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]
Monday, May 05, 2008
Thursday, April 24, 2008
Under-the-Radar Petition at the FDA from American Dietetic Association and Others
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!
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!
Tuesday, April 22, 2008
The Solar Powered Plate
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!
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!
Monday, April 21, 2008
When Good Intentions Have Unintended Consequences
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!
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!
Tuesday, April 08, 2008
Where's Regina?
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).
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
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
-----
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. "
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
-----
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
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?
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?
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?
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?
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?
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?
Wednesday, April 02, 2008
Translation? Food Fight
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!
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!
Wednesday, March 19, 2008
My Big Fat Diet - Aim High, Think Big, Score One More!
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:
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."
Tuesday, March 18, 2008
Getting to Know Dr. Jay Wortman
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...
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.
Monday, March 17, 2008
Almost a Half-Cup of Sugar in One Meal!
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!
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!
Monday, March 03, 2008
Items of Interest
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.
. - 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.
. - ABC News: Atkins a Diet for your Wallet?
Video about rising grain prices.
. - Jimmy Moore Interviews Dr. Dean Ornish
. - Kevin at Low Carb HIT
Thinks Dr. Mike Eades and Anthony Colpo are both wrong about the metabolic advantage...read why!
Friday, February 29, 2008
Five Simple Rules
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]
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]
Monday, February 25, 2008
What the World Eats
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:
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:
Saturday, February 23, 2008
Comment Moderation Update
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
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.
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.
Subscribe to:
Comments (Atom)
Posts
