Sunday, June 24, 2012

The Nutrition Debate #56: Metabolic Disregulation

Readers of Dr. Kurt Harris’s Archevore website may have noticed that at the end of the Archevore Diet tab there is a footnote, the last clause of which is “…or it may just be too late.” Since Dr. Harris is not currently blogging, this cryptic remark has me wondering: “just…too late” for what? Can he mean too late to restore “normal” carbohydrate metabolism? And, most importantly (naturally), I’d like to know if this alarming news applies to me. I wonder if Dr. Harris ever explained that comment in one of his posts. It is a hard subject to Google. What are the key words: “Just too late”?
Anyway, I have noticed that many bloggers in the ‘nutrisphere,’ including many of the most cutting-edge, scientific ones, have drifted away from low-carb to Paleo to Paleo with “safe carbs.” Most of these bloggers do not clearly differentiate between “healthy people” and people who have developed issues with metabolic regulation. Significantly, neither do the American Diabetes Association, the USDA’s Dietary Guidelines for Americans or the public health establishment in general. Just ask almost any traditionally-schooled “certified” dietician or Certified Diabetes Educator (CDE).
The current trend in nutrition blogs is “healthy eating,” a good thing, but insufficient for the rapidly growing percentage of the population who are becoming carbohydrate intolerant. This manifests itself in weight gain, of course, but also in associated lipoprotein and blood glucose disregulation, known collectively as Metabolic Syndrome. I wonder sometimes if the blogger/researcher/clinician does not him or herself suffer from metabolic disregulation. I do, and by changing what I eat I found a fix.  So I think this is worth blogging about at length.
The largest audience of “seekers” on diet-related matters, I’ve noticed, are those with a weight issue. They may be a little overweight, a lot overweight, obese or even morbidly obese, and they all want to lose weight effectively and permanently. I was and still am one of those. When I weighed 375 pounds I wanted to lose weight. When my doctor suggested Atkins, I had no idea I would eventually lose 170 pounds. Nor did I realize that I would dramatically improve my lipid health and my T2DM and my hypertension. Neither, however, did I imagine that I would later regain 70 of the pounds I had lost and ‘give back’ some of my health gains, except interestingly my lipid panel gains.
I know that weight loss is the primary area of readers’ interest because my blog, The Nutrition Debate, covers a wide subject area, but my most popular columns (which Blogger tracks for me) are about diets and weight-loss. The problem of losing weight and keeping it off is intractable. That is not to say that there is not also a very large audience of people out there generally who follow nutrition who have a keen interest in “healthy eating.” These include a large cohort who wishes to avoid the Diseases of Civilization and others like the Paleo/Ancestral Health movement, the slow food people, the CSA movement and the fitness community. All of these do not necessarily need, and are not looking for, a therapeutic diet, unlike those of us who already have damaged metabolisms.
 So, that is the distinction that I think has to be made. I enjoy reading about neurotransmitters and hormones and enzymes and the latest, “our old friends” the gut flora. However, for me personally, I am keenly interested in what it means “…to be just too late”. There is a failed mechanism in MY metabolism such that for me it is “just too late?” By whatever name -- insulin resistance, or impaired glucose tolerance, or carbohydrate intolerance, or leptin resistance, or some consequence of any and/or all of these conditions, I must be resigned to what one commenter said on another blog, that: “Some of us cannot tolerate more than small amounts of carbs, and probably will never be able to do so.”
If so, as this becomes clearer to me, or perhaps as I come to accept what is already pretty clear, that will mean that I need to adopt for the rest of my days the Way of Eating that I followed when I lost 170 pounds. That is what someone who has T1DM or is gluten and/or casein intolerant has to do. Except that these folks – and I know a few people who have one or both of these disorders – don’t have a choice. They will die (the Type 1s), or wish they would (figuratively speaking), if they do not follow a strictly prescribed way of eating all day every day for the rest of their lives. In that sense I’m lucky. I can cheat and think I got away with it…at least in the short term. But there’s the rub. It is an insidious disease. I have to “own up” to it: I have a disregulated metabolism.  It is “just too late” for me. There, I said it.
© Dan Brown 6/24/12

Sunday, June 17, 2012

The Nutrition Debate #55: The Beleaguered Gary Taubes

I’ve just reread Gary Taubes’s “The Soft Science of Dietary Fat,” first published March 31, 2001 in Science and available in PDF format on any search engine. I recommend it to anyone interested in taking a fresh look at this subject through a clear prism. It is a brilliant exposition on a subject that has been distorted beyond recognition for more than 50 years.
I was motivated to read it again in search for a way to understand why and how so many intelligent people who should be informed about such things (including a friend who has been a Type I diabetic for over 60 years) “believe absolutely” that saturated fat and dietary cholesterol are “bad” for our health and should be avoided.  I’m not trying to change what she believes. She’s certainly an expert in her disease (T1DM) and a survivor of it. I just want to understand why.
Gary Taubes doesn’t need me to defend him. He “studied applied physics at Harvard and aerospace engineering at Stanford (MS, 1978,”) and then got “a master’s degree in journalism at Columbia University in 1981.” “He has won the Science in Society Award of the National Association of Science Writers three times,” according to his website. After “The Soft Science of Dietary Fat,” he became famous (and controversial) with his July 7, 2002 New York Times Sunday Magazine cover story, “What If It’s All Been a Big Fat Lie?” A polar-opposite rebuttal from The Center for Science in the Public Interest, a powerful vegan lobby group in Washington, DC, was published in their November 2002 newsletter.
Taubes went on in 2007, after 5 years of research and writing, to publish “Good Calories – Bad Calories” (“The Diet Delusion” in the UK, 2008), a seminal text for “the initiated.” In an “Afterwords” in the paperback edition, Taubes admits he had less impact on the medical establishment, particularly clinicians, than he would have liked. A more approachable text, “Why We Get Fat: And What to Do About It,” came out in 2010. Since then, he has been back on the cover of The New York Times Magazine with “Is Sugar Toxic” (April 13, 2011). Clearly Taubes’s books and articles all deal with controversy in medicine and nutrition.
Many physicians and researchers openly attribute Taubes for inspiring them in their career direction. He certainly has inspired me. He may even be the inspiration for the title of this blog, The Nutrition Debate. The debate needs to be continually renewed. We need to be constantly reminded at all levels, from simple nutrition “groupies” like me, who bundle ideas of others to put it out there for the world to consider. If the light level behind the mirror of conventional thinking is raised, perhaps the world will update their thinking with the “alternate hypothesis” that Taubes describes in “Good Calories – Bad Calories.” Perhaps, the silver back of the mirror will dissolve and become transparent. Following is an excerpt from Taubes’s 8,000 word essay in the 2001 Science magazine article “The Soft Science of Dietary Fat.”
“The original simple story in the 1950s was that high cholesterol levels increase heart disease risk. The seminal Framingham Heart Study, for instance, which revealed the association between cholesterol and heart disease, originally measured only total serum cholesterol. But cholesterol shuttles through the blood in an array of packages. Low-density lipoprotein particles (LDL, the “bad” cholesterol) deliver fat and cholesterol from the liver to tissues that need it, including the arterial cells, where it can lead to atherosclerotic plaques. High-density lipoproteins (HDLs, the “good” cholesterol) return cholesterol to the liver. The higher the HDL, the lower the heart disease risk. Then there are triglycerides, which contain fatty acids, and very low density lipoproteins (VLDLs), which transport triglycerides.
“All of these particles have some effect on heart disease risk, while the fats, carbohydrates, and proteins in the diet have varying effects on all these particles. The 1950s story was that saturated fats increase total cholesterol, polyunsaturated fats decrease it, and monounsaturated fats are neutral. By the late 1970s – when researchers accepted the benefits of HDL – they realized that monounsaturated fats are not neutral. Rather, they raise HDL, at least compared to carbohydrates, and lower LDL. This makes them an ideal nutrient as far as cholesterol goes. Furthermore, saturated fats cannot be quite so evil because, while they elevate LDL, which is bad, they also elevate HDL, which is good. And some saturated fats – stearic acid, in particular, the fat in chocolate – are at worst neutral. Stearic acid raises HDL levels but does little or nothing to LDL. And then, there are trans fatty acids, which raise LDL, just like saturated fat, but also lower HDL. Today, none of this is controversial, although it has yet to be reflected in any Food Guide Pyramid.”
Taubes is taking a few hits today in the Paleo world because of one of his ten “certain conclusions” from “Good Calories – Bad Calories:” that “insulin is the principal regulator of fat metabolism.” Maybe “a bridge too far,” but nobody in the Paleo World would dispute his first conclusion: “Dietary fat, whether saturated or not, is not a cause of obesity, heart disease, or any other chronic disease of civilization.” But, take note Loren Cordain and Robb Wolf, et. al.: Taubes was touting stearic acid while you guys were still in short pants (figuratively speaking, of course).                                               
© Dan Brown 6/3/12

Sunday, June 10, 2012

The Nutrition Debate #54: Loren Cordain, Robb Wolf and Kurt Harris

What do these three guys have in common? If you said Paleolithic nutrition, you would only get an argument from Kurt Harris. Although he started out with a huge bow to Gary Taubes, and then called his blog PaNu for Paleolithic Nutrition, he subsequently changed the name to Archevore. His thinking continues to evolve, and he no longer uses the word Paleo. His website says his thinking “is not derived from a single science or field of inquiry, but draws first on medical sciences like biochemistry and endocrinology, and only then looks back with history and paleoanthropology.” I like that.
Other differences between Harris and the other two is that Harris is an MD and has not (yet) written a book. Cordain has a PhD in exercise physiology, and Wolf has a BS in Biochemistry, a popular podcast on Paleolithic nutrition and exercise, and is a power lifting champ and weightlifting coach. He worked with Cordain in his biochemistry lab and describes Cordain as his mentor. Cordain’s book, “The Paleo Diet” (2002) was a best seller and has now come out in a revised edition (2011), which I have just read. I have also just read Wolf’s book, “The Paleo Solution,” published in 2010.
Both books preach essentially the basic Paleo prescription: no grains, no dairy, no added sugars, no legumes and very little salt. Eat only lean meat, non-starchy fruits and vegetables (for vitamins, phytochemicals and fiber) and mostly monounsaturated and some polyunsaturated fats.  Both diets cut you some slack in different ways. Cordain gives you a day or two “off diet” a week, to induce you to try it. Wolf says “just try it for a month” to see and feel the difference. Cordain allows a little honey; Wolf says, barring autoimmune problems, “it’s tough to build much of a case against grass-fed butter.” Both authors advocate lots of exercise.
Cordain’s “The Paleo Diet” is a useful introduction to the paleo way of eating, as are many online sources. It is designed for someone who doesn’t want to get “into the weeds” of the science, and asks the reader to trust in the author’s academic research credentials and lab staff. He assumes you won’t eat much organ meat, so he substitutes plant protein for the nutrients you would otherwise miss. He advises that you only eat “lean meat” and fats mostly from monounsaturated and polyunsaturated sources, the latter for the essential fatty acids (EFAs), n6 and n3, in the right balance. In the revised edition he says he has “softened his stance on the saturated fat issue,” allowing that stearic acid is “healthful,” unlike palmitic acid “which dominates the fat of feedlot cattle.”
Wolf’s book, “The Paleo Solution,” starts off with a primer in Paleo biochemistry for the non-geek. He works hard, and mostly succeeds, at making it “accessible.” His book also has a lot more energy and is more fun to read. It seems to be geared to a younger demographic. Interestingly, Cordain’s book makes many references to the bogey man of a decade ago (“fad low-carb diets”), while Wolf’s target is vegans. Personally, being a (Type 2 diabetic) low-carber myself, and acutely aware of the vegan menace in public health policymaking in Washington, I side with Wolf. It is interesting that both authors seem to need an antagonist.
Cordain’s book has an index but no footnotes and the bibliography adds only gravitas (and pages) – it isn’t divided by chapter – so there is no easy way to dig deeper into any of the claims made. It does include brief menu and recipe sections. Wolf’s book has no index or footnotes either, but the bibliography is divided by chapter. His menus incorporate some recipes. Both books are commercial in that their primary purpose appears to be pecuniary, although much of Wolf’s material is available online, gratis.
My favorite of these three, though, is Dr. Harris. His approach is so sublime. He says at his website, for example, “An Archevore is someone who eats based on essential principles, and also someone who hungers for essential principles. Take your pick.” And, “After hearing Gary Taubes on the radio, I had an epiphany and ever since I've been exploring the field of nutrition through the lenses of medicine and evolutionary biology.” And, “I have had a lifelong interest in science and medicine as culture, and believe all claims to scientific authority should be subject to thoughtful skepticism.” How can you not like this guy? His intellectual curiosity is the driver; the scientific method his “mechanism”; his vision pure. Unfortunately, in recent months he hasn’t posted on his blog, but his website Archevore is still ‘up.’ Take a look at it.
© Dan Brown 5/27/12