Saturday, January 26, 2013

The Nutrition Debate #85: My Goal Weight and the BMI Table

Like many who are overweight, obese or morbidly obese (what a dreadful term!), I have spent a lot of time over the years thinking – dreaming really, about my goal weight. I think this may be especially true of those of us who have finally found a way to lose weight without hunger and now see the pounds dropping off easily. And they are fat pounds, because we have become “fat burners,” through ketosis, enabling us to burn fat for energy by severely restricting our carbohydrate intake. We are always wondering, How far can I go? How far do I really want to go? How thin could I be?

The “experts” tell us not to be too ambitious – to set modest goals, because they know how common it is to fail. They say that even a 10% (or less) weight loss will make a big difference in our health markers, especially for Cardiovascular Disease (CVD). But we can dream, can’t we? We can imagine ourselves as much thinner (if we are more than 10% “overweight,” as many of us now are). As I was seeing two pounds of fat dissolve a week for about a year (about 5 years ago), I imagined that I could be just 187 pounds – half my starting weight of 375 pounds. At my low point I had lost 170 pounds (45% of me), and was just 17 pounds shy of my goal when, on a 3-week vacation, I stopped losing.

Today, after regaining 70 pounds over the last four years, I am starting to lose again. As of this posting I have re-lost 30 pounds (60%) of the 50 I am targeting towards my new goal of 225 pounds. That will represent a loss of 150 pounds (40%) from the start. That weight, 225 lbs, is my new goal weight – the one I will strive to maintain for the rest of my life.

But what do all these numbers mean? My wife told me I would look like a scarecrow if I had lost all 187 pounds. A neighbor who saw me on the street when I was near my low of 205 said, “Are you okay? Are you well?” Funny! Maybe I wouldn’t recognize myself, had I gotten there. Who knows? I certainly would have been a different man – just half the man I used to be, my wife used to joke. And at 225 I will still be clinically classified as obese. But I’ll be happy, for a time.

Goal weight is a very subjective thing. It is purely personal. My present goal is to lose 50 pounds in two stages. I started at 275 and want to get to 225. The first stage, which I started last September, was to lose 25 pounds by year’s end, then 25 more before my next doctor’s appointment in late-April. So the first part required that I persevere through the Thanksgiving and Christmas holidays. I reached the first goal, on January 3rd, a few days late.

The second 25 pounds has to be lost while we are at our winter home in Florida, and includes a week-long vacation in Aruba. I’ve never lost weight, or even been able to maintain my weight, in Florida or on vacation, when we eat out (and drink) every night. But the trip to Aruba is now history – and I made history. I went there at 250 and came home at 250! Now, the challenge is to lose 25 pounds in the next 13 weeks. That’s very doable; just 2 pounds a week. I’ve done it before, many times. The question is: Will I do it in Florida? Will I make history again? I’ll let you know – end of April.

Ideal weight is a total other thing. It is also very subjective, if a bit more impersonal.  What I call my body type (“big boned”) might actually just be my body image from having lived a lifetime looking at it. Why else would there be just one clinical standard in the U.S. (since 1998) for judging weight? It is universal and requires only height and weight and is, in my subjective opinion, totally unrealistic. I am referring, of course, to the Body Mass Index (BMI) table, linked here. In it a person (male or female of any “body type” who is now 5’-11” tall should weigh between 136 and 172 to be considered “normal “weight. The average “normal weight for a person my height would be 150 pounds. That’s ridiculous. It’s skeletal, a mere scarecrow. My father told me he weighed 150 in the Great Depression, and again when he was diagnosed with TB in 1950. After a nine-month stay in hospital put a little flesh on his bones, he weighed 175!

So, my goal weight of 225 pounds is still much higher than my ideal weight. It is in fact 75 pounds higher. It is higher even than the BMI scale range (179 to 208) allows for me to be considered “overweight.” In fact, 225 pounds is still considered “obese” for a 5’ – 11” person. The “obese” range is 215 to 279. But that’s okay. It’s my goal weight.

Lean Body Weight is another term that is sometimes used by athletes (and thin people) with only a small amount of body fat. To me it is a foreign concept, an exotic species.  It is achievable, no doubt, and the most desirable weight to be, if you have the physique ,the genetic predisposition and a history of eating right and staying “trim.” It is also a very useful weight to use when deciding how much protein to eat to avoid unwanted gluconeogenesis if you are a Type 2 diabetic and are working to achieve optimal glucose control and weight loss through diet. But that’s another story.
© Dan Brown 1/26/13

Saturday, January 19, 2013

The Nutrition Debate #84: Carbohydrate Intolerance – the new ‘buzz’ words

Authors Jeff Volek and Stephen Phinney use the phrase “carbohydrate intolerance” seven times in their introduction to “The Art and Science of Low Carbohydrate Living.”  They’re telling us something. They’re want to replace the medical term Impaired Glucose Tolerance (IGT) with “carbohydrate intolerance” to make it more “accessible,” and I approve.

IGT involves hormones, enzymes and cell receptors, and unless you’re a molecular biologist, these terms make the eyes glaze over. Besides, the biological actions that occur within the body are autonomic, whereas we eat food consciously, for the most part. And we don’t eat glucose. We eat carbs. Our digestive system breaks down  all carbs, including all simple sugars and all complex carbohydrates (starches), into single molecules, most of them glucose.

So, “carbohydrate intolerance” is an excellent way to describe some people’s metabolic response to eating ALL carbs. I am stressing all carbs because of the popularity of distinguishing between simple sugars (mono and disaccharides) from complex carbs, or polysaccharides (starches).  And to differentiate “natural sugars” (as in fruits) from “added” sugars. Sure, they contain some small amounts of indigestible fiber, but they’re all the same, folks! They’re all glucose.

It is true that the common simple disaccharide sugar, sucrose, breaks down to 50% glucose and 50% fructose, and fructose is metabolized differently than glucose. (It is diverted to the liver where it is detoxified and turned into fat.) But all complex carbohydrates (the starches) break down and are absorbed into the blood as glucose. All glucose will raise blood sugar by the same total amount, and some complex carbohydrates will raise blood sugar more and more quickly that sucrose, e.g. a slice of bread vs. a hard candy or watermelon, or even popcorn.

Another extreme example of misinformation about nutrition is a statement I read recently in a magazine: “The complex carbohydrates in apples give your body a longer, more even energy boost compared to high-sugar snacks.” That is false. Utter nonsense. There are no complex carbohydrates in an apple. An apple is 86% water, 3% (indigestible) fiber and 11% simple sugars (67% fructose/33%glucose). An apple is, in fact, just a delicious “high-sugar, high-fructose snack.”

So I applaud the initiative of Volek and Phinney to create a user-friendly “buzz word” to describe the condition that affects a large and rapidly growing “cohort” of the population – those of us who have eaten a “Western Diet” and have succumbed (perhaps due to  genetic predisposition) to one of the most common diseases of Western Civilization, Metabolic Syndrome. See the Nutrition Debate #9 here for the indications. But here I want to focus on understanding that we are, many of us, carbohydrate intolerant. We must accept that and learn what we can do about it.

We are the obese. Okay, a more user-friendly term: we are the overweight. This applies to all of us from a little overweight to the morbidly obese. Our mechanism of fat synthesis and metabolism is a little or a lot broken. We are also the hypertensive. Our blood pressures rise as we gain weight (and drop when we lose it). We are also the ones with “high cholesterol,” often misdiagnosed as high Total Cholesterol and high LDL lipoproteins (which can be manipulated easily with a statin); instead, we have a more difficult-to-treat form of dyslipidemia characterized by low HLD lipoproteins and high triglycerides. See the Nutrition Debate #25, #27, #67, #68 and #72 for what to do about that.

The first step is to recognize ourselves – to know that we are members of this “cohort” that has an association with being obese or overweight, and has high blood sugar, high blood pressure and “high cholesterol.” And that having all these indications puts us at much higher risk of death or another “morbid” outcome. Are you motivated yet? Will you reject the failed treatment protocols of taking more pills and being constantly hectored to lose weight? Remember the old aphorism: “The definition of insanity is doing the same thing over and over again and expecting different results.”

A reasoned approach, on the other hand, would be a different diet. If you are a Type 2 or even prediabetic, and you and your doctor know that carbohydrates raise your blood sugar unnaturally, then why in heaven’s name would your doctor advise you to eat carbohydrates? YOU ARE CARBOHYDRATE INTOLERANT! Accept it, and then do something about it!  

You’re in good company. Many kinds of intolerances are now recognized as detrimental to health: Fructose intolerance, FODMAPs, salicylates, gluten, casein, etc. The consequences, short and long term, vary, but in general individuals who recognize, accept, and deal with intolerances report greatly improved health and day to day quality of life.

Sorry for all my “shouting.” Learn what carbohydrate foods are. Then, try a Low Carbohydrate diet. For this, you’re on your own; I can’t do everything for you. Just kidding. Start with one of my favorites at The Nutrition Debate #19 here.

© Dan Brown 1/19/13

Saturday, January 12, 2013

The Nutrition Debate #83: “The 8-Hour Diet,” based on “brand new science”

On the Today Show on January 2nd author David Zinczenco told host Matt Lauer that his new book, “The 8-Hour Diet,” described a way to lose weight based on “brand new science.”  My wife told me about this segment of the morning TV show, and so I searched the archives and played it back. I also found an excerpt from the book on here.

When I asked my wife how it worked, she was a little vague, saying something about stomach shrinking… When I saw the re-play, I understood why. The author, with Lauer as critic and foil, showed lots of goodies: yoghurt, berries, orange juice and bran muffin for breakfast, a big salad, two slices of pizza, cup of soup plus potato chips or French fries for lunch, and a big rib eye steak with potatoes, veggies and a piece of chocolate cake for dinner. Lots and lots of comfort foods and no counting of anything: calories, carbs, protein or fat. This diet didn’t look like a diet at all! And it had eye appeal as well. Zinczenco described the diet as “lean protein, good fats, and complex carbs” – the current, politically-correct composition.

The only limiting factor was that all the food for any particular day had to be consumed within an 8-hour window: 9 to 5, 10 to 6, or even 11 to 7. The particular example given was 10:30 for breakfast, 12:30 for lunch, and 6:30 for dinner. The day starts with coffee or tea (black?) but no breakfast before work, the “breakfast” being eaten at a mid-morning break, and lunch and dinner at conventional times. Instead of the conventional breakfast at home, the author suggested a brief (under 10 minute) period of strenuous exercise to “turbocharge” (jump start) your metabolism and “get rid of the calories stored in your liver.” Translation: burn the stored carbohydrates, in the form of glycogen, in your muscles and liver – a pretty good idea actually.

The other “indulgence” the author offered is that you could do this 8-hour diet for only (“even just”) 3 days a week to lose as much as 5 pounds a week and 20 pounds in 6 weeks.  He tried it himself, he said, and lost 7 pounds in 10 days. He called this 3-day-a-week practice “intermittent fasting.” Known as IF, this is a common weight-loss practice. I did it recently for two days (after my weight drifted above “target”) and lost 7 pounds in two days while eating only a VLC breakfast (no-lunch or dinner and no snacks) for two days. It was mostly water loss but my body needed to get energy from somewhere so it burned fat (and muscle) to maintain my energy balance. This is not a good thing to do as a rule, but okay if you need a quick momentum shift.

David Mendoza, a well-known, low-carb Type 2 diabetic author, recently offered a similar “weight-loss tip.” He said that whenever his weight drifted above “target” (he describes his current weight as “low-normal,” which is truly enviable, if not skeletal), he skips dinner that day. He said he has only had to do that 9 times in the last 6 months).

So, I have to say this diet has obvious appeal for a “healthy” person with “normal” metabolism, which excludes anyone with any of the indications of Metabolic Syndrome (see #9 here). It is clever merchandizing to sell a book on the Today Show to an audience of women who aren’t the least bit interested in the mechanism or counting  – only in the eye-appeal of all their favorite foods and the comfort of not having to deny themselves anything except eating for 16 hours a day for three days a week. Zinczenco points out that that’s not so tough either, since most people already fast between dinner and breakfast. To stress this point he noted the word breakfast is composed of “break” and “fast.” He also spoke disparagingly of the practice many have today of “grazing all day long,” including sometimes after dinner. For three days a week, at least, that is a “no-no.” And if you’re still eating carbs, I like the idea of a brief strenuous exercise routine early in the morning to burn them up.

But what’s the real physiological mechanism of the 8-Hour Diet?  It works on the principle of the fed state and the fasting state, hardly a brand-new science. It is the basis of the hard scrabble existence of mankind on this earth from the beginning of the Paleolithic Era. You hunt, you eat, you rest while you digest, and then you burn stored fat while you hunt again when your hormones tell you that you need to eat again. Your body regulates this “harmonic ensemble” to maintain homeostasis, quoting ‘certain conclusion’ #2 from Gary Taubes’s “Good Calories-Bad Calories” (see The Nutrition Debate #5 here).And this cycle continued throughout life and for 500 generations, until the advent of the Neolithic Era 10,000 years ago. Agriculture introduced cultivated grains, grain storage, domesticated animals, and more-permanent human settlements.

The fed state echoes the time in the Paleo Era when, after eating, food is digested and absorbed. This is known as the glucogenic state since all carbohydrates and about half the protein we eat eventually becomes glucose, the latter through a process called gluconeogenesis. The fasting state begins when the glucose energy from the last meal has left the stomach and small intestine (where most of it is absorbed into the blood stream), and hormones switch the body to a ketogenic state. In a ketogenic state our bodies break down body fat (triglycerides) for energy. This state is also called ketosis because when the triglycerides are broken down to fatty acids and glycerol, they produce ketone bodies as a byproduct. Dr. Richard Veech of the National Institutes of Health says, “…ketosis is a normal physiologic state. I would argue it is the normal state of man.”

This natural state of ketosis occurs today every day between dinner and breakfast when we fast (>12 hours, if we don’t ‘snack’ after dinner). The 8-Hour Diet being promoted in this book just extends the nightly fast from 12 to 18 hours, 3 days a week.

© Dan Brown 1/12/13

Saturday, January 5, 2013

The Nutrition Debate #82: A New Dietary Paradigm?

A new dietary paradigm is emerging for a Way of Eating that could avoid, mitigate or ameliorate the devastating impact of Metabolic Syndrome and the Diseases of Civilization with which it is strongly associated. These outcomes affect about half the population that may be genetically predisposed and therefore susceptible. The new paradigm arises from what biologists are learning of the benefits, in terms of longevity and health, associated with Calorie Restriction (CR).

This blog does not, however, advocate for Calorie Restriction per se. It is instead advocating a restricted-calorie Very Low Carbohydrate Ketogenic diet. It closely resembles the concept of “nutritional ketosis,” a phrase that was, I believe, first used by Jeff Volek and Stephen Phinney in their book, “The Art and Science of Low Carbohydrate Living.” It was later further popularized by Jimmy Moore (of “Livin’ La Vida Low-Carb” fame), who recently lost over 50 pounds in 5 months on their program. “Nutritional Ketosis” refers to a low level of ketosis in which the body is “keto adapted” so that it burns ketone bodies instead of glucose as its primary energy source. A low millimolar concentration of ketone bodies can be measured in the blood. To me, the two best aspects of being in mild ketosis are: 1) you have lots of energy and 2) you’re not hungry, so long as you have a supply of body fat to ‘burn’ for energy (and you continue to eschew carbs!).

To quote Dr. Richard L. Veech of the National Institutes of Health: “Doctors are scared of ketosis. They’re always worried about diabetic ketoacidosis. But ketosis is a normal physiologic state. I would argue it is the normal state of man.” This ketosis falls far short, however, of the level of ketone concentration that is required for the anticonvulsive “ketogenic diet” used to treat juvenile epileptics. That “ketogenic diet” is a very high fat diet in use since the 1920s as an effective treatment for childhood epilepsy. It’s still used at places like Johns Hopkins for treatment of drug-resistant forms of childhood epilepsy. It is effective in about 50% of cases. The level of ketosis that I am advocating is much less extreme.

I have inferred and constructed my interpretation of this new dietary paradigm from “The Neuroprotective Properties of Calorie Restriction, The Ketogenic Diet and Ketone Bodies” (see Sect #3 of the full manuscript). I first referred to that manuscript here in The Nutrition Debate #79, “Calorie Restriction and Longevity.” In that column I spoke of the benefits of Calorie Restriction in animal models. In #81, “Calorie Restriction in Humans” here, I describe the concept of “altered pathways of nutrient disposal,” introduced by other authors that I cite, as they affect glucose metabolism. I also discuss some health concerns of CR in humans. But the authors, after discussing the neuroprotective properties of CR, then discuss the ketogenic diet (Sect. 4) and ketone bodies (Sect. 5). This is how and where I came to this new paradigm.

The “ketogenic diet” is also associated with multiple benefits. In the author’s words (Sect. 4), “the neuroprotective effects of the ketogenic diet are not limited to epilepsy;” “The antiepileptic effects of the ketogenic diet have been associated with improvements in cognitive function”; “Similarly, oral intake of a ketogenic medium-chain triglyceride diet improved cognitive function in patients with Alzheimer’s disease.” “Neuroprotective” is how they describe the effect that the ketogenic diet has in reducing the incidence of diseases like Parkinson’s, Alzheimer’s and Huntington’s.

 And here’s the key or “link” to the new paradigm: the authors assert in this paper that the “underlying mechanisms” of the ketogenic diet are “similar to those activated by calorie restriction” (emphasis mine). But does this mean that you have to eat a diet that is so very high in fat as to be anticonvulsive (+/-90% fat content)? Happily, it does not. That’s why, I think, the title and the text of this manuscript includes section (#5) on ketone bodies. What are ketone bodies? They are byproducts of catabolism, i.e., the breakdown of fat molecules (triglycerides). “During conditions of reduced glucose availability, energy is derived from the conversion of fats to ketone bodies,” they explain. Reduced glucose availability!

“Following a day of fasting or exposure to the ketogenic diet, ketone bodies reach low millimolar concentrations in the blood” (my emphasis). “Fasting and the ketogenic diet increase the permeability of the blood-brain barrier to ketones,” so that “ketone bodies cross the blood-brain barrier.” Ketone bodies are good – in fact, they are the ideal – brain food.

The conclusion (Sect. 6) of the article begins: “Calorie restriction and the ketogenic diet share two characteristics: reduced carbohydrate intake and a compensatory rise in ketone bodies.” A further conclusion: “An expanding body of evidence indicates that ketone bodies are indeed neuroprotective, and that the underlying mechanisms are similar to those associated with calorie restriction – specifically at the mitochondrial level.” That is their conclusion, not mine!

Come to think of it though, this “new dietary paradigm” is exactly what I have been advocating consistently throughout this blog. For a quick look at a list of past subjects, open “The Nutrition Debate Index of Columns” in the upper right corner of the blog. It’s listed first under “Favorite Links and Videos.” It’s all there for you in the archives. Check it out.

© Dan Brown 1/5/13