitamin A, iron, calcium, folate and zinc, and 25% fail to meet requirements for protein, vitamin B6 and vitamin C.

HELLO!

We have a serious problem with malnutrition and the best the Missouri Eat Smart Guidelines committee can come up with is stricter limits on dietary fat and increasing fiber?

Has the committee that drafted this guideline even looked at what is being served in our schools?

Columbia public schools offer this delight each day:
Smucker's PBJ Uncrustable, Pepperidge Farms Goldfish Pretzels, Rice Krispie Treat, 1% cholocate milk, baby carrots and a fruit.

Can you imagine what would be said to a parent packing such a lunch for their child?

But guess what? That lunch conforms to the standards for low-fat with just 21g of dietary fat (24% of calories) - just ignore the fact that once protein is tallied, carbohydrate accounts for 508 of the 789 calories - that's 127g of carbohydrate, or the equivalent of 32-teaspoons of sugar in a child's metabolism in one meal!

But hey, it provides 6g of fiber - above the target 5g standard, right?

The public schools have the audacity to call that abomination a nutritious lunch?

Oh, and don't get me started on the soy-based products being used in meals and that fact not being disclosed to parents, unless of course, they poke around to read the allergen lists.

Beef Tacos on the menu?

I'd expect they're made with beef, wouldn't you? Nope...they're based on an "enriched" product schools purchase - made with some beef and an ingredient listed as "VPP" - vegetable protein product - better known as soy protein.

Chicken Nuggets on the menu?

I'd expect they're breaded chicken pieces, wouldn't you? Nope...they're also based on an "enriched" product schools purchase, already prepared - made with some chicken and an ingredient listed as ISP - isolated soya protein.

Think it can't get worse?

I don't think schools do much more than open a can, heat and serve these days - just reading through the spreadsheets available online makes that pretty clear - almost everything sold in school breakfast and lunches are convenience foods, from various vendors, that are nutritionally bankrupt, but easy to heat and serve.

If a parent were to habitually feed their child that crap, at the very least they'd be chastized as irresponsible - yet this is how the schools operate each day, serving what can only be called food-garbage each day and they have audacity to label them "healthful" and nutritious.

When you have a chance, read through the proposed Missouri Eat Smart Guidelines, then let the committee know what you think in the open public comments!

If people don't start speaking up, and demanding truly nutrient-dense meals for their children, it's only going to get worse!

Caution: Childhood Obesity

2008-06-19T06:29:00.003-05:00

In the last month, two major media sources (Washington Post and Time magazine) have devoted page upon page to the epidemic of childhood obesity.

Washington Post: Young Lives at Risk: Our Overweight Children

Time: Our Super-Sized Kids

There is no doubt in my mind that there are, indeed, more children who are much heavier today than there were when I was growing up, and that parents of obese children should have access to resources to help them help their child.

What I find disturbing is that the current level of alarm, hysteria and obsession with children's growing waistlines hasn't caused any to pause, step back, and examine the facts. Instead, it seems, the drum beats on to reduce calories, reduce fat, add mroe fruits and vegetables, lots of whole grains and increase activity.

The message is part of a perpetual campaign to convince our population that we must do it "for the children," with an indictment against parents who are said to not see nor do anything about their fat children; that the community, doctors, schools, health organizations, the food industry and the government must lead these wayward parents to understand how to improve both diet and activity levels for their children.

We see and read about extreme cases of childhood obesity, extreme examples of poor eating habits, and extreme lifestyle habits; we're reminded that is how it happens - too much food and not enough activity, the recipe for growing fat children in America today.

But excess accumulation of fat isn't the only problem - we're also hit with the sobering reality that, in addition to heavier children, our children are also growing sick sooner; we're told of children with type II diabetes (once called "adult onset" diabetes since it was virtually unheard of in children or teens), dyslipidemia, PCOS, metabolic syndrome, precocious puberty, high blood pressure, heart disease and more. The statistics are frightening and we're constantly reminded that today's children will likely die earlier than their parents if we don't do something!

The mind-numbing statistics, experts expressing grave concerns, fine examples of poor eating habits, and images of the most extreme cases of obesity in children all work to create a strong sense that we all must do something, that all of our children are at risk, that the future is at stake if we don't do the right thing and do it now!

Is the hype really helping?

Are the solutions on the table going to work not only to prevent childhood obesity, but reverse it in those children whom are already obese?

Considering the solutions presented today is identical to the solutions offered throughout the past three decades, I can only conclude things will get worse not better; the longer it goes on, the stronger the pressure on parents will grow to 'get with the program' and follow the direction of the expert recommendations.

As parents, we have an obligation to protect our children, keep them safe, nurture them and do the best we can as we raise them.

My previous post provided an example of how the current guidelines to use BMI as the gold standard measure of overweight and obesity in children is problematic. The fact that a child can be a normal healthy weight in one month and then overweight or obese in another without any change in weight or height tells us the charts are inaccurate. The fact that the hypothetical child would have dropped from 59th to 52nd percentile for weight on the traditional chart, but went from normal to overweight on the BMI chart, speaks volumes about its deep flaws.

What's telling is that almost all the comments left in the hypothetical 'set-up' of the situation post were the belief the child gained weight. That is understandable, given the repeated message we all hear that overeating and inactivity make you gain weight. If the child now had a BMI indicating she was overweight, she must have gained weight if her BMI just two months ago said she was normal-healthy weight. Too bad it wasn't true.

If we, as parents and a nation, truly wish to resolve the issue of childhood obesity, we must begin to re-examine our assumptions and how we've arrived where we are today. Our children are not only growing fatter, they're growing sicker, and doing the same thing with only the volume turned up on the message isn't going to change this. Throwing medication at the problem isn't going to make it go away. Surgical intervention isn't going to reverse it, and certainly can't prevent it before the fact.

We have the answer, yet we ignore it.

We'll explore that in another post coming soon!

In the meantime, feel free to leave your comments about the issue of childhood obesity, its causes and its solution.

Nothing Changed But Her Age

2008-06-18T17:18:00.002-05:00

In my earlier post, about the little girl, absolutely nothing changed in two months, other than she was now 3-years 10-months old and before was 3-years 8-months old.

I charted the hypothetical little girl at 3-years 8-months as standing 38" tall and weighing 34.5-pounds - placing her in the 84th percentile for BMI for age, the top of the "normal healthy weight" classification. With no upward growth and no weight gain in two months, this same child would now be in the 85th percentile for BMI for age, making her "at risk for overweight" in some circles, or simply "overweight" in others.

Interestingly, if we calculate her traditional fall on the height and weight charts, her weight at 3-years 8-months places her in the 59th percentile for weight for age; at 3-years 10-months it's dropped to the 52nd percentile for weight for age. Yet this child is now labeled as being among the statistics of overweight and/or obese children.

The dirty little secret about children's BMI charts is they slope downward starting at age 2 until about age 6! Take a look:

How often do we read or hear how parents are totally blind to their child's weight problems?

How many out there realize the difference between "normal healthy weight" of a three year old girl and 'at risk for overweight" (or overweight) is just 0.5-pounds, to be classified "overweight" (or obese) it's just one more pound if you use the BMI for age chart?

How many realize that within as short a period of time as a month, with no gain or loss and no upward growth a child can move from one category, normal healthy weight, up to overweight?

Yet this is the "gold standard" we parents are told is best to determine if our child is overweight or obese, in need of intervetion to prevent them from becoming an obese adult!

What do you think?

You can go play with the calculators available online:

Children's BMI Calculator

Children, Age 2 to 20, Growth Chart Percentiles Calculator

How Does It Happen?

2008-06-18T13:58:00.001-05:00

Imagine for a moment, you're a parent - of an adorable 3-year old girl. Since birth she's thrived and is quite the little social butterfly now that she's getting older. She eats well, plays hard and is just a delight. Your last visit to the pediatrician, when she was 3-years 8-months old, went great - with all the alarms about childhood obesity, you were pleased the doctor was so proactive to weigh and measure her, even more happy when he declared she was a healthy weight and doing great!

Fast forward a couple of months, today your little girl has what seems to be a cold that's progressing, so you make an appointment and the doctor's office squeezes you in.

When you arrive, the nurse takes you into the exam room, weighs and measures your daughter (just like last time) and takes her temperature. She asks you to wait a few minutes, the doctor will be in soon.

A short time passes and the doctor comes in, examines your daughter and doesn't think it's something that needs antibiotics and explains how to monitor her fever and keep her hydrated. He then says, we need to talk about her weight, her BMI places her in the 85th percentile, which puts her at risk for overweight.

You're stunned!

How could this have happened in just two months?

How is it possible you've not seen this coming?

What Do the Obese Think?

2008-06-17T16:07:00.002-05:00

A recent survey found that being obese invites social discrimination, but the obese do not wish to be labeled as "sick" or diseased. As noted in the press release about the survey findings:

"Obese people frequently feel overwhelmed and disheartened by the publicity about their condition," he said. "They often feel disrespected and not understood by medical practitioners. Our participants express the view very forcefully that they feel victimized by current social attitudes about obesity. To be told that, in addition to the problems that they recognize only too well, they are now regarded as 'sick' is unlikely to assist them to find a solution."

Study participants said they find it difficult to act on the health messages about obesity, he said. Most participants reported that they had tried weight loss remedies that their physician recommended and were generally dissatisfied with the help doctors provide.

Health care providers' efforts to convince overweight patients to lose weight are largely unsuccessful, Komesaroff believes, possibly because they do not understand the key issues that obese people face.

More A to Z Diet Trial Data

2008-06-17T12:13:00.002-05:00

Readers may recall that last year, in March 2007, a study was published from a dietary trial comparing four dietary approaches for weight loss: Atkins, Ornish, LEARN and Zone - the A to Z Weight Loss Study.

Many reading through the findings cried foul - those in the Ornish group hadn't reduced their fat sufficiently, those in the Atkins group consumed more carbohydrate than recommended, and so on.

In my blog post I noted "...this study failed to achieve compliance out of the gate!"

I also noted that "We have before us is a study that really does indicate carbohydrate restriction can work well over a period of one year. Without sub-group analysis to evaluate results tied to compliance (hey, some of the participants had to be doing the various diet right, dontcha think?) we can't know just how effective doing Atkins or any of the diets is with good compliance though since the researchers didn't take their data to that level of analysis in this paper."

Ask and ye shall have an answer!

A follow-up paper was published in the International Journal of Obesity - Dietary Adherance and Weight Loss Success Among Overweight Women: Results from A to Z Weight Loss Study.

As the researchers note in the background of their abstract: "Dietary adherence has been implicated as an important factor in the success of dieting strategies; however, studies assessing and investigating its association with weight loss success are scarce."

Their objective?

"We aimed to document the level of dietary adherence using measured diet data and to examine its association with weight loss success."

And so they performed a secondary analysis on the data from the trial and lo' and behold, those who closely adhered to the dietary recommendations of their assigned diets were found to have greater weight loss when compared with those less compliant with their dietary recommendations.

The researchers found that "within each diet group, adherence to score was significantly correlated with 12-month weight change."

Atkins rs= 0.42 p=0.0003
Zone rs= 0.34 p=0.009
Ornish rs= 0.38 p=0.004

When comparing the highest level of compliance with the lowest the researchers noted significant differences in weight loss in the Atkins group!

Atkins
Highest compliance = 8.3kg
Lowest compliance = 1.9kg
p = 0.0006

Zone
Highest compliance = 3.7kg
Lowest compliance = 0.4kg
p = 0.12

Ornish
Highest compliance = 6.5kg
Lowest compliance = 1.7kg
p = 0.06

The researchers concluded, "Regardless of assigned diet groups, 12-month weight change was greater in the most adherent compared to the least adherent tertiles. These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss."

The Other Side of the Obesity as Disease Debate

2008-06-17T07:57:00.002-05:00

Obviously the debate about classifying obesity a disease is not a new idea, for years various researchers, special interest groups and organizations have debated the merits of defining obesity as a disease, with each round of reasoning and review of the evidence leading to the determination that obesity is not a disease unto itself, leaving it to remain categorically a health issue - a risk marker and a condition one is better to address than to ignore, but not a disease in need of specific medical intervention per se, but a condition with treatment options at the discretion of those within the medical community treating obese patients.

This distinction is important - while medical interventions are available, they are not the sole option for those who are obese; nor are all individuals with a BMI of 30 or greater automatically deemed to have a chronic disease in need of treatment by licensed healthcare professionals. If someone is obese, they are clearly able to seek medical treatment if they desire that option, just as they can opt instead to join Weight Watchers, read and follow the South Beach Diet on their own, or, gasp!, do nothing if their obesity is not causing them other health problems.

In order to fully understand the implications of the current position foisted in the Obesity Society white paper, it's important to look at the arguments as they've developed over the years. One exceptionally well written paper was published in October 2001 in the International Journal of Obesity - Is Obesity a Disease?

In that paper, the authors take time to review and discuss the "characteristics of obesity to determine if they fit the common and recurring elements of definitions of disease." They utilize a sample of definitions of disease taken from "authoritative English language dictionaries" to determine a common understanding of what defines "disease" and from there, examine if obesity fits the definition.

They tell us, "we identified the following common and recurring components:

(a) a condition of the body, its parts, organs, or systems, or an alteration thereof;
(b) resulting from infection, parasites, nutritional, dietary, environmental, genetic, or other causes;
(c) having a characteristic, identifiable, marked, group of symptoms or signs;
(d) deviation from normal structure or function (variously described as abnormal structure or function; incorrect function; impairment of normal state; interruption, disturbance, cessation, disorder, derangement of bodily or organ functions)

Then ask, "[h]ow well does obesity fit the definition of disease?"

Using the above criteria for disease, they evaluate whether defining obesity as a disease can be accomplished within the definition of disease.

There should be little disagreement that obesity satisfies conditions (a) and (b) above. That is, (a) an excess accumulation of fat can certainly be thought of as a condition of the body, and as for (b), the list of potential causes is so extensive that the causes of obesity must surely be found there.

Condition (c) poses a problem. Indeed, obesity can be diagnosed visually from physical proportions, or with the help of height and weight measurements. In cases of doubt, body composition methodologies offer numerous methods to measure body fat to the required degree of precision. However, there are no signs that inevitably characterize the condition other than the excess adiposity, which is the definition of obesity. The causes of obesity are numerous and diverse, ranging from and including combinations of environmental, behavioral and genetic aspects of energy intake, partitioning and expenditure. Its common accompaniments¾impaired glucose tolerance, dyslipidemia, hypertension¾are not inevitably present. Thus, condition (c) is met, but only in a circular or tautological sense: the only characteristic (pathonomic), identifiable sign of obesity is also the characteristic which defines obesity, ie fatness.

Condition (d) is even more problematic. The deviations specified range from simple deviation from normality, to impairment, interruption or cessation of vital functions. Moreover, what is meant by deviation from normality is not clear¾it can imply undesirable variation or simple statistical rarity.

Evidence for impaired physical and social functioning in severe obesity (eg BMI>40) clearly exists. In these cases, excess fat is usually accompanied by various signs of impairment and it can be argued that severe or extreme obesity would usually meet condition (d) for most definitions of disease, including those which specify impairment of function.

However, impairment is not inevitable or even usual in most persons who meet the present BMI or percentage fat criteria for obesity. In contrast to severe obesity, mild obesity only 'threatens' eventual impairment inasmuch as a risk factor, by definition, confers a greater probability of some future adverse event. Yet its association with these events is, at our present state of understanding, probabilistic. We cannot foretell who will develop an obesity-related health problem. In fact, some persons who meet the criteria for obesity will live long lives free of any of the morbidities known to be influenced by obesity. We are therefore placed in the conceptually awkward position of declaring a disease which, for some of its victims, entails no affliction.

Many obese persons are competent, functioning members of society. Nor do these persons necessarily subjectively consider themselves impaired, except perhaps insofar as they feel themselves victims of social discrimination. They might fail to meet some arbitrary standard of physical fitness (eg climbing stairs, running) but such a standard would also exceed the capability of many non-obese but sedentary individuals. While physical fitness is desirable, its absence has not generally been considered an impairment. It would be possible to set an arbitrary standard of fitness which many obese and non-obese people would fail to meet, and to consider this as evidence of impairment; however the present criteria for obesity do not do so.

A further conceptual problem arises when obesity occurs in a disease such as Cushing's Syndrome. Obesity is one of the components or signs of that syndrome. Is the obesity which is a sign of Cushing's disease, itself a separate disease?

In sum, to call obesity defined solely on the basis of a BMI or percentage body fat in excess of some threshold a disease leads immediately to the following problems:

the only sign or symptom may be the excess fat which is also the only defining feature of the condition¾there are no other inevitable clinical or subclinical signs;

many obese persons suffer no impairment as a consequence of their obesity;

it ignores the probabilistic nature of the relation between obesity and consequent adverse events which is accurately conveyed by the term risk factor;

it poses conceptual problems, eg is the obesity which is a sign of a disease, itself a disease?

They continue on, at great length about the various ethical issues involved - from the creation and fostering of a victim 'mentality' of the obese, to the issue of responsibilities that range from patient behaviors to obligation to provide medical treatment, from the problems of vested interests leading the cause to declare obesity a disease to determining who pays for treatments.

They come full circle and conclude, "None of the foregoing is meant to argue that obesity is not a public health problem of the first magnitude. However, it would be a mistake to attempt to label it a disease in the traditional sense in order to emphasize its importance if it does not meet reasonable criteria for such diseases. Conceptual clarity is a cardinal virtue in science and philosophy and it should not be sacrificed to expediency.

Finally, it seems neither logically necessary nor tactically essential to have obesity labeled a disease in order for it to be taken seriously. Public health measures and preventive medicine often receive generous funding (eg annual physical examinations, immunization programs, smoking cessation campaigns, promotion of exercise and active lifestyles). Whether and how our institutions and organizations pay for obesity treatment should ultimately depend on what health outcomes we value, how much we value them, and the cost of achieving them, not on whether obesity is labeled a disease."

Is Obesity a Disease?

2008-06-16T09:49:00.004-05:00

I left readers with photos of three incredibly fit men on Friday - each is an elite athlete in the octagon, practicing mixed martial arts, at the top of their game.

I asked one question, aside from the UFC, what do they share in common?

Many answered they all share the common BMI classification "obese" - although that is correct, the answer I was going for was they're all "diseased" and in need of medical treatment for their obesity according to the authors of a new white paper published by the Obesity Society.

That's right, if the opinions expressed in this white paper are adopted, the men pictured would all be considered suffering a chronic, debilitating disease which needs treatment by healthcare professionals.

The committee that drafted the position paper took the unusual step to discard the evidence-based (forensic) model and opted for a philosophical argument from a utilitarian perspective.

While they credit themselves for taking this approach because "there can be no higher authority than reason," they ignore the important qualification for something to be declared a disease - is it a disease?

This abandonment of evidence, data and scientific inquiry undermines their approach by simply skirting the true purpose to determine if something is rightly, indeed, a disease state. To get around this wee inconvenience, instead they argue "...the utilitarian argument can address the question "should obesity be declared a disease?" as opposed to "is obesity a disease?"

The ramifications of this mind-bending mental-gymnastics are far-reaching, the authors ignore the moral and ethical can of worms opened if their position is adopted, with their beliefs trumping evidence as they remain steadfast in the belief that it doesn't matter *if* obesity is a disease, it should be declared one anyway because,

"Many obese people are desperate for treatment - the number of people who self-treat and those treated by commercial programs is larger than the number currently treated by the medical establishment. If obesity were considered a disease and entitled to the same considerations given to other diseases, treatment paradigms would change fundamentally...If treatment were covered, more physicians would be likely to engage patients in treatment protocols. The FDA would come under pressure to approve obesity drugs, and physicians would be more likely to use obesity drugs in treatment...With this increased attention, medical treatment options, especially drug treatment, likely would become more aggressive. Medical treatment and obesity surgery would be given more attention by physicians, health administrators, insurance companies, and employers, resulting in greater access by patients to higher quality care."

For those unaware of the various philosophical approaches, Utilitarianism is the idea that the moral worth of an action is solely determined by its contribution to overall utility, that is, its contribution to happiness, satisfaction, preferences or pleasure as summed among all persons affected. This is a form of consequentialism - the moral worth of an action is determined by its outcome - the ends justifies the means.

Because it is an 'ends justifies the means' line of thinking, it can be characterized as a quantitative and reductionist approach to ethics. And to be sure, this issue has far reaching ethical and moral implications - in the stroke of a pen, this perspective potentially takes 1/3 of our population and defines them as diseased, in need of medical intervention and treatment, by way of the crudest measure of obesity - the BMI.

As the three men in Friday's post highlight, obesity as defined by BMI is unreliable, thus flawed as a measure to determine if one is obese. This flaw isn't news, it's well established in the medical and research community as problematic, which is a reason why many continue to suggest the utilization of more refined measures, like waist-hip ratio and/or an actual measure of body fat percentage.

But even this well known flaw does not stop the authors from even suggesting the BMI standard be LOWERED to classify obesity! That's right, not only do these folks think we should abandon medical standards and wax lyrical about how obesity should be declared a disease, they also feel the BMI needs to be lower too!

Sandy Szwarc at Junkfood Science has a well written article about the paper already, so I'll skip the points she already made. I'll note here that one sentence bears repeating about why the philosophical approach in this paper is wrong, "By this logic, or course, poverty could be a disease... Black or ethnic minority a disease... Old age a disease... Homosexuality a disease... Ugliness a disease... Low intellect or literacy a disease."

In addition to the points made by Sandy, a big issue remains - what about the legal issues and medical ethics involved if obesity were declared a disease?

First and foremost is that should obesity be declared a disease, therefore a chronic medical condition, it would then follow that only licensed healthcare professionals would be qualified to treat obesity. The treatments would, of course, include a handful of diet pills, lifestyle interventions and/or bariatric surgery. Fully medicalized as a disease, obesity would no longer be 'treated' outside the licensed medical community because anyone offering services to the obese would be practicing medicine without a license since all disease treatments are the protected domain of licensed healthcare professionals.

More importantly however, is the problematic position "declaring obesity a disease" becomes for the healthcare professional. We'll explore these issues throughout the coming week.

What do you think? Should obesity be declared a disease? Why or why not?

What Do You See?

2008-06-13T14:09:00.003-05:00

Other than being UFC fighters, what do these three men, Shane Carwin in the top photo and Cain Velasquez to the left and Brad Morris to the right in the bottom photo, share in common?

Guess in the comments and I'll explain on Monday!

Dr. Westman: Yet Another Possible Explanation

2008-06-09T16:06:00.003-05:00

After reading the findings comparing the Masai, and the rural and urban Bantu in Tanzania, Dr. Eric Westman penned a reply to the British Journal of Sports Medicine:

Yet another possible explanation
Eric C Westman, researcher Duke University

Thank you for this contemporary assessment of dietary intake among the Masai pastoralists. Through the paradigm-shifting lens of a recent comprehensive summary of the lack of science to implicate saturated fat as a cause for heart disease [1], and new studies which suggest carbohydrate to be more worrisome than saturated fat for atherogenesis [2-4], there is a simple explanation for why the Masai do not develop atherosclerosis despite consuming a high-fat diet that the authors did not consider: high-fat diets (not containing man-made fats) are not atherogenic.

1. Taubes G. Good Calories, Bad Calories. Knopf Publishing, 2007.
2. Krauss RM et al. Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr 2006;83:1025-31.
3. Mozaffarian D et al. Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women. Am J Clin Nutr 2004;60:1102-3.
4.Volek JS et al. Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res 2008;Mar 15 (Epub ahead of print]

Blood Sugar Control Useless?

2008-06-07T10:18:00.001-05:00

In what has to be one of the most irresponsible reporting on study data I've ever seen, the New York Times today headlined Tight Rein on Blood Sugar Has No Heart Benefits, penned by Gina Kolata.

Throughout the entire article we find statements without qualification as to how study participants were attempting to lower blood sugars:

Two large studies involving more than 21,000 people found that people with Type 2 diabetes had no reduction in their risk of heart attacks and strokes and no reduction in their death rate if they rigorously controlled their blood sugar levels.

[...]

Thus both studies failed to confirm a dearly held hypothesis that people with Type 2 diabetes could be protected from cardiovascular disease if they strictly controlled their blood sugar.

[...]

Still, said Dr. John Buse, president for medicine and science of the diabetes association, the blood sugar/cardiovascular disease hypothesis has failed for people with established Type 2 diabetes.

For these patients, “intensive management of A1C for cardiovascular risk probably isn’t worth it,” Dr. Buse said.

The two studies both sought to control blood sugars through intensive use of pharmaceuticals - with no control group to compare findings in those utilizing dietary and lifestyle interventions shown to improve blood glucose and HbA1C levels (carbohydrate restriction) with lower levels of medications or no medication.

The blanket statement that the trials " failed to confirm a dearly held hypothesis that people with Type 2 diabetes could be protected from cardiovascular disease if they strictly controlled their blood sugar" leaves out one critical qualification - the sentence should end with "through intensive use of medication."

More than 50% of Americans Have a Chronic Health Condition!

2008-06-05T15:02:00.001-05:00

A sobering finding from a recent Gallop Poll - 51% of Americans suffer with chronic health conditions such as heart disease and diabetes. That's more than half of us!

As noted in the Reuters article, Many Americans Stuggling in Life, Survey Finds, "Healthways President Ben Leedle said 51 percent of Americans are stuck in a cycle of chronic disease such as heart disease and diabetes, in part because of their poor choices. 'Many are stressed, worried and overweight, all factors which lead to illness and, ultimately, lifelong health conditions,' Leedle added."

An alarming 66% of working Americans reported one or more chronic disease or recurring condition, and greater than 20% reported calling in sick at least one day and on average six days in the past month!

What the heck is going on?

We spend more on healthcare than any other nation in the world, have the highest percentage of a population vaccinated, and are unusually obsessed with our health, diets and a variety of health risk markers! Yet more than half the population suffers a chronic disease?

What do you think is happening? Leave your comments!

My Big Fat Diet - Now Available on DVD

2008-06-05T14:21:00.001-05:00

In March of this year I posted about a low-carbohydrate diet study, conducted in a small village on Alert Bay in Canada, with those from the area participating in what would be a ground-breaking trial to see the effect of returning to a dietary composition which reflected more traditional ratios of fat, carbohydrate and protein without going back to an absolutely pure traditional diet based on only traditional foods.

As I noted in my post, the findings were "expected" - it was reported that subjects in the study, following the dietary approach:

Lost 10.1% of body weight
Shed 9.7% of their waist circumference
Improved their waist-to-hip ratios significantly
Triglycerides (TG) declined 19.9%
HDL rose 17.4%
TG/HDL ratio improved 30.2%
TC/HDL ratio improved 11.5%
Total Cholesterol (TC) and LDL had no significant change

What's neat about this study is that they didn't just participate and then have researchers follow-up and report the findings - they also filmed a documentary about the study while it was in progress.

That documentary is now available and you can purchase a copy here! (for the record, I have no vested interest in sales of the DVD)

Dogmatic Conclusions to Make Your Head Spin

2008-06-05T13:23:00.004-05:00

One of the oft repeated concerns about a carbohydrate restricted, high-fat diet is long-term effects. With globalization and a wide-variety of foods available in even remote locations today, it's increasingly difficult to find traditional populations whom may be ideally suited to assess the long-term effect of such a diet.

One such population does exist - the Masai of Africa - for whom meat, milk and blood are their daily dietary staples, a naturally low-carbohydrate diet that has been traditionally consumed for generations. They offer us a unique opportunity to assess how such a diet impacts the 'health risk markers' held dear in modern science and medicine.

Does their diet, high in fat, make them fat?

Does their diet, high in fat, make them hypertensive?

Does their diet, high in fat, lead to high cholesterol levels?

For decades many have assumed that a diet rich with dietary fat leads to obesity, high blood pressure and high cholesterol, which then is assumed to lead to heart disease and other chronic health problems.

In the June 3, 2008 issue of the British Journal of Sports Medicine a study investigating the Masai and their dietary habits and comparing them with rural and urban Bantu consuming different dietary practices is quite enlightening and tells us a story about how consuming dietary fat per se is not the underlying cause of obesity, high blood pressure or high cholesterol.

In the study published, Daily Energy Expenditure and Cardiovascular Risk in Masai, Rural and Urban Bantu Tanzanians, we learn that researchers investigated the dietary habits of three distinct populations within the same country - Tanzania - thus limiting confounding variables due to vastly different cultural conditions.

In total, the researchers investigated the health and health risk markers of 985 Tanzanian men and women - 130 Masai, 371 rural Bantu and 484 urban Bantu - with each group reporting very different dietary habits.

The Masai reported a high-fat, low-carbohydrate dietary pattern.

The rural Bantu reported a low-fat, high-carbohydrate dietary pattern.

The urban Bantu reported a high-fat, high-carbohydate dietary pattern, similar to a Western diet.

Which group to do think fared best?

BMI (average)

Masai = 20.7
Rural Bantu = 23.2
Urban Bantu = 27.4 (as a whole, the group was, on average, overweight)

Incidence of Obesity (BMI at or higher than 30)

Masai = 3%
Rural Bantu = 12%
Urban Bantu = 34%

Waist-Hip Ratio (lower is better)

Masai = 0.87
Rural Bantu = 0.89
Urban Bantu = 0.93

Blood Pressure

Masai = 118/71
Rural Bantu = 134/80
Urban Bantu = 134/82

Prevalence of Hypertention

Masai = 4%
Rural Bantu = 16%
Urban Bantu = 21%

Total Cholesterol

Masai = 3.89mmol/L (152mg/dl)
Rural Bantu = 3.60mmol/L (140mg/dl)
Urban Bantu = 4.50mmol/L (176mg/dl)

HDL (higher is better)

Masai = 1.08mmol/L (42mg/dl)
Rural Bantu = 0.91mmol/L (36mg/dl)
Urban Bantu = 1.08mmol/L (42mg/dl)

LDL

Masai = 2.09mmol/L (82mg/dl)
Rural Bantu = 2.13mmol/L (83mg/dl)
Urban Bantu = 2.69mmol/L (105mg/dl)

Triglycerides

Masai = 1.36mmol/L (121mg/dl)
Rural Bantu = 1.45mmol/L (129mg/dl)
Urban Bantu = 1.61mmol/L (143mg/dl)

Total Cholesterol/HDL Ratio (less than 4 is 'ideal')

Masai = 3.72
Rural Bantu = 4.38
Urban Bantu = 4.53

LDL/HDL Ratio (the lower the better)

Masai = 2.21
Rural Bantu = 2.46
Urban Bantu = 2.69

ApoB/ApoA-1 Ratio (measure of LDL particle ratios, lower is better)

Masai = 0.74
Rural Bantu = 0.83
Urban Bantu = 0.81

So, there you have the major findings. What did the researchers conclude?

No! It couldn't possibly be their dietary habits, it must be that the "potentially atherogenic diet among the Masai was not reflected in serum lipids and was offset probably by very high energy expenditure levels and low body weight."

Now their level of physical activity certainly may be contributing to their overall health, but it's certainly not independent of their dietary habits. In fact, I would contend that while it's ideal to be active, that is not the driving force in 'health' or lack thereof - it's dietary habits that dominate our health outcomes, our level of activity may be important too, but activity in and of itself is no solution to a piss-poor diet.

We need, before activity, a proper diet to enable us to perform phyisical activity, not the other way around! So while the researchers here could not bring themselves to even consider that the habitual diet of the Masai - high-fat and low-carbohydrate - was the driving force in their good health and enabled high levels of activity, I'll say it!

Here we have evidence that a high-fat, low-carbohydrate diet, consumed habitually does not lead to obesity, high blood pressure and dyslipidemia, and it may, in fact, lead to beneficial long-term health and increased levels of activity in those habitually eating such a diet.

2010 Dietary Guidelines Committee

2008-05-22T07:31:00.002-05:00

From Nutrition & Metabolism Society:

As you probably know, the U.S. Department of Agriculture (USDA) shapes the contents of the food pyramid. They are currently in the process of developing plans for the 2010 Food Pyramid and selecting experts for the committee.

This panel should reasonably include scientists or nutritionists who have experience with diets low in carbohydrates and, understand their impact on health.

In the past, the USDA has not included such researchers on their panels.

We're reaching out to you to ask for your help in communicating to the USDA the importance of including viewpoints like Dr.'s Feinman, Volek, Westman and Lustig on the Dietary Guidelines Advisory Committee. Your encouragement will help ensure that the Committee has a balanced view of diet and nutrition.

Following is a sample template letter to the USDA (Carole.Davis@cnpp.usda.gov). Please customize with your own personal story, (Be sure to cc: NMS info@nmsociety.org and your Congressional Represenative and Senators). The dead line for nominations is May 23 so please take the time to do this now.

Personal stories about results of lowering carbohydrates in your diet will send a powerful message to the USDA. Let them know you have valuable input and a voice that will be heard.

For a list of qualified candidates, please consider NMS Scientific Board Members.

Thank you.

--------------------

Sample Letter

Carole.Davis@cnpp.usda.gov

Nutrition Promotion Staff Director
Co-Executive Secretary of the Dietary Guidelines Advisory Committee
Center for Nutrition Policy and Promotion
US Department of Agriculture
3101 Park Center Drive, Room 1034
Alexandria, VA 22302

Dear Ms. Davis:

I am writing you about the recent announcement about the establishment of the Dietary Guidelines Advisory Committee for the 2010 Food Pyramid. I understand that the selection process is currently underway to determine what voices will be part of the discussion about the framework for the American diet. Some aspects of the current food pyramid are not a reflection of the needs that most Americans like myself have in order to maintain health. I encourage you to ensure that researchers who have performed extensive studies on the benefits of adjusting variables in the diet, like Dr. ___________ be included on the panel.

I have many reasons for wanting to make sure that the panel includes experts on the science behind different kinds of diets, such as diets low in carbohydrates. [insert your own personal story - 1 or 2 paragraphs - about the results you have achieved by lowering the carbohydrates in your diet. Write about how these results have made you feel. What health effects have you seen?]

Facts about the science of low-carb diets are important to the discussion about the new food pyramid. I urge you to make sure the Dietary Guidelines Advisory Committee includes scientists who are well-informed about these issues.

Sincerely,
[Your name]

Cc: www.NMSociety.org
(your senator)
(your congress person)

Bragging Rights

2008-05-21T11:24:00.005-05:00

Last week, on Friday, my husband was on the front page of our local newspaper, the Columbia Tribune!

In vitro treatment success rate soars at Columbia clinic

In vitro fertilization, once a long shot for couples unable to conceive naturally, is becoming a much better option thanks to new technology, but high costs still prevent some couples from pursuing the treatment.

During a recent interview, Gil Wilshire, endocrinologist at Mid Missouri Reproductive Medicine and Surgery Inc., practically jumped out of his seat when discussing the rate of IVF pregnancies, embryos that were successfully implanted.

"I can’t even believe I’m giving this to you," he said, sliding a piece of paper with his office’s statistics across the desk. "Last month I did five transfers, and four got pregnant. ... That’s incredible."

Last year, Wilshire said, his office broke all internal records. It saw a 44 percent success rate for patients between the ages of 38 and 40 years old and a 67 percent success rate for patients ages 35 to 37. Patients older than 40 were successful 17 percent of the time. Those numbers are significantly higher than the most recent national rates, which are also on the rise. Mid Missouri Reproductive performed 56 total IVF cycles in 2007.

The Missouri Center for Reproductive Medicine and Fertility at Columbia Regional Hospital, the other large fertility clinic in town, had a slow year, with only two pregnancies out of nine IVF cycles. But the center has just completed a move into a $1.4 million renovated fertility clinic at Columbia Regional Hospital, and doctors say they’re expecting a big 2008 and 2009.

"We’ve been a two-site program for the last five or six years," said Danny Schust, one of two endocrinologists at the program. Schust said the laboratory was previously housed at University Hospital and the clinic was at Columbia Regional. "It was disjointed. It really makes no sense," he said. "So we’re excited to have it all together."

There are other reasons for optimism. In vitro fertilization has switched from a simple numbers game, where doctors tried to overwhelm long odds with large numbers of sperm and eggs, to a more precise science.

"Back in the early ’90s, when I did my fellowship in reproductive medicine and endocrinology, a good success rate was 14 percent," Wilshire said. "We were groping in the dark as a profession. We’d put a bunch of embryos up there and pray to God, hopefully the embryos would stick and you’d get a pregnancy in there."

If a couple decides to undergo the costly IVF treatment, doctors first prescribe a drug - gonadotropin - that stimulates ovulation to cause the woman’s body to release multiple eggs. They remove eggs from the woman and place them in a petri dish protected in an incubator. The doctor then has two choices: pour sperm over the egg in hopes that one will make its way in or, in cases of men with low sperm counts, use a "micro manipulator machine" to inject a single healthy sperm into the egg.

Then it’s time for the fertilized egg to grow. One of the most exciting advances of recent years is the "medium" used to replicate the fluid of the womb. This medium - made up of amino acids, sugars and nutrients - has been perfected by scientists to replicate conditions in the womb.

Whereas 10 years ago doctors would have to implant the embryo in the womb after one or two days in the petri dish, they now can wait five days, until the embryo has divided into eight cells and is well on its way to becoming a fetus. "The real advances are in the IVF lab. I wish I could say the doctors are getting better, but I think it’s the embryologists who are getting better," Schust said.

But the doctor’s skill comes next. After five days, he or she must remove one or two of the fertilized eggs and implant them near the top of the womb. Wilshire said when he began practicing, he would put in four or five embryos just to be sure one would take. Today, he says, he rarely puts in more than two.

Wilshire proudly wielded the "coaxial catheter," a thin, rotating pipette used to do the implantation.

"I liken it to fly fishing," he said. "When you’ve got crystal-clear water and you’ve got a big trout in the pool, if you even look in there or drop a stone, it scurries away - it’s very scared and skittish. However, if you’re a good fly fisherman, you’re way away and you cast just right, then the fly goes out and it goes ... down real lightly like a natural fly, and the trout comes up and gets hooked."

None of this is cheap, however. IVF cycles typically cost about $7,000 without medication. Once the medications are included, that figure can rise to $10,000 or more. In Missouri, group health insurance policies are not required to cover IVF, but a bill sponsored by Rep. Steve Hodges, D-East Prairie, would mandate that all policies covering more than 25 employees cover the treatment.

Hodges said he got the idea for legislation after hearing the story of a New Madrid couple who needed help from family members to pay for IVF.

"For people who want a child that badly - and the procedure is fairly taxing, not counting the expense and emotion involved - I just thought, ‘We spend lots of money trying to save lives, why not spend some money trying to create one?’ " Hodges said. "I have a saying: ‘A good thing is always a good thing,’ and I think this is a good thing."

Roman Gladiators: Diet Made Them Fat

2008-05-05T10:28:00.004-05:00

An interesting article in News in Science, Ancient Worlds - Roman Gladiators Were Fat Vegetarians - gives insight that their diet, heavy with carbohydrate, made them fat.

"Tests performed on bits of bone taken from the skeletons of some 70 gladiators buried at Ephesus seem to prove that they ate mainly barley, beans and dried fruit," said Dr Karl Grossschmidt, who took part in the study by the Austrian Archaeological Institute "This diet, which has been mentioned in the oral history, is rather sad but it gave the gladiators a lot of strength even if it made them fat," said Grossschmidt who is a member of the University of Vienna's Institute of Histology and Embryology." [emphasis mine]

Under-the-Radar Petition at the FDA from American Dietetic Association and Others

2008-04-24T13:29:00.008-05:00

Now that the pharmaceutical industry has its first FDA approved weight-loss drug available to the public, over-the-counter (OTC) no prescription needed Orlistat, it's time to eliminate the competition in the marketplace - dietary supplements - used by many Americans to help with weight loss.

On the Regulations.gov website, an interesting petition exists that has had virtually no attention in the media - Treat Weight Loss Claims for Dietary Supplements as Disease Claims - filed as a citizen petition to the FDA by the American Dietetic Association, the Obesity Society, Shaping America's Health and GlaxoSmithKline Consumer Healthcare.

The full document PDF is available here as well as on the page linked above.

The document is quite interesting and it's obvious the petitioners do not want input from the public or an open comment period - they just want the FDA to take the action they request, no questions asked, no comments, no looking at anything other than what they've provided the FDA. Basically telling the FDA to just trust them!

The petition requests FDA to require manufacturers of weight loss supplements to obtain FDA review of their claims before the products can be sold, asserting such claims are "disease claims" as clearly indicated by the title page of the petition document - "Citizen Petition of the American Dietetic Association, The Obesity Society, Shaping America's Health, and GlaxoSmithKline Consumer Healthcare requesting the Food and Drug Administration to determine that claims that dietary supplements promote, assist, or otherwise help in weight loss are disease claims under Section 403(R)(6) of the Federal Food, Drug and Cosmetic Act."

We learn more in the section Action Requested, "In support of this action, petitions present extensive scientific evidence and consumer survey data that has been developed during the past decade. This new information conclusively establishes three critical facts. First, the condition of being overweight is a significant risk factor for serveral serious diseases, including diabetes, cardiovascular disease and cancer. Second, many Americans understand the health risks of being overweight and they rely on dietary supplements to lose weight. Third, there is little, if any, evidence, indicating that dietary supplements marketed for weight loss actually work. As a result of these three facts, many Americans are being thwarted in their efforts to lose weight, and reduce the risk of disease, by ineffective weight loss supplements."

To support their postion, they assert that claims such as the above are "qualified health claims" that require authorization and approval from the FDA and state they believe "there is no credible evidence whatsoever to support any type of qualified health claim for a weight loss supplement...In the case of weight loss supplements, there is no credible evidence to indicate that supplement themselves assist in weight loss or, even if they do so, that there is a commensurate risk reduction of disease from the use of any such supplements."

A qualified health claim is a claim authorized by the US Food and Drug Administration (FDA) that must be supported by credible scientific evidence regarding a relationship between a substance (specific food or food component) and a disease or health-related condition. Both of these elements -- a substance and a disease -- must be present in a health claim. An example of a qualified health claim is: "Calcium may reduce the risk of osteoporosis."

The petitioners even go so far as to strongly suggest public input and comment is not necessary, they carefully take the position that overweight need not be redefined as a disease, but rather a risk factor for disease; thus providing the FDA an opportunity to act in their favor without notice or comment rulemaking.

"Finally, in this context, petitioners must emphasize that FDA is not required to engage in norice and comment rulemaking under the Administrative Procedures Act (APA), 5 USC 553, before implementing the actions requested in the petition. That is because the petitioners are not asking FDA to change its earlier interpretation of the way that two of the criteria in the structure/function rule apply to weight loss claims. Rather petitioners are requesting FDA to apply a particular provision in its existing regulations to weight loss claims in light of the substantial body of literature and consumer survey data developed during the past decade. An agency's application of its regulations to particular factual scenarios certainly does not require notice and comment rulemaking under the APA. Moreover, to the extent that FDA concludes that granting this petion woudl require the agency to modify its earlier statements about weight loss claims in the preamble to the structure/function rule, such statements constitute "advisory opinions" that can be modified at any time following notice in the Federal Register."

At least we find public comments are open online (even if nothing is found elsewhere online to hint this petition even exists)....the public comment and submission page is here.

Time to get to work!

The Solar Powered Plate

2008-04-22T13:06:00.002-05:00

I feel a rant coming on today - Earth Day - when as if on cue, the media is hot and heavy with the message that the best thing any one of us can do to reduce our carbon footprint is to eat less meat. In newspapers, magazines and blogs we find all sorts of reasons behind the rush to banish meat from our diets:

Toronto Star: "Eat less meat. Raising cattle, sheep and pigs uses up resources."

Sacramento Bee: "Another thing is, gosh, if you can reduce demand, get people to eat less meat, all those things would be great."

The Day: "People should eat less meat. You would be healthier and so would the planet,” because of the tremendous resources used in raising and processing meat for consumption."

The Guardian: "But there is a bigger reason for global hunger, which is attracting less attention only because it has been there for longer. While 100m tonnes of food will be diverted this year to feed cars, 760m tonnes will be snatched from the mouths of humans to feed animals - which could cover the global food deficit 14 times. If you care about hunger, eat less meat."

The Guardian: "For both environmental and humanitarian reasons, beef is out. Pigs and chickens feed more efficiently, but unless they are free range you encounter another ethical issue: the monstrous conditions in which they are kept. I would like to encourage people to start eating tilapia instead of meat. This is a freshwater fish that can be raised entirely on vegetable matter and has the best conversion efficiency - about 1.6kg of feed for 1kg of meat - of any farmed animal. Until meat can be grown in flasks, this is about as close as we are likely to come to sustainable flesh-eating."

PETA: "Mr. Gore likes to be thought of as an environmentalist steak-and-potatoes kind of guy, but there's no such thing as a meat-eating environmentalist," says PETA Vice President Bruce Friedrich. "He needs to confront the 'inconvenient truth' that meat production is the main culprit in global warming."

I could continue with more quotes, but I think you get the point - we're being told, repeatedly, we need to eat less meat!

With all the urgency in this message, the question begs - is eating meat really an environmental problem?

The answer really is a "yes" and "no" - meat from livestock is an excellent source of complete protein, vitamins, minerals and fatty acids essential to human health.

The big problem isn't so much the meat, but the way we in the United States (and more and more countries around the world) raise livestock today - intensive feedlot operations which demand huge amounts of "inputs" to fatten cattle quickly.

The various reports on the global impact of raising livestock are based on factory farming practices which are indeed damaging to the environment. To really understand how, we need to look at how livestock in the US, and in other parts of the world, is now routinely raised for food and how the messages about the "inputs" is virtually ignored by the popular and politically correct message to eat less meat. All of these "inputs," interestingly, are also required for growing the plant-based vegetarian/vegan diet being promoted as the way for us to save the plant....but those promoting that message don't bother telling us that in their cries we must eat less meat.

Like I said, the problem isn't the meat - it's the method used to produce the meat. You see, cattle, pigs, turkeys and chickens are no longer pastured - that is allowed to graze in fields all day - instead, they're raised in what has been rightly named "factory farms" [CAFO - Confined Animal Feeding Operations] where they're raised in huge numbers - apparently the largest operations in the United States have tens of thousands of cattle in one facility at a time.

The practice of CAFO is fairly new, gaining ground in the US since the 1960's and was/is seen as a way to produce food while controlling cost and a uniform standardized product output.

But to achieve the output desired requires some intense "inputs" - namely fossil fuel based fertilizers, chemical pesticides, diesel and fuel for transportation, energy for manufacturing ferilizers, pesticides and feeds, pharmaceuticals to maintain animal health (somewhat) while feeding a diet they are not designed to eat, supplements to provide vitamins, proteins and such not in the feed, energy and resources to house and maintain the animals from birth to slaughter and managing large volumes of waste that is unsuitable for use as fertilizer since the diet teh animal is raised on renders it toxic.

While the industry calls these practices "efficient" - they're anything but, and I'd say are part of the problem we're trying to solve.

The equation looks sort of like this:

Synthetic Fertilizer & GMO Patented Seeds [$] ----> Pesticides [$] ---> Feed [$] ---> Cows [$] ---> Building [$] ---> Electricity [$] ---> Pharmaceuticals [$] ---> Manure Lagoons [$] ---> Transportation [$] ---> Food

On the other hand, properly raised livestock is solar powered food, it's equation looks like this:

Sun [free] ---> Grass [free] ---> Hay & Silage [$] ---> Cow [$] ---> Food & Organic Fertilizer

Funny, while the politically correct message these days is eat less meat, it truly should be eat more - from livestock raised properly - that is livestock that turns the energy of the sun into high quality food for human consumption rather than requiring intensive energy inputs as the means to an end.

This food - pastured meats - is food that truly is created from the sun to become a solar powered plate of delicious and nutritious quality food for us to enjoy, not only guilt-free, but that also is environmentally friendly too!

You see, what those repeating the message above fail to disclose is that livestock, especially cattle, are not naturally grain consumers - they eat mostly grass, ground covering legumes, and an assortment of weeds and other plants that are indigestible for humans.

These plants grow in abundance in rich soil, turning the energy of the sun into food for the cow - which in turn allows us to consume that same energy that's not usually available to us when we consume the flesh of the animal.

Not only that, but grazing animals do more than turn the energy of the sun into food for us - they fertilize and replenish the soil upon which they graze, allowing rich soil to accumulate and grow plants rich with nutrients, which in turn squesters carbon in the soil and those plants sucking CO2 out of the air.

Farmers from long ago understood the relationship between their animals and their crops too - livestock did much of the necessary "work" for the health of the total farm - grazing in the fields, depositing manure to provide food to birds that followed along behind them (chickens, turkeys, etc.) and create rich soil deposits to optimize the grass and ground covering plants growth, and consuming silage from crops planted on the farm and hay baled throughout the warm months.

All this in a dynamic that allowed the farmer to not only have quality protein from the meat, but also healthy soil to grow nutrient-dense plant foods to provide for both his animals, his family and his community.

This dynamic is lost in factory farming of animals and in monoculture crop farming of plant-foods, where one crop dominates again and again, requiring the use of synthetic fertilizers, pesticides and now, even patented seeds year after year.

And rather than address this issue, we're being told to eat less meat to save the planet.

We're told that's green and good and that it's the way of the future; that it's healthier for us and the environment; that we'll all benefit if we just eat less meat.

Sorry, no can do - I'm simply not going to be part of growing an industry that will continue to require, in higher and higher quantity, synthetic fertilizers, fossil fuels, chemical pesticides, sterile patented seeds farmers need to buy from the industry year after year since storing seed is either useless or illegal whle still requiring huge amounts of energy to transport and process the resultant crops into foodstuff...!

I'm not going to enhance their profits while they destroy our health and the balance of nature with unnatural and intensive input requirements to grow their self-defined "healthy" food products.

Soyburgers? No thanks!

Soymilk? You're kidding, right?

Quorn? Oh, don't even go there!

Tofurky? What's up with mock "meat" anyway?

This Earth Day my commitment is not to enhance the bottomline of ADM, Cargill or Monsanto, but to:

A) Support my local farmers commited to traditional farming practices that enhance the health of the planet and those eating from its bounty - those who pasture their animals and grow crops using organic methods

B) Grow some of our food this summer - tomatoes, lettuce, beans, cucumbers, carrots and more, in our garden

C) Try my best to create and eat foods that really are on a solar powered plate - local fruits, vegetables, nuts and seeds and yummy pastured meats, eggs and dairy!

When Good Intentions Have Unintended Consequences

2008-04-21T11:11:00.003-05:00

Unlike adults, children - especially those under five - are quite unique in their requirements for calories and nutrients each day. That is because they're on a trajectory of growth that requires significant calories, making it is next to impossible to estimate accurately their energy needs by any formula that applies to adults.

Yet this fact doesn't stop the well-intentioned from taking the standard dietary recommendations for adults and simply downsizing portions, in the assumption that smaller portions of the same foods recommended for adults will translate to adequate nutrition for children.

Back in January 2007, I wrote about a study in Sweden that found children fed a diet low in fat were found to have a higher incidence of insulin resistance, significant nutritional deficiencies, and weighed more with higher BMI's than children fed a diet higher in fat.

As I noted in that post, "In previous generations the focus was mainly on getting and providing enough food to meet these energy needs; today we've modified our view and extrapolated our notions about a "healthy diet" - carbohydrate-rich, low-fat - to our children. Not a day goes by that there isn't an article or segment in the news that we need to feed our kids less fat and more "good" carbohydrates."

Also in January of last year, I shared with readers a day in the life of my son by posting pictures of the foods he consumed throughout the day, along with how his menu stacked up for nutrients and calories, along with how his eating differed from the sample menu offered by the American Academy of Pediatrics (AAP) as an example of "healthy eating" for children.

In that post I noted, "the menu [from the AAP] fails to provide adequate intake of Vitamin E, Vitamin K, Copper, Selenium, Potassium and omega-3 fatty acids" for a toddler.

I also wrote, "We seriously need to start re-thinking our dietary recommendations for children; right now our dietary recommendations and policy are failing them because our phobias about dietary fats have seeped into their lives as we've modified their diet to limit fat and include an abundance of carbohydrate-rich foods that does not, at the end of the day, have the desired effect."

The desired effect these days is prevention of childhood obesity and rather than truly look at how children are eating, the experts continue to downsize adult dietary recommendations and assume they'll meet the requirements of children. The worst of the assumptions is that if parents feed their children a downsized adult diet, with a variety of foods while limiting dietary fats, their children will learn good eating habits and avoid obesity.

While I was away on vacation, I read the disturbing findings reported in the Observer - a survey of nursery preschools in the UK found that 70% are feeding children inadequate calories each day because they're feeding them too many fruits and vegetables in an attempt to make sure they're eating enough fiber!

As Sarah Almond, a pediatric dietitian, noted, "We expected the study to show nurseries were serving children food that was too high in calories, fat, saturated fat and salt, and low in vegetables and fruit. Instead, we found that the majority of nurseries had gone to the other extreme and appeared to be providing food that was too low in calories, fat and saturated fat and too high in fruit and vegetables."

[...]

"Because a significant number of children attend nurseries from 7am until 7pm, the food and nutrition they receive there are key to their health," said Almond. "Nurseries are applying requirements of healthy eating for school-age children and adults to the one-to-four age group, who have entirely different requirements."

These findings speak volumes about the unintended consequences of good intentions that are based on dogma and assumptions rather than hard data. And when hard data points to the opposite of the assumptions and dogma, it's ignored.

In our desire to prevent childhood obesity, we're missing the forest for the trees and ignoring the critical requirement they have for both energy and nutrients to grow properly. It is easy to assume that a child under five doesn't need a lot of calories, especially when we think about how many we need as adults. If we believe the average adult needs about 2000-calories a day, then that tiny little kid should only need a fraction of what we need since they are much shorter and weigh a lot less, right?

Wrong.

Check out the Energy Calculator online, created by the USDA/ARS Children's Nutrition Research Center, designed to help parents and caregivers estimate calorie needs for children.

If you input the numbers for an average three year old boy (38", 32-pounds and active 1-hour or more a day) you'll learn he needs 1710-calories a day on average!

What do you feed a three-year old boy to meet his energy requirements and nutritional needs? I can tell you this - it's not a low-fat diet!

Where's Regina?

2008-04-08T15:05:00.002-05:00

I know, I know, I've been remiss in my blogging duties!

For those wondering where I've been - I recently launched a new website for families with children, here in Missouri - Mid-Missouri Family. I've been a bit taken aback by the overwhelming response to its launch - a lot more visitors each day than I'd anticipated (a good thing) with many, many emails to answer each day, and subscriptions to the newsletter far exceeding my expectations (a great thing)!

And now, just as I'm getting into a routine for time to update that each day and write for my blog - I'm off on vacation through the 19th - so I'll be back here again, posting to my blog, on April 21st (that is if I don't blog while I'm on the road - just no promises that I will be able to).

Time for Critical Appraisal

2008-04-08T14:12:00.002-05:00

Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal

Current nutritional approaches to metabolism syndrome and type 2 diabetes generally rely on reductions in dietary fat. The success of such approaches has been limited and therapy more generally relies on pharmacology. The argument is made that a re-evaluation of the role of carbohydrate restriction, the historical and intuitive approach to the problem, may provide an alternative and possibly superior dietary strategy. The rationale is based on the accepted idea that carbohydrate restriction improves glycemic control and reduces insulin fluctuations which are primary targets. Experiments are summarized showing that carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets and that substitution of fat for carbohydrate is generally beneficial for risk of cardiovascular disease. These positive effects of carbohydrate restriction do not require weight loss. Finally, the point is re-iterated that carbohydrate restriction improves all of the features of metabolic syndrome.

Anthony Accurso
Richard K Bernstein
Annika Dahlqvist
Boris Draznin
Richard D Feinman
Eugene J Fine
Amy Gleed
David B Jacobs
Gabriel Larson
Robert H Lustig
Anssi H Manninen
Samy I McFarlane
Katharine Morrison
Jorgen VESTI Nielsen
Uffe Ravnskov
Karl S Roth
Ricardo Silvestre
James R Sowers
Ralph Sundberg
Jeff S Volek
Eric C Westman
Richard J Wood
Jay Wortman
Mary C Vernon

Full-Text PDF

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You'll note the above list includes two individuals that I've recently posted about, Dr. Annika Dahlqvist and Dr. Katharine Morrison, along with a number of individuals you all know from their books, published studies and commitment to the science of carbohydrate restriction.

They're all members of the Nutrition & Metabolism Society, an organization committed to "providing research, information and education in the application of fundamental science to nutrition. The Society is particularly dedicated to the incorporation of biochemical metabolism to problems of obesity, diabetes and cardiovascular disease."

If you haven't done so, you can join today - membership helps NMS in the "promotion of scientific information in an environment where such information is not adequately supported by government and private health agencies. "

Gorillas Dying Prematurely

2008-04-08T14:05:00.002-05:00

What happens when you feed this to a gorilla?

Ground corn, Soybean meal, Cracked wheat, Sucrose,Wheat germ meal,Animal fat (preserved with BHA, propyl gallate and citric acid), Dried whole egg, Dicalcium phosphate, Calcium carbonate, Iodized salt,Vegetable oil, Choline chloride, Stabilized ascorbic acid (source of Vitamin C), Ethoxyquin (a preservative), Ferrous sulfate, Zinc oxide, Copper chloride, Manganous oxide, Cobalt carbonate, Calcium iodate, Sodium selenite,Vitamin A supplement,Vitamin D3supplement,Vitamin E supplement, Thiamine (Vitamin B1), Niacin, Calcium pantothenate, Pyridoxine hydrochloride (Vitamin B6), Riboflavin (Vitamin B2), Folic acid, Biotin,Vitamin B12supplement.

Apparently they develop heart disease and die prematurely.

Maybe they need more soy, corn and wheat with less animal fat, eh?

Your Leg or the Bread?

2008-04-08T13:21:00.003-05:00

While Dr. Annika Dahlqvist is challenging the conventional wisdom of diet and health in Sweden, so too is Dr. Katharine Morrison in the UK; a GP who "is one of a vocal minority who contend that the orthodox advice given to type one and type two diabetes patients is not only unhelpful but might be counterproductive."

In today's Herald, Are Diabetics Suffering for No Reason, provides readers with a look at the benefit experienced by those with diabetes who modify their diet to restrict carbohydrates.

John Gibson's leg had been ulcerated, swollen and inflamed for weeks. "It looked like a damson from my toes to my knee," the 61-year-old recalls. His specialist suggested it would have to be amputated. "He whipped out a camera and photographed it. I said, Is this going to be the last time you see it?' and he said, It might be.'"

But when he next visited, Gibson explains as he sits at home in Mauchline, Ayrshire, the specialist was astonished to see that the leg had healed. "He asked me, Where's the ulcer?'" The former army nurse explained that his diabetes was now being managed on a special low-carbohydrate diet, recommended by his GP. "The specialist told me, Oh, we don't believe in that.'"

Truly amazing, isn't it?

A man's leg, saved from amputation....but that's no reason to even consider a carbohydrate restricted diet if you have diabetes.

No siree, no can do, let's not forget, "Diabetes UK continues to recommend that diabetic people follow the same balanced diet recommended for the rest of the population. Low in fat, sugar and salt, with plenty of fruit and vegetables, meals can contain some starchy foods such as bread, potatoes, cereals, pasta and rice."

And who really wants to give up eating bread, pasta, rice, potatoes and cereal anyway?

"Hope Warshaw says many study subjects are unable to stick with Bernstein-style diets. "Diabetes lasts the rest of your life. You need to find an eating plan that you can follow for that long as well."'

I don't know about you, but if I had to choose between my leg or the bread.....mmmm, thinking......thinking......

How about you?

Do They Serve Exclusively Grass-Fed Meat at the Funny Farm?

2008-04-08T13:05:00.003-05:00

I'll be waiting for the men in white jackets to take me away.

Seems I suffer this new eating disorder, orthodexia, characterized by shunning foods with "artificial ingredients, trans fats or high-fructose corn syrup."

Oh, I also read labels and plan my menus (gasp!) for the week ahead; which according to Dr. Steve Bratman (who coined the name for the condition) is a sure sign I need help.... “If you get a thrill of pleasure from contemplating a healthy menu the day after tomorrow, something is wrong with your focus."

What do you think? Is orthorexia a health concern or hype?

Translation? Food Fight

2008-04-02T09:18:00.003-05:00

In the months since Dr. Annika Dahlqvist won concession from a key government group in Sweden, the National Board of Health and Welfare, on January 16, 2008 that a low-carb diet is "in accordance with science and well-tried experience for reducing obesity and Type 2 diabetes," a storm has been brewing, with the National Food Administration (SLV) [a different government group in Sweden] protesting Dr. Dahlqvist's open letter to schools calling for more fat in the diets of children.

Apparently it's playing out in all the national papers in Sweden Arbetarbladet, Helagotland, Dagens Nyheter, Gefle Dagblad, Nerikes Allehanda, Eskilstuna-Kuriren, Blekinge Läns Tidning, Privata Affärer, Vestmanlands Läns Tidning, Allehanda.se, Västerviks Tidningen, Norra Västerbotten, Svenska Dagbladet, Göteborgs-Posten, Barometern, Webfinanser and more) with Aftonbladet opening a poll to their readers.

Vad tror du att barn mår bäst av?
[translation: What do you think that children are better off with?]

Choices:

Fet mjölk och smör
[translation: Fat milk and butter]

Lättmjölk och margarin
[translation: Skim milk and margarine]

As of this writing, 27,836 have cast a vote in the poll and 89.6% have answered the Fat milk and Butter!

My Big Fat Diet - Aim High, Think Big, Score One More!

2008-03-19T08:42:00.002-05:00

What happens when you convince a small, remote town to modify their diet to restrict carbohydrate?

You get a study called "My Big Fat Diet," where everyone participating agrees to shun the carbohydrate and dig in and enjoy meat, eggs, cream, real cheese and a variety of non-starchy vegetables.

Dr. Jay Wortman propsed such a study, and after months of ethics reviews and consultations, Wortman and his team of researchers tested the theory that high-calorie Western foods are the root cause of those health problems, not due to the dietary fat content, but the carbohydrate.

As the CBC reported, "[h]e set up a year-long study of the diet in Alert Bay, where 60 people agreed to live on a more traditional aboriginal diet of meat, seafood and non-starch vegetables such as cauliflower.His theory is that sharply reducing the consumption of carbohydrates and sugar will cut deeply into the very high rates of obesity and diabetes in native communities.

People who took part in the study lost significant amounts of weight, Wortman said. They also showed improvements in their cholesterol levels and diabetes control."

The preliminary findings are captured in a poster abstract, available here.

The findings are, in a word, expected.

What Wortman and his team found is what others have found in other studies - those who modify their diet by restricting carbohydrates and eating protein and fat ad libitum lose weight, improve triglycerides and HDL, have no significant findings for LDL or total cholesterol, see improvement in glycemic control with reductions in HbA1c.

In this study's subjects, it is reported that they:

Lost 10.1% of body weight
Shed 9.7% of their waist circumference
Improved their waist-to-hip ratios significantly
Triglycerides (TG) declined 19.9%
HDL rose 17.4%
TG/HDL ratio improved 30.2%
TC/HDL ratio improved 11.5%
Total Cholesterol (TC) and LDL had no significant change

More importantly, in the initial analysis, those with diabetes were found to have significant improvements in their HbA1c levels - seeing a decline from a mean 7.1% to a mean 6.1%. This is again a study that finds diet alone improves HbA1c significantly while also reducing or eliminating medication!

Now one would think that results like this, and others before it, would inspire those whom remain skeptical to see the value in such a dietary approach; after all, it is helping those with chronic health conditions to lose weight, improve specific risk markers and also reduce medication requirements.

Well, not so fast say the 'experts' sought for comment by the CBC for their article!

"The diet he is advocating has been compared with the high-protein, low-carbohydrate Atkins diet, which has been criticized by the American Society for Nutrition for causing dramatic weight fluctuations, leading to illness.

The Health Canada Aboriginal Food Guide still recommends native people eat rice, bread and pasta."

So, Health Canada Aboriginal Food Guide is going to continue to tell native peoples to keep eating that rice, bread and pasta; despite evidence, from multiple studies now, showing eliminating these foods is benefiicial to health?

But worse still is the message that is now in vogue, that modifying diet to restrict carbohydrate is too hard to do, unsafe anyway, so don't try.

As well, living on a more traditional diet may present challenges for many native communities, said Bernadette Dejonzague, a registered dietitian and a diabetes prevention program co-ordinator. This is because access to food sources such as sockeye salmon may be limited by contamination and transportation issues.

More insulting however, is the insinuation that native peoples are too stupid to modify their diet back to the traditional!

Many people who live in native communities "wouldn't know what to do with a deer or moose, even if they were able to shoot one,'' said Dejonzague, who is a member of the Abenaki First Nation and based in London, Ont.

Let's just forget the fact that native peoples lived off the land for generations prior to the introduction of flour, sugar and refined carbohydrates!

As Canada.com reported, "Starchy food such as flour for bannock, potatoes and pasta were introduced about a century ago and the impact on the aboriginal diet was devastating. Because of our people's low incomes we find it necessary to stretch out food and what better way than to add lots of starches such as bannock and potatoes. The Hudson Bay Company introduced us to bannock and we bought it hook, line and sinker. It found a market for flour at our expense."

At least Canada.com had the guts to be open and honest about the choices one must make, "We need to return to our roots of healthy eating and exercising. Our people in both the urban areas and reserves must examine their eating habits and adjust accordingly.People who have diabetes have two choices: They can treat the symptoms through medication or they can go to the root of the problem and follow a more traditional diet.

So get off the couch and snare a rabbit, set a net, shoot a deer or moose, and when summer comes go out and pick a mess of berries. Walk past the junk food aisle at the supermarket and head to the vegetable section. Our good health depends on what we eat and the Namgis First Nation has thrown out the challenge."

Getting to Know Dr. Jay Wortman

2008-03-18T10:44:00.002-05:00

I had the pleasure of meeting Dr. Jay Wortman, a physician working with the Aboriginal population in British Columbia, Canada, a couple of years ago at the Scientific Sessions of the Nutrition & Metabolism Society in New York. Before I post about the recent preliminary findings from the study he led, I'd like to let readers get to know him, in his own words.

In the blog he recently launched to provide information about the dietary study, he included an introduction for readers to understand how he came to carbohydrate restriction as an individual and as a physician.

These are his words.

The story so far...

Jay Wortman, MD

There are two beginnings to the story that brought us to this point.

The first was something that happened when I was about four years old in my grandmother’s house in the small northern Alberta village of Fort Vermilion. This was an early settlement in the network of Hudson’s Bay fur-trading posts that dotted the northern Canadian landscape in the formative years of our country. My grandmother was the matriarch of a large Metis family and her log house sat next to the Hudson’s Bay store on the banks of the mighty Peace River. In my early childhood the store was still a place where trappers would bring the pelts of fur-bearing animals after a winter on the land. It was a creaky wooden building with an oiled floor and a wood stove for heat.

Typically, when a trapper was delivering the bounty of their winter’s work, they would stop to have tea with Grandma to catch up on the local gossip after their months on the land. It was during one of these visits that, as a young child, I was being a pest underfoot while the adults were trying to talk. I recall the old trapper reaching into his pack and pulling out a strip of dried moose-meat which then kept me occupied as I chewed this tough but tasty treat for the next hour. I always recall this vividly because of how delicious it was and how I could never find anything as good among the various kinds of store-bought jerky later in life. I also recall, as a young child, my grandmother baking all kinds of wonderful things in the wood stove she used to heat her house in the -50 degree winters. The smells of breads, cookies and cakes would fill the whole house, leaving vivid olfactory memories. Looking back on this, it is apparent to me that diet was changing and that, while the men were still eating traditional foods on the land, my grandmother was baking with sugar and flour, highly refined introduced foods in town. Both my grandparents developed type 2 diabetes as did other close relatives including my mother.

The second beginning occurred about 48 years later when I discovered that I, too, had type 2 diabetes; that the Aboriginal genetic tendency towards this disease had slowly snaked its way up through my family tree to bite me.

As a physician, you somehow believe that you are going to be immune to the diseases that you diagnose and treat in others, that you are going to know enough and be careful enough to avoid these pitfalls of the human condition. This, coupled with the fact that I had a very young son who was born the year I turned 50, made my self-diagnosis doubly shocking for me. I knew that diabetes shortened my life expectancy, that it was the leading cause of blindness and kidney failure, that my chances of dying from a heart attack were now significantly elevated and that I might face the indignity of limb amputations and severe disability along the way. Of all these concerns, however, the prospect of not seeing my two-year old son grow into maturity was the thing that disturbed me most.

I knew diabetes from my training and clinical experience. In fact, I took extra training in diabetes in my last year of family medicine residency to prepare to be the resident doctor for the children’s diabetes summer camp, something I did for four years after graduating. I knew about the diabetic diet, how life-style change was supposed to be the “cornerstone” of diabetes management and which drugs were to be prescribed to achieve normal blood sugar control and why. I also knew that, for the most part, newly diagnosed type 2 diabetics went on drug therapy immediately because of the ineffectiveness of life-style interventions and that, even then, most tended to struggle and fail in their attempts to maintain normal blood glucose values, the holy grail of diabetes management. Further complicating my situation was the fact that I abhorred the use of medication, often joking that “drugs were just poisons with some desirable side-effects”.

Clearly I had been in denial as the classic symptoms of type 2 diabetes had crept up on me. I had put on some weight and was fatigued all the time, I struggled to get through bouts of afternoon drowsiness, I was getting up at night to urinate and I was constantly thirsty and I started to have to squint to see the television news in the evenings. I had also had begun to notice that my blood pressure was rising into the zone that would require treatment. I rationalized all these developing problems as the natural and inevitable effects of ageing until it suddenly dawned on me that what I had were the typical signs and symptoms of diabetes. I tested myself and confirmed that my sugar was way too high. I clearly recall that moment in my bathroom at home on a weekend. I was stunned and I didn’t know what to do. I decided I needed some time to look at the recent science and to formulate a management plan for myself. In order to buy the time to do this, I decided, right then and there, not to eat anything that would exacerbate my soaring blood sugar. I stopped eating carbohydrates.

Now, although I obviously knew that these types of foods, starches and sugars, would raise my blood sugar, discontinuing them was not an accepted therapy for my condition and I never intended it to be; it was just a stalling tactic to be used until a suitable plan could be implemented. And, at the time, I didn’t have a clue about low-carb diets. Nevertheless, I instantly stopped eating carbs and thus embarked on an amazing journey of recovery and discovery.

The first thing that happened was that my blood sugar normalized. This was almost instant and was followed by a dramatic and steady loss of weight. I started dropping about a pound a day. My other symptoms swiftly vanished, too. I started seeing clearly, the excessive urination and thirst disappeared, my energy level went up and I began to feel immensely better. I bought an exercise bike and started riding it for 30 minutes every day as I continued to avoid starches and sugars. I still didn’t know anything about low-carb diets but I was beginning to figure out that something extraordinary was happening as I shunned these foods. It was my wife who pointed out that I was on the Atkins diet. Like many women, she had struggled to lose weight after the birth of our son and had tried various diets including Atkins. I recall that when she brought home an Atkins book I was dismissive, suggesting that it was just another of the fad diets and that it probably wouldn’t work over the long haul. Now that I was obviously more receptive she brought out the book and showed it to me and, sure enough, as I read it, I realized that I was “doing Atkins”. More or less, actually, as I wasn’t really following Dr. Atkins’ stepwise approach to carb restriction, I was still simply avoiding all carbs.

My job at the time was focussed on Aboriginal health and I was acutely aware of the high rates of diabetes in the Canadian Aboriginal population. We have rates that are three to five times higher than those of the general population. There are also very high rates of obesity and metabolic syndrome, precursor conditions to type 2 diabetes. These epidemics were devastating Aboriginal communities and causing huge costs for health care services to the affected. Millions were being spent on testing supplies, drugs and insulin across the country and much more on transporting people from remote communities for medical attention and the treatment of complications like kidney failure and amputations. A lot of money was dedicated to education and prevention but it appeared that the trajectory of the epidemic was still rising in spite of these best efforts. In my experience, travelling into the affected communities, there was almost a sense of fatalism, a feeling that it was hopeless. Even in communities where extra resources were being applied and research was being done to see what would work, we weren’t able to reverse the terrible trend. The problem was confounding everyone involved.

As I began to realize that my simple dietary intervention was rapidly and effectively resolving my own case of diabetes, I naturally started to look at the broader Aboriginal diabetes epidemic through the lens of diet. In the course of my duties, I would often travel into First Nations communities, some of them quite remote. On these visits, I started to question people, especially the elders, about their traditional foods and old ways of eating. It was common, especially in coastal communities, to be fed traditional foods like salmon, halibut and shellfish. Inland, one would be fed moose, deer and elk. It was also common to see modern foods next to the traditional fare. It was not unusual to have potato and pasta salads with the salmon and moose, cakes and cookies for dessert and all of it chased with juices and pop. And there was always the ubiquitous, much loved bannock bread, something almost everyone regarded as a true traditional food.

In my informal surveying of the old ways of eating, however, I began to understand that the actual traditional diet (before the introduction of bannock bread) did not have a significant source of starch or sugar. Everywhere people ate berries but it was apparent that this one food didn’t constitute a significant source of carbohydrate calories and that the vast majority of calories came in the form of protein and fat. There were also a number of seasonal wild plants eaten in various places but these were all low in starch or sugar, akin to modern greens. The traditional diet was looking very much like a modern day low-carb diet in terms of its macronutrient content.

It was around this point in time that a study was published in a medical journal where a group of overweight men were put on the Atkins diet and followed for six months. They lost significant weight and experienced an improvement in their cholesterol levels. This was getting media attention because it had always been thought that cholesterol would get worse on a low-carb diet as carbohydrate calories were replaced by fat calories. I had a couple of bright young community medicine specialists on my staff and I suggested to them that we should design a similar study for a cohort of First Nations subjects. They were successful in tracking down the author of the paper and we got him on the phone to discuss his study and our idea of replicating it. This is how I came to meet Dr. Eric Westman, a professor of medicine at Duke University in North Carolina, and the first in a succession of principled, inquisitive scientists and clinicians I was to encounter on my odyssey to understand why this unconventional dietary therapy was so successful in reversing my type 2 diabetes.

Dr. Westman was extraordinarily patient and generous as he helped us put together a proposal to run a dietary trial in a coastal First Nations community. We enlisted the health workers in a community a short distance from our office and proceeded to submit a funding proposal to the Canadian Institutes of Health Research. The rejection of our proposal gave me the first hint of what I came to understand was a deeply ingrained institutional aversion to low-carb diets. Dr. Westman’s stories of his own difficulties in getting funded, in passing institutional ethics review and in getting his study results published were also instructive. I had started speaking publicly about my ideas and had already begun to experience some push-back, as well. It soon became apparent that something that had so brilliantly improved my health was viewed with intense fear and suspicion by those who are supposed to be authorities on diet and nutrition. I found I was openly attacked by dieticians when I suggested that a low-carb diet might be a valid way to lose weight and manage diabetes. This surprised me, especially as I became more versed in the science that supported this view. I was also surprised to find that a debate that should be dispassionate and grounded in evidence would often become so emotional and irrational.

More studies began appearing in the scientific literature. Some randomized controlled trials were done where low-carb dieters were compared to people following the American Heart Association so-called prudent diet which was low in fat and saturated fat. In each case, the low-carb diet delivered better results in terms of compliance, weight loss and lipid improvements. These studies tended to get media attention because the Atkins diet was in the midst of a popular resurgence at the time. We began to see low-carb products appearing on store shelves. Shops dedicated to low-carb dieting sprang up. At one point, a survey determined that one in nine Americans was restricting dietary carbohydrates. Perhaps the most defining development in this trend was the emergence of several brands of low-carb beer.

The impact of the widening popularity of low-carb dieting began to be felt among the food producers whose products were high in carbohydrate content. There were news reports of declining sales of foods like orange juice, bread, potatoes and pasta. This led to the development of direct marketing strategies to reverse this trend by many sectors of the agri-food industry. More ominous and perhaps telling of things to come, however, was an announcement by the pasta producers after they held a global meeting in Rome to discuss strategies to counter the threat of low-carb dieting. Their spokesperson said they had decided against a direct marketing campaign in favour of a plan to “work behind the scenes”. This was interesting in light of the fact that, for every report of a study that supported low-carb dieting, it seemed there would be a negative report of some kind. Whenever something appeared in the media, I would track down the source study to see what actually happened. It became apparent to me that the research supportive of low-carb tended to be solid and well executed while the studies that were negative were not well done and often contrived. In spite of this, they tended to get the same air time in the media. I sometimes found that the media reports themselves skewed things against low-carb more than did the study they were reporting on. I began to wonder if people working “behind the scenes” were having a hand in this.

The eventual decline in popularity of low-carb dieting was clearly influenced by confusing messaging directed at the public. On the one hand, the results of good studies were being reported suggesting this was a good way to lose weight and improve related conditions while, on the other hand, most authoritative sources denounced the diet as dangerous and not to be adhered to over any length of time. People were told that it was not sustainable and that weight regain would be their fate if they tried it. This was an easily self-fulfilled prophesy, of course. As I had learned, it takes an effort of will to cut out all those comfort foods and sweets to which we have become accustomed and it is easy to succumb to the fear of harm, especially when authoritative sources are telling you that you need carbs for your brain to function, that your kidneys will suffer and that you increase your risk of heart disease, osteoporosis and bad breath, something most people fear even more than death itself. I think that “behind the scenes” efforts were successful in propelling this misinformation and were ultimately successful in protecting threatened economic interests by deflating the trend toward low-carb dieting. This was most unfortunate, but, in the meantime, the science in support of low-carb continued to accumulate.

I had started speaking to Aboriginal audiences about my ideas of a link between their changing diet and the epidemics of obesity and diabetes. At one meeting, a First Nations man, inspired by my idea, challenged another man to a diet competition. They agreed to go to their respective health clinics and get weighed and measured and to report their results at intervals. I started receiving e-mails from James Wilson, the Kwakiutl challenger who lived in Campbell River on Vancouver Island. He was a type 2 diabetic who had been on insulin for 17 years, yet was unable to get his blood sugar levels into normal range. He was also medicated for hypertension and had high cholesterol and he was considerably overweight. After two weeks I received an e-mail informing me that he was now consistently achieving normal blood sugar values and was completely off his insulin. He had lost17 lbs. After another two weeks, and another 13 lbs. weight loss, he was able to discontinue the blood pressure medications. I saw him again after 18 weeks at which point he had lost about 50 lbs. and was demonstrating excellent blood sugar, blood pressure and cholesterol readings without the need for any medication. I asked him at this point whether he used exercise to achieve these remarkable results. He hadn’t; all he had done was avoid starch and sugar, just as I had. Jimmy’s success was a further impetus for me to get a study going to see if this kind of result could be achieved among larger numbers of people in a First Nations community. I had come to realize that, in the face of deeply held views prejudicial to low-carb in many quarters, getting a study launched was not going to be as easy as I had initially thought. I developed a strategy to lay some groundwork from which another study proposal might get funded. Instrumental to this plan was someone who was become a friend and respected colleague, the Honourable Dr. Carolyn Bennett. At the time she was the Minister of Public Health and was working to develop what was to become the Public Health Agency of Canada. In her cross-country travels, she was making a visit to the region in which I worked and I was asked to accompany her to a meeting that was a 90 minute plane flight away. I used this opportunity to tell her about my theories on diet and diabetes, especially as to how it may be relevant to First Nations. I shared with her a sheaf of scientific papers I had collected on the topic. Much to my surprise and delight, she read the research literature and understood its importance. Later, when I was able to obtain some funding to support a small symposium on the topic, she generously agreed to host the meeting, graciously lending the credibility of her office to this endeavour.

In February 2003, a group of leading scientists in nutrition, research, public health and Aboriginal health gathered in Hull, Quebec to debate the issues around diabetes in the Aboriginal population, traditional diet and low-carb diet. As I began to plan this meeting, one of the first people I invited was Dr. Westman. He agreed to participate and suggested that I should also invite another researcher who he regarded highly, Dr. Steve Phinney, an internist with a doctorate in nutritional biochemistry. He directed me to a paper Dr. Phinney had recently written on the high-fat low-carb Inuit diet and his research at MIT where he applied an Inuit diet to bicycle athletes to demonstrate that there was no effect on stamina, something that challenged the conventional wisdom. I called Dr. Phinney and caught up to him as he was driving his diesel Jetta on a California freeway near UCDavis where he was professor emeritus. I think he figured I was perhaps a little nutty but agreed to attend the meeting anyway. A few days later, I got a call from Kansas from Dr. Mary Vernon, someone I knew only as the co-author of a book titled, “Atkins Diabetes Revolution”. Dr. Westman had provided Dr. Vernon with my number and suggested she call me to invite herself to my symposium which she did. It turned out that Dr. Vernon had years of experience successfully treating patients with metabolic syndrome and type 2 diabetes using a low-carb diet approach in her Kansas family medicine clinic. All this while she also trained national champion performance dogs.

In 2002, Dr. Walter Willett, the renowned Harvard nutrition researcher, had published an article in Scientific American in which he argued that the USDA Food Pyramid had it wrong, that the advice on fats and oils was misguided and that there were too many refined carbohydrates in their recommendations. Dr. Willett ranks among the top 25 scientists in the world in citations and is a giant in the area of nutrition research, something I did not fully appreciate when I naively invited him to attend my little symposium. I was pleased when he accepted and only much later did I appreciated how amazing a feat it was to have attracted such a prominent scientist.

I also invited public health people, nutritionists and some of my Aboriginal physician colleagues and Jimmy Wilson and his sister Prilla. We designed the symposium to consider three questions:

1. Does the extent of the epidemic of diabetes in Aboriginal populations constitute a public health emergency?
2. Is there enough evidence that traditional diets and low-carb diets are similar to support further research in this area?
3. Is there enough evidence to warrant immediate program activity in this area?

By the end of the symposium, the group answered a resounding “yes” to each of these questions. This laid the groundwork that allowed me to eventually get a dietary trial approved and funded. I was also able to spend two years on research leave at the University of British Columbia Department of Health Care and Epidemiology where Dr. Rick Mathias, a professor of medicine there, provided the necessary institutional support to get my study launched. Drs. Phinney, Westman and Vernon also participated as co-investigators. Dr. Vernon began calling our team the “Wortman Group”, something that I found very flattering considering that I was a relative neophyte in this area and was among clinicians and scientists whose knowledge and expertise was vastly superior to my own. Our meetings to plan the diet study were full of Socratic-like question and answer sessions with Dr. Phinney providing an inexhaustible font of scientific knowledge in the area of nutritional biochemistry. We literally talked nutritional science morning, noon and night anytime we were together, to the extent that I joked that we should get Continuing Medical Education credits for out time together.

Even with the promise of funding support from Health Canada and institutional support from UBC, actually getting the study started was still not a slam-dunk. I had to submit to two Institutional Review Boards, first at UBC and then at Health Canada. We ran into the typical to-ing and fro-ing at UBC and got through the process in a fairly reasonable time. I naively thought that having done the UBC review, getting through the second review would be easier. I was wrong. We got a barrage of questions and concerns and it looked like we might not get their endorsement at all as they informed us that they didn’t consider this to be something that could be defined as research. This was a source of puzzlement to me and my team. Westman had already had studies with a similar design published and Phinney, who has had numerous studies published, and sits on the editorial board of a major American scientific journal, found this incomprehensible. I was actually caught in a classic Catch 22. Health Canada had decided, correctly I thought, that my study was research using human subjects and therefore, according to their rules, could not be funded until it passed ethics review. Meanwhile, the ethics review people were telling me that it wasn’t research and therefore they would not approve it. After what seemed like interminable manoeuvring I was able to get approval to go ahead as a “pilot study”.

In the meantime, I had been in discussions with two First Nations communities as potential sites for the study. Both were on islands, had fairly large First Nations populations adjacent to non-native communities and received their health services from local clinics. These attributes were desirable in terms of the practicality of recruiting and supervising cohorts of subjects who would be asked to follow our study diet for a year. The study design, in order to pass ethics review, hinged on the involvement of a local physician who would be responsible for the medical management of the study subjects. On the one hand, I found it odd that, although nothing prevented anyone from buying an Atkins diet book and self-administering a low-carb diet, our proposed study was deemed too dangerous to go ahead without direct medical supervision. On the other hand, there were a number of good reasons for involving the local doctors, the primary one being that anyone who was taking medications for diabetes or blood pressure would have to rapidly reduce or discontinue their meds as they started the diet. Failure to do this would cause blood sugar and/or blood pressure to go too low potentially endangering the health of participants. While a nurse could easily manage this, the level of fear about the potential harms of this “radical” diet were such that only a doctor would do. We were sensitive to the fact that doctors practicing in small remote communities are often over-worked, so we designed the study protocol to minimize the amount of time and effort that would be required by the physicians with most of the work to be done by a study nurse who we would employ locally.

As it turned out, we were successful in getting the necessary physician support in only one of the two communities that we approached. Dr. Clayton Ham, the Namgis Health Centre physician, agreed to participate. He was open-minded but also displayed what I thought was a healthy scepticism. In the end, his attitude was that our current approach wasn’t working particularly well so maybe we should try something different. Over the course of the study, as he witnessed the improvements people achieved on the diet, his initial ambivalence changed to enthusiasm and he began to counsel his diabetic patients to consider joining the study.

Our study design required that we recruit 100 subjects in order to achieve statistical significance and we were planning on attracting 50 people in each community. We decided to get started recruiting in the community with the cooperative physician while we continued the search for an additional study site. As it turned out, the response in Alert Bay was greater than we had anticipated and we quickly realized that we would be able to achieve the desired numbers without involving another community. This turned out to be a blessing as it allowed me to invest in more nursing time and to spend more of my time in Alert Bay. I was able to recruit a local nurse, Deb Vermunt, whose husband was the director of the local band-operated health clinic. Deb was a quick study and enthusiastically threw herself into the task of learning about this dietary approach and our study protocols. She was well-liked by the subjects and was instrumental in our success in attracting people to the study and helping them remain compliant with the diet.

In my first approach to the Namgis First Nation, I had made a presentation to the Chief and Council explaining the rationale for the study and seeking their endorsement to go ahead. As it turned out, not only did they enthusiastically approve, but some of them immediately started to change their diet along the lines of the proposed study diet. After obtaining council’s approval it took several more months to get the actual study started but, in the meantime, we serendipitously acquired a couple of very strong local advocates. The Chief, Bill Cranmer, started avoiding carbs and was so pleased with his health improvements that he became a vocal advocate. The band manager, also a hereditary chief, interpreted our approach to mean that he should eat only traditional foods which he did. He lost 35 lbs and his wife lost 70 lbs. By the time we were ready to start recruiting subjects many people had heard all about the diet and had already witnessed its benefits.

Early in the planning for the study I was unsure whether I would get funding through the usual channels. I had heard about the Robert C. Atkins Foundation which had been established by the late famous low-carb diet doctor. I was visiting New York on other business and used that opportunity to meet with the Foundation’s director of research, Dr. Abby Bloch. I was hoping that the Atkins Foundation might consider funding my project. In preparing for the visit, I had Googled Dr. Bloch and discovered that she was a dietician. This intrigued me because my experience to that point was that dieticians were not favourably predisposed to low-carb diets. Dr. Bloch met me for dinner and told me a fascinating tale of how she had been a very sceptical critic of low-carb diets until she was recruited by Dr. Atkins to run his research foundation. She had worked at the Sloan Kettering Cancer Centre, had done nutritional research and was a contributor to the standard textbook of nutrition used in American universities. When she retired, someone talked her into meeting Dr. Atkins who was looking for a director of research. She told him what she thought of him and his diet but he offered her the job anyway. He said that her opinions didn’t matter; he was more concerned with ensuring that the research he funded was done to the highest scientific standards. On that basis, she took the job, much to her own surprise. Then she began to discover the scientific literature that supported low-carb diets and was surprised to find that there was already lots of it out there. As she began to fund more research, the results were so positive that it convinced her there was merit in this dietary approach. Since she was highly regarded in her profession she would still be invited to speak at conferences and would discuss the evidence that she was discovering that supported a diet that everyone had believed to be harmful. She was shocked to find that, not only did her colleagues not want to discuss the evidence, but that they attacked her personally. She told amazing stories of how they would launch emotional tirades, condemning her and telling her she should never be allowed to speak at their conferences again. Obviously upsetting to her, this was doubly disappointing for me, as I had hoped that I had finally found a dietician who could explain to me why there was such a negative attitude towards this diet. She was as mystified as I was.

In the end, the Atkins Foundation generously offered to fund my study; however, in the meantime I had also been able to secure Health Canada funding. I had a frank discussion with Dr. Bloch and her colleagues and declined their funding. I felt that because of its origins, the validity of the study results would be vulnerable to accusations of bias. They were very understanding as they knew more than anyone how politically charged an environment I was entering.

Abby introduced me to another wonderful person who had been associated with Dr. Atkins, his nurse of 30 years, Jacqueline Eberstein. Jackie told a similar story of how she was very sceptical when first recruited by Dr. Atkins and then, after seeing the results, how she became very committed to this way of treating people for obesity and related conditions. She had lots of personal stories to tell of what it was like to work with Dr. Atkins and would often tell me that, were he still alive, he would be very interested in the work I was doing. Jackie co-authored the book, “Atkins Diabetes Revolution” with Dr. Vernon and was a wealth of knowledge on how to manage diabetes through carbohydrate restriction. Both Abby and Jackie became my good friends and informal members of the study team and they both visited Alert Bay to help with the initial training of the local staff.

I began attending the conferences hosted by the Nutrition and Metabolism Society, an organization of scientists and clinicians dedicated to improving our understanding of the biological mechanisms of carbohydrate restriction. It was when I attended a NMS conference in Brooklyn that I experienced one of the high points of my journey. Veronica Atkins, the widow of Dr. Atkins, and a big supporter of the researchers working in this area attended the meeting. Much to my surprise and delight, she graciously invited me to her home for dinner. In her beautiful Manhattan apartment, high above Central Park with a view of the Statue of Liberty, eating a delicious low-carb osso bucco prepared by her personal chef, I reflected on how life can be such an amazing journey, how far I had come from that little village in northern Alberta and how my own illness had transformed my life into a quest to push the boundaries of diabetes management at a time when this disease was becoming a global health crisis. I wondered where this journey was going to eventually take me.

Along the way, in terms of my own health, I continued to maintain normal blood sugar and blood pressure simply by avoiding carbs. I experienced some trepidation after doing this for a few months when I decided to get my cholesterol checked. I had become accustomed to eating lots of fatty foods and I was certain I was eating much more than the prescribed amount of saturated fat. I had developed my own wickedly delicious low-carb chocolate ice-cream receipe which used heavy cream and egg yolks. I was eating that daily and having bacon and eggs for breakfast and steak and chicken with the skin on and other fatty foods for dinner. Lots of cheese, too. So when it came to checking my cholesterol, I have to admit I was afraid. I had been taught that a diet high in saturated fat would lead to an unhealthy lipid profile. Much to my surprise and relief, I had excellent cholesterol levels and, as an added bonus, my HgA1c (the long range measure of blood sugar control) was also well down into the normal range. I was clearly on the right track.

My most recent blood tests, done just a couple of months ago at about the five year point of my personal low-carb diet experiment, continue to demonstrate excellent results. It is also interesting to note that I have very low markers of inflammation; my white cell count and C-reactive protein are at the low end of the normal range. Higher levels of these markers are associated with metabolic syndrome, type 2 diabetes and an elevated risk of cardiovascular disease. This is something that I now understand from recent research to be another benefit of carbohydrate restriction. Although there continues to be a lack of long-term studies supporting low-carb diets, my own long-term experience has been excellent. Other members of the “Wortman Group” who have had years of clinical experience with low-carb dieting confirm that my results are the norm.

I have adhered to the diet and maintained a weight loss of about 25 lbs for over five years now. I am convinced that my health is better than it has ever been. I have learned an enormous amount in an area of science that physicians, unfortunately, tend to ignore. And I have come to understand that nutrition is the most important factor in determining one’s health status and how a simple nutritional change can have a powerful therapeutic effect when applied to diet-related illnesses like obesity, metabolic syndrome and type 2 diabetes.

The study and how it affected the people of the Namgis First Nation and other residents of Alert Bay is the subject of the documentary, “My Big Fat Diet”, by Mary Bissell and Barb Cranmer. I think Mary and Barb have done a wonderful job of capturing the beauty of the Namgis territory and the warmth and charm of the people who live there. I will let the film speak for itself.

When the data collection is complete we will do the usual statistical analyses and write a paper to be submitted for publication in a scientific journal. In the meantime, I have started this website to serve as a forum to discuss the documentary film and this dietary approach and to serve as a vehicle for me to continue to share with you what I am learning in the course of my personal odyssey.

Although the journey is far from over, I will pause on this occasion to thank the people who have helped me get this far: my research colleagues, Drs. Phinney, Vernon and Westman, Jacqueline Eberstein and Dr. Bloch, Drs. Richard Feinman and Jeff Volek for the Nutrition and Metabolism Society and their excellent research, my enlightened colleagues at Health Canada who made the study possible and who I suspect prefer to remain nameless, the staff of the Department of Health Care and Epidemiology at UBC, especially Dr. Rick Mathias, whose support has been instrumental, all the staff of the Namgis Health Centre and especially Dr. Ham, Deb Vermunt and Eva Dick, the Namgis Chief and Council, the people of Namgis First Nation and the community of Alert Bay and especially those who put their trust in me and tried the diet, Mary Bissell and Barb Cranmer and their crew for the excellent documentary, and Veronica Atkins and her late husband, the good doctor, whose pioneering work in this area has not yet achieved the recognition that it deserves, Dr. Robert C. Atkins.

Almost a Half-Cup of Sugar in One Meal!

2008-03-17T09:59:00.002-05:00

While out this weekend, I passed by a Subway shop and noticed new posters up that promoted their "Fresh Fit Kids Meals." I didn't have time to stop and read the poster, but did take some time this morning to take a look at the website to see what they're touting as a healthy alterntative for children.

Subway Fresh Fit™ Kids Meals
You no longer have to sacrifice nutrition or flavor when you're short on time. Choose a Mini sub (ham, turkey or roast beef) and pair it with a delicious side, like fresh apple slices or raisins. Then select from 1% low fat white milk or 100% juice for a tasty, better-for-them meal that kids will love.

On the page above, the picture of the meal includes a black forest ham mini-sub, a box of raisins and Minute Maid 100% Juice Fruit Punch.

According to the page featuring the healthfulness of the kids meals, Subway promotes the meal as a better option than McDonald's and Burger King's kids meals.

Why?

With negligible differences in calories, it's all about the fat content of their kids meal versus the others' offerings. So if the calories of each are close, but the Subway meal is half the fat, what's keeping the calories similar?

Carbohydrate.

That's right - when you choose the Subway kids meal, you're giving your child more carbohydrate (basically, in the body, sugar).

In fact, after poking around on the Subway website, the nutrition information available reveals the kid's meal noted above is the equivalent of almost 1/2 cup of sugar (after deducting the fiber, the meal provides 86g of digestible carbohydrate - or the equivalent in the metabolism as 21.5-teaspoons of sugar).

Would you willingly sit your child down, offer him/her a bowl filled with 1/2 cup of sugar and a spoon to dig in?

Well, that's basically what you do if you order the kid's meal with a ham mini, raisins and juice box....what Subway is promoting as "healthy" eating for kids!

Items of Interest

2008-03-03T09:26:00.003-06:00

While I have a number of posts in the works that I've mentioned in previous posts, I'm a bit swamped - so rather than not post anything, I thought I'd post some interesting news:

Growing fruits and vegetables leads to penalties
The New York Times had an Op/Ed from a farmer who found growing watermelons and tomatoes to come with penalties from the Farm Service.
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Warning Labels for Cheese - Say it isn't So!
DAIRY foods could soon have to carry cigarette-style health warnings in a bid to slash Britain's soaring levels of obesity and heart disease, according to a report yesterday...the food watchdog is also considering asking manufacturers of products high in saturated fat, such as cheese and butter, to put cigarette-style warnings on packs which would urge consumers to eat such products in moderation or as a rare treat.
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ABC News: Atkins a Diet for your Wallet?
Video about rising grain prices.
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Jimmy Moore Interviews Dr. Dean Ornish
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Kevin at Low Carb HIT
Thinks Dr. Mike Eades and Anthony Colpo are both wrong about the metabolic advantage...read why!

Five Simple Rules

2008-02-29T10:27:00.006-06:00

PJ, over at the Divine Low-Carb!, recently issued a challenge in a post, You Choose! The March of Madness for PJ, where she asks experienced low-carbers to present a plan for her to follow throughout the month of March.

So here is a challenge for the many experienced lowcarbers out there. March is coming up in 5 days. Present a plan for me that is:

1 - LOWCARB AND SIMPLE (not 'cycling' and not 'moderate carb' and not 'atkins by the book according to OWL modified by xyz...')

2 - HAS NO MORE THAN FIVE MAIN RULES (though a given rule can have details, e.g. if supplements is one of the rules it can have a list/dosage, if fat is one of the rules it can have types/quantity)

3 - WITHIN THE PARAMETERS ABOVE (no seafood or gluten etc.)

Here's what I will do:

1. I will choose one of them and officially follow it for March, from the 3rd to the 31st, four full weeks starting on a Monday -- because that is how my weight spreadsheet is set up LOL.

2. I will track and graph my weight every day

3. AND how I feel every day

4. AND what I ingest/do every day (I use a digital gram scale for measures)

5. AND do measurements before/after,

and at the end of the month we will all see how well that given plan worked out for my body. I may not be perfect on it but I'll track what I do so it's fairly known what degrees of it I may have screwed up.

MY THEORY IS, that since I don't have ANY given goal-setting plan that inspires me enough to make a commitment to it, that instead, I will make a commitment to someone ELSE: the commitment just happens to involve a given lifestyle plan.

Can you do it?

RULE 1: NO SPECIFIC GRAM COUNTING - just eat what's allowed & simply enjoy your meals

In the current state of affairs, eating is becoming terribly complicated by an under-current that suggests we feel guilty for eating, seek to limit our desire and pleasure from good food, and contantly count calories, grams of this or that and worry about everything we place in our mouth.

No more of that - eat and enjoy what is allowed and simply pass on anything not on your list of good foods to eat.

In addition, we don't live and eat in a world of grams - it isn't even natural to have to divvy up portions by cups, ounces or any other measure. We're supposed to just simply eat, but somehow we've come to a place where that's no longer a simple affair.

Rather than fight that totally, I'm going to present information to calculate minimums for some things, that have to be included each day, ranges for others, and optional add-ins - these are to be calculated out for an individuals current weight so they're eating enough each day to avoid a state where the body conserves energy in the face of famine conditions, while also providing variety and good habits to build upon over time.

RULE 2: Eat Enough - Starvation Level of Calories Doesn't Work Long-Term

In order to eat enough, one has to know how many calories they need, at minimum, each day - over the years I've found the basal metabolic rate (BMR) to be a good minimum to use. Online calculators, like the one at Discovery Health, are accurate enough for this purpose. Once you enter your information, it will return how many calories you need each day for basic metabolic function, before any movement or physicial activity.

This is the minimum calories to target eating each day and it allows a +/- 5% range, so if you miss by 5% one day that's OK; if you're over now and then by 5%, that's OK too. Recalculate BMR with every 20-pounds of weight loss.

RULE 3: Consume Adequate Protein

Protein is, in my opinion, the most critical of foods/macronutrients to consume each day - it helps to regulate appetite, but more importantly provides the essential amino acids to repair and build within the body.

Calculating out a minimum amount of protein to be "adequate" is fairly easy - you take your body weight in pounds and multiply it by 0.40. This will allow for an adequate intake of amino acids for both essential needs, and for the production of glucose through gluconeogenesis.

But who lives in a world of grams? It's easier then to take the gram target and convert it into ounces each day - makes it easier to decide what to eat! So, to determine how many ounces each day, you simply divide the grams by 6.5 - the average amount of grams of protein per ounce in meat, cheese, eggs, poultry, fish. Now some have 7g, some have 6g - I suggest using the 6.5 as an average.

Do not count plant protein in your minimum - so you can eat whatever cuts of meat, poultry, fish, game you want, and include eggs, cheese (real, whole milk cheese only - see below). You may also boost protein with whey or egg protein powder or RTD-shakes that contain only whey protein and less than 2g carbohydrate per serving. No soy protein isolates are allowed in the shake option.

Eggs ideally will be from organic, free-range chickens; meats (ideally) should be grass-fed, pastured.

Recalculate protein requirements with every 20-pound weight loss. Each day, eating enough protein is critical, so target eating at least the calculated minimum; eating more than that is fine if you're hungry and often necessary if you're active...so if you find you are hungry, eat more protein if needed, but avoid excessive protein consumption, which is hard to define, but generally means more than 35% of calories or greater than 0.8g-1g of protein per pound of body weight (depending on level of physicial activity).

Dairy is included in your protein, but do not consume more than a combined total of 4-ounces of dairy foods each day - this includes plain whole milk yogurt, real whole milk cheese (no processed cheese allowed), heavy cream and/or half & half. Dairy must be organic.

RULE 4: Choose fats wisely

For cooking and topping vegetables, use ONLY the following fats and oils:

Olive oil, organic butter, virgin coconut oil, avocado oil, walnut oil, sesame oil, macadamia nut oil, drippings from bacon, real mayonnaise, or rendered fats from chicken or meat.

What isn't allowed is anything that contains canola, soybean oil, vegetable oil, partially (or fully) hydrogenated oils or corn oil.

Two exceptions: Salad dressing is one exception to this rule if one is using commercial dressing - canola based dressing is allowed in this case, if the carbohydrate content is 1g or less per 2-TBS serving. Real mayonnaise is the other exception if you cannot find one that is made with the acceptable fats/oils.

The meats and animal foods consumed have fat content, so added fats/oils should be used to top vegetables and salads and the amount should be individualized to meet calorie intake minimums. Adjust fats & oils as appropriate with weight loss. If you are using an online food journal to keep track of things, like FitDay.com, the percentage of calories from fat will be high - greater than 60% each day, sometimes as high as 70% or more.

RULE 5: Eat Enough Plant Foods

Plant foods - vegetables, nuts, seeds, fruits, legumes - provide variety and also are nutrient-dense. The same cannot be said for most grains, so while you're losing weight, avoid grains, but eat enough of the allowed plant-foods each day to keep things interesting.

As a rule of thumb, absolute minimum of non-starchy vegetables each day is 3-cups - choose whichever non-starchy vegetables you wish and top with whatever fats/oils you like, season however you want.~ You may include up to 6-cups of non-starchy vegetables each day if you wish. Herbs and spices may be used as desired.

OPTIONAL ITEMS:

You may also include up to 1-cup of select fruits each day - any type of berries, canteloupe, honeydew melon or tomatoes.~ The caveat with the fruit is it must be accompanied by a protein-fat food, like cheese, yogurt or meat.~ For example, if you'd like 1/2 cup of blueberries, enjoy them in a 1/4 cup of plain whole milk yogurt topped with a tablespoon of walnuts or pecans, or in 1/4 cup of heavy cream.

You may also have up to 2-ounces of any nuts/seeds each day.~ Nuts you may have include: walnuts, pecans, pine nuts, pistachios, sesame seeds, pumpkin seeds, and macadamia nuts; also nut/seed butters are an option. Two that are not allowed are peanuts (legume) and cashews. If your current body weight is greater than 300-pounds, you may include up to 4-ounces of nuts if needed to bring calories up to meet BMR.

You may include up to 15 olives in a day - green or black; and/or 1/2 an avocado; and/or 2-TBS of legumes (chickpeas, red kidney beans, navy beans, peas, etc. - but no peanuts).

Essential Nutrient Insurance

While it's definitely possible (and not all that difficult) to plan menus with 20g to 60g net carbohydrate and all the essential nutrients we need, it's not something someone new to low-carb does well without practice, and even those who have followed controlled-carb for a period of time sometimes miss hitting nutrients that are essential because they don't know which foods are best to include for nutrient-density. So, rather than write a book about this, an unofficial "rule" - it's a good idea to include some "essential nutrient insurance" in your day....two key vitamin supplements:

A. Basic multivitamin-mineral complex that is not a "mega"....choose a capsule vitamin, not the brick-hard type; it should include 100% of RDA, but not "mega" levels.

B. Cod Liver Oil and/or Fish Oil; depending upon time of year and where you live. During the winter months - mid-October through mid-April, if you're in a central or northern latitude, use cod liver oil; all others in sunny year-round locations, get sun and use fish oil instead; during mid-April to mid-October use fish oil if you're in a central or northern latitude while also getting your sunshine!

Dose is generally 1-teaspoon per 50-pounds of body weight, with a maxiumum of 1-tablespoon per day.

For those with significant weight to lose - 50+ pounds - it can also help to include:

C. Chromium picolinate (200mcg)

D. Alpha Lipolic Acid (600mg) + L-Carnitine (1g)

E. Krill oil capsules (500mg) [do not include if you have a shellfish allergy]

What the World Eats

2008-02-25T09:05:00.003-06:00

If a picture is worth a thousand words, than the Time photo-essay What the World Eats Part I speaks volumes.

To view the pictures from around the world: What the World Eats Part I

Months ago, when Diet Blog featured this subject, I took a picture of our weekly food but then didn't have an opportunity to post it here. So, today - here's what an average week of food looks like for us:

Comment Moderation Update

2008-02-23T09:28:00.004-06:00

Just a quick reminder about comment moderation - the reasons a comment may be rejected include:

Trying to sell something to others via the comments
Personal attacks on another commentor
Comment has absolutely no relevance to the subject matter of the post nor any other comment on the thread of comments for the post
Attempting to re-direct traffic to a site selling products/services contrary to this blogs message
Profane and/or vulgar comments

All are absolutely free to disagree, challenge anything I've written and/or comment about their experience (with a product or service)....but the above guidelines are a reminder that I do moderate comments, and while I'm reluctant to reject a comment, occasionally I find myself having to. If a comment of yours is rejected (doesn't appear) and you have a question about why, you can always email me and ask why.

Dr. Jamie Bailes: The Fat-Free Fallacy

2008-02-23T08:05:00.003-06:00

Dr. Jamie Bailes, a pediatrician at Marshall Unieristy in Huntington, WV, recently penned an article for Diabetes Health - The Fat-Free Fallacy: Is it Obesity's Great Enabler?

Obesity in the United States is increasing in epidemic proportions. This is true in children as well as adults. It's estimated that the healthcare costs associated with obesity and its related complications will exceed $130 billion this year.

If something is not done to stem this burgeoning tide of obesity, then the healthcare system that we know will soon crumble.

Why are we seeing this dramatic increase in childhood obesity?

It is certainly true that children are not as active as they were 30 or 40 years ago. Television, video games and computers can entertain kids 24 hours a day. Parents are often relying on technology to babysit their children and are not spending as much time outdoors with them exercising or just playing.

Is this the only reason for the surge in obesity? As a pediatrician who specializes in childhood obesity, I see many children who are very active but they are also massively overweight. What about these children? I believe many of these children are victims of what I like to call the "fat-free fallacy."

Scapegoating Fat Backfires

In 1977 the U.S. Department of Public Health issued a statement encouraging Americans to eat less fat. In 1988 the U.S. Surgeon General recommended that we restrict our consumption of dietary fat. The assumption was that as we eat less fat the thinner we would become. The multi-billion-dollar food industry was quick to jump on the bandwagon. The race was on to produce fat-free everything. If food didn't have fat then it was OK to eat as much as you wanted.
Americans consumed more fat-free foods in the 90's than the previous three decades combined. This fat-free philosophy is exactly why we are becoming so obese as a society. Obviously if fat were the problem, then obesity would have decreased during this time. Instead, obesity did not decrease but skyrocketed to unprecedented levels.

But fat is not bad for you. Being fat is. The two are not related! Fat actually helps to satisfy our appetites and keeps us from eating too much or too often. Fat is also an important flavoring for food.

I, too, was a victim of this fat-free fallacy. I had been taught (brainwashed) that in order to lose weight we must eat less fat. I was a huge proponent of cutting back fat intake and watching total calories. I recommended at least 30 to 45 minutes of vigorous exercise daily.

I knew that it was very hard to lose weight. I didn't push overweight children to lose weight, thinking that if they could just maintain their current weight as they grew that would be significant progress. I felt like I was doing a good job. I believed whole-heartedly that I was explaining to these children the correct way to lose weight.

An Eye-Opening Study

In the late 1990's, a first-year pediatric resident physician at Marshall University did a required research project in which he looked at about 100 children whom I had counseled about weight loss. The results were astonishing to me. Not only did these children not lose weight or even slow down their weight gain, most gained weight at the same rate and some even faster.
The results did not lie. All of this time and energy that I had been spending to help children lose weight had been a waste of time. It just didn't work. A low-fat diet only worked for about one out of every 25 patients. Was this the best we could do?

I was determined to succeed. I began to look at other ways to lose weight. A third-year medical student at the time asked me about using a high-protein, carbohydrate-restricted diet for weight loss. At the time I knew very little about approach. This was not something that was taught in medical school. I couldn't believe that this would be successful or that it could be good for you, so I was very skeptical. How could eating high-fat foods not be bad for you? This is what I learned in textbooks from professors in medical school.

However, I still could not ignore the facts. We had cut back our fat intake and yet we were becoming fatter as a nation.

Low Carbs Make a Case

I researched and relearned the physiology and biochemistry behind low-carb diets. As I began to take a closer look, my findings were not what I expected. It all came back to insulin. Insulin is what causes fat storage. Insulin is what drives weight gain. Insulin is what is secreted when we eat carbohydrates. Insulin is one of the most powerful and efficient substances that our body uses to control the use, distribution and storage of energy. Insulin is essential for life. Without insulin, we would quickly waste away and perish. Just ask the teenager with type I diabetes who has been hospitalized for diabetic ketoacidosis because of not taking his or her insulin.

Let's look at what happens after a meal that is high in carbohydrates. Carbohydrates are broken down into thousands of molecules of glucose that are quickly absorbed through our small intestines into our bloodstream. Our body has the ability to monitor this rapid rise in blood sugar and quickly secretes insulin to counterbalance this. This is true if we do not have diabetes. Our nervous system keeps our blood glucose levels very steady no matter what we eat. These values almost never get above 120 or less then 70mg/dl. This is true whether we eat a meal that consists of pure sugar, a meal loaded with complex carbohydrates, a meal consisting of only protein or fat, or when we have fasted for two or three days. Almost all of our cells use glucose for energy.

Our bodies are extremely efficient energy machines. Only a small part of what we eat is actually used or needed by the muscles or other cells for energy. If these energy-using cells do not need any extra energy what happens to the majority of the glucose that we ingest? Insulin converts a portion of that glucose to another starch, called glycogen. Glycogen is stored in the liver and can maintain our blood sugar levels in the normal range for several hours after a meal. This is why we do not have to eat continuously. Glycogen can quickly be converted to glucose whenever glucose is not readily available in the bloodstream.

Why Low-Fat Diets Don't Work

What about the rest of the glucose? Where does it go after a meal? Herein lies the answer to why most low-fat diets do not work. The extra glucose is converted to fat. Fat is our main storage area for energy. Let me say this again: insulin promotes the production and storage of fat. That's right, even without eating fat our body produces fat from sugar.

Insulin is an extremely efficient hormone. It is the master hormone of our metabolic system. Its most important function may be the control and maintenance of our blood sugar, but insulin performs a myriad of other activities. In the appropriate amount, insulin keeps the metabolic system running smoothly and everything in balance.

However, in great excess it becomes a dangerous hormone wreaking havoc through the body. Mountains of scientific evidence implicate insulin as the primary cause or significant risk factor for high blood pressure, heart disease, arteriosclerosis and high cholesterol. It may also have a causative role in type 2 diabetes.

With type 2 diabetes our body needs extra insulin to help to maintain our blood sugar. The insulin that is available just does not work as well and we become resistant to its effects.
With type 1 diabetes we have a little different story. Our body can no longer make the insulin that we need therefore we have to take manufactured insulin to maintain our blood sugar. More carbs equals more insulin.

Teenage girls with diabetes know that insulin causes them to gain weight. Many recent studies have shown that in order to keep from gaining weight a very high percentage of teenagers with diabetes omit their insulin. We cannot continue to allow this to happen. This leads to uncontrolled diabetes and horrible long-term complications.

More Protein = Greater Insulin Control

So, how can we control our insulin requirements? The key to good blood sugar control, the key to weight loss and the key to lowering our insulin secretion is very simple. Eat fewer carbohydrates and eat more protein.

Protein keeps us from being hungry. A meal high in protein stays with us a lot longer than a meal high in carbohydrate content, which is quickly absorbed and does not satisfy our appetite as long. When we eat protein our body does not need as much insulin. Our blood sugar values are much steadier and we do not have the wide fluctuations that we see with high carbohydrate foods. This dietary approach works whether you have diabetes or not. It is perfect for anyone who is overweight or has type 2 diabetes. Type 1 people with diabetes can benefit by improved blood sugar values and lower insulin requirements.

I have seen hundreds of children actually lose weight with our plan. Eight and nine year old kids have lost 40 to 50 pounds. Obviously, the health benefits are tremendous, but the greatest improvement is what we see with self-esteem. Children's energy and blood pressure improve, and their lipid profiles universally improve. Before-and-after pictures of these successful children can be viewed on our website http://www.nomorefatkids.com/.

In general, the fewer carbohydrates we eat the better. However, we should get a minimum of 30 grams of carbohydrates per day. The standard approach of 60 to 75 grams of carbohydrates per meal and 30 grams per snack is way too much. If you do not want to restrict carbs to 30 grams per day, then somewhere between 60 to 100 grams per day will still allow for weight loss if it is combined with exercise.

Remember: Eat all the protein you desire. Do not worry about where the protein comes from or how it is prepared. People who eat more protein end up eating fewer total calories. Protein keeps us from being hungry and satisfies our appetite more than any other macronutrient. This is the key for successful weight loss. It is hard to lose weight if you are hungry all the time.

More ACCORD

2008-02-21T09:35:00.003-06:00

Laura Dolson, at About.com, recently posted about the ACCORD Trial mess in a Tale of Two Diabetes Studies. To get you started:

Many people who follow low-carb diets do it to achieve greater blood glucose control. Therefore, it was disconcerting when ten days ago the news was full of a large study of diabetics ("ACCORD") which was halted when it was found that patients in the more aggressive treatment group, who had lower blood glucose as a result, had more deaths than the patients with higher levels of blood glucose.

Note that none of the researchers said that the lower blood sugar itself caused the result -- it could have been the more agressive drug therapy that these patients were on, or some other factor. Nor are they clear on what caused the extra deaths at this point. And no one was recommending that treatment programs or goals be changed based on this preliminary data. In fact, the American Diabetes Association recommended not changing anything. However, this did not stop the media from producing headlines such as, "Diabetes Study Shows Lowering Blood Sugar Increases Death Risk" and "Diabetes Study Upends Another Long-held Belief". In my opinion, these kinds of headlines are blatantly irresponsible, and I also wonder what is to be gained by blasting this story everywhere before we have a decent analysis of what was going on in the study.

The findings in the ACCCORD study prompted researchers in Austalia to peek into a similar study in progress there called ADVANCE. Were the results the same? No, not at all! Their data did not show increased deaths in the lower blood glucose group, despite the fact that twice as much data has been collected so far in the ADVANCE study. So the interim advice is to wait until the results of both studies, plus one additional similar one, are available.

What are we to think?

Continue reading full article...

Normal Blood Sugars; Type 1 Teens

2008-02-19T08:50:00.002-06:00

Methods for achieving stable normoglycemia during an educational camp for youth with type 1 diabetes mellitus

Stan De Loach, Ph.D., CDE Certified Diabetes Educator and Clinical Psychologist in independent practice México, Distrito Federal, México

ABSTRACT
Objective
For children and adolescents with recent-onset DM1 to learn to quickly and safely achieve normoglycemia (71—99 mg/dl) and glycemic stability (MAGE score £ 95), using self-directed learning methods, insulin analogues, reduced concentration of dietary CHO, and ad libitum physical activity and SMBG, during an educational camp.

Methods
A 5-person international multidisciplinary team managed time, task, territory, technique, and technology boundaries, while responding to the educational and emotional needs of 9 Campers (8—17 years of age [11.8 ± 2.6]), with average diabetes duration of 1.62 years (± .88), during a residential 57-hour (3-day/2-night) diabetes camp.

Campers chose foods from meal buffets, calculated lispro insulin doses, and exercised and monitored BG at will. SMBG values documented in each Camper's combined glucose/ketone monitor furnished statistical data.

Results
Mean arrival and departure BG was 209 mg/dl (± 101.5) and 87 mg/dl (± 23), respectively [P less than .0025].

Mean 3-day BG (95 mg/dl ± 21) and MAGE score (66 ± 27) validated stable euglycemia.

Conclusions
Integrating self-directed diabetologic education, basal/preprandial insulin therapy with analogues, elective physical activity and SMBG, and reduced concentration of dietary CHO rapidly and safely established routinely normal mean daily glycemic levels and stability in this sample.

Gary Taubes

2008-02-16T19:52:00.001-06:00

Gary Taubes
Stevens Institute of Technology; February 6, 2008

Getting Creative with Seven Little Words

2008-02-15T10:15:00.001-06:00

In January, the New York Times Tara Parker Pope held a little contest on her blog, based on Michael Pollan's seven little words:

Eat food. Not too much. Mostly plants.

She asked readers "of the Well Blog to submit their own 2-3-2 word sequences sharing advice for the rest of us. Submit as many entries are you want. Here are the rules:

Dispense wisdom. Don't be gross. No profanity."

The winner?

Ate plants. A big heap. Still hungry.

Next week I'll review Pollan's newest book, In Defense of Food: An Eaters Manifesto - in the meantime, you can add your own 2-3-2 creation in the comments here!

There are none so blind as those who will not see

2008-02-15T09:09:00.004-06:00

An article in Yahoo News, Fast-food binge harms liver, but boosts good cholesterol: study, caught my attention yesterday. Within the article, which provided details from the findings of a neat little study in Sweden, was an intriguing quote from the lead researcher, Dr. Frederik Nystrom:

"That signs of liver damage were linked to carbohydrates was another key finding, he said.

"It was not the fat in the hamburgers, it was rather the sugar in the coke," he said."

The study?

A sort of duplication of Morgan Spurlock's Supersize Me - Fast food based hyper-alimentation can induce rapid and profound elevation of serum alanine aminotransferase in healthy subjects - in which subjects were to consume two meals a day from fast food restaurants and cease any daily exercise for a month.

Eat a-plenty they did! Where their baseline calorie intake was an average 2273-calories each day, during the study they consumed 5753-calories a day! Not only did they gain weight (as expected), they also experienced an increase in their waist circumference and BMI, their HOMA-IR (insulin resistance score) increased, and their liver panel indicated development of Non-Alcoholic Fatty Liver Disease (NAFLD) to boot!

The underlying culprit was simply calories, or even an increase in dietary fat - but the significant increase in both sugar and total carbohydrate in the diet.

Now take a look at what's being reported in the media, as picked up by Conditioning Research:

It is interesting to see how this has been reported elsewhere:

MedPage today says: Explain to interested patients that this small study suggested that overdoing it on high-fat foods, even during a short holiday period, for instance, and a failure to exercise can cause liver damage.

eh? the researchers said it was the sugar not the fat

NHS Choices says: The study does provide a further reason to avoid overeating (especially food high in saturated fat) if one is needed.

er...the researcher said that "The study showed that the increase in saturated fat correlated with the increase in healthy cholesterol"

---------------------
Then there is the CBS article, "The study, published in the advance online edition of Gut, doesn't show which was more damaging - bingeing on fatty food or being sedentary."

ABC News, "The extra fat is the big enchilada here..."

My take? There are none so blind as those who will not see.

Additional Blog Takes:

John Briffa - Why Carbs Can Turn Your Liver into Foie Gras
Hyperlipid - French Paradox in Sweden

And the Answer is...

2008-02-11T10:17:00.000-06:00

Steven H. Woolf, MD, MPH, from Virginia Commonwealth University and Marion Nestle, PhD, MPH, of New York University:

"When the prevailing message fails to achieve its intended aims or achieves the wrong ends, the solution is not to abandon the enterprise but to reshape the message to achieve desired outcomes."

Do Dietary Guidelines Explain the Obesity Epidemic?

What Would You Do?

2008-02-08T17:07:00.000-06:00

When the prevailing message fails to achieve its intended aims or achieves the wrong ends, the solution is to...?

More Weight Gained Over 6-Years on Low-Fat Diet

2008-02-08T12:03:00.000-06:00

Last week I posted about our collective belief, as a nation, that weight loss and maintenance is a problem solved by simple math - balance the "in" with the "out" columns of the calorie ledger and weight will be lost when the "out" exceeds the "in" and will be maintained when the two are equal.

Or so we're told.

I threw out the idea that weight isn't simply about math, but about chemistry.

The latest issue of the American Journal of Clinical Nutrition is out, and within is a very intriguing study where this very issue was central to the research conducted. It's one piece of the "weight is chemistry" equation, so let's take a look.

In the study, A novel interaction between dietary composition and insulin secretion: effects on weight gain in the Quebec Family Study, researchers followed subjects for six years to see what effect, if any, levels of insulin secretion had on weight.

The objective was to "determine whether physiologic differences in insulin secretion explain differences in weight gain among individuals consuming low- and high-fat diets."

This interest to investigate such was born from clinical trials where subjects consumed low-fat diets where results often revealed that there are huge variations between individuals consuming similar dietary ratios of macronutrients and reported calories; these differences are often chalked up to psychological and behavioral factors - motivation, compliance with diet, under-reporting of foods consumed, etc., ignoring the possibility that there is a physiological variation that may be at work.

In this study, the researchers noted the findings of Dansinger et al who compared four dietary approaches (Atkins, Ornish, LEARN and Zone), noting that "Of those assigned to the Ornish very-low-fat diet, mean weight loss was again small, 2 kg, but individual weight change ranged from almost –30 kg to >10 kg. This interindividual variation is commonly attributed to differences in motivation and compliance, but biological factors may also be contributory."

Thus the researchers in this study considered the the following for a test hypothesis: Low-fat diets are inherently high in carbohydrate because, for most people, the third major nutrient, protein, remains within a fairly narrow range. Carbohydrate has the most potent effect on insulin secretion of the major nutrients. Therefore, individuals with high insulin secretion consuming a low-fat diet might be especially susceptible to weight gain.

To investigate this, they "examined the associations between insulin concentration at 30 min (insulin-30) during an oral-glucose-tolerance test (OGTT) and change in body weight or waist circumference in the Quebec Family Study (QFS)" over a period of six years."

The findings were very interesting.

The primary findings of this study are that a proxy measure of insulin secretion strongly predicted weight gain and change in waist circumference over 6 y in adult whites, especially among those consuming lower-fat diets.

...our results and those involving GI suggest the existence of a unique physiologic phenotype that responds poorly to high insulin-stimulating diets, regardless of whether these diets are high in carbohydrate or have a high GI. Moreover, the combination of a high-carbohydrate and high-GI diet—that is, a diet high in glycemic load (GL)—may produce especially great weight gain among individuals with this phenotype.

While the researchers reached the conclusion that these findings suggest there exists a "unique physiological phenotype that responds poorly to high insulin-stimulating diets" - such assumes we're supposed to consume a low-fat, high carbohydrate diet; if we're not responding well to such a diet, it's because some have a unique physiological phenotype rather than consuming a diet that is at odds with human physiology.

I'd counter that it's just as likely it has nothing to do with a "unique phenotype" among us, but rather the expected results of a modern diet at odds with our physiology. Minor quibble.

Nonetheless, the finding is important as it points directly to individual metabolic factors playing a role within the context of the diet - low fat verus high fat - not just calories. In this study, it was insulin secretion. It mattered, especially in those consuming a low-fat diet.

ACCORD Trial Mess

2008-02-07T11:07:00.000-06:00

From the New York Times,

...a major federal study of more than 10,000 middle-aged and older people with Type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday.

It's hard to make heads or tails of what happened as the actual data has not been released - we're left to read through press reports and information provided by the NIH to try to determine what went wrong in the trial. Everyone seems to be bending over backward to get the message across that the intensive drug therapy - a large number of pharamaceuticals taken together - had nothing to do with the higher incidence of death in the trial.

But one must really wonder!

Speculation abounds, but that hasn't stopped some from foisting out the idea that it is the lowering of blood sugars to normal ranges that was the problem, not the means utilized to do it.

Dr. Irl Hirsch, a diabetes researcher at the University of Washington, said the study’s results would be hard to explain to some patients who have spent years and made an enormous effort, through diet and medication, getting and keeping their blood sugar down.

They will not want to relax their vigilance, he said.“It will be similar to what many women felt when they heard the news about estrogen,” Dr. Hirsch said. “Telling these patients to get their blood sugar up will be very difficult.”

Call me crazy, but didn't this study throw every pharmacuetical intervention at these folks?

Perhaps the problem wasn't the lowered blood sugars, but toxicity and side-effects from massive drug therapy to acheive a lower blood sugar level?

“Many were taking four or five shots of insulin a day,” he said. “Some were using insulin pumps. Some were monitoring their blood sugar seven or eight times a day.”

They also took pills to lower their blood sugar, in addition to the pills they took for other medical conditions and to lower their blood pressure and cholesterol. They also came to a medical clinic every two months and had frequent telephone conversations with clinic staff.

What this trial lacked was a control group utilizing an effective, non-pharmaceutical approach - a carbohydrate restricted diet - to lower blood sugars and A1c, which would have resulted in less medication, not more to achieve glycemic control.

If and when the data is published, I'll update - but for now think it highly irresponsible of anyone to speculate that it was simply the lowering of blood sugars that caused the problem given the wide variety and large number of medications used to intensively reduce blood sugars; and worse is to suggest that those with type 2 raise their blood glucose levels!

PETA in the Ring to Deny Obese Food (unless it's vegan)

2008-02-06T15:43:00.000-06:00

PETA to Mississippi: "Let Fat People Eat!"

February 5, 2008

Jackson, Miss. - A provocative bill introduced by state representative W.T. Mayhall Jr. that would bar Mississippi restaurants from serving obese people has captured PETA's attention, but the group is suggesting an amendment. The animal rights group thinks it can do HB282 one better: instead of refusing to serve overweight people altogether--something that would raise the ire of restaurants and patrons alike if the bill were actually passed and implemented--PETA is proposing that restaurants be required to serve only healthy vegan meals to consumers who are struggling with their weight.

Citing research studies that show that vegans and vegetarians are much thinner on average than their meat-eating counterparts, PETA points out that most vegan foods are naturally high in fiber (there is none in meat and dairy products), and low in fat and contain zero cholesterol (which is only found in animal products).

"There's no reason to starve fat people--they just need to pile their plates with healthy, vegan food," says PETA Vice President Bruce Friedrich. "Vegan meals like hearty vegetable casseroles, bean burritos, and pasta with mushrooms, tomatoes, and green peppers not only are satisfying but will slim you right down too."

PETA's letter to Rep. Mayhall follows:

February 5, 2008

The Honorable W.T. Mayhall Jr.
Mississippi House of Representatives

Dear Representative Mayhall:

On behalf of PETA's more than 1.8 million members and supporters, I am writing to commend you for your creative effort to combat the obesity epidemic in Mississippi. I'd also like to suggest a change to HB282 that we think would make it truly effective.

Changing the bill slightly would not just make a point--it could actually address (and even solve) Mississippi's obesity epidemic rather than simply generating a discussion about it.

Instead of refusing to serve obese people, restaurants could be required to serve them only vegan dishes. Vegan food is not only delicious and satisfying, but overwhelming scientific evidence shows that vegans and vegetarians are far less likely to be overweight than meat-eaters. Vegans are also far more likely to be in better overall health because, among other things, vegan foods contain no cholesterol and lots of fiber, the complete opposite of meat- and dairy-based meals. The American Dietetic Association--the nation's largest group of nutrition professionals--reviewed hundreds of studies and concluded that vegetarians have lower rates of obesity, heart disease, diabetes, and certain types of cancer than people who eat meat.

A U.S. government review of studies on weight loss found that two-thirds of dieters gain back all the weight they've lost within a year, and a whopping 97 percent gain it all back within five years. The only weight-loss plan that has been proved to take weight off--and keep it off--for more than a year is a vegan diet. Most vegan foods are naturally low in fat, so quantity and calorie restrictions are often unnecessary. Obese people can still eat the portions that they're used to while watching pounds slip away and good health return!

Please contact me at 757-622-7382 if you have any questions. Thank you for your consideration. Please accept PETA's best wishes for good health (and trim waistlines) for all Mississippi residents.

Sincerely,

Bruce Friedrich
Vice President

Tweaking the Don't Feed the Obese Bill

2008-02-05T13:53:00.001-06:00

Many will recall the bill introduced in Mississippi that would ban restaurants from serving obese people.

Now it seems some recognize that such a law would be unworkable, so they're trying to tweak it along to be more palatable for passage.

A press release today touts the ideas of public interest law professor John Banzhaf, who suggests "Focusing your bill on protecting children rather than adults would remove the major objection to it, and provide a strong argument for it - one likely to be echoed by many groups concerned about child health and welfare."

BELOW IS A DRAFT OF THE MAIN PROVISIONS OF THE REVISED BILL BANZHAF PROPOSES:

No employee of a fast food chain outlet shall serve to any child who appears, to a reasonable person, to be under the age of 16 and to be obese, any single food item reported by the company to contain more than 500 calories, nor any meal where the calories in all of the food items in the meal (including any drinks, but not including sauces not provided at the counter) as reported by the company exceed 1000 calories.

However, all such food items may be served if the child is accompanied by a parent or guardian, or if the child presents a letter or note on the letterhead of a physician, hospital, or other health care entity certifying that he is not obese or that for medical reasons he should be served such food items, or if he or she provides such proof in a form or manner approved by the State Department of Health, including but not necessarily limited to, a wallet-sized card from any of the above sources or from the school which the child attends.

Oy!

Read the full press release here.

Estimated 10% of Teens in US Have Metabolic Syndrome!

2008-02-05T13:27:00.000-06:00

The February issue of the Journal of Pediatrics reports a recent study finding an alarming increase in the prevalence of Metabolic Syndrome (MetS) in teens in the United States.

First, let's look at the definition of MetS for teens used to determine how many teens are estimated to have the condition:

a waist circumference at or above the 90th percentile for age and sex;
blood pressure at or above the 90th percentile;
a high triglyceride level at or above 10 mg/dL;
a low HDL cholesterol level at or above 40 mg/dL;
and an impaired glucose metabolism at or above 100 mg/dL (pre-diabtes)

Using data from the National Health and Nutrition Examination Survey (NHANES) from 1999-2002, the researchers found that an estimated 9.4% of teens meet the definition MetS; and that 33% of obese teens, classified by BMI, fall within the definition.

This is pretty disturbing when we consider the last time such data was reviewed, back in 2003 (using earlier-years NHANES data), it was found that 4% of teens met the difinition of MetS above.

To be fair, some quibble that the definition for teens is less stringent than adults, and that if the adult definition is used, then 5.8% of teens meet the adult definition of MetS and 25% of obese teens meet the adult definition.

The bottomline is that no matter how you slice and dice the data, there is a rising prevalence of metabolic syndrome among teens in the United States.

Back on October 2006 I wrote about the increasing prevalence of hyperinsulinemia in the adult population in the United States. At the time, I wrote, "[l]ike the canaries in the mine, slowly dying in the presence of odorless but harmful gases, we're slowly dying in the presence of seemingly logical yet harmful dietary recommendations. All the researchers can keep repeating is eat less and move more; while encoraging us to eat more more whole grains, more fruits and vegetables, more skim milk and non-fat dairy, more beans, more soy and limit saturated fat by eating less meat."

Now today, we're seeing an alarming rise in the incidence and prevalence of metabolic syndrome in our teens - tomorrow's adults - and being spoon-fed the pab that "that the increased prevalence is driven by the rise in obesity."

As the Editor's Perspective noted in the journal, "The obesity epidemic in children is out of control. Our children are living in an obesiogenic environment that fosters all of the components of the metabolic syndrome, regardless of the definition used. It is very likely that a high proportion of youth today who have all the components of the metabolic syndrome will go on to develop cardiovascular disease and type 2 diabetes in adulthood. Clinicians must continue to increase their awareness of the existence of the syndrome and begin to treat it before it becomes even more of a health hazard for our youth."

Here's the big, glaring problem - the elephant in the room if you will - it isn't weight gain per se that is driving up the incidence of metabolic syndrome in our young population - it is the diet they're consuming that's driving up their blood glucose and insulin; and that is causing elevated triglycerides, suppression of HDL, hypertension, visceral fat accumulation and impaired glucose metabolism in a state of chronic hyperinsulinemia!

This is happening despite improvements to school lunches, greater awareness about limiting sweetened beverages, increasing activity in and out of school, and consistent messages about healthful "low-fat" eating inundating our kids today; this is happening because they're still being encouraged to consume a diet rich with carbohydrate, the message now being whole grains are better than refined grains.

It's excessive carbohydrate driving the bus here and until we're able to, as a population, wrap our head around the idea that we cannot continue to feed our children a diet rich with excessive carbohydrate - whole grain or otherwise - that is also concurrently deficient in micronutrients and essential fatty acids and amino acids, we will not see these trends reverse.

Bill Introduced to Mandate Restaurants Deny the Obese Service

2008-02-01T10:48:00.000-06:00

MISSISSIPPI; HOUSE BILL NO. 282
An act to prohibit certain food establishments from serving food to any person who is obese, based on criteria prescribed by the state department of health; to direct the department to prepare written materials that describe and explain the criteria for determining whether a person is obese and to provide those materials to the food establishments; to direct the department to monitor the food establishments for compliance with the provisions of this act; and for related purposes.

Be it enacted by the legislature of the state of Mississippi:
SECTION 1.
(1) The provisions of this section shall apply to any food establishment that is required to obtain a permit from the State Department of Health under Section 41-3-15(4)(f), that operates primarily in an enclosed facility and that has five (5) or more seats for customers.

(2) Any food establishment to which this section applies shall not be allowed to serve food to any person who is obese, based on criteria prescribed by the State Department of Health after consultation with the Mississippi Council on Obesity Prevention and Management established under Section 41-101-1 or its successor. The State Department of Health shall prepare written materials that describe and explain the criteria for determining whether a person is obese, and shall provide those materials to all food establishments to which this section applies. A food establishment shall be entitled to rely on the criteria for obesity in those written materials when determining whether or not it is allowed to serve food to any person.

(3) The State Department of Health shall monitor the food establishments to which this section applies for compliance with the provisions of this section, and may revoke the permit of any food establishment that repeatedly violates the provisions of this section.

SECTION 2.
This act shall take effect and be in force from and after July 1, 2008.

http://billstatus.ls.state.ms.us/documents/2008/pdf/HB/0200-0299/HB0282IN.pdf

Poor Math Skills Leading to Weight Gain?

2008-01-31T10:46:00.001-06:00

What if Willpower Matters Little in the Long-Term for Weight? provoked quite a discussion in the comments and led me to consider my own beliefs about the role of willpower in both weight loss and weight maintenance for the long-term after losing weight.

What got me thinking about the role of willpower is our collective belief that one must exert their will over their desire for food in order to overcome the strong desire to eat, often what amounts to too much food.

We're repeatedly told that we suffer mindless eating habits, a toxic food environment, and a host of other influences which lead us to overeat; all of which can be overcome if we simply set our minds to choosing foods wisely, strictly rationing our intake with portion control methods, and sticking to recommended intakes of each food group to target particular ratios of calories from carbohydrates, proteins and fats.

When doing these things fails to produce long-term weight management, the individual is often the target of blame - they failed by failing to follow the recommendations. They failed to have adequate willpower to continue as directed. They failed to restrict calories sufficiently enough for the long-term to maintain weight effectively.

Rather than challenge the concept - consciously restricting food intake - we instead accept that such is normal and focus on the failure as an execution problem by the individual, often stated many different ways, but always boiling down to calories in exceeding calories out if the individual could only get it right then all would be well.

This makes weight loss and management a math problem.

In order to lose and maintain weight one must then be good at math in order to be able to constantly be vigilant in counting their calories in each day to keep consumption within target outputs.

So, maybe it isn't willpower, but poor math skills leading to long-term failure to maintain weight loss?

No, I don't really believe that...but, it does open the door to consider the idea that weight isn't simply a math problem that is easily solved by changing inputs and outputs of numbers; that in the long-term exerting will to restrict calories over desire to eat is not really all there is to successful weight management.

If weight is not a math problem, then what is the problem?

If we look at the issue differently - set aside the idea that in the long-term one must exert willpower to maintain a calorie balance and seek to understand what truly drives our appetite, we find that weight is not a math problem, but a chemistry problem!

Weight is chemistry.

Chemistry thus influences obligate requirements for nutrients and energy, as well as our ability to exert our will over our desire.

Willpower then depends upon chemistry.

What does the data say about that concept? We'll take a look in upcoming posts - in the meantime, your comments and thoughts are welcome!

I'll be back Thursday

2008-01-21T16:38:00.000-06:00

So, you know how it goes - you think your schedule is such that you'll have plenty of time to get everything done. Except it doesn't always go that way. This week is no exception - we're leaving on vacation tomorrow, so I'll be traveling and unable to post.

UPDATE 01/27/08: I'll return to posting on January 31, 2008...thank you for your patience!

Message in the Dryer: Lose Weight

2008-01-19T08:18:00.001-06:00

The Ad Council and the U.S. Department of Health and Human Services are placing tiny T-shirts in dryers throughout New York City, urging laundry-doers to “Shrink a few sizes.”

Ouch!

The campaign, done pro bono by McCann Erickson, sends the presumed to be overweight or obese to HHS’s Smallstep site, where they are further encouraged to “shed those holiday pounds, reduce their risk for obesity and lead a healthy lifestyle,” according to the press materials.

So now the government thinks shaming people is going to make them lose weight?

What if Willpower Matters Little in the Long-Term for Weight?

2008-01-18T09:32:00.000-06:00

In my last post I noted that the idea of counting calories to maintain a balance between calories in and calories out is an unnatural state of being. Yet is it exactly what is promoted, has been promoted for decades, and increasingly is being promoted in what could be considered a 'cradle to grave' approach, where even children are being subjected to messages designed to make them ever aware of calories in, calories out - if they gain weight, it's obviously their fault that they didn't get it right.

As I said in my previous post, "For some reason we are stuck in this thinking that the problem isn't the concept, but the execution."

Some lively discussion in the comments followed, as well as a good number of emails - with most boiling down to four main themes - any type of restriction is difficult, counting carbohydrates is as unnatural as counting calories, most people won't eat just whole, natural foods and most people won't do what it takes anyway.

How depressing!

But I definitely understand the points made, and think at least opening a discussion on the issue has value for the future.

Afterall, we can safely say, based on the evidence available, almost every weight loss diet dreamed up in the last century works - data clearly shows that calorie restriction, dietary fat reduction, carbohydrate restriction, increasing protein, manipulating glycemic index or glycemic load, using shakes and meal replacements, fasting approaches, and even weight loss surgery all enable an individual to lose weight.

The diet or medical intervention one utilizes does not matter all that much - they all work for weight loss - so to say one approach is better than the other for weight loss truly has little value for long-term success to maintain weight loss.

Weight loss isn't the problem - keeping the weight off afterward is the really critical issue that we continue to fail to address in a meaningful way to actually see long-term results.

Oh, don't get me wrong, the diet industry, along with the medical and research communities talk a good story, point to data from those few who manage to maintain their weight loss in a national registry, and repeat again and again that failure comes down to lack of willpower in the individual. If only a person would continue, for the long-term, the dietary principles they utilized to lose the weight, they would not gain back the weight lost.

As Sandy Szwarc said in a Junkfood Science post early last year, "Only long-term results, after weights have stabilized, are relevant when evaluating any diet and, more importantly, any actual impact on health outcomes."

While I don't always agree with Sandy's take on things, or her conclusions, she is well known for taking an evidence-based approach in her writing and on this issue I agree 100% - not because everything she wrote in the above linked article was spot-on, but because she stated something so obviously ignored in the current urgency to do something about the "obesity epidemic" that seems to have no workable long-term solution.

The rising incidence of obesity in the United States is not new - for decades now we've watched as each year more and more of our population is classified as overweight or obese; and it does not appear to be reversing, despite the continuous messages to eat less and move more, be aware of calories in and calories out, just do it and stick to it.

Oddly it seems, the louder the messages get, the fatter the population grows.

Yet, while it's acknowledged that in the long-term dieting doesn't seem to result in long-term weight stabilization and maintenance, few are asking why.

Instead we're left with the idea that all these tens of millions of people who lose weight on a diet lack the willpower and resolve to maintain a healthy-balanced diet in the long-term.

It's the failure of the individual not the dietary principles they're told work - as I said before, the failure is not the concept, but the execution.

Every single year, tens of millions of people set out to lose weight and the vast majority do lose weight - they celebrate, buy new clothes, enjoy high self-esteem, are empowered by their success and feel great.....and then are just too damn weak, so they eat themselves back to where they started?

Is this not where the idea that it's a lack of willpower takes us?

If it's not willpower, then what does enable successful weight loss followed my maintenance and improved health outcomes in the long-term?

Before embarking on an exploration of this issue next week, I'd like to hear from readers about their experiences - success and failure - and what ultimately you've learned over the years? If you had to give advice on how to maintain weight loss for the long-term, what would you suggest based on your experiences?

Calorie Counting: A Hard Sell

2008-01-15T10:07:00.000-06:00

The results of a survey conducted by the International Food Information Council were presented at the American Farm Bureau Federation's annual conference. The highlights and findings were discussed in an article in the Voice of Agriculture, in which we learn "42 percent of survey respondents feel that the food and health information they receive from various sources is contradictory. Slightly more than 30 percent said it was inconsistent."

Rachel Cheatham, Director of Science and Health Communications for the IFIC says "This really is the issue, [t]here is an overload of information. How do we package this information so that people understand it and know what to do with it?”

The survey results found that "very few people understand or apply the concept of energy balance, in which calories consumed and calories used are treated as an equation that results in weight maintenance, or depending on the individual’s goals, weight loss or gain. Almost half of the survey respondents said they don’t balance the calories they take in with the calories they use, while 16 percent said they do increase their exercise to compensate for eating more than usual."

I have to say I'm not surprised - it's simply not natural for us to be so calorie obessed, to the point where we are ever aware of the calories were eating each day - so it's no wonder that most people don't make it a point to "balance" calories in and calories out each day!

The article however makes this an issue of selling the concept to consumers rather than questioning its validity; "calorie counting is a hard sell."

For some reason we are stuck in this thinking that the problem isn't the concept, but the execution. If it were only that easy. If it were only a matter that people don't get it and more education would lead to better compliance. If it were only a matter of calories in and calories out, and just following a recipe to eat x-servings of this and y-servings of that each day to remain within prescribed calorie intake.

I've said it many times before - the flaw is in the recommendations, not in those trying to follow them! It's more than just calories, and rather than try to sell consumers on an unnatural way of eating each day, perhaps time is better spent understanding how modification of the macronutrients (carbohydrate, protein and fat) can lead to spontaneous reduction of calorie intake without counting calories.

Until the powers that be begin to address the role of nutrients and micronutrients on hunger and satiety, on nutritional status, and on health and well-being, little is going to change.

Afterall, the thinking goes that it remains the fault of the individual to not follow the recommendations rather than the recommendations failing to live up to expectations and provide the necessary nutrients and satiety to be followed long-term successfully.

I've said before, "The failure of the dietary recommendations are no small matter, various agencies go to great pains to explain away the long-term failure and wind up making the issue one of personal failure rather than admit the flaw is in the recommendations."

If you'd like to read more on the issue of our flawed recommendations, two previous articles provide greater depth on the subject:

Protein Provides Satiety Through PYY

2008-01-14T11:50:00.000-06:00

In our strange world, we have researchers now promoting the idea that a pharmaceutical version of the gut hormone PYY may offer a solution to help individuals lose weight.

In the MSN article, Natural Gut Hormones May Provide a Treatment for Obesity, we learn that researchers are seeking to develop a pill to provide the satiety hormone PYY.

"The advantage of developing weight loss medications based on gut-derived satiety hormones is that they enhance a process that occurs naturally. It is expected, therefore, that side effects will be minimal," says Dr Sainsbury-Salis.

Folks, we're not PYY deficient; in fact, I'd argue we're not eating the foods that stimulate PYY to effectively sate appetite naturally.

As I noted in a previous blog post about research investigating PYY, "A high protein diet led to spontaneous calorie reduction as PYY increased. The phenomenon was consistent with both the animal model using mice and in human studies used to validate the mice model. Over a longer term, the higher protein diet stimulated weight loss and enhanced PYY synthesis and secretion in mice."

As I noted in that post, the study I wrote about included quite specific detail about how diet influences the release of PYY in humans - "The ready availability of carbohydrate-rich grains and cereals has been a recent development in human nutrition with the onset of organized agriculture. Many of the physiological systems that regulate food intake were probably established and may function better under lower-carbohydrate and higher-protein dietary conditions."

Those were not my words, but the words of the researchers!

And now we have researchers looking to design a pill to provide what we already have naturally - if we eat adequate protein and fat. But, let's not go there and discuss diet, let's just pop a pill and continue along with the supposed "healthy diet" that obviously is not sating out appetite!

Insulin Resistance and Cardiomyopathy

2008-01-10T08:43:00.000-06:00

An interesting abstract was published in the recent issue of the Journal of the American College of Cardiology - Insulin-Resistant Cardiomyopathy, Clinical Evidence, Mechanisms, and Treatment Options.

Increasing evidence points to insulin resistance as a primary etiologic factor in the development of nonischemic heart failure (HF). The myocardium normally responds to injury by altering substrate metabolism to increase energy efficiency. Insulin resistance prevents this adaptive response and can lead to further injury by contributing to lipotoxicity, sympathetic up-regulation, inflammation, oxidative stress, and fibrosis.

Animal models have repeatedly demonstrated the existence of an insulin-resistant cardiomyopathy, one that is characterized by inefficient energy metabolism and is reversible by improving energy use. Clinical studies in humans strongly support the link between insulin resistance and nonischemic HF.

Insulin resistance is highly prevalent in the nonischemic HF population, predates the development of HF, independently defines a worse prognosis, and predicts response to antiadrenergic therapy.

Potential options for treatment include metabolic-modulating agents and antidiabetic drugs. This article reviews the basic science evidence, animal experiments, and human clinical data supporting the existence of an "insulin-resistant cardiomyopathy" and proposes specific potential therapeutic approaches.

-------------------------

Too bad the researchers didn't include a carbohydrate restricted diet in their list of potential treatment options!

Two-Fold Reduction in Triglycerides! How? Low-Carb!

2008-01-10T08:40:00.000-06:00

In a recent study - Metabolic Effects of Weight Loss on a Very-Low-Carbohydrate Diet Compared With an Isocaloric High-Carbohydrate Diet in Abdominally Obese Subjects, published in the Journal of the American College of Cardiology, researchers reported favorable results for obese adults randomly assigned a low-carbohydrate diet for 24-weeks (six months).

As reported in heartWire, "After six months, isocaloric energy-restricted very-low-carbohydrate, high-fat and high-carbohydrate, low-fat diets produced similar weight loss and substantial reductions in a number of cardiovascular disease risk markers," write Jeannie Tay (Flinders University, Adelaide, Australia) and colleagues in the January 1, 2008 issue of the Journal of the American College of Cardiology.

"Neither diet displayed adverse effects, suggesting diverse dietary patterns, including very-low-carbohydrate, high-fat diets, may be tailored to an individual's metabolic profile and dietary preference for weight management."

The investigators note that while the traditional diet reduced LDL-cholesterol levels, the low-carbohydrate, high-fat diet resulted in greater increases in HDL cholesterol and singificantly larger reductions in triacylglycerol levels (a two-fold greater reduction compared to the traditional low-fat diet).

In fact, if we go to the full-text, we find the researchers went so far as to write "consistent with other recent studies, the VLCHF (very-low-carb high-fat) diet produced greater reductions in TAG and increases in HDL-C than the HCLF (high-carbohydrate low-fat) diet. This suggests that the VLCHF diet as a weight loss strategy may confer the greatest clinical benefits in patients who present with hypertriglyceridemia, low HDL levels, abdominal adiposity, and insulin resistance"

Did you catch that - "greatest clinical benefits" - part?

In the paper we learn that subjects were randomly assigned to either of the moderately energy-restricted diet plans for 24 weeks. For those assigned to the very-low-carbohydrate, high-fat diet, 4% of total calories were obtained from carbohydrates, 35% from protein, and 61% from fat, including 20% of total calories from saturated fat. Subjects randomized to the high-carbohydrate, low-fat diet followed a more traditional macronutrient profile, with 46% of calories obtained from carbohydrates and 30% from fat, including <8% from saturated fat.

Now we all know the American Heart Association insists we must keep saturated fat at less than 7% of our calories because intakes higher than that will kill us (eye roll) - yet here we have stunning improvements with saturated fat intake at/above 20% daily for six months! If you haven't read it yet, Dr. Richard Feinman wrote a good article about saturated fat recently.

So, what gives? It seems the subjects in this study significantly reduced their carbohydrate, and that carbohydrate does matter. Also, this study confirms previous data published that found similar improvements in those restricting carbohydrate.

Slowly but surely more data is coming forward that validates carbohydrate restriction for not only weight loss, but health improvements!

Animal products are ‘whole foods,' too

2008-01-09T17:15:00.000-06:00

Dana Carpender's latest - I couldn't have said it better myself!

Animal products are 'whole foods,' too
Dana Carpender

The nutritional buzz phrase is 'whole foods.' This is encouraging. I've been watching the nutrition scene long enough to remember when people who insisted that whole-grain bread was more nutritious than enriched bread were scorned as 'food faddists.'

But the admonitions to eat whole foods seem to apply only to grains, fruits and vegetables. Officialdom still recommends discarding large fractions of animal foods. Yet few see these fractionated animal foods as the refined, depleted foods they are.

Take dairy. Virtually all recommendations for dairy products include the qualifiers 'low-fat' or 'fat-free.' But that's not the way it comes out of the cow. Yes, whole milk has more calories than skim. It also has far more vitamin A, because it's carried in the butterfat. (Some skim milk is fortified with vitamin A —- the equivalent of adding a few vitamins back to nutritionally depleted white flour.) Because fat aids in calcium absorption, you'll get more calcium from whole milk. Whole milk from grass-fed cows supplies CLA, a fat that increases fat-burning and reduces heart disease and cancer risk, and omega-3 fats, which reduce inflammation, and heart disease and cancer risk. It is worth paying premium prices for such milk.

And eggs. Oh, poor eggs. There they are, just about the most perfect food in the world, and what do people do? They throw away the yolks. The part with almost all the vitamins, including A, E, K and the hard-to-come-by D, not to mention brain-enhancing choline and DHA. Eggs from pastured chickens also have yolks rich in omega-3. Better to throw away the whites, not that I'd recommend that, either. Just eat whole eggs, will you?

Then there's chicken. When did 'chicken' become synonymous with 'boneless, skinless chicken breast?' Chicken breast is a good food, but the whole chicken is better. Dark and white meats both have nutritional strengths. They are not identical in vitamin and mineral content. Chicken skin is a good source of vitamin A, again because it's fatty. I wrote recently about liver's nutritional bonanza, and hearts are nutrient-rich as well, making giblet gravy a great idea. Simmering the leftover chicken bones yields flavorsome broth rich in highly absorbable calcium and joint-building gelatin. (I save my steak bones, too, for beef broth.)

Our ancestors, ever mindful of where their next meal was coming from, relished every edible part of every animal they killed. Indeed, paleoanthropologists assert that hunter-gatherers ate the rich, fatty organ meats first, preferring them to muscle meats, and smashed bones to eat the marrow. As recently as a century ago, marrow was such a popular food that special spoons were made for scooping it out of bones. I love the stuff. I've been sucking the marrow out of lamb-chop bones since I was a tyke. A 1997 article in the journal Nature asserts that human brain capacity decreased at the dawn of agriculture 10,000 years ago, very likely because of a reduction in animal-fat consumption. Whole animal foods are part of our nutritional heritage.

My low-carbohydrate eating habits are often referred to as a 'fad.' Whatever. If it was good enough for my hunter-gatherer ancestors, it's good enough for me. Do you want to know what's really a fad? Removing the fat from milk and the yolks from eggs, and discarding three- quarters of the chicken, all organ meats and most bones. There's not a culture in the world where our narrow, refined, low-fat, flavorless versions of animal foods are part of the traditional diet.

Continuing reading for recipe included in original article!

ADA Says Low-Carb Okay for Weight Loss, So What?

2008-01-09T13:19:00.000-06:00

An article published today in Diabetes Health, ADA Now Supports Low-Carb Diets, reminded me that I have not yet posted my thoughts on the updated guidelines for Medical Nutrition Therapy (MNT) recently issued by the American Diabetes Association (ADA). This will probably be longer than usual, so bear with me!

On December 28, 2007, the ADA issued a press release to highlight the publication of and changes within their clinical practice recommendations, better known as the Standards of Care in Diabetes.

Each year the guidelines are updated and this year was no exception - as noted in the press release, "Until now, the ADA did not recommend low carbohydrate diets because of lack of sufficient scientific evidence supporting their safety and effectiveness. The 2008 Recommendations include a statement recognizing the increasing evidence that weight-loss plans that restrict carbohydrate or fat calorie intake are equally effective for reducing weight in the short term (up to one year). The "Standards of Medical Care in Diabetes--2008" document reviews the growing evidence for the effectiveness of either approach to weight loss. In addition, there is now evidence that the most important determinant of weight loss is not the composition of the diet, but whether the person can stick with it, and that some individuals are more likely to adhere to a low carbohydrate diet while others may find a low fat calorie-restricted diet easier to follow."

There are two main issues I'll look at in the above statement today:

1. that low-carbohydrate diets are as effective as low-fat calorie restricted diets for weight loss for up to one-year

2. that composition of diet is less important than whether a person can stick with the dietary approach for weight loss.

In order to fully understand exactly what the ADA is saying with regard to the first issue, we need to return to the August 2006 issue of Diabetes Care, where an updated consensus statement was published, Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A consensus statement from the American Diabetes Association [ADA] and the European Association for the Study of Diabetes [EASD]

As I noted in my review of that consensus statement "Rather than question the dietary recommendations, or explore emerging data supportive of dietary interventions that are different from the recommendations, the statement instead concludes that "the limited long-term success of lifestyle programs to maintain glycemic goals in patients with type 2 diabetes suggests that a large majority of patients will require the addition of medications over the course of their diabetes."

The final sentence in the section discussing medications, which followed the section on lifestyle intervention, sets the stage for what is to come, "addition of medications is the rule, not the exception, if treatment goals are to be met over time."

In August 2006 the ADA, along with the EASD, threw up their hands and decided that dietary and lifestyle intervention was futile, therefore the only logical place to go was intensive pharmaceutical intervention at diagnosis.

The authors wrote, in the paper's conclusion, "We now understand that much of the morbidity associated with long-term complications can be substantially reduced with interventions that achieve glucose levels close to the nondiabetic range. Although new classes of medications, and numerous combinations, have been demonstrated to lower glycemia, current-day management has failed to achieve and maintain the glycemic levels most likely to provide optimal health care status for people with diabetes."

On this the ADA remains steadfast - pharmacological intervention is the first step with lifestyle intervention upon diagnosis. The freely available full-text of the Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy clearly continues with the August 2006 consensus that lifestyle intervention for those diagnosed with diabetes will not work, therefore medication must be initiated upon diagnosis.

Yet we find the ADA falling all over itself to tout its position change for weight loss - that now a low-carbohydrate diet is considered as effective as a low-fat calorie restricted diet for weight loss? And somehow we're supposed to be jumping for joy that they made this change?

If we take the entire package of documents published in the Diabetes Care Supplement, we cannot reach any conclusion other than the ADA has made up its mind and is not going to review the evidence. They may concede that a low-carbohydrate diet can help with some loss of weight, but nothing else - and even that carries the caveat that one must be intensely monitored if they do decide to follow a low-carb diet.

But, going back to the first point - the concession that low-carbohydrate diets and low-fat calorie restricted diets are both effective for weight loss over the short-term.

Quite frankly this statement by the ADA is meaningless when we consider the full context of their position because they hold that "current-day management has failed to achieve and maintain the glycemic levels most likely to provide optimal health care status for people with diabetes."

While many lauding the change as a step in the right direction for the ADA, I'm not impressed, nor convinced - if anything, the ADA only confirmed what they've already said previously.

We only need to go back to the publication of a 22-month study, in which diabetic subjects were found to have significant health improvements following a low-carbohydrate diet, to read the ADA reaction in an article at WebMD - "While agreeing that carbohydrate restriction helps people with type 2 diabetes control their blood sugar, ADA spokesman Nathaniel G. Clark, MD, tells WebMD that the ADA does not recommend very low-carb diets because patients find them too restrictive. "We want to promote a diet that people can live with long-term," says Clark, who is vice president of clinical affairs and youth strategies for the ADA. "People who go on very low carbohydrate diets generally aren't able to stick with them for long periods of time."

Which brings us to issue two above - diet composition does not matter as much as a diet one can follow, a theme the ADA has been hot and heavy on for at least two years now.

Let's review the sentence in the ADA press release carefully, "In addition, there is now evidence that the most important determinant of weight loss is not the composition of the diet, but whether the person can stick with it, and that some individuals are more likely to adhere to a low carbohydrate diet while others may find a low fat calorie-restricted diet easier to follow."

Evidence? What evidence?

The Standards of Medical Care in Diabetes 2008 includes this sentence, "Although numerous studies have attempted to identify the optimal mix of macronutrients for meal plans of people with diabetes, it is unlikely that one such combination of macronutrients exists. The best mix of carbohydrate, protein, and fat appears to vary depending on individual circumstances. For those individuals seeking guidance on macronutrient distribution in healthy adults, the Dietary Reference Intakes (DRIs) may be helpful;" referencing the IOM documents published back in 2002.

The Nutrition Recommendations and Interventions for Diabetes: A Position Statement of the American Diabetes Association 2008 includes "Nutrition counseling should be sensitive to the personal needs, willingness to change, and ability to make changes of the individual with pre-diabetes or diabetes. (E)"

Note with that the letter "E" assigned to it, classing it as "expert opinion" - so again, where is the evidence? Each study referenced dates between 1997 and 2004 - so what exactly is the new evidence alluded to in the updated documents?

Oh, that's right, there is NONE...this is simply an opinion and has already been stated numerous times before.

I've said it before, "evidence versus sophistry; with just enough opinion thrown in to ensure glycemic control remains elusive..."

The ADA refuses to acknowledge that diabetics deserve clear statements about how to achieve normal blood sugars, and instead continues headlong on this path that they somehow deserve to eat like anyone else in the population and can mediate the effects of carbohydrate-rich food with medications.

:::sigh:::

So yeah, the ADA now says one can try a low-carbohydrate diet for weight loss, for the short-term (up to 1 year) and that some will somehow manage to follow such a diet. But let's not forget, if you do decide to follow a low-carbohydrate diet, you're also going to be subjected to much more intense monitoring than your low-fat calorie restricted peer and you're left with no advice other than the same-old same-old once your year is up.

Then what?

The failed ADA diet?

Lifelong medication with continued stepped-up pharmaceutical requirements with each passing year until you're dependent upon insulin injections?

The ADA, even with this new position that a low-carbohydrate diet may be used for up to one year for weight loss, still continues to fail in their mission - to prevent and cure diabetes and to improve the lives of all people affected by diabetes - because they refuse to actually review the hard data available; and instead continue in this sophistry that dietary recommendations need to be based upon what one wants to eat rather than what one should eat based upon metabolic, hormonal and physiological facts.

Low-GI Diet for 1-year Suggests Improvements for T2DM?

2008-01-08T13:19:00.001-06:00

As I was browsing through the January issue of the American Journal of Clinical Nutrition this weekend, a perspective written by John Miles caught my attention. In his article, A role for the glycemic index in preventing or treating diabetes, he wrote, "Elsewhere in this issue of the Journal, Wolever et al (7) report the results of the Canadian Trial of Carbohydrates in Diabetes (CCD). Patients with well-controlled type 2 diabetes who were treated with diet alone were randomly assigned to receive either a high-GI diet, a low-GI diet, or a low-carbohydrate, high-monounsaturated fat diet for 1 y.

The study was carefully conducted and of longer duration than many earlier trials. The investigators found no weight loss and a small increase in glycated hemoglobin (HbA1c) in all 3 groups. This increase in HbA1c is what one would expect with no intervention (8). The fact that glucose concentrations 2 h after an oral glucose challenge were significantly lower in persons who had followed the low-GI diet for 1 y than in those who followed the other 2 diets for 1 y suggests improvement in either insulin sensitivity or insulin secretion (or improvements in both)."

Sounds like a compelling study, so intrigued, I clicked open the study mentioned, The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein, and read the abstract.

In it, researchers concluded "In subjects with T2DM managed by diet alone with optimal glycemic control, long-term HbA1c was not affected by altering the GI or the amount of dietary carbohydrate. Differences in total:HDL cholesterol among diets had disappeared by 6 mo. However, because of sustained reductions in postprandial glucose and CRP, a low-GI diet may be preferred for the dietary management of T2DM."

Here I was even more intrigued - a study trial comparing three different dietary approaches, and one low-carb for a year?

But I wondered, how was it that the low-carb diet didn't do as well as other studies would suggest it should have?

Wanting to know this, I opened the full-text to understand how it was possible that greater improvement was not found in the "low-carbohydrate" subjects and why HbA1c didn't remain stable or improve in the course of one year with either low-GI or low-carbohydrate diets. Previous study data published by others would suggest that HbA1c would at least remain stable with low-carb, no?

Well, it took no more than five minutes to fully see why things turned out as they did - the "low-carbohydrate" diet was not a low-carbohydrate diet afterall - at baseline the subjects assigned the low-carb diet ate an average of 210g of carbohydrate each day and during the low-carb diet consumed an average of 199g of carbohydrate each day.

Hello? In whose fantasy world is 199g of carbohydrate each day a low-carb diet?

Ah, but I digress...

While the researchers took pains to measure many risk factors, at the end of the year, the subjects in every group experienced progression of their diabetes risk factors - there simply was no improvement to laud in this trial, no matter how you twist the data.

What's absolutely disappointing in how the findings are presented is that the researchers honed in on two measures of improvement - CRP and post-prandial glucose - to the exclusion of significant declines in other measures that are critically important for those with type II diabetes.

Where do I even begin?

Weight remained fairly stable in all three groups, with only the low-GI group actually gaining some weight, despite no meaningful difference in calorie intake from baseline through one year on the low-GI diet.

Worse though is the lack of critical thought around the marked and significant increase in waist circumference in all three diet groups.

The high-GI group started with a waist circumference of 99.1cm - it increased over the year to 103.1cm (+1.6 inches) - this despite stable weight on the scale (84.4kg at baseline; 84.3kg after 1-year on the diet).
The low-GI group started with a waist circumference of 98.3cm - it increase over the course of the year to 104.9cm (+2.6 inches). They also experienced a weight gain, going from 81.1kg at baseline to 83.9kg at the end of the study (+6.2-pounds gained).
The supposed "low-carbohydrate" group - eating 199g carbohydrate on average - started with a waist circumference of 98.6cm - it increased over the study period to 103.1cm (+1.8-inches) - like the high-GI group, this increase was despite a stable scale weight...they started at 84.7kg and ended the year at 84.3kg.

If that wasn't bad enough - all three groups experienced increases in their HbA1c too.

Those consuming a high-GI diet saw a rise from 6.2 to 6.34; low-GI saw a rise from 6.2 to 6.34; and those on the supposed low-carb diet rose from 6.1 to 6.35.

Over time the researchers reported that this rise was statistically significant - and I'd say clinically significant too!

Now with just these risk measures, you'd think there was enough to maybe, just maybe, inspire the researchers to challenge the efficacy of any of the above diets for those with type II diabetes. Maybe even say that perhaps the level of carbohydrate - despite quality or glycemic index or load improvements - matters; that simply modifying the type of carbohydrate in the diet does NOTHING for glycemic control and if carbohydrate is consumed habitually at levels seen in this study, perhaps someone with type II diabetes should expect a continued progression of their disease?

But, ya know what? They didn't even consider that. And the above problems were not all they reported either.

Let's see what else was reported in the data:

Total cholesterol didn't do much in any of the groups; LDL didn't change significantly in any group....HDL however declined in the low-GI group, but rose in the high-GI and supposed low-carb groups.

Triglycerides fell slightly in the high-GI and supposed low-carb groups, but rose in the low-GI group.

Two more markers of potential health risks found to be problematic in the low-GI diet over a year - and the researchers even noted it in the full-text - "With the low-GI diet, mean triacylglycerol was 12% higher, HDL was 4% lower, and the ratio of apoB to apoA was 4% higher than with the low-CHO diet

But a 12% increase in triglycerides and a 4% drop in HDL didn't set off any alarm bells either.

Neither did the fact the low-GI group saw an increase in their fasting plasma glucose over the year, which was also noted and basically disregarded.

With regards to the main focus in the abstract, C-Reactive Protein, the researchers did find a significant difference between the low-GI diet and the high-GI diet, but also noted that between the low-GI diet and the supposed "low-carb" diet there was no significant difference.

Yet, they chose to focus on the low-GI diet as better for a type II diabetic, despite the fact it led to

weight gain
waist circumference increase
increase in HbA1c
increase in fasting plasma glucose
a marked rise in triglycerides
and a decline in HDL

The conclusion here speaks volumes when taken in context to the carbohydrate intake in each group, "In subjects with T2DM managed by diet alone with optimal glycemic control, long-term HbA1c was not affected by altering the GI or the amount of dietary carbohydrate."

Better stated might be, with no meaningful change in absolute carbohydrate consumption, even with improvement in quality of carbohydrate - it is likely a type II diabetic will experience progressive decline in glycemic control along with other declines in risk factors over a year.

The data is published right in the full-text - the glycemic index as a means to reverse or prevent diabetes is no solution.

In this study, those who followed the low-GI diet had the worst overall outcome - they gained weight, increased waist circumference, saw triglycerides rise while HDL fell, and experienced a decline in glycemic control as evidenced by their increased HbA1c.

Yet you wouldn't know it from the abstract which focuses instead on "sustained reductions in postprandial glucose and CRP" and then concludes that "a low-GI diet may be preferred for the dietary management of T2DM."

And then back to the article from John Miles, who said this study "suggests improvements" in those who followed the low-GI diet for one year. Who's he kidding?

Low-Carb Ketogenic Diet - Greater Weight Loss and More...

2008-01-08T11:01:00.000-06:00

A neat little study was published in the January 2008 American Journal of Clinical Nutrition - Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum.

In the study, researchers followed seventeen obese men, confined to a metabolic ward, for a month while they consumed either a low-carb ketogenic diet or a moderate carbohydrate diet on an ad libitum basis (eat as much as desired from foods allowed).

Over the course of the study, the protein intake of both dietary regiments was fixed to provide 30% of calories; carbohydrate was restricted to 4% of total calories in the men consuming the low-carb diet and 22% in the men consuming the moderate carbohydrate diet; and fat intake rounded out the calories in each diet with no specific limitation on fat consumption in either.

All meals were prepared and provided as requested by the men and they were allowed to eat whatever they wanted of the allowed foods in each meal with no restrictions other than on their carbohydrate options. The men on the low-carb diet consumed less calories each day on their own and reported higher feelings of satiety while on the diet.

On average, the difference in carbohydrate intake was great - the men on the low-carb diet consumed just 22g of carbohydrate each day, while those on the moderate carbohydrate diet consumed 170g each day. Both levels of intake were significant reductions from baseline, where the men averaged 396g of carbohydrate each day.

Weight loss was greater for the men following the low-carb diet, who averaged a weight loss of 6.34kg (13.95-pounds) compared to the moderate carb diet averaging a loss of 4.35kg (9.57-pounds). Calorie differences between the two groups do not fully explain the greater weight loss in the men consuming the low-carb diet since they ate about 1731-calories a day compared to the men consuming the moderate carb diet consuming about 1898-calories a day. This difference - about 167-calories a day - translates to a month long difference of 5016-calories, or 1.43-pounds....yet the difference between the two groups was 4.38-pounds greater weight loss in those on the low-carb diet.

Digging deeper into the published data we also find that the men on the low-carb diet experienced statistically significant improvements in blood glucose, insulin and HOMA-IR, as well as favorable improvements in their cholesterol levels with a reduction in total cholesterol and LDL, an increase in HDL and a significant reduction in triglycerides.

All of these favorable changes occured while the men consumed a dietary fat intake similar to that at baseline. Where at baseline they consumed an average of 126g of total fat with 43.8g of saturated fat, their dietary intake while following low-carb didn't change much - they averaged 129g of total fat on the low-carb diet and 46.3g of saturated fat. This basically highlights that modifying one's diet to be low-carb does not mean one suddenly increases dietary fat consumption significantly - in this trial, dietary fat was pretty much the same compared to baseline.

So, with this study, we have one more to add to the pile that supports carbohydrate restriction for satiety, ad libitum-spontaneous calorie reduction, weight loss, improvements to glucose, insulin and insulin resistance, along with favorable improvements (although not statistically different from the moderate carbohydrate diet) to lipids.

ADA Revises Nutrition Recommendation for those with Diabetes

2007-12-28T12:19:00.000-06:00

I'm still reading through the just released Nutrition Recommendations and Interventions for Diabetes - the 2008 position statement from the American Diabetes Association regarding dietary recommendations for those at risk for or diagnosed with diabetes.

While I finish reading the actual documents and write up what I think of the paper, here are links to what others are saying today:

Jimmy Moore - New 2008 ADA Recommendations Partially Acknowledge Low-Carb Diets

Adam Campbell - Apparently Hell Just Froze Over

Dr. Mary Vernon - HAS THE AMERICAN DIABETES ASSOCIATION SPARKED YET ANOTHER ATKINS REVOLUTION?

Merry Christmas!

2007-12-23T18:48:00.000-06:00

What If Saturated Fat Is Not the Problem?

2007-12-21T10:40:00.001-06:00

An article in dLife, written by Richard Feinman, PhD:

Here’s an idea to chew on: The carbs in your diet tell your body what to do with the fat you eat, so it’s the type and amount of carbohydrates that matter when it comes to your weight and health.

Virtually every bit of health information today includes the advice to avoid saturated fat — the so-called evil stuff that lurks in animal foods like steak and eggs. The basis for this recommendation is that research has shown a correlation between saturated fat intake and total cholesterol and LDL (“bad cholesterol”). The problem with these studies is that the effects are not large, there is wide variation among individuals and, in most of these studies, the predicted benefit in incidence of cardiovascular disease did not materialize. In addition, we now know much more about risk factors for cardiovascular disease (CVD) beyond LDL. No assessment of CVD risk can be made without considering HDL (“good cholesterol”), triglycerides, and the size of the LDL particle. Plenty of research shows that these markers can worsen when people reduce their intake of saturated fat and that they can improve by reducing the intake of carbohydrates.

You don’t have to be a medical researcher to recognize that this is a politically charged issue. The thing that is missing for the public is an impartial evaluation of all the data on saturated fat. My personal opinion is that there is much contradictory data and a recent review of the situation suggests that there is not sufficient evidence to make any recommendations.

There is a sense that, in the absence of definitive evidence, lowering saturated fat will at least do no harm. This is not right. The problem for people with diabetes is what happens when saturated fat is replaced with carbohydrate, and research has repeatedly shown that this may actually be harmful. Consider that, according to the Centers for Disease Control and Prevention, during the onset of the current epidemic of obesity and diabetes, almost all of the increase in calories in the American diet has been due to carbohydrate. The percent of total fat and saturated fat in our diet decreased. In men, the absolute amount of saturated fat consumed decreased by 14 percent!

One of the most striking reasons to doubt the across-the-board proscriptions against saturated fat is the report from the large scale Framingham study in the Journal of the American Medical Association, titled “Inverse association of dietary fat with development of ischemic stroke in men.” You read that right: The more saturated fat in the diet, the lower the incidence of stroke.

Perhaps the most compelling research was published in a 2004 issue of the American Journal of Clinical Nutrition by researchers from the Harvard School of Public Health. Their study showed that, in postmenopausal women with heart disease, a higher saturated fat intake was associated with less narrowing of the coronary artery and a reduced progression of disease. Even with similar levels of LDL cholesterol, women with lower saturated fat intake had much higher rates of disease progression. Higher saturated fat intake was also associated with higher HDL (the “good” cholesterol) and lower triglycerides.

If saturated fat isn’t the problem, what is?
In this study, in which greater saturated fat intake was associated with less progression of coronary atherosclerosis, carbohydrate intake was associated with a greater progression. Carbohydrate, through its effect on insulin, is the key player. Insulin not only sweeps up glucose from the blood but it also plays air traffic controller, making the call as to whether that glucose is turned into fat or is used for energy. Most importantly, insulin determines what happens to dietary fat — whether it gets stored or oxidized for fuel. In fact, the fat profile in the blood (cholesterol and triglycerides) is not strongly tied to diet.

A recent study by Jeff Volek at the University of Connecticut compared low-carbohydrate and low-fat diets. Even though the low-carbohydrate diet had three times as much saturated fat as the low-fat diet, levels of unhealthy fats in the blood were lower in the low-carbohydrate group. How is that possible? That is what metabolism does.

What is the best diet?
We don’t know the ideal diet composition. We do know that saturated fat, unlike trans-fat, is a normal part of body chemistry and extreme avoidance is not justified by current scientific data. Removing some saturated fat to reduce calories is good, but adding back carbs appears to be deleterious. It appears that healthy, carbohydrate restriction will trump the effects of any kind of fat. For a person with diabetes, blood glucose must be the first consideration. If you have relatively tight blood sugar control, the amount of saturated fat you eat may be a non-issue. You can do what we did before the diabetes-obesity epidemic: regulate your intake by your taste and your natural appetite. No one ever did want to eat a pound of bacon.

Sources:
1. Food and Nutrition Board: Macronutrients. In: Dietary reference intake: National Academies Press; 2005, p.484.

2. JB German, CJ Dillard: Saturated fats: what dietary intake? Am J Clin Nutr 2004, 80:550-559.

3. MW Gillman, et al. : Inverse association of dietary fat with development of ischemic stroke in men. JAMA 1997, 278:2145-150.

4. D Mozaffarian, EB Rimm, DM Herrington: Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women. Am J Clin Nutr 2004, 80:1175-1184.

5. JS Volek, et al. A hypocaloric, very low carbohydrate, ketogenic diet results in a greater reduction in the percent and absolute amount of plasma triglyceride saturated fatty acids compared to a low fat diet. NAASO, Boston, MA, October, 2006.

Obesity: Is it a Form of Malnutrition?

2007-12-20T11:12:00.000-06:00

In a presentation at Berkeley in November, Gary Taubes included a quote from the 1967 International Conference on Obesity.

"Even a brief visit to Czechoslovakia would reveal that obesity is extremely common and that, as in other industrial countries, it is probably the most widespread form of malnutrition."

This idea, the obesity is a form of malnutrition, isn't new and there is increasing data pointing to nutrient deficiency as contrbuting to the growing prevalance of overweight and obesity around the world.

How can that be though? Don't a number of studies point to our increasing calorie intake, along with a more sedentary lifestyle, as the cause of our growing waistlines?

While it is difficult to believe that one could be deficient for essential nutrients - vitamins, minerals, trace elements, essential fatty acids, and essential amino acids - while consuming so much food, let's see what the published data tells us.

Back in Janaury I wrote about a study out of Sweden that found four-year-old children already insulin resistant and overweight. One statistically significant finding was that the heaviest children were those consuming the least amount of dietary fat; they were also found to be deficient in vitamin D, iron and omega-3 fatty acids. Yet they were classified as obese. How did they manage to eat too much yet fail to meet nutrient intake levels for health and well-being?

In 2000 a survey of workers at a fertilizer plant revealed that many were overweight and obese - concurrent with their intake of excess calories they were found to be deficient in vitamin A, thiamin (B1) and consumed a poor ratio of mineral salts. The researchers concluded "Hyper-energetic, disbalanced nutrition, and incorrect nutritional-behavioral model are factors that determine the prevalence of overweight and obesity among the workers examined."

A study published last summer concluded that "Vitamin D insufficiency was associated with increased age, BMI, and SBP, and decreased HDL-C."

Just this month, a stunning paper was published examining the presence of micronutriet deficiencies in women. The researcher, Dr. Aswaf "examine[d] the relationship between micronutrient deficiency and the prevalence of mothers' overweight/obesity in Egypt using the 1997 Egyptian Integrated Household Survey. The ordered logit results show an overlap between micronutrient deficiency and the prevalence of mothers' overweight/obesity in Egypt. The odds of being overweight/obese are 80.8% higher for micronutrient deficient mothers than for non-deficient mothers, keeping all other variables constant."

Lastly, and by no means the end of the data we could look at, data published from the NHANES surveys tell us something really interesting - over the last few decades our intake of protein has remained stable, level, not increased; our intake of fats and oils has also remained stable; our intake of carbohydrate has increased - yet deficiency in critical nutrients is increasing amongst the population, with too many Americans failing to meet requirements for Vitamin E, C, A and D, selenium, magnesium and potassium.

With just these few studies, there appears to be a connection between micronutrient intake and excess weight - malnutrition parallel to an overweight or obese body state.

For some time now, I've written about how the dietary recommendations are flawed. They're focused on macronutrient ratios - carbohydrate, protein and fat - with the assumption being that if you follow such an eating pattern, you'll meet micronutrient requirements.

One small problem - even the menus published by the government and medical organizations to provide an example to the public of how to eat are nutritionally deficient for critical essential micronutrients. In fact, I've even posted side-by-side menus that showed the recommended diet compared to a controlled-carb diet was nutritionally inferior to the controlled-carb menu. In such comparisons, I use menus that are published by organizations rather than create them myself to reduce any chance for bias on my part.

So, I wasn't surprised to learn about a new study that Cassandra Forsythe wrote about a couple of weeks ago.

Go ahead - go take a peek - it's worth the read!

Growing Pains

2007-12-19T12:01:00.000-06:00

A new report, Expert Committee Recommednations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report, issued by the American Academy of Pediatrics (AAP) this month, is designed to tackle the growing prevalence of childhood obesity in the United States.

Its recommendations should make any parent shudder - not only does the position of the AAP assume overweight and obesity in children is a problem of behavior, it assumes every child in the United States, with the exception of those classified as "underweight" by BMI, is in need of routine intervention and prevention to avoid overweight and obesity in adulthood.

I kid you not.

Every child in the United States, except those with a BMI classifed as "underweight," will now be subject to a risk assessment and prevention measures at every doctor visit. The implication within the document is clear - parents simply cannot be trusted to know how to raise normal healthy weight children over the long-term, even when their child is a normal weight, thus routine, repeated messages must be delivered at each and every opportunity.

The new guidelines call for healthcare professionals to question and investigate all of your family behaviors and habits at home - everything from what you eat, when you eat, how often you watch television or use a computer, if you eat out, where and how often, and how much time is spent being sedentary versus being active is to be collected and noted in your childs medical chart.

Despite the fact your child is classified within a "healthy weight" you'll be subject to your own scrutiny as a parent too - if you're overweight or obese, your child will be flagged as "at risk" due to your weight, not their weight.

Should the clinician note any abberant behavior - heaven forbid you allow your child, for example, a level of television time deemed excessive - you'll be scolded to limit television time. Heck, even if nothing is found and all is well, you'll still get the lecture about diet, exercise, limiting fast food and avoid sugary drinks....just in case....overweight and obesity is, afterall, a problem of behavior and you need constant reminder of that if you are to comply.

Where the guidelines sink to Brave New World levels is what is recommended for those children who have a BMI classed at or above the 85th percentile. There is to be no more sugar-coating the problem. Children with a BMI between the 85th and 94th percentile are overweight and children at or above the 95th percentile are obese.

In addition to the above assessments of risk, they'll now be subject to routine bloodwork and you'll be expected to do something about the "problem behaviors" now.

The first stage will be "Prevention Plus" through your doctors office. You'll now be expected to visit the doctors office for monitoring more frequently and ensure your child eats 5+ servings of fruits and vegetables daily, ideally eliminate sweetened beverages from your child's diet or limit to 1 per day, limit television time to less than 2-hours per day, make your child do physicial activity for 1+ hours per day, prepare meals at home, eat at the family table 5-6 times per week, have a "healthy" breakfast daily, and get the whole family on-board with the changes. You'll have 3-to-6 months for the doctor's office to see results, with visits scheduled to follow-up and monitor each month, and if no progress is noted, you and your child will be bumped to stage 2.

Stage 2 assumes you didn't do enough on your own, so now you and your family will be expected to follow a "structured" planned menu, reduce television time to less than 1 hour per day, engage in planned "supervised" physical activities and record what you are doing to prove you're complying with the recommendations and "achieving targeted behaviors"! If progress is not noted within three to six months, yup, you'll be bumped to stage 3.

In stage 3 you'll enjoy an intervention team (note sarcasm) that includes a behavior counselor (social worker, physcologist or other mental health provider), registered dietitian, exercise specialist and primary care provider, as well as weekly office visits to monitor progress in the "structured program in behavior modification" which will include, "at minimum", food monitoring, short-term diet and physical activity goal setting and "contingency management."

This "Comprehensive Multidisciplinary Intervention" now intensifies the urgency and seeks to maximize "behavior changes." That's because, if all this fails to result in progress and a reduction of BMI to the "healthy weight" category, they're going to pull out the big guns and take your child to stage 4 - the "Tertiary Care Intervention," which can include admission to a tertiary care facility for children as young as two, very low-calorie diets for children as yound as two, medications for children as yound as six, and/or bariatric surgery for children older than twelve.

Within the link above is the second document, Assessment of Childhood and Adolescent Overweight and Obesity, which details how to determine if a child is overweight or obese and reinforces the need for intervention, even in healthy, normal weight children. Noteworthy in this document is the explicit determination that BMI is the end-all-be-all measure of risk. While they note the BMI has flaws, and that the use of calipers to determine fatness is useful - "skinfold thicknesses are predictive of body fat in children and adolescents" - they continue on to dismiss its use and state "the expert committee does not recommend the routine clinical use of skinfold thickness measurements in teh assessment of childhood obesity."

What this means is that if you have an athletic, muscular child, who happens to have a high BMI due to muscle, you're going to be expected to do something about his/her weight to bring BMI to a "normal healthy" range.

Throughout the document the expert committee goes to great lengths to detail how to ask questions of parents and children, what to look for as problematic behaviors, and how to convince parents to modify those problematic behaviors.

A third document within the PDF package, Recommendations for Prevention of Childhood Obesity, we learn the justicification of the new guidelines in the opening sentences, "The majority of US youth are of healthy weight, but hte majority of US adults are overweight or obese. Therefore, a major health cahllenge for most American chidlren and adolescents is obesity prevention - today, and as they age into adulthood."

Let's not address what caused adults in this country to grow heavier, let's just continue to assume it's gluttony and sloth, lack of willpower, eating too damn much food, being lazy and more - those bad, bad, bad behaviors - and not allow our children to fall into the same trap and repeat, repeat, repeat to children they must eat a healthy diet and exercise daily!

We must do this, even if they're a healthy weight now, because - by golly - look at the adults around them! Bad examples, bad behaviors, bad, bad, bad.

Within the document we find lots of suggestions about how to monitor, control and modify behaviors - everything from positive reinforcement to cognitive restructuring to self-assessment to decision support.

Then there is the Recommendations for Treatment of Child and Adolescent Overweight and Obesity document. In it we're treated to the dogma to eat a "healthful" diet before getting to the real meat of the purpose - sections on food behaviors and then dietary intervention that includes the "use of balanced macronutrient/low-energy diets" for our children as a means to an end.

This is followed with reminding readers about the importance of physical exercise and the role of structured and unstructured activity each day and more on limiting television viewing and media usage.

Of course it, like the other documents, would not be complete without a full presentation of behavior approaches and techniques to use when a child is overweight or obese by BMI along with the drugs of choice and the option for bariatic surgery.

It also justifies the use of a staged behavior modification approach starting with prevention and reaching tertiary care if needed. Unlike the previous documents, it provides more detail by age. Those details make it clear that a child as young as six, when after six-to-twelve months of increasing intensity without sufficient progress, it may then "be appropriate for patient to receive evaluation in tertiary care center," followed by flow-charts to make the decision-making process as to when to step-up intensity a no-brainer.

I really have no problem with the idea of helping parents help their child eat a good diet, I have no problem with encouraging children to be active and play actively each day.

What I do have a problem with is the wholesale implication that children who are overweight and obese are so because they have behaviors which must be modified through intense, staged interventions that have no solid evidence to support their use across the population!

Worsening this is that now, even healthy normal weight children, are to be subject to repeated, routine messages to make it clear they must maintain a BMI within normal or else they too can look forward to intense behavior modification intervention.

You may wonder if anyone has ever investigated how such an approach may affect children long-term?

The last document includes an interesting sentence, "The purpose of this article is to offer practical guidance to providers by providing recommendations, including those that LACK THE BEST POSSIBLE EVIDENCE." (emphasis mine)

It also includes a section titled "Potential Psycological Complications of Behavior-Based Treatment" and states, "Only one study, a 10-year follow-up study of children who completed behavior interventions for obesity, reported on potential complications of treatment. Epstein et al found increased rates of psychiatric disorders such as depression, substance abuse, and eating disorders..." noting it was unclear if these were a result of comorbid conditions associated with obesity.

Amazingly, after staing only one study followed-up on children after behavior intervention, they pooh-pooh this by pointing to another study as supporting behavior intervention comes with little to no risk to children in the future - "Other trials showed improvements in children's psychological functioning and did not find higher rates of eating disorders among children treated with a family-based, behavior, weight management intervention."

I wondered what that study was all about since the clear message here is not to worry about damaging children with this type of intervention. The reference is to a study conducted by Faith et al - Effects of contingent television on physical activity and television viewing in obese children - published in Pediatrics in 2001.

How this expert committee sleeps at night, I don't know!

This is a bait-and-switch citation in what's now being put forth as the standard of care to imply these interventions aren't going to have any long-term consequences to our children's mental health and well-being.

The study referenced, unlike the one that followed up TEN YEARS later, was short-term for twelve weeks, investigating whether making television viewing contingent on a physical activity (pedaling a stationary bike in front of the television) would reduce television viewing time. It did. But it DID NOT investigate any phsycological impacts, nor did it follow up years later to see if there were any psycological impacts.

Nice try though - and anyone reading the document who does not follow the reference trail will never know. Given this type citation madness is included, in what is probably the most important factor - long-term outcome and potential consequences - one must question what else in the document also has this type of reference?

Folks, we have here a plan to now subject every child to intense and routine messages about body weight, BMI, eating, activity and their "behavior" - with no hard evidence it will provide the desired long-term results and the potential to seriously cause harm as our children grow-up in such an environment of intense scrutiny, monitoring and implication that BMI must remain within "normal" or else.

This expert committee has apparently lost all belief in "First Do No Harm."

The Perils of Crossing the Establishment Boundaries on Dietary Advice

2007-12-18T13:48:00.000-06:00

Two opinion pieces in USA Today bring forth the very problematic issue of dietary advice when dispensed by a practicing physician and that advice happens to be contrary to the conventional wisdom.

In the first, Doctor's dietary advice for diabetics not enough, Connie B. Diekman, president of the American Dietetic Association - Chicago, goes to great lengths to reinforce the notion that doctor's are the wrong source of dietary advice and that Registered Dietians are "are more educated about the science of food and nutrition than any other health care professional, but they also know how to translate that science into useful, practical advice that anyone can understand and follow."

She also says that "Dietitians do not simply hand a person a menu. A registered dietitian takes into account a person's age, weight, blood cholesterol levels and other medical needs to develop a plan that is right for that person.

There is no "one-size-fits-all" eating plan for managing diabetes. Patients need to pay attention to portion sizes, timing of meals and specific food choices. They need to eat smart, avoid weight gain and balance the day's food choices with regular physical activity.

A registered dietitian is the best source of advice in all these areas."

In the second, Eat in moderation, the CEO for the American Association of Diabetes Educators - Chicago, Lana Vukovljak, weighs in with - "By touting his "five-fingered diabetic diet" as the key to weight loss and controlled blood glucose, he is perpetuating misinformation and doing his patients a disservice. Eichenbaum advises patients to avoid "bread and baked goods, potatoes and root vegetables, rice, pasta and fruit except for berries." But that diet severely restricts meal plan options, ignores cultural preferences and lifestyle needs, and often results in increased non-compliance. Dietitians and diabetes educators stress the necessity of dietary changes and physical activity. Instead of making broad dietary directives that eliminate entire food groups, however, they encourage moderation and reduced portion sizes. They also make dietary recommendations that factor in an individual's cultural tastes and lifestyle requirements.

Diabetes education helps people incorporate behavior change into their lives by personalizing recommendations and simplifying nutritional messages."

It appears whatever was written by Eichenbaum caused a big stir - two major organizations responded with very clear implications that the author was unqualified and potentially dangerous to patients well-being, thus readers need to ignore whatever it was that appeared in the paper.

What exactly caused the hub-ub?

Well, it was another opinion piece in USA Today, Simple diets work best with diabetes, written by a Dr. Dan Eichenbaum, MD who is an opthamologist in North Carolina.

In that he had the audacity to write, "In numerous studies, elevated blood sugars have been linked to diabetic vision loss despite potentially successful medical and surgical treatments. Medication should be used to control blood sugar only after an optimum diet and exercise regimen has been established.

Most patients, however, expect medication to control blood sugars no matter what they eat. They adjust insulin or pill dosages to cover their dietary indiscretions. Unfortunately, dieticians routinely give patients complex diets that require a ruler, a scale and a calculator. It is no wonder that few diabetics can adhere to these elaborate eating regimens.

I explain to my patients that eating carbohydrates is like putting diesel fuel in a vehicle that can only run on gasoline.

Just as a gas engine won't burn diesel, a diabetic's "engine" cannot burn carbohydrates."

But, he didn't stop there, he also included foods he specifically tells his patients to avoid - bread, pasta, potatoes, baked goods, root vegetables, rice and even fruits except berries. He keeps it simple and says "Patients who eliminate these items lose weight and can easily control their sugar levels. Expecting patients to abide by a diet that is difficult to follow causes non-compliance and increases their risk of blindness."

I point to these today because they highlight the position many clinicians are in when it comes to offering patients dietary advice - they're squarely between a rock and a hard place.

If Dr. Eichenbaum had instead penned something that simply regurgitated the current party-line dietary guidelines, do you think there would have been a similar response questioning his qualifications or patient care?

Hey, have you ever seen Dr. Mehmet Oz slammed in the mainstream media or have his qualifications questioned when he appears on Oprah or Larry King Live espousing the consensus opinion for dietary recommendations?

Of course not - he's preaching the consensus opinion and therefore what he says is okay, his apperances are even highly promoted with viewers encouraged to watch and listen to him. This despite the fact he is not a registered dietitian!

See, as long as your advice is aligned with the consensus, you'll be fine; step outside the boundaries publicly and you'll quickly find your advice ridiculed by the establishment, along with having your qualifications challenged and the clear implication that your patients should wonder if you're harming them!

It does not matter if you've based your advice on hard data from peer-reviewed studies; it certainly doesn't matter that your training as a physician included statistics, biochemistry, biology and other pertinent subjects; and it doesn't matter diddly that your patients see improvements when they follow your advice - what matters is you've crossed the line and made it public that you're dispensing nutrition advice contrary to the current dietary recommendations published by the leading health organizations and you're not a "registered dietitian" to boot.

The above responses to this doctor's words drive home one of our biggest challenges in public healthcare today - the consensus-driven-model that explictly endorses dogma trumping the evidence-based model.

All one needs to do to begin to truly understand how deep this consensus-based-model runs, is to take some time to read through various position statements published by the leading health and medical organizations about what they recommend for diet to clinicians in practice and the public.

Take the American Heart Association position paper on diet, you'll find it's almost identical to that issued by the American Diabetes Association, which is itslef almost identical to that issued by the American Dietetics Association, which is basically the same as the American Cancer Society - the list goes on and on as to this universal message contained within each position statement published by these organizations.

These documents are often held up as the "standards of care" for use in medical practice, informing the clinican that they're written from and based upon the best available evidence, brought together by committee and agreed upon through consensus of those bringing the document together for publication.

These position papers also routinely include references to the alternative approaches that have support in the data, but these are routinely dismissed as inconclusive, deemed controversial, inappropriate or potentially harmful, with the explicit message that no one should advise such an approach to any patient because the evidence is not strong enough. Noticably absent are those studies with the strongest data, while those studies with findings considered minor enough to dismiss are included and highlighted to make the position against their efficacy appear strong.

The interesting thing is, in various position statements, there is a very clear consensus between the organizations when it comes to dietary recommendations - they're all making the same basic recommendations, they all claim to be based on the best available evidence, and they all affirm similar beliefs about macronutrient ratios in a "healthful diet," which leads anyone reading them to believe they're supported by research and evidence from high-quality data. Surely they must be right if all agree on the simple basics!

Wait...wait...wait.....no one seems to ask - are they all so similar because the evidence is so strong and supportive of the dietary recommendations contained within, or are they simply the result of long-held beliefs and dogma driving consensus across organizations?

You can actually begin answer that question yourself.

Simply get your hands on at least three to five position statements from different medical organizations about their dietary recommendations. Then, if you want, you can read them all, but you don't really have to since they're all likely the same bottomline message anyway.

No matter what, your real investigation about the underlying forces driving how the statements are prepared starts in the references.

Look at and compare them in each and between each paper and you'll start to see how they point to each other as basis for supporting evidence and consensus.

It really doesn't matter what organizations you choose - you'll find this "circular reference tactic" within them all, with NONE actually providing conclusive hard data to support their position. They don't need to actually provide mountains of supporting data because with the circular reference tactic, they have each other, and by pointing to the other as supportive and evidence-based they imply the data is "over there" without really doing anything more than taking anyone following the references on a wild goose chase while maintaining the status quo for the the party-line dogma about diet and health.

Then foot soldiers within these organizations will criticize and challenge anyone who dares to not only look beyond these circular reference tactics to find solid evidence that points to an alternative approach, but then actually recommends the alternative to patients and says they do in a public forum, like the media. Such challenges to the status quo simply cannot and will not be tolerated as we can see from the responses above to one doctor who did just that.

Given the strong and dire warnings about the "obesity epidemic" in our country, isn't it time we actually look at the literature and see what the data contains and really hammer out a true evidence-based model of dietary recommendations for the public?

Isn't it time for us to move past this idea "we know" what works, to actually go find out what works based on data and hard evidence?

Glycemic Index Doesn't Matter Much in Overall High-Carb Diet

2007-12-14T15:26:00.000-06:00

Ever wonder what would happen if you place 19 obese, hyperinsulinemic women on a diet where calories aren't restricted, but glycemic index is tweaked a bit?

The short answer - not much when you look for differences between diets that are high or low glycemic index.

But y'all know I'm not about the short answer already, so how about we take a look at a newly published study, No effect of a diet with a reduced glycaemic index on satiety, energy intake and body weight in overweight and obese women, that has some very interesting findings that were notable but ignored in the paper.

Make a note of the paper title, it's important later!

Let's start with some background. For this study, researchers recruited otherwise healthy, obese women who had hyperinsulinemia. They were free of underlying conditions like diabetes, were not taking medications for cholesterol, hypertension or other medical conditions, were not pregnant or breastfeeding, and had not recently dieted to lose weight, nor recently lost or gained weight, thus deemed "weight stable" to participate.

The researchers then determined their habitual food intake and calories consumed each day, noting the subjects consumed an average of 1859-calories/day - 48.8% carbohydrate, 16.7% protein and 34.4% fat [227g carb, 77.6g protein, 71g fat].

The study was then underway, with the women consuming one of two diets for 12-weeks in a cross-over design, so the study lasted a total of 24-weeks. The objective of the study was to "investigate whether a diet with a reduced glycaemic index (GI) has effects on appetite, energy intake, body weight and composition in overweight and obese female subjects," so the researchers provided cereals, breads, rice, pasta and potatoes with different glycemic index for the women to consume while following either the low or the high glycemic diet.

The women were told to consume their foods as they did in their habitual diet and continue eating how they usually ate before starting the study.

In the paper, the researchers noted that "[t]here were no differences in energy intake, body weight or body composition between treatments. On laboratory investigation days, there were no differences in subjective ratings of hunger or fullness, or in energy intake at the snack or lunch meal."

They concluded, "This study provides no evidence to support an effect of a reduced GI diet on satiety, energy intake or body weight in overweight/obese women. Claims that the GI of the diet per se may have specific effects on body weight may therefore be misleading."

Yesterday, Sandy Szwarc at Junkfood Science blog penned her article Carbs humbug? — Are carbs really fattening? about the study, with her perspective being that this is one more piece of evidence that carbohydrates are not fattening.

She wrote, "Despite oft-repeated fears that refined “bad” carbs send our glucose and insulin levels soaring, these researchers found “no differences in glucose, insulin and non-esterfied fatty acid responses to the lower versus higher GI breakfasts, with no differences in either total area under the curve or single measurements at any time point.” Concerns that carbohydrates in the diet stimulate insulin production and are responsible for obesity and illness were recently examined here."

I point to the article at the Junkfood Science blog because it's a good example of seeing the forest while missing the trees.

Let's look at the data in the study now, comparing the dietary changes with their baseline starting values...with the baseline number first, followed by the measured effect of each diet (values are rounded up or down where appropriate).

Low-Glycemic Index Diet, 12-weeks
Baseline - Low-GI Diet
Weight: 87.5kg - 89.1kg
Waist: 103cm - 105cm
Fat Mass: 42.3kg - 44.54kg

Calories: 1859/day - 1928/day
Carbohydrate: 227g/day - 248g/day
Protein: 78g/day - 82g/day
Fat: 71g/day - 69g/day

High-Glycemic Index Diet, 12-weeks
Baseline - High-GI Diet
Weight: 87.5kg - 89.2kg
Waist: 103cm - 106cm
Fat Mass: 42.3kg - 42.9kg

Calories: 1859/day - 1874/day
Carbohydrate: 227g/day - 223g/day
Protein: 78g/day - 83g/day
Fat: 71g/day - 71g/day

The researchers didn't spend much time in the paper discussing the weight gain, fat mass increase, or change in waist circumference. In fact, they noted "[t]here were no differences in body weight, waist circumference or fatness between intervention periods. Weight increased during both intervention periods, although weight gain did not differ between treatments."

They didn't discuss the differences from baseline, nor seek to understand how it is that hyperinsulinemic women, who are obese, gained both weight and body fat while consuming diets that were not that much higher in calories than baseline - certainly not high enough to theoretically gain as much as they did!

But more importantly - look at the increase in waist circumference - more than one inch (3cm) is not something to sneeze at in just 3-months, nor is the scary gain of 4.9-pounds of body fat while consuming the low-GI diet for 12-weeks!

Why did that happen?

The researchers didn't discuss the possibility that high insulin played a role or that blood glucose from carbohydrates consumed had anything to do with it.

Perhaps it happened because insulin and blood glucose didn't budge?

The paper does not include baseline values of insulin and glucose in the table to compare it to each diet, but does provide a telling look at how dietary glycemic index, in the context of a high carbohydrate diet, when compared with each other had no effect on either:

And in case you missed it, what this showed, quite nicely I'll add is that 12-weeks of a high carb diet - whether the perceived junky high-GI or "healthy" low-GI carbs - can make you gain weight, body fat and see your waist grow bigger too...while doing absolutely nothing to resolve a state of hyperinsulinemia!

But yeah, the brilliant conclusion was that there was no difference between low-GI and high-GI...let's not confuse ourselves with the more important findings here!

Low-Carb, Too Much Stress on the Body? Say It Isn't So!

2007-12-10T12:19:00.000-06:00

After seeing the article Low carb diets may stress body too much, studies find, on Carol Bardelli's blog, discussion about it on Active Low-Carber Forum, and receiving emails asking me about my thoughts on it, I decided perhaps it's time to add a post here about it.

The article includes one important paragraph that I'll focus on:

The ASU researchers Carol Johnston and Pamela Swan, along with collaborators Sherrie Tjonn and Andrea White, both registered dieticians, and Barry Sears, of the Inflammation Research Foundation and creator of the Zone diet, have published three papers during the last two years, appearing in Osteoporosis International, The American Journal of Clinical Nutrition and most recently in the Journal of the American Dietetic Association.

From the publications above, it's claimed that researchers have found:

1. With these studies, their research uncovered that the ketogenic diet may increase bone loss because of an increase in acid in the body and not enough intake of alkalizing minerals like potassium to neutralize this effect. In addition, a higher percentage of calcium was found in the urine of those on the KLC diet, leading the researchers to believe that the bones are “leaching” calcium.

This would be the finding from the unpublished data included in a Letter to the Editor published in Osteoporosis. It was from a cohort following a low-carb diet or non-ketogenic low-carb diet for two weeks.

Two weeks?

Haven't longer studies reached a different conclusion? The link I just provided is also in the journal Osteoporosis, but it's from a three month study and in it, the researchers concluded, "Although the patients on the low-carbohydrate diet did lose significantly more weight than the controls did, the diet did not increase bone turnover markers compared with controls at any time point. Further, there was no significant change in the bone turnover ratio compared with controls."

2. Another study by these researchers looked at the metabolic advantage of one diet over the other. They found that the reduction in fat loss and weight loss was about the same for both diets over a six-week trial. In addition, body mass index was significantly lower after six weeks in both diet groups. However, those following the KLC diet experienced a greater increase in LDL cholesterol than those following the NLC diet. HDL cholesterol did not seem to be impacted significantly.

This would be from a six week trial comparing the effect of a ketogenic low-carb diet and a non-ketogenic low-carb diet, where the researchers finding was as stated above.

Interesting little problem can be seen, however, when you go to the full-text of the paper - I'm very curious about what they fed (or recommended) those following the ketogenic diet - they managed to get 15g of fiber in them, yet failed to reach recommended intake for folate, vitamin E, iron, magnesium and potassium.

What were they feeding/recommending to these people?

Yes, this is a study I have serious questions about - because it is virtually impossible to miss folate if one is eating non-starchy vegetables as the majority source of carbohydrate, just as it is virtually impossible to miss vitamin E for the same reason. Add to this, failing to meet iron is next to impossible with the combination of meat and leafy greens when one is following a low-carb diet properly, and even magnesium and potassium should come in at levels at least above 80% of recommended intakes.

I even emailed Dr. Sears shortly after the paper was published, asking specifically, "I'm reading through your paper published in the AJCN this month and wondering what was on the menu for both groups? I see the macronutrient and micronutrient values, but am having some difficulty understanding what was provided for meals since some of the nutrient values are quite disparate (like the carbohydrate, cholesterol and polyunsaturated fats). Would it be possible to send me a day's menu of each diet so I can better understand the types of foods the subjects ate during the study?"

Oddly, I received no reply - usually Dr. Sears replies when I email him a question, but with this request for information, he did not. Of course, my request remains open for him or any of his researchers to email me and until such questions are answered about actual food consumed on both diets, the data remains suspect in my opinion since we don't know what was eaten to influence such a nutrient deficiency, which indeed may have influenced the outcomes seen!

3. They also noted that dieters on the NLC diet versus the KLC diet experienced more energy. Their most recent article published in October explains that the body needs carbohydrates for energy so if you are taking in an extremely low amount of carbohydrates and only receiving energy from protein, intense exercise is actually harming your body more than helping it. Without adequate amounts of carbohydrate stores, or glycogen, muscles rapidly fatigue during sustained exercise.

This is from a two-week trial. What's with this two week data offered up as proof these days?

Folks, this one is just a no-brainer. Dr. Steve Phinney has found, and published that time to adapt to a ketogenic diet is required, and once adapted endurance returns to pre-diet levels. That the cohort reported being more fatigued in two weeks is not surprising - in fact, it's expected. "Impaired physical performance is a common but not obligate result of a low carbohydrate diet. Lessons from traditional Inuit culture indicate that time for adaptation, optimized sodium and potassium nutriture, and constraint of protein to 15–25 % of daily energy expenditure allow unimpaired endurance performance despite nutritional ketosis."

Vegetarian Diet in Pregnancy: Insulin Resistance in Children

2007-12-08T09:20:00.000-06:00

For many years now there has been a push in the United States to convince the public they need to consume less animal foods and more plant-based foods. Earlier this year I reviewed our dietary habits based on consumption patterns in the US as documented by the Food and Agriculture Organization (FAO) and the Economic Research Service (ERS) of the USDA and was really shocked by the level of intake for added sugars, cereal grains and vegetable oils.

The most recent assault on common sense came this week when Newsweek featured The Fertility Diet on its cover, promoting it and the findings from epidemiological data that was the basis of the book as a proven way to eat to enhance fertility. As I noted in my review of the book and study earlier this week, the study findings and book "do not make a proven strategy or evidence-based approach to prevent or reverse ovulatory dysfunction."

I didn't write much about the potential effects on babies born to women consuming such a diet because the post was already very long. However, it needs to be discussed considering new data published this week. For all intents and purposes, The Fertility Diet is recommending a predominently vegetarian diet - limit red meat and animal foods, strictly limit saturated fat, favor protein from beans and include full-fat dairy. This is almost identical to how the population in India eats!

A study published in the January 2008 issue of Diabetologia, Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: the Pune Maternal Nutrition Study, highlights the profound effect on the offspring of women consuming an habitual vegetarian diet. [link opens to full-text of paper]

In the abstract we learn the researchers set out to understand how elevated total plasma homocysteine concentrations predict birth weight and risk factors for type II diabetes - "We studied the association between maternal vitamin B12, folate and tHcy status during pregnancy, and offspring adiposity and insulin resistance at 6 years."

To do this they followed 700 pregnant women in six villages (and their children) over six years; "We measured maternal nutritional intake and circulating concentrations of folate, vitamin B12, tHcy and methylmalonic acid (MMA) at 18 and 28 weeks of gestation. These were correlated with offspring anthropometry, body composition (dual-energy X-ray absorptiometry scan) and insulin resistance (homeostatic model assessment of insulin resistance [HOMA-R]) at 6 years."

What the researchers found was not only disturbing, but may have long-term implications not considered critical to long-term health of children previously.

In the table presenting the maternal nutrition data during pregnancy, we learn the women consumed adequate calories - the majority did not consume meat, poultry or fish, but did consume dairy (milk, yougurt, cheese, etc.).

At week 18 of pregnancy, the majority of calories in the diet came from carbohydrate - 70%, fat contributed 17% of energy and protein 13%; at 28 weeks of pregnancy the dietary macronutrient ratios were similar - carbohydrate 72%, fat 16%, protein 12%. The women (without folic acid supplementation) consumed a diet righ with foods high in folate, as evidenced by the finding that only one woman in the whole group was deficient for folate - all others exceeded levels desired in pregnancy.

Alarming however was the finding that the majority were deficient for vitamin B-12 - 60% of the women had blood levels of B-12 less than 150pmol/l. While the finding was alarming, it was not unexpected since the women were not consuming meaningful intakes of animal foods from which we find vitamin B-12 in our diet - the majority of the women were vegetarian, consuming a high carbohydrate, low-fat diet - the type of diet, in fact, promoted in The Fertility Diet book.

The women in the study seem to have done well in their pregnancies and gave birth to healthy babies, some were low birth weight, but as I said, they were overall "healthy."

So why then am I writing about this study?

Well, the effect on their children, over the next six years was telling and speaks volumes about how diet and micronutrient intakes during pregnancy may effect offspring.

When the researchers followed up on the children six years later, they found a seemingly healthy bunch of kids - "At 6 years, the children were light, short and had a low BMI compared with an international (UK) reference; none were overweight or obese as defined by International Obesity Task Force criteria."

You would think that was good news, wouldn't you?

Well, it wasn't their outward appearance or their normal BMI that was problematic, it was their fatness and insulin resistance at age six that shocked the researchers!

"...skinfold thickness measurements showed that the children were relatively truncally adipose; the mean SD score for subscapular skinfold thickness was -0.42 compared with the UK growth standards, in contrast with -2.23 for weight and -1.86 for BMI. Higher fat mass and higher body fat per cent were associated with higher fasting insulin concentrations, higher HOMA-R and higher 120 min plasma glucose concentrations (p = less than 0.05 for all)."

A few paragraphs later we learn, "The highest HOMA-R was in children whose mothers had the lowest vitamin B12 and highest folate concentrations."

What this means is that the children born to women consuming the highest levels of folate rich foods - green leafy vegetables and beans - and the least (or none) animal foods, had children with the highest risk of insulin resistance!

The researchers opened their discussion section bluntly, "We have demonstrated for the first time in a purposeful, community-based prospective study an association between maternal nutritional measurements in pregnancy and two major risk factors for type 2 diabetes in the offspring," and didn't stop there, "higher maternal folate concentrations predicted greater adiposity (fat mass and body fat per cent) and higher insulin resistance, and lower vitamin B12 concentrations predicted higher insulin resistance. Children born to mothers with low vitamin B12 concentrations but high folate concentrations were the most insulin resistant."

They concluded with "...our data raise the important possibility that high folate intakes in vitamin B12-deficient mothers could increase the risk of type 2 diabetes in the offspring. This is the first report in humans to suggest that defects in one-carbon metabolism might be at the heart of intra-uterine programming of adult disease."

If you are pregnant or planning to conceive, you may want to think twice before shunning foods that provide vitamin B-12 - meats, eggs, poultry, fish and dairy!

Free Copy of Protein Power

2007-12-07T16:09:00.001-06:00

Drs. Mike and Mary Dan Eades have a special gift for you for the holidays - a first edition, hardbound copy of Protein Power Lifeplan - pay for shipping and the book is free!

Here is what Dr. Eades wrote on his blog today:

Through December 20 (after which it will be impossible to get the book by Christmas) we will give away a 1st edition hardcover (not a paperback) copy of the Protein Power LifePlan to anyone of our readers who wants it. That’s right, it’s absolutely free. The price is zero. (Click here to go to the product page on our website and order if you’re interested.)

And in the interest of disclosure, I've got no vested interest here - I saw Dr. Eades post and decided to share the love!

Jonny Bowden Responds to Beverage Association Spin

2007-12-07T12:16:00.000-06:00

Earlier this year, in September, Jonny Bowden penned an article, Diet Soda No Bargain, on his blog.

He recently received an email from the Director of Communications, Tracey Halliday, for the American Beverage Association criticizing his article, saying it was "erroneous" and emphatically stated that "All of our industry's beverages-- including regular or diet soft drinks-- can be part of a healthy way of life when consumed in moderation and as part of a healthy lifestyle."

He responds on his blog.

Enjoy!

With Gene, Carbohydrates Stored as Fat

2007-12-07T08:55:00.001-06:00

I actually had a laugh-out-loud moment this morning as I read the first paragraph in the article - Scientists discover genetic basis for why high-carb diets make us fatter - which read:

A high-carb diet has always been considered as a factor behind piling on the pounds. Now, a study in mice conducted by researchers at the University of Wisconsin-Madison has found that the genetic basis as to why this happens. [emphasis mine]

Always? Okay, whatever...

The study, published in the December 5 issue of Cell Metabolism, found that mice with and without a particular gene - SCD-1 - processed carbohydrate in their liver differently. Those with the gene converted the glucose from carbohydrate to fat to be stored and grew fat; those without the gene utilized the carbohydrate for energy and remained a normal body weight.

The media is focusing heavily on the supposed "refined" aspect of the carbohydrates consumed by the mice, but abstract itself makes no mention of "refined carbohydrate;" noting the dietary comparison included a high-sucrose, very low-fat diet compared with a high-fat diet to investigate differences in the metabolism of mice with and without the SCD-1 gene.

The lead researcher, James Ntambi, noted, "It looks like the SCD gene in the liver is responsible for causing weight gain in response to a high-carbohydrate diet, because when we take away the gene's activity the animals no longer gain the weight. These findings are telling us that the liver is a key tissue in mediating weight gain induced by excess carbohydrates."

Since this was a study in mice, it was refreshing to see that one article, in the Star, noted that "Human studies have shown that people on high carbohydrate diets have "dramatic" increases in their levels of the SCD enzyme."

While many articles are implying that a drug may be developed to inhibit the gene in humans, Scientific American got to the point quickly, "This finding reveals that the liver determines whether or not eating refined carbohydrates will lead to fat gain. The researchers say this system is a good example of a direct diet-gene interaction. But they also say that a drug to turn off that fat-making liver gene wouldn’t be a good idea. Without that gene, the mice could no longer make glucose. They ended up hypoglycemic—suffering from low blood sugar. So the solution is, sadly, what you already knew: eat fewer processed carbohydrates."

I'd take a step further and say eat fewer carbohydrates, period.

Housekeeping Update

2007-12-06T20:14:00.000-06:00

Since launching Weight of the Evidence I've been reluctant to include banner ads in an effort to avoid the perception of potential conflict-of-interest. Maintaining the blog, however, is time consuming and does come with some expenses - like the occasional study I have to pay to obtain full-text access to, domain name renewal each year, book purchases, etc.

Thus far, I've managed to maintain the blog ad-free (with the exception of the Amazon Affiliates program linking to books) but have found myself setting aside the blog writing more and more often in favor of other projects...and then missing my blog and the writing and time involved in it!

So, in an effort to see if the blog can cover its own expenses, I'm testing the water with some banner ads. At this point I'm still a bit reluctant and am being very selective about the banner ads I do choose to include here.

For now the advertisements you see, I can assure you that they meet certain conditions if they're here:

1. I have purchased product or service from the company and was very satisfied with service, product and customer care
2. No companies have a "dog in the fight" of diet and nutrition
3. Some have something "valuable" to offer - like uPromise for college savings (I've been a member myself since before my son was born)
4. As always, if it's a book, I've purchased it myself, read it and recommend it (expcet where noted - ie. Gary Taubes, Good Calories, Bad Calories)

I'll evaluate how things are going with this in 90-days and consider reader comments and feedback about whether to continue after the 90-days pass. I'll be mixing things up - adding banners at the end of posts, in the sidebar, and in the footers.

Thank you for your patience!

What's Inside?

2007-12-06T17:23:00.001-06:00

I wish the video didn't freeze on the frame that gives away the end, but it's still worth the view!

Must See Videos

2007-12-05T15:57:00.000-06:00

Dr. Malcolm Kendrick presenting at the Leeds BMA meeting.

PART 1: Cholesterol

PART 2: Familial Hypercholesterolemia

PART 3: Statins

PART 4: Heart Disease

PART 5: CVD Populations

If you like the video presentation given by Dr. Malcolm Kendrick, you may want to read his book,The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It