Sunday, April 21, 2019

Retrospective #65: Introducing the “Low Carb Dietitian” (2012)

The “Low Carb Dietitian” is Franziska Spritzler, RD, CDE. The About Me tab on her website in 2012 describes her beginnings as a dietitian some time earlier: “I've always had a strong belief in the power of good nutrition.  After eight years as a court reporter, I became a dietitian because I wanted to help people improve their health by making dietary changes. Once I began working in the outpatient nutrition setting, I quickly developed a passion for diabetes management.  As a Certified Diabetes Educator (CDE), my goal is to provide accurate, useful information and support people's efforts to optimize their blood glucose control and achieve a healthy weight.”
But that’s garden variety stuff. Every dietitian is similarly motivated. But in July 2011, in her first post on her website, Franziska explains why her advice was going to be different. She had a transformative experience. “My purpose in creating this website is to inform people about healthy low carb living.  This site contains information that is likely very different from that which can be found on the websites of other dietitians. However, if you'd told me a year ago that I'd be touting the benefits of a low carb lifestyle, I would have probably said you were crazy!”
Before Franziska saw the light, she followed standard establishment public health community diet and nutrition advice. “I'd been eating a very healthy, semi-vegetarian or pescatarian diet (I consumed dairy, eggs, and fish but no poultry or meat) for many years.  Because of genetically high cholesterol, I limited my saturated fat intake, always ordering egg white omelets instead of regular, eschewing butter and choosing trans-fat-free margarines instead, and avoiding cheese and cream sauces.  I rarely ate desserts, occasionally having just a bite or two of my husband's cake/ice cream/cheesecake, etc., when we were dining out.”
That’s when Franziska, who had recently attained both RD and CDE credentials, got the bad news.
“So, when I received the results from labs that were done for life insurance purposes back in January of this year [2012], I was speechless. Not only was my LDL ("bad") cholesterol elevated, my hemoglobin A1c (a measure of blood sugar levels over a two-to-three-month period of time), although still within normal range at 5.5%, was still far higher than would be expected for someone my size who ate the way I did. Now, while these numbers were not outrageously high, as one who works with people who have diabetes or prediabetes every day, they certainly suggested to me that something was not right with my blood glucose metabolism [emphasis added].  I purchased a glucometer and began testing after meals, and discovered my blood sugar levels at one hour were significantly higher than they should be. Within the next few weeks, I saw that the more carbohydrates I ate, the higher the number would go.  My fasting blood sugar always remained within normal range, however.”
So, since her education and clinical experience had taught her that “something was not right with (her) blood glucose metabolism,” what did she do? Franziska Spritzler tells us the incredible tale of what happened next.
“I made an appointment with an endocrinologist, who wasn't overly concerned since my fasting levels were so normal. He did want to retest my A1c, and by that point, it had increased slightly to 5.6%.  I cut down on the carbs slightly (not too much, though -- I'd been taught that we need enough carbs to keep our brains and other organs working properly), and then I started doing research online about strategies to control postprandial, or post-meal, blood glucose.  It seemed that many people were using low carbohydrate diets with great success in managing their diabetes and postprandial blood sugars. I was skeptical, but once I started reading the available research on carbohydrate restriction, it all started to make complete and perfect sense [emphasis added]. I discovered that the high carbohydrate, low fat diet I'd been taught to believe was ideal was anything but for many people struggling with diabetes, insulin resistance, obesity, and dyslipidemia.  This was quite difficult for me to accept at first, but now that I have, I'm quite excited about the potential to help people struggling with these conditions.”
Franziska has been very successful. After taking charge of her own health, Franziska now travels the world as invited speaker, has written a book, and is now a featured writer on DietDoctor.com. Congratulations, Franziska!

Type 2 Nutrition #483: “…when used with diet and exercise.”

Have you ever noticed how the TV diabetes medication ads always conclude with “…when used with diet and exercise”? That common refrain riles me a bit, but I’ve never examined why. I think it’s time I do.
First off, by self-examination I admit to being something of a curmudgeon. However, I tend to grouse only about the abysmal state of our collective health, including how we (including I) got into this mess. In other respects, I think I have a positive outlook on life, but you’d have to ask the people who know me best if that’s true. Regardless, my readers could fairly describe me as a crusty, grumpy old man. This column, however, is not about me. It’s about why the diabetes ads conclude with the caveat, “…when used with diet and exercise.”
I think it’s a government requirement. The Food and Drug Administration (FDA) has to approve all claims made by drug manufacturers. The FDA also dictates for what and when a drug may be prescribed. That includes as a first course of treatment, as well as any adjunctive therapy if the first medication fails to achieve the primary target. In the case of a drug to treat type 2 diabetes, that would be lowering the patient’s serum blood glucose, usually as measured today by a blood marker, the hemoglobin A1c (hgA1c), or simply, the A1c test.
Metformin is the first drug prescribed today for the treatment of Insulin Resistance (IR), as measured (too late)  by an Impaired Fasting Glucose (IFG). Metformin is generic, cheap and widely accepted as the standard-of-care, almost universally prescribed first after diet and exercise have failed. After Metformin, a generic drug, the clinician has a wide choice of drugs, depending on other risk factors and co-morbidities. That’s when the phrase, “…when used with diet and exercise,” usually appears. The competing drugs all have this in common.
And that’s what gets me riled. Every doc is supposed to tell their overweight and Pre-diabetic patients to “lose weight and exercise” before ANY meds are prescribed.  “Eat less and move more,” “eat a plant-based” or “Mediterranean” diet and get lots of exercise (to lose weight!). And everyone FAILS. They fail to stop or reverse the slow but inexorable slide to drug dependence, eventually “graduating” to Type 2 diabetes. So why do the diabetes ads still advise people to continue this failed strategy?
Answer: The FDA mandates it. But, what does Big Pharma care? It’s a throwaway line because so long as PATIENTS continue to eat what government and their doctor has “prescribed” as a “healthy diet,” T2D WILL BE a “progressive disease,” and the PATIENT will continue to worsen.” BIG PHARMA IS THE BIG WINNER.
There is no downside for Big Pharma. They’re not telling you how and what and when to eat. Certainly no one would say that exercise is not good for you. Besides, exercise is a well-documented way for Type 2 diabetics to slightly improve their insulin sensitivity, which is good. But for weight loss, exercise is not an effective method.
THE ONLY DOWNSIDE IS FOR THE PATIENT. By following the advice to eat what the government “prescribes” as a “healthy diet,” patients are being herded like lemmings into the hands of Big Pharma. Whether this is a corrupt cabal, I’ll leave it for you to decide. But more to the point, in your own self-interest, you might want to ask, why has the advice, “…when used with diet and exercise,” failed? And why does it continue to fail even as you take more medications. Is it because exercise, while a good thing, is not a good way to lose weight
Is it because the “healthy” diet the government prescribes is NOT REALLY A HEALTHY DIET? If eating lots of carbs (like corn) is a good way to fatten beef cattle in a “feed lot,” is it not also a good way to fatten people? Yet, the government’s Nutrition Facts label on all “processed” foods prescribes that the Percent Daily Value (%DV) for carbs recommended for women (on a 2,000kcal diet) is 300g, or 1,200kcal, or 60%. And for men (on a 2,500kcal diet), is 375g, or 1,500kcal, also 60%. Did you know that? Do you think, maybe, that is too many?
If you want to avoid the inevitable “graduation” to a cocktail of anti-diabetic medications, including the ones advertised on TV, you might want to consider dropping your intake of carbs, to 40, 20, 10 or even 5%, like me. 

Saturday, April 20, 2019

Retrospective #64: Very Low Carb Eating: Ten Years Later (2012)

In August, 2002, I had been a morbidly obese Type 2 Diabetic for 16 years. My physician had tried for years without success to get me to lose weight on a “balanced” diet. Then, one day he said to me, “Have I got a diet for you!”
At 375 pounds I had been taking progressively more and more oral diabetes medications since my diagnosis in 1986. I was maxed out on micronase (a sulfonylurea), and Metformin, and had recently started takin Avandia in futile attempts to control my progressively worsening blood sugar. When Avandia didn’t work, I was then (in 2002) going to be left with only one option: to become an insulin-dependent T2, injecting basal and mealtime insulin.
It turns out, though, that my doc had recently read Gary Taubes’s, July 7, 2002, NYT Magazine cover story “What If It’s All Been a Big Fat Lie?”  Out of curiosity he tried the recommended Very Low Carb diet advocated in the story (20 grams of carbs/day), and it worked for him. So, he thought it might work for me too, and as he walked me down the hall to schedule a follow-up appointment, he said, “It’ll probably be good for your diabetes too.”
The result: Within a day on this strict Very Low Carb diet, as a heavily medicated Type 2 diabetic I was experiencing “hypos” (dangerously low blood sugars). I called my doctor, and he told me to stop taking the Avandia. The next afternoon, when I had another hypo, he told me to cut in half the micronase and Metformin. A few days later he said to cut them by half again. He then saw me monthly for a year to monitor my blood and other health markers. In the course of that year I further reduced the micronase from 5mg to 2.5 to 1.25mg and finally completely phased it out. I still take Metformin to suppress gluconeogenesis if, as I sometimes do, I eat too much protein at supper.
In the first 9 months on the Very Low Carb diet I lost 65 pounds (1½ lbs./wk.). I then retired from work and kept that weight off for several years. Then, over the course of a summer, I added back 12 pounds (mostly from eating ice cream before bedtime, as I recall). But by this time, I had also been lurking and learning from Dr. (Richard K.) Bernstein’s online Diabetes Forum. I had also read Bernstein’s “Diabetes Diet” and his “Diabetes Solution,” so I decided to try his program (30grams of carbs a day). It was more focused on blood sugar control for diabetics.
On Bernstein I lost 100 pounds in 50 weeks (2lbs./wk.). Altogether I lost 170 pounds, settling in at 205 pounds. I have since regained some of that weight, but frankly I have been “off the ranch” for a while. I am still, however, much healthier than before. I eat Very Low Carb most of the time and have retained most of the health benefits.
My average HDL has more than doubled (from +/- 39 to +/- 84mg/dL) and my triglyceride average has been cut by 2/3rds (from +/- 150 to +/- 49mg/dl). I try to limit my carb calories to 5% of my calories and my protein to 20%, leaving 75% for fat. I do not limit salt, dietary cholesterol or saturated fat. I eat eggs and bacon and coffee with full cream and pure stevia for breakfast, and just a can of sardines for lunch. For supper, it’s just meat or fish and a low carb veggie with lots of butter or tossed in olive oil and roasted. In a restaurant I’ll have a cocktail (or 2) or two glasses of wine. The only dessert I’ll ever eat is berries (with heavy cream) on a very special occasion. I love a cheese plate (without bread or fruit), but it’s just too much food. I always regret it if I occasionally order it.
After the first year, I continued to see that doctor 3 times a year until his unfortunate demise. I went just to get blood tests to monitor my A1c, lipid profile (cholesterol panel), and other tests he wanted to do (kidney, thyroid, electrolytes and EKG). They were all always normal. And my hsCRP, a chronic systemic inflammation marker, plummeted from “high” to consistently less than 1.0 (very low risk of cardio vascular disease).
My new doctor, after studying my chart on my first visit, suggested I see him once a year. I was pleased that was his initial impression of my health, but I said I wanted to see him three times a year, just to keep track of my success.

Friday, April 19, 2019

Retrospective #63: Impulse Control and Metacognition

Maybe 15 years ago, in an effort to understand how (not why) I had “fallen off the wagon” with respect to my Very Low Carb Ketogenic Diet (VLCKD), I developed an interest in the subject of impulse control. A friend on Dr. Bernstein’s Diabetes Forum (I’m a Type 2 diabetic), suggested I set up a “Google Alert” on the subject, so I did.
One of the first hits introduced me to the term “metacognition,’ which literally means “knowing about knowing.” For my study of impulse control, I translated this to “thinking about thinking.” So, I started a “thread” on “Impulse Control and Metacognition” on the Forum. It got about 50 replies and 3800 views. It was an interesting discussion.
An early reply on the thread from the Forum Moderator suggested that impulse eating might actually be a physiological rather than a psychological issue. She pointed out that Dr. Bernstein has mentioned that with beta cell burnout there is less amylin production, and low amylin levels mean the brain isn’t getting the message that you are not hungry. But I wasn’t interested in finding a pharmacological approach to the problem.
There is also the leptin/ghrelin hormone interaction, but again hormone signaling to/from the hypothalamus is too high brow and still a developing area of science. I wanted to keep my experiment simple and personal, so I started.
In the discussion, I pointed out that when I have been tempted to snack before dinner, or reach into the bread basket in a restaurant, or hit the freezer for ice cream before bedtime, I was aware that a finite idea had entered my mind: “the temptation.” The idea was usually dismissed quickly, but then frequently returned, sometimes quickly and sometimes more than once. On its return, I have sometimes acted on it, always to my later shame and chagrin. I would beat myself up. That was an emotional response. I wanted to explore a more rational response.
My first thought was to put “the idea” out of mind when the temptation first presented. Just deny the thought a foothold. I cleared the brain the way I do when I put my head on the pillow at night to fall asleep. By not “allowing” the thought to stay on the brain, or by substituting another thought for “the temptation,” it went away. It did not persist. If it returned, I just created another distraction. I changed the subject. It could be another idea, a simple distraction, or it could be an action. Whatever it was, the concept was to catch the “bad” thought “in the bud.”
Examples: If I am eating in a restaurant with others and the bread basket is presented, I take it and pass it on. Or I start a conversation (not related to bread). Recently, when eating alone in a restaurant, I distracted myself by becoming engrossed in a newspaper. Another time I watched and listened (unobtrusively) to people at another table. In other words, I quickly took action to side track “the temptation.” Actions are better than abstract ideas like “will power” and “steely resolve.” You have to be limber, imaginative, and prepared for temptation, and act.
Of course, one of the very best ways to suppress “temptation” is for food to be out of sight. If I can see it, I get the idea to eat it! If I don’t see it, I don’t get the idea, usually – even though I know the ice cream is in the freezer or the nuts are in the pantry. The actual sight of food is the “trigger,” and avoiding the sight is the best solution. The difference between seeing the food and not seeing it, for me, is huge. It has nothing to do with hunger or noshing. I can be mildly ketogenic (with low serum insulin) and a stable blood glucose and still cave at the sight of food.
Others have dealt with impulse control in different ways. Some use “healthy fears,” others use the fear of catastrophic outcomes. For me, fears are both too negative and too extreme. But whatever you do to undo or relearn a behavior, even using an irrational fear, it is, in a way, a rational process. It allows you to exercise the mind and be in control of the outcome.
Quickly supplanting the initial temptation with a diversionary response – either thought or action – is my kind of metacognition. Thinking about thinking is the essential precursor, and a diversionary thought is often sufficient. The best outcome, however, is a diversionary action. Quoting Alfred Korzybski from his preface to “Science and Sanity, “…if they are not applied but merely talked about, no results can be expected.”

Thursday, April 18, 2019

Retrospective #62: Meatless Monday Madness

In summer of 2012 a USDA newsletter to employees produced a minor contretemps within the agency and a major uproar across the USA among beef producers and meat eaters. According to a Fox News alert, the newsletter said, “This international effort encourages people not to eat meat on Mondays.” It asks, “How will going meatless one day a week help the environment? According to the UN, “the production of meat, especially beef [and dairy] has a large environmental impact. Animal agriculture is a major source of greenhouse gases and climate change.”
But USDA spokeswoman Courtney Rowe said the USDA does not endorse the “Meatless Monday” initiative. So, Fox had a little fun in the chicken coop, and the brouhaha passed with little notice due to the 2012 Summer Olympics.
The story, for me however, was how the vegan lobby has embedded itself into the interstitial tissue of the ‘corpus governmentalis,’ or body politic. The pathway of infection of this parasitic movement is the ingestion of vegan messages within the hallways of large centralized government agencies like the USDA, wherein it has colonized and reproduced. The United Nations, of course, is always a target, given that by design it is a receptive host to parasitic attacks of every nature and from all quarters. In the U.S., Washington DC is targeted, especially at times of big top-down government with a compromised immune system such as we had with the Obama administration.
The vegan bug is especially virulent when it is introduced into the alimentary canal. It manifests itself in such forms as the Center for Science in the Public Interest (CSPI). Founded in 1971, the CSPI calls itself a consumer advocacy group focusing on nutrition. They are well known for their longstanding opposition to saturated (i.e. animal-based) fats. It also advocates taxing soft drinks. Critics refer to CSPI as "the Food Police."
Walter Olson of the Cato Institute, a Washington D.C.-based libertarian think tank, wrote that CSPI’s "longtime shtick is to complain that businesses like McDonald’s, rather than [people’s] own choices, are to blame for rising obesity." He called CSPI's suit against McDonald's on behalf of a California mother a "new low in responsible parenting. In the 1980’s CSPI maintained that trans fats were “more healthful” than saturated fats and had persuaded many restaurants, including McDonald's, to switch from lard to trans fats in making French fries. Today CSPI has reversed its position on trans fats, but it still campaigns vigorously against animal (saturated) fats.
Then, in 2009 a more virulent strain of veganism began to infect the body politic in the U.S. and internationally. Robert Goodland, PhD, (now deceased), and Jeff Anhang published their seminal treatise on bovine flatulence, “Livestock and Climate Change: What if the Key Actors in Climate Change were Cows, Pigs and Chickens.” 
Goodland retired as lead environmental officer after 23 years at the World Bank. Previously, in the 1970s, he and I worked together – he as staff ecologist and I staff architect – at the Cary Arboretum in Millbrook, NY. Even at Cary, Goodland was a “mover and shaker.” He proposed (and I built) a solar heated headquarters for the Arboretum.
His bovine flatulence gambit aimed to be no less earth shattering than his solar energy initiative. Cleverly, it is itself parasitic. Its vegan premise attaches itself to one of the Left’s most fundamental and passionate causes, global warming. Their report claims, “Our analysis shows that livestock and their byproducts actually account for at least 32,564 million tons of CO2 per year, or 51 percent of annual worldwide GHG emissions.” Never mind that the UN Food and Agricultural Organization claimed 18 percent. Goodland then posits, “If this argument is right, it implies that replacing livestock products with better alternatives would be the best strategy for reversing climate change. In fact, this approach would have far more rapid effects on GHG emissions and their atmospheric concentrations—and thus on the rate the climate is warming—than actions to replace fossil fuels with renewable [solar] energy.”
So, in the end Goodland forsook solar energy for this Meatless Monday Madness! Never mind that 150 years ago in the U.S. 60 million buffalo emitted more CO2 into the atmosphere via bovine flatulence than 9 million dairy and 31 million beef cattle do today. But don’t tell that to NYC’s mayor Bill DeBlasio. Goodland’s legacy lives on in that city’s school system with the recent introduction of Meatless Mondays. The Madness goes on. Robert would be pleased.

Wednesday, April 17, 2019

Retrospective #61: Stefansson and “The Eskimo Diet”

About 100 years ago a Canadian ethnologist, Vilhjallmur Stefansson, spent 11 years living among the Inuit in the frozen North. For 9 of those years he ate substantially a diet composed of meat (including fish), some organ meats, and fat with just a little carbohydrate (glycogen contained in the muscle tissue and liver). In the summer months he ate a few berries. Upon his return to ‘civilization,’ from his observations of the Inuit with whom he had lived and of his own health, he postulated that such a diet was sufficient for good health. It was, he averred, a complete diet.
Stefansson’s lectures on his experience with an all meat diet drew derision and cries of charlatan from the scientific and medical community. So, to ‘prove’ his hypothesis, he proposed a daring experiment. He offered himself and a colleague, Karsen Andersen, with whom he had shared his experience in the Arctic, as an in vivo experiment (n=2). In 1928, under supervision of doctors at New York’s Bellevue Hospital, they volunteered to live for 1 year on meat and fat alone. The results, which I first read in Gary Taubes’s "Good Calories -- Bad Calories," were fascinating.
Stefansson’s own account of his Arctic adventures was published, for popular consumption, in Harper’s Monthly in November and December 1935. The balance of this blog post will be the report of W. S. McClellan and E. F. Du Bois, the lead investigators of the Bellevue study. Their paper was brought to my attention by Ginny L who was, in 2012 when this was written, a frequent poster and valued resource on Dr. Richard K. Bernstein’s Diabetes Forum.
The paper, “Prolonged Meat Diets with a Study of Kidney Function and Ketosis,” was published July 1, 1930, in the Journal of Biological Chemistry. Herewith, in their entirety, are the conclusions of the previously skeptical doctors:
1. Two men lived on an exclusive meat diet for 1 year and a third man for 10 days. The relative amounts of lean and fat meat ingested were left to the instinctive choice of the individuals.
2. The protein content varied from 100 to 140 gm., the fat from 200 to 300 gm., the carbohydrate, derived entirely from the meat, from 7 to 12 gm., and the fuel value from 2000 to 3100 calories.
3. At the end of the year, the subjects were mentally alert, physically active, and showed no specific physical changes in any system of the body.
4. During the 1st week, all three men lost weight, due to a shift in the water content of the body while adjusting itself to the low carbohydrate diet. Thereafter, their weights remained practically constant.
5. In the prolonged test, the blood pressure of one man remained constant; the systolic pressure of the other decreased 20 mm. and the diastolic pressure remained uniform.
6. The control of the bowels was not disturbed while the subjects were on prescribed meat diet. In one instance, when the proportion of protein calories in the diet exceeded 40 per cent, a diarrhea developed.
7. Vitamin deficiencies did not appear.
8. The total acidity of the urine during the meat diet was increased to 2 or 3 times that of the acidity on mixed diets and acetonuria was present throughout the periods of exclusive meat.
9. Urine examinations, determinations of the nitrogenous constituents of the blood, and kidney function tests revealed no evidence of kidney damage.
10. While on the meat diet, the men metabolized foodstuffs with FA: G ratios between 1.9 and 3.0 and excreted from 0.4 to 7.2 gm. of acetone bodies per day.
11. In these trained subjects, the clinical observations and laboratory studies gave no evidence that any ill effects had occurred from the prolonged use of the exclusive meat diet.
Stefansson was a very colorful character. He was twice president of the prestigious Explorers Club. He lectured in anthropology at Harvard and was Director of Polar Studies at Dartmouth College. His Wikipedia entry concludes: “Stefansson is also a figure of considerable interest in dietary circles, especially those with an interest in very low-carbohydrate diets. Stefansson documented the fact that the Inuit diet consisted of about 90% meat and fish; Inuit would often go 6 to 9 months a year eating nothing but meat and fish—essentially, a no-carbohydrate diet. He found that he and his fellow European-descent explorers were also perfectly healthy on such a diet. When medical authorities questioned him on this, he and a fellow explorer agreed to undertake a study under the auspices of the Journal of the American Medical Association to demonstrate that they could eat a 100% meat diet in a closely observed laboratory setting for the first several weeks, with paid observers for the rest of [the] year. The results were published in the Journal, and both men were perfectly healthy on such a diet, without vitamin supplementation...."

Tuesday, April 16, 2019

Retrospective #60: Dietary Composition: Dr. Ludwig’s Study

Back in 2012, David S. Ludwig, MD, PhD, and colleagues at New Balance Foundation Obesity Prevention Center (Harvard), and Children’s Hospital, Boston, and Brigham and Women’s Hospital, Boston, and Baylor College of Medicine, Houston, and Vanderbilt University, Nashville, published the results of a well-designed, four-year study in June 27 issue of the Journal of the American Medical Association (JAMA). The purpose was to study “the effect of dietary composition on energy expenditure during weight-loss maintenance “(my emphasis).
Three days later the New York Times published an opinion piece, "What Really Makes Us Fat," loosely based on the study. In it, award winning science writer Gary Taubes, said, “What was done by Dr. Ludwig’s team has never been done before.” He concluded his piece with, “The public health implications are enormous.” (emphasis added)
The study began after all subjects had achieved a 10% to 15% weight loss by a calorie restricted (60%) “run-in” diet. Then, each for 4 weeks, the participants ate three isocaloric (2,000kcal/d) diets: 1) a low-fat diet (60% carbs, 20% fat, 20% protein, high glycemic load); 2) a low-glycemic index diet (40% carbs, 40% fat and 20% protein, moderate glycemic load); and 3) a very-low carb (Atkins) diet (10% carb, 60% fat and 30% protein, low glycemic load).
The JAMA authors concluded: “Our study demonstrates that commonly consumed diets can affect metabolism and components of the metabolic syndrome in markedly different ways during weight-loss maintenance, independent of energy content. The low-fat diet produced changes in energy expenditure and serum leptin that would predict weight regain. In addition, this conventionally recommended diet had unfavorable effects on most of the metabolic syndrome components studied herein. In contrast, the very low carbohydrate diet had the most beneficial effects on energy expenditure and several metabolic syndrome components…” (HDL & triglycerides), emphasis added by me.
Energy expenditure, the primary outcome measure of the study, was measured by state-of-the art stable isotope analysis at Baylor. This outcome was especially stunning: “The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective,” the authors stated. “TOTAL ENERGY EXPENDITURE DIFFERED BY APPROXIMATELY 300 KCAL/D BETWEEN THESE 2 DIETS” (VERY LOW CARB AND LOW FAT), “AN EFFECT CORRESPONDING WITH THE AMOUNT OF ENERGY…EXPENDED IN 1 HOUR OF MODERATE-INTENSITY EXERCISE.”
In other words, as Taubes explained, “…when the subjects were eating low-fat diets, they’d have to add an hour of moderate-intensity physical activity each day to expend as much energy as they would effortlessly on the very-low-carb diet. And this while consuming the same amount of calories. If the physical activity made them hungrier – a likely assumption – maintaining weight on the low-fat, high-carb diet would be even harder,” Taubes wrote.
Taubes then posited, “If we think of Dr. Ludwig’s subjects as pre-obese, then the study tells us that the nutrient composition of the diet can trigger the predisposition to get fat, independent of the calories consumed. The fewer carbohydrates we eat, the more easily we remain lean. The more carbohydrates, the more difficult. In other words, carbohydrates are fattening, and obesity is a fat-storage defect. What matters, then, is the quantity and quality of carbohydrates we consume and their effect on insulin.” These five sentences say it better than a whole book!
Ludwig’s subjects are, frankly, “pre-obese.” As the study states, “only 1 in 6 overweight and obese adults report ever having maintained weight loss of at least 10% for 1 year.” Taubes reasonably says Ludwig’s subjects are “almost assuredly going to get fatter, so they can be research stand-ins for those of us who are merely predisposed to get fat but haven’t done so yet and might take a few years or decades longer to do it.” Does this sound like you?
Taubes then concludes, “From this perspective, the trial suggests that among the bad decisions we can make to maintain our weight is exactly what the government and medical organizations like the American Heart Association have been telling us to do: eat low-fat, carbohydrate-rich diets, even if those diets include whole grains and fruits and vegetables.” NOTE BENE: “…EVEN IF THOSE DIETS INCLUDE WHOLE GRAINS AND FRUITS AND VEGETABLES.”
Your choice: Eat Very Low Carb, or eat whole grains, fruits and vegetables and exercise 1 hour a day to burn them off.