Friday, December 29, 2006

Tag - I'm It!

What might you find interesting about me that you wouldn't know if I didn't tell you?

That's the concept of playing tag online - if you're tagged, you reveal five little known things about yourself and then get to tag five other people to do the same. Suzique, over at the Low-Carb Lab recently tagged me in her No-No-NOLA blog...I'm game, how about you?

Little known things about me:

1. I have Fred Flintstone feet. Enough said.

2. Once, years ago, I had a bowl of M&M's on my desk for so long, untouched, they collected dust -- ewww. Yup, I can sit for days/weeks/months with a bowl of M&Ms next to me and not eat one of them - and it's not like I don't like them, they're okay, it's just I've never been a big fan of milk chocolate, so it's not tempting to me....really good dark chocolate, that's another story.

3. I'm a PADI certified Open Water Diver and my favorite SCUBA spot (so far) is off Maui, Hawaii - the waters around Molokini are pristine and home to more than 250 species of fish to see while diving to depths up to 150-feet (I only dove to 60-feet).

4. I've been to Pakistan - to attend a wedding - and was able to visit Karachi, Islamabad, Bourbon and Taxila...a very cool vacation! And the weddings there are a lot of fun - they last for days and days, with parties for every reason you can think of to have a party; bride-to-be is getting married, let's have a party, groom-to-be is getting married, let's have a party, oh - the couple together needs a party too, the brides and grooms parents have a party, the wedding is followed by a party, the reception - yup, another party!

5. I was a competitive hunter and show jumper growing up - pretty darn good too! In my best year I made it to the finals in an attempt to qualify for the New York Horse Show.....but, somehow, I actually managed to disqualify myself by falling off my horse on the simplest of all jumps - I fell at the first cross-rails in a six bar competition, the lowest jump on the course!

...and life goes on without a ribbon from the Garden!

Who shall I tag?

Who might be up to the task that you might also enjoy learning something new about?

Tag, you're it - Mike Eades, Jonny Bowden, Lou Shuler, John Briffa and, last but not least, Richard Morris.

Saturday, December 23, 2006

Tuesday, December 19, 2006

Study: Six Weeks from Normal to Pre-Diabetic

A study, Effect of Eucaloric High- and Low-Sucrose Diets With Identical Macronutrient Profile on Insulin Resistance and Vascular Risk, published in the American Diabetes Association (ADA) journal, Diabetes, investigated the relationship between sugar intake and risk of developing diabetes.

What's fascinating, and disturbing at the same time, is how this study made it through peer-review without questioning the conclusion that a high-sucrose intake as part of a balanced, eucaloric, weight-maintaining diet had no detrimental effect on insulin sensitivity in healthy nondiabetic subjects compared with a low-sucrose diet; when the data clearly shows subjects at baseline had a normal fasting blood glucose level of 4.8mmol/L (86.4mg/dL) which rose to the ADA defined pre-diabetic level, 100-125mg/dL, rising to 5.6mmol/L (100.8mg/dL) in just six weeks.

The subjects' HOMA-IR score also climbed from a reported 1.99 at baseline to 2.14 when assigned the diet containing 10% sucrose, and to 2.39 when assigned the diet containing 25% sucrose, after just six weeks on either diet. The HOMA-IR, you'll recall, is the Homeostasis model assessment for Insulin Resistance. A value greater than 3.8 is indicative of insulin resistance. It is calculated by using the formula: HOMA-IR = insulin (µU/mL) × glucose (mmol/L) ÷ 22.5.

Over a period of just six weeks, the subjects in this study experienced a rise in their HOMA-IR scores and their fasting blood glucose, yet the researchers concluded "a high-sucrose intake as part of a balanced, eucaloric, weight-maintaining diet had no detrimental effect on insulin sensitivity in healthy nondiabetic subjects compared with a low-sucrose diet."

Even the headlines are trying to convince us this study somehow proves sugar doesn't cause diabetes - Sugar not linked to diabetes rise, suggests study.

In the above article we're told, "Writing in Diabetes, Dr. Hunter and his co-workers report that no weight changes were recorded for either group, and that there was no significant differences in glucose uptake and production. Additionally, no significant adverse effects for a number of other metabolic and physiologic parameters were observed between the groups, he said, such as elasticity of the arteries, and glycaemic profiles."

In this study, a high-sucrose intake as part of an eucaloric, weight-maintaining diet had no detrimental effect on insulin sensitivity, glycaemic profiles, or measures of vascular compliance in healthy non-diabetic subjects," said the researchers."

It is likely that other dietary factors such as excess calories and lifestyle factors such as physical inactivity and weight gain may be more important than carbohydrate type," said Hunter."

How exactly does a finding, completely at odds with the data, get published? I have to wonder, are these conclusions and subsequent headlines because "This study was supported by an unrestricted research grant from The Sugar Bureau and Suikerstichting, the Netherlands."?

Let's hypothetically say the source of funding did somehow influence the conclusions for a moment - shouldn't the peer-review process, prior to publication of the paper, caught that the data showed progression to pre-diabetes in healthy subjects in just six weeks?

Seriously - it took me less than five minutes to see the red flags - both missing and ignored data.

The missing data red flag - in the study, the researchers calculated and included the baseline HOMA-IR yet did not do so in the final data or mention the HOMA-IR after the two diets in the paper. Why?

The ignored data red flag - the rise in fasting blood glucose from baseline to the six week endpoint in the two diets. Why?

I'm no expert in diabetes, but even I know that rising fasting blood sugars that rise from normal to pre-diabetic levels, and an increase in HOMA-IR, in just six weeks, is not a good thing; and certainly not indicative that the diet studied is benign, having no effect on the metabolism of glucose.

But, hey, we're told once again sugar doesn't cause diabetes.

You want to know something? It's true - it doesn't. It's not the sugar per se, it's the excessive total carbohydrate that includes sugar and starch in the diet.

In both diets subjects increased total carbohydrate from 280g a day (17g of fiber) to 437g a day. After just six weeks, the difference between the 437g carbohydrate diets with 10% sucrose or 25% sucrose was insignificant, but the difference from a baseline diet with 280g of carbohydrate compared with the trial diets containing 437g of carbohydrate should be a wake-up call for anyone investigating how insulin resistance and pre-diabetes, which places one on the road to develop diabetes, can happen in just six weeks.

It's right there in the data - fasting blood glucose rose in six weeks from normal to pre-diabetic -- and not one researcher or peer-reviewer saw fit to highlight that fact.

Ignore the data at your own risk.

Friday, December 15, 2006

A Gallon of Soda a Week!

That's what the latest figures from the Census Bureau say each American drinks, on average, each week.

1454-calories a week, just from soda!

375.7g carbohydate a week, just from soda!

54g of carbohydrate a DAY, just from soda!

13.5-teaspoons of sugar a DAY, just from soda!

Santa is too Fat!

We've taken away Cookie Monster's cookies, said Candyland might contribute to childhood obesity so maybe kids shouldn't play it, and banned cupcakes from school birthday parties. Just when you thought it wasn't possible to suck the life out of childhood anymore than we've already done, now we need to make Santa lose weight.

As reported in the Scotsman, Santa Claus is too fat and a poor role model for children!

THE festive image of a fat, jolly Santa could be sending out the wrong message in the fight against obesity, experts warned yesterday.


Dr Miles Fisher, consultant physician at Glasgow Royal Infirmary, said: "Santa is the archetypal picture of abdominal obesity."

He added: "The image of Santa is of a round, jolly person and it is meant to be one of hilarity, but if you have obesity around your tummy, then it is very bad for you. "

Before, we thought it was just not good to be overweight, but now we know that having fat around your middle is particularly bad."

Attitudes toward Overweight and Obese

"Why should the whole population basically pay for the preventable actions which other people choose?"

That was the question posed by Paul Frijters of the Queensland University of Technology as he introduced a "user pays" principle to curb the escalating costs of healthcare associated with the obesity epidemic in Australia.

Professor Frijters urged the Federal Government to lift restrictions on health insurance companies to ask questions about a person's weight and allow them to calculate increased premiums based on body mass index.

Obesity has been linked to a number of life-threatening conditions such as type 2 diabetes, high blood pressure and heart disease.

"There's a much heavier use of medicine and there's much heavier use of hospital care by obese people," Professor Frijters said. "Obesity is so closely related to lifestyle choices and the costs associated with it are becoming so great that it's no longer tenable to simply gloss over it."

In the UK, the media is hot on the warning that obesity could bankrupt the healthcare system in that country.

Professor Sattar, an expert in metabolic medicine, said research had linked obesity to a range of diseases and disorders, including heart disease, cancer, depression, back pain, diabetes and skin problems. He said: "The problem of rising prevalence in obesity may get much worse - rates could climb still further, bankrupting the health system and leading soon to reductions in life expectancy. "So we need to think out of the box, nothing that has been looked at so far seem to have worked."

He said while individuals "clearly have some responsibility for their health", the rest of society should also play more of a role. He said the food industry should own up to the role they play through advertising and schools should be doing more to promote good diets and lifestyles.

Among the ideas put forth to help individuals take some responsibility - warning labels on larger size clothing with a phone number to call a helpline!

I kid you not!

The number should be promoted on the labels of all clothes sold with a waist of more than 40in (102cm) for men, 37in (94cm) for boys, 35in (88cm) for women, and 31in (80cm) for girls.

What's happening here in the states?

Well, from Texas we find this interesting opinion, "Then I stopped and thought — for every person who doesn’t have insurance and spends their time jamming unhealthy foods down their gullet, there’s a cost. When they wheel portly New Yorkers into the hospital with a burrito in one hand and a donut in the other — there’s a cost.

I don’t want the government controlling my life — but I also don’t want it to keep dipping into my pocket because someone else continues to make a stupid mistake that will cost themselves their life and the rest of us millions — if not billions — of dollars."

From Milwaulkee there's this - "None of my columns has elicited the wrath of the masses. I'm about to change that. Because statistically speaking, it's a pretty good bet for me to say that you're fat. And I'm ticked off because you're hurting my wallet.

People often ask how I stay so skinny. It's true; compared to most people I encounter on a typical day, I look like a rail. But according to the chart for body mass index, my current height and weight (6'1, 155 pounds) fits within the ideal BMI parameters.

What's my secret? And why am I ticked off that a big portion of my paycheck goes to treating obesity-related illness? Because my being skinny is not an accident; I have to work at it. During the past 13 years, I've run enough miles - more than 25,000 - to circle the Earth. When that damaged the tendons in my foot, rather than sit and mope, I hit the weight room, took up swimming, bought a bike and, if nothing else, took 60 minutes or more each day to walk. Though I have a weakness for chocolate, a look into my typical grocery cart reveals things like broccoli, spinach, multigrain bread and apples. My alcohol consumption is usually no more than one drink a week. Fast food? Strictly reserved for my few trips a year back home to Minneapolis. In other words, I make the choices necessary to avoid obesity-related illness."

And, a recent survey, reported in Insurance News Net found "more than 25% of Americans are comfortable with charging obese people higher premiums for their benefits."

Clothing with warning labels? Higher premiums based on BMI? Obese people choose to be fat?

What do you think?

Thursday, December 14, 2006

Big Brother Takes Job as Short Order Cook

Last week New York City became the first major city to approve a ban on industrial trans-fats in restaurant food preparation. As the mayor of New York, Michael R. Bloomberg, was quoted in the New York Times, the city is ''not going to take away anybody's ability to go out and have the kind of food they want, in the quantities they want. We are just trying to make food safer."

The mayor is also quoted on MSNBC as saying “Nobody wants to take away your french fries and hamburgers — I love those things, too, but if you can make them with something that is less damaging to your health, we should do that.”

What's to argue here? It's clear industrial trans-fats, created in a process to convert liquid oil to a stable solid fat by hydrogenation, are bad for us; they lower HDL, raise LDL, and data shows they contribute to inflammation and elevated risks of coronary heart disease.

Besides the known health risks, a wide range of leading health organizations, including the American College of Cardiology, the American Cancer Society, the American Diabetes Association, the American Medical Association, the American Society of Hypertension, the Medical Society of New York and the New York Academy of Medicine all support the ban.

Heck, even my thoughts upon hearing the news of the ban was positive.

That is until I thought about it and considered the potential long-term implications of this type of ban - a ban on a legal food ingredient that no one is forced to consume. Ever.

Sorry, but the argument that consumers have no choice because restaurants are using the ingredient unbeknownst to them doesn't hold water - you'd have to be living under a rock to not know partially hydrogenated oil is the oil of choice for making french fries, pastry and baked goods in the United States; and your taste buds would need to be non-functional to not taste the margarine instead of butter on the vegetables, potatoes or bread.

Besides that, no one makes you eat out - you choose to and you have the choice to spend your money at establishments that use these partially hydrogenated fats or spend your money at establishments that don't.

One issue on my mind, in considering the long-term implications, is the fact that these fats were lobbied into our food supply on a large-scale by the very same people now insisting they be banned - yes, the same people now telling us to stop eating trans-fats once upon a time insisted they were "healthier" for us than the fats traditionally used in food preparation.

For that history, you can read Dr. Mary Enig's article, The Tragic Legacy of the Center for Science in the Public Interest, penned three years ago, that detailed how CSPI led the way, by public relations blitz, to pressure restaurants to replace the oils traditionally used with partially hydrogenated oils. All in the name of improving the quality of our food and health!

This is the same organization that, back in 1988, in their newsletter, declared that "the charges against trans fat just don't hold up. And by extension, hydrogenated oils seem relatively innocent." Today, the Executive Director of CSPI, Michael Jacobson now claims trans-fats kill 30,000 people each year. He's the same Michael Jacobson that led the way back in the eighties to, shall we say, "motivate" restaurants to replace their oils with partially hydrogenated oils.

As an Op/Ed in the Wall Street Journal asked, "We wonder if he feels guilty?"

But let's put that aside. Let's give him the benefit of the doubt (shrug) that he didn't know, couldn't have known (big eye roll) and was really of the assumption that he was doing the right thing (sigh).

The ban leaves way too many questions unanswered.

Topping the list, what will now replace the partially hydrogenated oils?

You can be damn sure no one is going to even consider going back to what worked - naturally saturated fats like coconut oil, butter, beef tallow, lard or palm oil. Who is going to risk the public outcry if they even consider these oils, let alone actually use them? We absolutely have to ignore that they undergo significantly less damage when heated, hold up extremely well in high heat applications and produce an end product that often tastes better than those made with partially hydrogenated oil. Good grief, they're saturated fats! No can do!

So, then, what's out in the pipeline of options?

Well, let's see:

zTrim is one handy-dandy fat replacement, made of "an insoluble fiber made from corn and oat."

"The ingredient and the process are the brainchild of George Inglett, longtime researcher at USDA’s Agriculture Research Service labs in Peoria, Ill. The USDA licensed the rights to this all-natural grain to Fibergel Technologies, Inc., a wholly owned subsidiary of Z Trim Holdings, Inc."

Thank you USDA...more corn in our diets.

Food Processing magazine offers up some more "yummy" industrial options:

Rebalance System Satin 50
"a combination of thickeners, texture enhancing ingredients and Splenda sucralose for use in salad dressings, sauces and marinades. Manufacturers can reformulate the above mentioned items to achieve lower calories and/or reduced fat."

NovaLipid line of fats and oils
"Each one is specifically formulated to contain little or no trans fat. NovaLipid products have an extremely low taste profile, making them a suitable addition or alternative to a vast number of food applications such as shortenings, margarines, confections and many other prepared foods."

Neobee MLT-B
"a structured lipid based on medium-chain triglycerides (MCTs). It’s a suitable replacement for partially hydrogenated vegetable soil (PHVO). Designed to mimic the solid fat index of PHVO in baking applications, the product incorporates the dietary and health benefits of MCTs, which are metabolized in one-eighth of the time and deliver fewer calories than typical long-chain fats."

Clear Valley 65
"a high oleic canola oil brings superior performance to hydrogenated shortenings, and superior fry stability and improved fry flavor."

Nexsoy Trans Fat-Free
"an expeller-pressed soybean oil. It is manufactured without the use of chemical solvents or refining caustics. It has the stability of partially hydrogenated soybean oil but is free of unhealthy trans fats. It can be used in commercial frying applications, snack foods, dressings and sauces..."

And you thought Crisco was nasty stuff?

So, which of the above options will the restaurant you eat at use?

Or will they choose something else?

Who knows?

Who cares, trans-fats are banned, anything replacing them will be "healthier," right?

There's the fatal flaw in this idea that banning trans-fats from restaurant foods is going to lead to healthier foods and healthier lives of citizens consuming those foods. It's absurd to think we can regulate and legislate away our obesity epidemic, our alarming rates of diabetes and our suseptibility to chronic, degenerative disease. None of these laws change the one thing that is required to lose weight and prevent health problems - human behavior.

Everyone in New York knows you can't make someone stop eating french fries if they're so inclined - even Mayor Bloomberg conceeds he's not taking away your french fries - they're just going to be fried in something else, again.

So really, what's the point?

This ban isn't going to make New Yorkers healthier, fitter or eat less french fries or other calorie-rich, nutrient deficient food. I'd bet that this government-enforced decline in trans fat consumption in restaurants will be matched by something as just as bad, if not worse (considering our apriori obsession with total dietary fats and condemnation of dietary saturated fat), although we'll feel good that we're not allowing any appreciable trans-fats to be served to anyone eating in a New York this time around, and we'll continue to be ever-vigilant about those dreaded saturated fats because we can be sure the watchdogs will be out in force to make sure no one uses them to replace partially hydrogenated fat in food preparation!

But those consequences pale in comparison to the very real loss of personal liberty.

Think about it - what right does the government have to summarily ban trans fats from food preparation by restaurants when they're still readily available next door at the corner market?

Ahhhh, wait a minute....maybe that should be the next stop - ban foods with these nasty fats from the shelves; the current requirement for disclosure on nutrition labels is simply not enough to protect consumers from themselves and their indulgent ways!

In fact, there are still lots policies and bans that health officials have not yet proposed - if banning one food ingredient is really such a good way to promote health, why don’t we just pull out all stops and ban beef, bacon, coffee, sugar, salt, alcohol, mayonnaise, cream, butter, and whole milk products while we're at it? That way very few people could buy these "health damaging" foods. That would surely end the obesity epidemic pretty quickly, wouldn't it?

Yeah, that's the ticket, more regulation!

While I am being a bit snarky here, I personally have no arguement about the health damaging effects of industrial trans-fats - in fact, I would love to see them eliminated fully from the food supply. What's utterly insane is a city council selectively banning their use in one segment of the economy - restaurants - while they remain freely available elsewhere, while they tell us the ban is to protect and improve our health.

Honestly, the only real basis for serious opposition to such a ban is one fundamental principle - respect and value of individual freedom to act and judge with his/her own mind.

What the ban in New York shows us, quite clearly, is that it's easy to ban something everyone agrees is "bad" for us. Nothing else is required to put an end to its consumption other than "we know it's bad for our health" - forget cognition on the part of the individual consumer, no choice or decision making on his part in these trifling matters counts for anything according to the New York City Board of Health and its experts.

The freedom to choose can simply be ignored and brushed aside because the government knows better, and knows how to protect you from yourself, and your consumption of a legally available food ingredient.

Hey look - Chicago was quite miffed New York beat them to a ban on trans-fats; they're now looking at not only banning trans-fats, but also offering up an ordinance aimed at healthy living, a requirement that would mandate prominent posting of the calories, sodium and saturated fat content of each menu item offered at chain restaurants.

Nope, not trans-fat, but saturated fat.

This, of course, to "protect the children" - as Alderman Burke said, "I don't think adults necessarily have to be controlled, they make their own lifestyle choices whether it is eating, drinking or smoking, but when it comes to kids I think every medical expert would agree that something needs to be done. If you look at the statistics now about child obesity, the early onset of child diabetes, the early onset of cardiovascular problems with children, you will find it is of epidemic proportions in America. I think parents ought to be a little bit more aware of what their kids are eating."

Like we aren't already aware?

I ownder, where will this slippery slope will bottom out?

Some will believe government is "looking out for our good," but ask yourself if you can manage this on your own.

Wednesday, December 13, 2006

The Protein Debate

The Protein Debate

Loren Cordain, PhD
T. Colin Campbell, PhD


Letter to Editor Sees Light of Day...

Last week The Oregonian published A Jazz Man's New Groove, about Thara Memory, a jazz trumpeter who lost a leg and finger to complications of diabetes "but not his fire to make music."

It wasn't an article that caught my attention in my daily review of the news; in fact, I probably wouldn't have known of it if it weren't for a reader of my blog bringing it to my attention. Vivki A. emailed me because she'd sent a letter to the editor of the Oregonian about the article. That was last week. The editors have not indicated they'll be publishing her letter, so I decided I'd publish it for her.

Dear Editor,

Your story headlined "Diabetes steals Thara Memory's [a well known local trumpet player] lower leg and fingertip" make me feel so sad - and angry. It would better have been headlined "Memory hands his lower leg and fingertip to diabetes".

No, I'm not blaming Thara Memory for the loss of his lower leg and fingertip. I'm blaming his doctors, who gave him such bad advice about diabetes management that he had no alternative but to lose those limbs, plus his kidneys, forcing him on dialysis and making him an invalid with a severely restricted lifestyle.

These diabetic-related complications could have been entirely avoided had his doctors given him the proper tools - which they obviously did not.

If his doctors were like the vast majority, they probably gave him some pills, told him to lose weight, gave him a copy of the ADA diabetic diet plan and sent him on his way. They might have told him to test 2 or 3 times a day without telling him what to do with the results of that testing. And maybe even told him he had "excellent" control when his A1C(an average of blood glucoses over a 3-month period) was 7 or even anywhere near that number.

What they probably didn't tell him was that if he could get his A1C to under 6.5 he very likely wouldn't have lost the use of those limbs. Or the use of his kidneys. Or be wheelchair bound. Nor did they tell him how to do this.

Although it takes some effort, it can be done. I have, and I know many diabetics who have.

I blame the American Diabetic Association, whose diet plans almost all doctors give their diabetic patients. The same ADA who advise diabetics that they can eat like regular people, just cut down on portion size and use artificial sweeteners. Sure, you can have that slice of pie, crust made with flour, under the filling - just be sure to use artificialsweetners in the filling.They don't tell diabetics that any grain, such as rice, or foods made with grain - such as breads, pasta, cereals, and yes, that pie crust - will raise BGs alarmingly.

The ADA actually advocates eating breads, pasta, rice and cereals. That's quite clear from the food you mentioned in the article that Memory was eating. Rice? Rice will for SURE raise BGs.

My point is, the diabetic "epidemic" could be well tamed if people were told how they could live a diabetic life and reach its end with all their limbs and body parts intact. It could be that they aren'tmotivated to make the effort. But doctors never even give their diabetic patients the information that this is possible. Sadly, they probably weren't even taught this in medical school.

In closing, I would refer you to a letter to the editor that appeared in the NYTimes last week in response to an article they printed about the ADA and its sponsors. For your convenience, I'll paste it on here. And you might be interested in reading the original article, which is referred to.

New York Times Letter to the Editor December 4, 2006

To the Editor:

"In Diabetes Fight, Raising Cash and Keeping Trust" (front page, Nov.25) points out the conflict of interest in the American Diabetes Association's relationship with drug and food companies that makedonations to the association.

Indeed, you even quote an official of the association as saying that sugar ingestion is of little consequence for prediabetics.

I have been a Type 2 diabetic since 1999.

The article claims that "obesity and inactivity are the key risk factors" for Type 2 diabetes.Perhaps for some, but I was neither obese nor inactive, yet my bloodsugar levels were off the chart.

I was fortunate in finding a doctor who advised me to cut back significantly on carbohydrates. By doing so, I am able to achieve normal blood sugar numbers without using drugs or insulin.Perhaps someone should inform the American Diabetes Association that carbs turn into sugar when digested. But there's no money to be madefrom such advice, which I have never seen from the American Diabetes Association.

Irwin LevineHastings on Hudson, N.Y., Nov. 25, 2006

Feel free to do any editing necessary to make the segue graceful (if you can, smile)

Vicki A.

Saturday, December 09, 2006

True Believers

Science at its best is all about curious wonder, investigation and discovery. Those who follow a career path to research are often inquisitive, interesting people who have a strong desire to get to the bottom of things, to search for answers and to challenge long-held beliefs. I've had great opportunities to meet many researchers over the last five years and am always struck by their desire to take their knowledge and understanding one more step, repeatedly questioning if what they believe is true or not.

Often when a researcher holds a dissenting view on an issue - interprets data differently than others or reaches contrary conclusions - they find themselves ridiculed, ostracized and sometimes even censured! But, they often remain steadfast because they are sure something isn't right with the popular interpretation or use of the data.

Through the years we've seen a number of researchers eventually vindicated - last year two Austalian scientists were awarded the Nobel Prize in medicine after decades of ridicule over their discovery "that ulcers weren’t caused by stress, but rather by the bacterium Helicobacter pylori." That discovery turned medical dogma on its head but not without years of fighting the entrenched belief that ulcers were caused by stress.

Yesterday, as I was reviewing the latest issue of the American Journal of Clinical Nutrition, I wasn't surprised to read Dr. Martijn Katan's reply to Dr. Uffe Ravnskov's Letter to the Editor about Katan's editorial in May about the findings of a study by Krauss et al.

Now, while I could write all about it here, I think it's best to let you read all about it over at Dr. Mike Eades blog - he notes the same type of issues with the reply that struck me when I read it.


UK Solution to Childhood Obesity - Surgery & Drugs

In a stunning decision this week, reported in This is London, the National Health Services approved weight loss surgery for children as young as 14; those younger will be offered "anti-obesity" drugs.

They claim dramatic action is needed to save a generation from dying before their parents. More than a quarter of children are overweight or obese, with obesity rates of 14 per cent in those aged between two and 10 years.

At the same time, levels of inactivity have soared as many children no longer take part in competitive sport at school and playing fields have been closed.The Government has set a target to halt the year-on-year rise in obesity among children under 11 by 2010.

For the first time the Government's watchdog, the National Institute for Health and Clinical Excellence (NICE), has proposed guidelines for preventing and treating obesity in children.Surgery - which costs around £10,000 - would be an option for children who had reached an age of "psychological maturity", thought to be between 14 and 16 years.

Gastric surgery is a risky procedure - even for adults - which needs lifelong monitoring for potential complications.

What types of complications are we talking about subjecting these children to?

Short Term Complications (in the first 3 to 14 days)
  • Bleeding Leak
  • Abscess and Infection
  • Pulmonary Embolus
  • Death
  • Severe Nausea and Vomiting
  • Narrowing or ulceration of the connection between the stomach and the small bowel has been reported in one series in about 20% of all patients undergoing gastric bypass.
  • Bile Reflux Gastritis occurs when bile flows back into the stomach.
  • Fistulas, (an abnormal passage leading from one hollow organ to another) abscess and infection have been seen in gastric bypass operations.
  • Dumping Syndrome
  • Gallstones
  • Adhesions, scar tissue caused by healing after surgery
  • Diarrhea

Long Term Complications

  • Vitamin and Mineral Deficiencies - Decreases in iron, vitamin B12, and/or Folate levels were detected eight months to eight years (median, two years) after the operation.
  • Peripheral neuropathy (disorders resulting from injury to the peripheral nerves) has been reported after operation.
  • Osteoporosis and Bone Loss.
  • Gastric bypass procedures carry the highest risk of multiple micronutrient deficiencies, that may supervene despite close medical follow-up.
  • Patients with a gastric bypass have a greater frequency of microcytosis and anemia, more frequent subnormal serum levels of vitamin B12, and impressive failure to absorb food vitamin B12.
  • Gastrointestinal bleeding from a duodenal ulcer four years after having a gastric bypass procedure for obesity
  • Symptomatic gallstones requiring cholecystectomy
  • Abdominal Wall Hernia
  • Pregnancy Complications

Oh, let's not forget the drugs!

Weight loss drugs Xenical and Reductil could also be prescribed for teenagers, and even children under 12 if doctors think their lives are at risk. NICE accepts the drugs are not licensed for use in children but says doctors are legally permitted to do so if it will benefit their patients.

Professor Colin Waine, chairman of the National Obesity Forum, said "We believe there is a small group of obese children at significant risk who could benefit, once a child has finished growing and has achieved maximum height, and where there has been a failure of medical treatment.

"We wish it wasn't necessary but the risks are so great of not helping these children that surgery has to be be an option."This is because these children are at risk of developing type 2 diabetes in later life, they have significant risk factors for premature cardiovascular disease, and they are more at risk of developing cancer."

Friday, December 08, 2006

Nailing the Cause of Childhood Obesity

It seems these days there is a lot of finger pointing about the cause of the alarming rise in the incidence of childhood obesity.

It's the advertising children see...

No, wait, it's a lack of public parks...

No, really it's the fast food...

No, no, no, they don't have enough places to exercise...

Oh, wait, it's the inability to maintain a healthy balance between calories and activity...

No, they just eat too many calories...

Gosh darn it, it's the loss of physicial education in schools!

No, it's probably the school lunches...

Hey, what happened to recess?

Forget that, it's lazy parents...

Kids just need to learn to eat right...

They need to stop skipping breakfast...

They're eating the wrong snacks!

No, really, it's stranger danger keeping them from being active!

If they have a fitness magazine they'll lose weight...

Stop selling soda in schools, that's the ticket...

It's living in the suburbs...

We should hike up the tax on junk food to stop them from buying it...

They eat too much fat...

Damn those cupcakes...

Lay off the juice drinks...

Nah, they watch too much television...

Wait, it's too many hours surfing the internet and playing video games...

It's the trans-fats...

Give them more whole grains and less Lunchables!

They need healthy snacks!

They're too picky so parents just feed them what they'll eat...

It starts when they're toddlers....

No, it's their birth weight...

No, no,'s their mother's eating too many calories before they're born...

Oh, if only they were breastfed...

Wow - and that is just a sample from the results this morning in Google searching the phrase "childhood obesity."

Oh, and let's not forget, Cookie Monster is now singing "cookies are a sometimes food," schools have banned parties, and Candyland is being evaluated to determine if it's contributing to childhood obesity!

So, what do you think is causing childhood obesity?

Thursday, December 07, 2006

The Obesity Crusaders

Earlier this year I wrote "Waiting for the government, schools, daycare, health organizations, politicians, doctors, the food industry or others to fix the problem for you is no longer an option any parent should consider viable for the long-term health of their child. It's time we parents step up to the plate and take responsibility for what we're feeding our kids, what messages we allow marketers to ingrain in their minds, and what activities we encourage them to engage in each day."

Problem now? As the laws of unintended consequences go, now everyone is jumping in the game trying to solve the problem and what we're heading for isn't a solution, but a nanny-state!

In the United States we're not quite there yet, but consider this - Britain is establishing a database to track all children, their habits and behaviors, and investigate families whose children are flagged in the database as "at risk," based on particular behaviors - including failure to eat the government recommended five servings of fruits and vegetables each day!

The index - or those computer systems linked to it - will carry details of everything from vaccinations to whether a child is eating enough fruit and vegetables, or is struggling in the classroom...Doctors, schools and the police will have to alert the database to a wide range of "concerns". Two warning flags on a child's record could trigger an investigation.

Today, Britain's Daily Mail reported Sainsbury's (a retail grocery chain) will roll out a program of "Nutrition Nannies" to walk the aisles of their supermarkets and "advise families about what to buy to lose weight and stay fit."

Can you imagine?

It seems these obesity crusaders believe that the state has the right to define and enforce a single vision of what constitutes healthy living and a good life. The establishment of the "Children Index" database assumes the government's judgment is inherently superior to any individual's judgment - if you stray from the accepted vision, expect a knock at your door as you will be investigated; afterall you are putting your child at risk!

Think it can't happen here in the United States?

Monday, December 04, 2006

Let it Snow, Let it Snow, Let it Snow!

That's the snow on our back deck from the storm!

A bit more perspective on the depth of the snow:

Thursday, November 30, 2006

Shut Up and Eat Your Carbohydrates!

"Words are, of course, the most powerful drug used by mankind"
-- Rudyard Kipling

Listen closely.

Read between the lines.

You are being convinced, slowly and deliberately that any dietary approach or course of treatment that deviates from the American Diabetes Association position for medical nutrition therapy, even when scientifically valid and supported by hard data, is dangerous; be afraid, be very afraid.

Add doublespeak to the mix and what was healthful is now "dangerous"; what is inherently toxic is now good for you; and remember, you can just medicate any nasties away with a handful of drugs.

The mission of the ADA is to "prevent and cure diabetes and to improve the lives of all people affected by diabetes."

As data mounts from longer term studies, the number of researchers and physicans challenging the ADA Medical Nutrition Therapy recommendations, and the media points to contradictions in the standards of care, we're seeing intensified attempts at damage control by the ADA; the latest message being one of fear.

Fear that simply writing about the success some patients have with treatment, by physicians, who are not towing the party-line and following the ADA recommendations, well, it's blasphemy! - just writing about it, highlighting the success of an alternative dietary approach, is endangering the lives of millions of Americans!

The message to those interested in preventing or managing diabetes must be clear and maintained - pharmaceutical drugs are necessary, that no one wants to or can follow a diet without sugar, that carbohydrate-rich foods are necessary for health, and that only "proper consultation" with a dietitian can help one acheive their goals in managing their disease with lifestyle modification and pharmaceuticals.

Perhaps you've become aware of this upside-down logic?

If not, I offer you a few examples of how the ADA is working hard to create a state of fear in those at risk for or diagnosed with diabetes, who even think a low-carbohydrate diet may work for them after reading about significant improvements in the media about research studies or in clinical practice. The ADA has slowly moved from discouraging anyone from thinking they can follow a low-carb diet to implying any communication that they might see improvement if they do follow a carbohydrate restricted diet is dangerous and will not be tolerated.

WebMD: Do Low-Carb Diets Help Diabetes?

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."

Message - low-carb diets work, but no one can do it anyway.

MedScape: Revised Nutrition Guidelines for Diabetes Prevention Stress Weight...

Pearls for Practice:
  • Type 2 diabetes may best be controlled through diet by lowering total caloric intake to achieve weight loss. The best mix of macronutrients in this diet may depend on the individual patient, but low-carbohydrate diets are not recommended for all patients.
  • The current recommendations state that healthy patients with diabetes may consume the same amounts of protein, alcohol, and nonnutritive sweetener as the general population.

Message - have your cake and eat it too; why follow low-carb, you can have sugar just like anyone else.

ADA Letter to the Editor, Men's Health Magazine:

"...your publication printed dangerous information that could potentially jeopardize the lives of millions of Americans with diabetes or at risk for diabetes."

Message - writing about patients who effectively control their diabetes with a carbohydrate restricted diet is dangerous, a public health threat, it endanagers the lives of millions!

The ADA Letter to the Editor is nothing more than an attempt at damage control - every time someone in the media, a physician in practice, or researchers and their data challenge the ADA dogma and expose the contradictions (especially the "you have high blood sugars, a disorder of blood sugar metabolism, but keep eating sugar"), the ADA must respond and must do all it can to preserve itself as the authority of what is "right" and "wrong" for someone with diabetes.

Rudyard Kipling was right: Words are, indeed the most powerful drug used by mankind!

The ADA has made it abundantly clear, it's dangerous - a public health threat - to even write about patients' that have successfully managed their diabetes with a carbohydrate restricted diet; forget about the existence of hard data, ignore the mountain of studies piling up, and don't even think of exploring the potential of carbohydrate restriction as an alternative - just shut up and eat your carbohydrates!

Wednesday, November 29, 2006

ADA Responds to Men's Health Magazine Article

Reprinted with permission, The Fitness Insider, Adam Campbell, November 29, 2006. I have added "ADA" in red to clarify what was from the ADA letter since my formatting is different from Adam's.

The ADA Responds... And So Do I

As expected, the American Diabetes Association responded to my diabetes story.
I've posted it here, along with a few responses of my own. (Click the link for a PDF of the letter: Download ADA_Response.pdf)

ADA: Dear Editor,
In fairness to Men’s Health readers, we would like to clarify some of the issues presented in your December 2006 article, “The Cure for Diabetes.” This article was an opportunity to educate your readers about the greatest health crisis of the next quarter century – the alarming growth of diabetes. Unfortunately, your writer presented an unbalanced story on a disease that affects 10.5 percent (10.9 million) of all men aged 20 or older - with nearly one-third of them not knowing they have it.

AC: In fairness to people with diabetes, we wanted to clarify some of the issues presented in your 2006 Nutrition Recommendations, published in the September issue of Diabetes Care. You had an opportunity to provide diabetes and healthcare providers with unbiased, scientific recommendations, yet you presented an unbalanced report on the efficacy of low-carbohydrate diets in the prevention and treatment of diabetes. Our story intended to raise awareness on this relevant and important topic, and encourage physicians, scientists, and major health organizations to enter into a serious and objective discussion on the use of low-carbohydrate diets as a potential medical nutrition therapy for diabetes.

For instance, in your 2006 report, you stated, "Although there are no data specifically in patients with diabetes, diets restricting total carbohydrate to <130 href="">Duke University study in our story, which concludes, "The [low-carbohydrate diet] improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants." Does this not qualify as "data?" If your answer, is "No," then that begs the question, "Why not?" It's one thing to acknowledge that data exists, but doesn't meet your qualifications; it's another to simply deny its existence.

Perhaps you should have said, "There's no data over 22 months on people with diabetes." Otherwise, you've also denied the existence of this study from Jorgen Vestin Nielsen and Eva Joensson, which found that advising patients to consume a low-carbohdrate diet resulted in improved measures of long-term blood sugar, and that there was no occurrence of heart disease in these patients (23 patients in all). Unfortunately, heart disease did occur in 3 out of 5 patients who didn't adopt the diet.

In addition, this study, from Guenther Boden and colleagues at Temple University, found that “In a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in...much improved 24-hour blood glucose profiles, insulin sensitivity, and hemoglobin A1c; and decreased plasma triglyceride and cholesterol levels. The long-term effects of this diet, however, remain uncertain.” As you would no doubt point out, the authors stress that this was short-term, but there’s another way to think about this: If you can achieve these benefits in just 2 weeks on a low-carbohdyrate diet, what are the potential long-term benefits? While we whole-heartedly agree that more research is needed in are of medical nutrition therapy for diabetes, we can't understand why there isn't a movement by the ADA to better understand low-carbohdyrate diets.

ADA: The article glosses over the difference between type 1 and type 2 diabetes. Between 5-10 percent of Americans have type 1 diabetes, which occurs when the body does not produce insulin. Patients with type 1 must take insulin for the rest of their lives in order to survive. Because it is an autoimmune disorder, type 1 diabetes is not preventable – an important distinction from type 2 diabetes.

AC: We certainly understand this, and by no means intended to trivialize the seriousness of type 1 diabetes. However, this story was about type 2 diabetes. That said, many physicians have effectively used low-carbohydrate diets along with adequate insulin as a therapy for type 1 diabetes. Just ask Richard Bernstein, M.D., who has had type 1 diabetes for 55 years, and has not only successfully treated himself, but also thousands of patients. But again, like Mary Vernon, M.D., the doctor featured in my story, the ADA has chosen to disregard this observational evidence from practicing physicians.

Here are a few additional studies, including a couple that are based on patient data from Dr. Bernstein and Dr. Vernon. Again, according to the ADA, these data don't count.

Gannon MC, Nuttall FQ: Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes.Diabetes 2004, 53:2375-2382.

The Effects of a Low-Carbohydrate Regimen on Glycemic Control and Serum Lipids in Diabetes MellitusDaniel F. O'Neill, Eric C. Westman, Richard K. BernsteinMetabolic Syndrome and Related Disorders Dec 2003, Vol. 1, No. 4: 291-298.

A Pilot Trial of a Low-Carbohydrate, Ketogenic Diet in Patients with Type 2 DiabetesWilliam S. Yancy Jr., Mary C. Vernon, Eric C. Westman.Metabolic Syndrome and Related Disorders Sep 2003, Vol. 1, No. 3: 239-243

Clinical Experience of a Carbohydrate-Restricted Diet: Effect on Diabetes MellitusMary C. Vernon, John Mavropoulos, Melissa Transue, William S. Yancy Jr., Eric C. WestmanMetabolic Syndrome and Related Disorders Sep 2003, Vol. 1, No. 3: 233-237

ADA: For the past five years, the cornerstone of ADA’s message has been that lifestyle modifications are the first line of defense against the development of type 2 diabetes and diabetes complications. The landmark Diabetes Prevention Program study (DPP) in 2001, funded in part by the ADA, showed a 58 percent reduction in progression to type 2 diabetes among people who had maintained a healthy lifestyle, compared to the control group. This healthy lifestyle includes physical activity and weight loss.

AC: It's interesting that you bring up the Diabetes Prevention Program. It's a great example of how lifestyle intervention (diet and exercise) can be more effective than even medication for the prevention of diabetes. In fact, the conclusions from the DPP state: "The lifestyle intervention reduced the incidence [of diabetes] by 58 percent, and metformin [reduced it] by 31 percent... [so] the lifestlye intervention was signifcantly more effective than metformin."
Now, there are a couple of points to make in regard to this.

1. The first is that the DPP doesn't support the ADA's recommendations for a low-fat diet, particularly for people with diabetes. That's because although all participants were at high risk for diabetes when the study started, they were still all non-diabetic. And 4.8 percent of the people on the ADA's lifestyle intervention developed diabetes while on the program, compared to 7.8 percent of those taking metformin, and 11 percent who did nothing.

2. The DPP study states that participants were encouraged to lose 7 percent of their body weight through a low-fat diet and by engaging in exercise for 150 minutes a week. The results: Overall, the dieters ate, on average, 249 fewer calories a day, while 58 percent (does this number look familiar? See above) adhered to the 150-minute/week exercise quota, and 50 percent lost 7 percent of their body weight. So what can we conclude? That exercising and dieting for weight loss reduces your risk of diabetes. Wow! Fascinating stuff. I guess I'm not sure why this is being brought up in response to my story. I clearly pointed out in the story that the ADA recommends to "cut calories and add exercise to reduce insulin resistance." I can't say that anyone in the world debates this advice. Which is why it wasn't the point of the story. My story centered on the specific nutrition recommendations which encourage people with diabetes to eat a diet that features carbohydrates, the only nutrient that signficantly raises blood sugar, the defining marker of the disease. In fact, if you're diagnosed with diabetes, one of the first things they do is teach you to count carbohydrates. Why? So that you can adjust your medication. More carbohydrates equals more medication. And as I wrote in the story, the need for more medication usually indicates that a disease is worsening.

3. It seems to me that the DPP is an informative academic study, but not really relevant in practical terms because it's what the ADA has been recommending for years, and yet we still have an "epidemic" of diabetes. Shouldn't the ADA take some responsibility for what's happened? The ADA's Dr. Buse told me that ultimately, exercise and dieting won't work long-term, so it's best to go ahead and get them on medication right away. (You can read about it in this position statement.) This is well meaning, as the idea is to help people lower their blood sugar even if they won't help themselves (through diet and exercise). But overall, it's a bit like they're blaming the patients for the fact that their therapy isn't working. True, not everyone who develops diabetes is going to change their diet or start exercising, but shouldn't they be given all of their options first? I would have thought that because of the seriousness of this disease, the ADA would be looking for alternatives to the current recommendations, since clearly they aren't working. Especially an alternative as logical as reducing carbohydrates, which automatically reduces the need for some, if not all, medication in many cases.

ADA: It is important for a person with diabetes to consult with a dietitian to develop a food plan that will reflect the needs, tastes, preferences, and lifestyle of the individual. Proper consultation can result in the achievement of desired goals for weight loss or maintenance, blood pressure, blood cholesterol and blood glucose.

AC: You're preaching to the choir on this one. However, just because a person with diabetes might have a "taste" for sugar, doesn't mean they should be encouraged to go ahead and eat it. That seems to be the gist of the ADA's recommendations when they state, "Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucoselowering medications."

ADA: The scientifically-based meal plan recommended by the ADA includes a variety of foods containing carbohydrates from whole grains, legumes, fruits, vegetables, and low-fat milk. These foods are important sources of fiber, vitamins, and minerals.

AC: Sure, but it's based on high-starch foods like grains. And as I pointed out in the story, and you in your 2006 position statement (although worded differently), starch is no better than sugar when it comes to controlling blood glucose. It's also hard to accept the vitamin and mineral argument when compared to medication. For instance, perhaps a person would rather take a multi-vitamin instead of metformin or an insulin shot.

ADA: While low-carbohydrate diets have been a popular and controversial topic, current research does not support the long-term effectiveness and safety of low-carbohydrate diets for the treatment and management of diabetes. Diabetes is a progressive, life-long disease that must be managed long-term. It is not wise to rely on short-term study results for a disease that will always remain a part of that person’s life. The effects of such diets on kidney and cardiovascular disease risks are especially concerning, considering these are two of the biggest diabetes-related complications.

AC: Please show me the research that raises the concern. I understand that the ADA practices evidence-based medicine, so please produce the evidence that shows low-carbohydrate diets increase kidney and cardiovascular disease risk in patients with type 2 diabetes. In fact, it would be enlightening to see the evidence that shows the increase in kidney and cardiovascular risk in non-diabetics. For instance, Ron Krauss' work (1, 2, 3, 4, 5) shows that eating more carbohydrate and less fat increases the risk of cardiovascular disease. And as I showed in the story, more than a dozen studies over the last 5 years have shown that low-carbohydrate, high-fat diets are as effective or, in most cases, more effective at lowering overall heart disease risk than low-fat diets (which are high-carb by nature)--particularly because they raise HDL (good) cholesterol while simultaneously lowering triglycerides. Not to mention that lead to greater weight loss.

Here are several of those studies (many of the links include full text of the study):

Brehm, B. J., Seeley, R. J., Daniels, S. R. & D’Alessio, D. A. (2003) A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women.

J. Clin. Endocrinol. Metab. 88:1617-1623. Sondike, S. B., Copperman, N. & Jacobson, M. S. (2003) Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents.

J. Pediatr. 142:253-258. Samaha, F. F., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J., Williams, T., Williams, M., Gracely, E. J. & Stern, L. (2003) A low-carbohydrate as compared with a low-fat diet in severe obesity.

N. Engl. J. Med. 348:2074-2081 Foster, G. D., Wyatt, H. R., Hill, J. O., McGuckin, B. G., Brill, C., Mohammed, B. S., Szapary, P. O., Rader, D. J., Edman, J. S. & Klein, S. (2003) A randomized trial of a low-carbohydrate diet for obesity.

N. Engl. J. Med. 348:2082-2090 Volek, J. S., Sharman, M. J., Gomez, A. L., Scheett, T. P. & Kraemer, W. J. (2003) An isoenergetic very low carbohydrate diet improves serum HDL cholesterol and triacylglycerol concentrations, the total cholesterol to HDL cholesterol ratio and postprandial pipemic responses compared with a low fat diet in normal weight, normolipidemic women.

J. Nutr. 133:2756-2761 Volek, J. S., Sharman, M. J., Gomez, A. L., DiPasquale, C., Roti, M., Pumerantz, A. & Kraemer, W. J. (2004) Comparison of a very low-carbohydrate and low-fat diet on fasting lipids, LDL subclasses, insulin resistance, and postprandial lipemic responses in overweight women.

J. Am. Coll. Nutr. 23:177-184 Sharman, M. J., Gomez, A. L., Kraemer, W. J. & Volek, J. S. (2004) Very low-carbohydrate and low-fat diets affect fasting lipids and postprandial lipemia differently in overweight men.

J. Nutr. 134:880-885 Brehm, B. J., Spang, S. E., Lattin, B. L., Seeley, R. J., Daniels, S. R. & D’Alessio, D. A. (2005) The role of energy expenditure in the differential weight loss in obese women on low-fat and low-carbohydrate diets.

J. Clin. Endocrinol. Metab. 90:1475-1482 Meckling, K. A., O’Sullivan, C. & Saari, D. (2004) Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women.

J. Clin. Endocrinol. Metab. 89:2717-2723 Stern, L., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J., Williams, M., Gracely, E. J. & Samaha, F. F. (2004) The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial.

Ann. Intern. Med. 140:778-785 Yancy, W. S., Jr, Olsen, M. K., Guyton, J. R., Bakst, R. P. & Westman, E. C. (2004) A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial.

Ann. Intern. Med. 140:769-777 Aude, Y. W., Agatston, A. S., Lopez-Jimenez, F., Lieberman, E. H., Marie, A., Hansen, M., Rojas, G., Lamas, G. A. & Hennekens, C. H. (2004) The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat: a randomized trial.

Arch. Intern. Med. 164:2141-2146Seshadri, P., Iqbal, N., Stern, L., Williams, M., Chicano, K. L., Daily, D. A., McGrory, J., Gracely, E. J., Rader, D. J. & Samaha, F. F. (2004) A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity.

Am. J. Med. 117:398-405 McAuley, K. A., Hopkins, C. M., Smith, K. J., McLay, R. T., Williams, S. M., Taylor, R. W. & Mann, J. I. (2005) Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women.

Diabetologia 48:8-16 Dansinger, M. L., Gleason, J. A., Griffith, J. L., Selker, H. P. & Schaefer, E. J. (2005) Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial.

J. Am. Med. Assoc. 293:43-53 Daly, M.E., Paisey, R. Paisey, R. Millward, B.A., Eccles, C., Williams, K., Hammersley, S., MacLeod, K.M., Gale, T.J. (2006) Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes--a randomized controlled trial.

As for kidney disease, the concern you voice has never been shown, and it's inappropriate for the ADA to state this, especially since carbohydrate restriction leads to an improvement in blood glucose levels, which REDUCES the risk for kidney disease.

ADA: As a result of improperly addressing these crucial components of diabetes management, not only did your publication provide a disservice to your readers by suggesting that a low-carbohydrate diet is the only safe solution to the prevention and treatment of type 2 diabetes, your publication printed dangerous information that could potentially jeopardize the lives of millions of Americans with diabetes or at risk for diabetes.

AC: We didn't suggest that a low-carbohydrate diet is the only safe solution. But we did present another side to the story--that many people with diabetes have had and are having great success in controlling their blood sugar with a low-carbohydrate diet, despite the fact that the ADA doesn't recommend this as a therapy. The truth is, we think patients who can be successful with ADA recommendations should follow them, but we don't see any great success. In fact, we see a worsening of the problem.

ADA: Larry C. Deeb, MDPresident, Medicine & Science, American Diabetes Association
Richard R. Rubin, PhD, CDEPresident, Health Care & Education, American Diabetes Association
John B. Buse, MD, PhD, CDE, FACEPresident-Elect, Medicine & Science, American Diabetes Association

AC: So that's one letter. I've gotten a bunch of other letters, too. Here are a few:

Your article accurately reflects the rapidly changing scientific understanding of diet and diabetes, as well as the "oral tradition" of diet therapy before medications were available. Congratulations on a job well-done.

Eric C. Westman, MD MHS
Associate Professor of Medicine Duke University Medical Center

I am living proof of Mr. Campbell's conclusion about carbs and diabetes. I feel very fortunate that I was able to discover this relationship and not rely on the information provided by the ADA. If his article saves one person it would, in my opinion, accomplish more than the $51,000,000.00 spent last yr. by the ADA. Keep up the great work!

Steve Miller

That was a great article about diabetes. I identified with it completely. At 32 extremely overweight 220#, 5'9'' and lazy as hell I developed insulin dependant diabetes. The starches have to go, but that's OK there's a world of great alternatives out there to eat, which will actually make you look and feel like new again. Stop poisoning yourself one mouthful at a time. Now at 48 a 27 year civil servant at @165# and an 8 pack, I run 15 or so 5K?s and 2, 1/2 marathons a year, additionally I routinely place in weight lifting competitions at the local YMCA and the MWR gyms on the Navy Base where I work. That?s' 1st - 4th place in pull-ups, dips, pushups, sit-ups and bench. By the way that's against college students, mid twenties sailors and marines. There are worse hobbies!

Richard Dollar

I just finished reading the article on diabeties and agree wholeheartedly with the doctor 3yrs ago I was told I was diabetic my glucose count was 320, my acia blood test was 9 and i tipped the scale at 364 I went on a low carb diet and got immediate results Today my glucose is always between 80 and 100 my acia test is between 5 and6 which is normal and i have lost 120pounds i also include a daily exercise routine in my program and do not take any meds at all This diet plan definetly works!!

Thomas Urbanek

You are right on! We work with Dr. Bernstein and produced the Secrets to Normal Blood Sugars by Dr. Bernstein. As a pharmacist and diabetes educator, I have seen time and time again, that by reducing carbs, blood sugars go down and people get off of meds. And if you add a little phyical activity to the mix, the results are even greater. It will probably take another 5-10 years for the medical community to accept the obvious. But it will happen!Your Friend in Diabetes Care,
Steve Freed

Monday, November 27, 2006

Wednesday, November 22, 2006

Fatally Flawed Health & Risk Paradigms: Part 2

On Friday I wrapped up the first of two posts with:

The fatal flaw in the dietary recommendations is that it's not the fat - it's the excessive carbohydrate and sugar in our diets that is causing our chronic, degenerative diseases.

The fatal flaw is that we're specifically recommended a dietary pattern that increases the risk of higher than optimal blood sugars - advising the population that such a diet is going to reduce their risk, when it is increasing their risk!

I've written many times that the dietary recommendations to the population at large are flawed; I honestly cannot believe that it's intentional, but they're flawed nonetheless, and until we go back to the drawing board and tackle the flaws we're not going to see much change in the rates of obesity or alarming prevalance of diabetes.

How did we get so entrenched in the notion that dietary fat is the critically important macronutrient to modify in our diet to reduce risks?

For that history, an article by Gary Taubes, The Soft Science of Dietary Fat, is a good place to start.

Since its publication in 2003, two large, long-term studies have been published that found no increased risk in those who consumed more total fat and/or more saturated fat than recommended. The first was the Women's Health Initiative study, published earlier this year; the second was just published and examined the data from the Nurses' Health Study.The response to the findings in both were eye-opening. In various articles reporting the WHI findings, the mainstream experts contended the null findings were because dietary fat intake was not lowered enough to make a difference; the response to the Nurses' Health Study data contended that neither dietary pattern (low-carb or low-fat) was healthy.

For whatever reason, those deeply committed to the diet-heart theory cannot accept the idea the foundation of the theory is flawed, that perhaps it isn't dietary fat per se, but the total context of diet that really matters most.

In the last few years we have witnessed some very subtle massaging of the message about what we should eat though, although it is often stated as if this were what we've been told all along! The most obvious changes in the message are two things: dietary fat isn't all bad, in fact you can consume up to 35% of total calories from fat as long as you limit intake of saturated fat to less than 7% of calories and keep intake of trans-fat as low as possible (1% of total calories or less) and concentrate on vegetable sources of fat instead of animal sources; and we're now told about "good carbs" and "bad carbs" and told we should eat complex, low glycemic index carbohydrates and limit refined carbohydrates.

Evidence for these changes to the message? Scant, but that didn't stop anyone in the past from perpetuating the idea a low-fat, predominantly plant-based diet is optimal, so why would it now?How do we keep getting it wrong?

Let me say this - changing the message about quality of carbohydrate isn't an all bad thing, it's just incomplete.

That's because it really doesn't matter if you eat complex carbohydrate or refined carbohydrate when it comes to rising blood sugars and release of insulin. Oh, to be sure, complex carbohydrate works in the metabolism slower, but 100g of carbohydrate - complex or refined - is still 100g of carbohydrate to convert to blood glucose. As noted in previous posts, blood glucose, HbA1c, high insulin, high triglycerides and such are all correlated with poor health outcomes over the long-term.

Yet we continue to preach dietary advice that raises blood sugars, triglycerides and insulin, and over time increases percentage of HbA1c when an individual has become insulin resistant.

The flaw is our focus on dietary fat and the belief we require the majority of our energy from carbohydrates.

What to we keep dismissing as critical in the equation of good health and diet?

Protein, specifically complete protein that provides for our essential amino acid requirements.

Now many counter that protein stimulates insulin too, thus protein is a moot arguement in the dietary debate; besides we eat too much protein anyway!

But do we?

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; and 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.

A study published in May 2006 analyzed the newly updated food pyramids and found they were nutritionally deficient.

How does that happen? Everything these days is fortified or enriched to protect against nutrient deficiency!

It happens because the guidelines are not adequately designed to meet nutrient requirements, they're not focused on essential nutrients, but macronutrients as a percentage of calories; designed to promote reducing fat intake, choosing plant-based proteins over animal foods and convincing you to consume carbohydrates as the major source of your calories.

Did you know protein requirements are based on your weight, not a fixed gram intake that meets everyone's needs like other nutrients?

How often have you heard or read you only need 54g of protein each day? That's what it works out to if you do the math based on the Nutrition Facts panel on every packaged food and are targeting a 2,000-calorie per day diet. (2,000-calories, total fat 65g or 585-calories, total carbohydrate 300g or 1200-calories - leaves 215-calories from protein, or just 53.75g).

If we actually look at the recommendations from the Institutes of Medicine, we find protein intake is not based on a percentage of calories, but on an individuals body weight. So, 53.75g is adequate when you weigh 148-pounds. If you weigh more, you need more each day. The RDA is set at 0.8g/kg of body weight; the IOM acknowledges "much less than most people are typically consume," yet government agencies claim "Americans eat too much protein" in educational documents, including ones that target children.

What gives?

It comes back to the deeply entrenched fear of dietary fats - if you want to reduce fat intake, specifically saturated fat, you have to promote the idea to consume less meat, whole dairy, eggs and other animal foods. What happens, at the same time though, is that both the quality of protein intake and the absolute grams of intake is impacted - both are reduced.

But hey, you did reduce fat intake!

Even with the recent concession that it isn't necessarily total fat intake in the diet, the concurrent reduction in limits on satutated fat means an absolute need to reduce animal foods which come neatly packaged with saturated fats, monounsaturated fats and polyunsaturated fats. Oh, yeah, few highlight the fact that meat, like beef, has a majority of its fat calories from monounsaturated fat, not saturated fat.

Plant-based foods can be complete when consumed together to get over the limiting protein in one or the other, but they're simply not as rich with nutrients as animal-based proteins. Meats, eggs, liver, fish, whole dairy - excellent sources of not only complete protein (essential amino acids), but also zinc, selenium, vitamin B-12, potassium, magnesium and other B-vitamins.

When you choose plant-based proteins you're also eating more calories to consume the same amount of protein - that's because plant-based foods are not rich with protein, they're rich with carbohydrate.

So, what happens when you miss your daily requirement for essential amino acids (EAA)?

Well, if it's a day here or a day there, it probably won't have much impact on your health in the long-term. But, if it's the norm, not an occasional miss, it will have an effect since amino acids are the building blocks to repair and build throughout your body. As the Biology Project at University of Arizona highlights, "Failure to obtain enough of even 1 of the 10 essential amino acids, those that we cannot make, results in degradation of the body's proteins—muscle and so forth—to obtain the one amino acid that is needed. Unlike fat and starch, the human body does not store excess amino acids for later use—the amino acids must be in the food every day."

Our dietary guidelines specifically encourage a diet that is deficient in adequate protein and complete amino acids. Each time a study is released finding protein is critical in satiety, hunger regulation, ease of calorie restriction, and weight management - it is pooh-poohed and we're cautioned too much protein is bad for us and to stick with the recommendation to choose plant-based protein!

This leads us to consume excess carbohydrates, even when we think we're eating healthy. Excess is any level of intake above and beyond what we actually need each day.

Now answer this honestly - do you really think we need to consume 500g of carbohydrate each day for energy?

That's what we're currently averaging in the United States; who is consuming the 400g+ that I'm not?

The fatal flaw is in our fear of fat, we are not meeting our protein requirements, thus we keep eating in an attempt to do so, and the foods we're choosing are poor sources of complete protein and often littered with unnecessary calories from fats and oils.

The beauty of a carbohydrate restricted diet is this - isuch a diet forces you to make protein your focus each day and strictly limits the carbohydrate foods you do it to non-starchy vegetables, low sugar fruits, nuts, seeds - all rich sources of vitamins, minerals and trace elements; and when tolerated, whole grains and legumes as desired and within calories consumed.

A carbohydrate restricted diet is not making you eat more fat or more protein; in fact, odds are better than good that you'll be eating exactly the same amount of protein and fat as you did before you limited carbohydrate! What you're eliminating isn't vegetables, fruits, nuts or seeds - in fact, you'll most likely increase your intake of non-starchy vegetables; what you are eliminating is the nutrient-poor higher carbohydrate foods that provide too much carbohydrate and too little nutrition for those calories.

Many wring their hands trying to figure out what you replace carbohydrate calories with when you're on a carbohydrate restricted diet.

The answer is - you don't replace them with anything, you simply swap out the nutrient-poor carbohydrates for the nutrient-rich ones; and encourage non-starchy vegetables, nuts, seeds and low-sugar fruits as the foods to replace the potatoes, rice, beans, pasta and other high-carbohydrate foods.

A simple example is, the typical American lunch might include a cheeseburger on a bun, french fries with ketchup and a soda. A carbohydrate restricted lunch would instead be a cheeseburger sans the bun, a salad with ranch dressing and water or iced tea with a slice of lemon, no sugar.

Both will satisfy the appetite; both are providing identical complete protein; one is significantly less calories and less carbohydrate - all because a salad is swapped for the french fries and water/iced tea replaces the soda.

Now to be fair, we're told the standard American diet (burger, fries and a soda) is unhealthy; but we're also told the carbohydrate restricted meal is just as bad, if not worse for us.

If Americans aren't going to stop eating burgers, why are we not encouraging them to at least eat them in a way that provides a better nutritional profile with less calories?

It all comes back to the fatal flaw - the dietary fat.

Until we get past the fear of dietary fat, not much is going to change. :::sigh:::

Sidebar Updates

Let me take a moment to highlight additions to the list of resources in the sidebar:

Welcome to Dr. Briffa, Dr. Davis, Alan and Lou Schuler - they each have a blog you may be interested in visiting and reading.

Two new links to support forums are also among the additions - Beyond Low-Carb and Dr. Bernstein's Diabetes Forum.

Blogs and support forum links that no longer appear in my sidebar were removed, for the most part, for lack of timely updates. It should be noted that I don't always agree with those I link to - keeps things interesting! - but each blog or forum I do provide a link to does have compelling content and is a good read!

If there is a blog you host or know of that you think others might enjoy, email me for consideration - I update my sidebar about once a month.

Physicians don't address diabetes the right way

A letter to the editor in the Kennebec Journal (Maine) had this gem:

Physicians don't address diabetes the right way

On Nov. 4, the Kennebec Journal discussed the epidemic of diabetes. Diabetes is a nutritional disease. Dr. Sears said that this was a "societal problem" due to less activity and bigger portions.

But the Centers for Disease Control Health Report shows we are more active and many of us eat fewer calories than we did in 1994. Clearly calories in, calories out is oversimplified. Eating equivalent calories from carrots or coke will do profoundly different things to the body. Doctors must address the individual needs of patients, checking thyroid levels, stress levels, sleep deprivation and simple carbohydrate intake. But 72 percent of overweight patients are never even told by their doctors to lose weight (Nov. 7, KJ).

On Nov. 9 in the newspaper, we learned a low-carb diet is "not a risk" for heart disease. Protein sparing fasts have been shown to lower: "Fasting plasma glucose and HbA1c." In clinical practice, I have seen blood sugars drop into the normal range when patients change their diets. In effect, we have the cure for type II diabetes and we are not training our doctors to use it. Even in 2006, only 30 percent of medical doctors have ever taken a separate course on nutrition. These are the specialists who are trying every drug possible when the diet of their patients is literally killing them.

Dr. Christopher Maloney

Monday, November 20, 2006

The Cure for Diabetes?

Way back in July 2002 Gary Taubes article in the New York Times, What if its All Been a Big Fat Lie, was a big fat headache for those deeply commited to the decades old dietary dogma.

Well, get ready for another firestorm of controversy about dietary recommendations! In the December 2006 issue of Men's Health magazine, Adam Campbell takes on the American Diabetes Association in his special report The Cure for Diabetes.

He teases us with his opening sentences...

What if the American Heart Association endorsed the trans-fat diet? Problem, right?

Look at what the American Diabetes Association is spoon-feeding people with diabetes: sugar.

Not to worry: We've got the solution right here.

...and leads in with the controversial approach to managing and reversing diabetes of one small town doctor in Kansas, Mary Vernon, MD.

Her secret weapon against the disease? A low-carb diet.

There's no question Dr. Vernon is trouble - but for whom? Not her patients, that's for certain. They just won't stay sick. People walk into her office afflicted with type II diabetes and, by every objective medical measure, walk out cured. There's $51-million that says that isn't supposed to happen, not in a clinic in Kansas, and definitely not the result of cleaning out the refrigerator.


If Dr. Vernon and a growing cadre of researchers are correct about carbohydrates, we may be looking at an epic case of ignorance on the part of the medical community. That, however, pales next to the implications for the American Diabetes Association, namely that the very organization dedicated to conquering diabetes is rejecting what could be the closest thing we have to a cure.

This is one of those must read articles!

Go on.....go and read it now!

Part 2 of Fatally Flawed Health & Risk Paradigms is rescheduled for posting tomorrow!