Wednesday, July 31, 2013

The Nutrition Debate #130: How Much Protein Should You Eat?

If you’re considering a Very Low Carb (VLC) diet program to lose weight, if you’re to succeed, you will need to get “into the weeds” a little. So, first, a few definitions:  Very Low Carb is usually defined as 20 to 30 grams of carbohydrate a day. Low Carb is frequently defined as 50 to 100 grams a day or 20 to 30 grams per meal. Low Carb is not what I am doing. This post is for serious Very Low Carbers who want to lose serious weight and do it in a healthy way and without hunger.

If you decide you want to try eating this way, you will also need to accept that it is also a limited-calorie diet program. If you haven’t tried this before, that’s not going to be as difficult as it sounds because you won’t mind eating less if you aren’t hungry between meals. And you will not be hungry between meals, I promise. In fact, after a few days you will stop thinking about food. You will not be interested in eating snacks, and you will forget it’s time to eat lunch. Really.

So, after deciding to eat VLC, the next thing you need to decide is how much protein should you eat? The answer is: it depends. It is different for everyone because it depends on your weight (not your current weight but your ideal “lean body weight”), your muscular development, your age, your exercise regimen, and your general level of activity. These are some of the variables, but there is also a constant: your basic need for protein for countless bodily activities. Protein’s component amino acids are necessary and even essential for life. Everybody needs to eat protein. In fact everybody needs to eat a variety of protein (with fat) to get “essential” amino acids that the body cannot make itself.

The easiest way to get all 22 amino acids, including all the essential ones, is to eat a variety of animal proteins. That isn’t the only way, but the main reason it is easier is the amount of protein that is needed at each meal. I have been successful following the advice of Richard K. Bernstein, MD, himself a life-long type 1 diabetic and author of “Diabetes Solution .” He is a pioneer in “eating-to-the-meter” – in fact, he could fairly be described as THE pioneer.

Dr. Bernstein advises his readers to eat equal portions of protein in three small meals every day that are equally spaced about five hours apart. That allows the protein, which digests more slowly than carbohydrates or fat, to be absorbed and circulate (as amino acids) in the blood for 4 to 5 hours to replenish the cells and repair muscle tissue. That also allows a 14 hour fast between dinner and breakfast during which ketogenesis occurs, if there is no glycogen in storage in the liver (from eating carbohydrates). This means you will burn body fat during the night to supply your basal metabolic energy needs. So, to lose weight while you sleep, don’t eat too many carbs, or too much protein, at dinner.

How much protein should you eat at each meal? One widely used rule of thumb is 1.1 grams of protein per kilogram of “lean body weight.” You are not eating protein to feed your fat; the protein you eat is related to your lean body mass, that is, your body as configured with only the minimum amount of fat needed to cushion the body and supply energy stores. To most of us who have been overweight for as long as we can remember, this will look like an unattainable, even unimaginable ideal. Nevertheless, “lean body weight” is the measure you should use for protein calculations.

Converted to U.S. units, 1.1 grams per kilo is 0.5 grams of protein per pound of lean body weight. Now you have to pick your lean body weight. When I lost my first 60 pounds, I didn’t know about counting protein so I didn’t. When I started the Bernstein diet program (for diabetics), and lost 100 pounds in 50 weeks, my weight was 325 pounds (148kg.) So I fudged the number. Instead of “lean body weight,” which I thought was ridiculous, I substituted a still unrealistic “ideal” weight of 180 pounds. That worked out to 90 grams of protein a day, divided into 3 equal meals of 30 each.

More recently, after I lost that 100 pounds, the unimaginable became almost attainable. So, I changed my idea of “ideal” body weight to be what would be for me, I’m sure, truly an unattainable “lean body weight” of 150 pounds. That is in the middle of the “normal” weight range in the BMI table for a person 5’-11” tall. Based on this truly skeletal lean body weight, my protein intake should be 75 grams a day, divided into 3 equal meals of 25 grams each. So that’s what I use. 

My regular breakfast (2 fried eggs, 2 strips of bacon, coffee with ghee) is 20 grams, and my regular lunch (a can of sardines in olive oil) is 15 grams. That leaves 40 grams to splurge on dinner. And if I eat that many grams of protein at dinner, I better remember to take my Metformin to suppress the gluconeogenesis! Or just eat 20 grams of protein with dinner. That’s 55g total, which is still 10% more than the 50g/day recommended in the HHS/USDA Nutrition Fact panel.

How many grams of protein do you have for breakfast?

Saturday, July 27, 2013

The Nutrition Debate #129: Low Carb Diet Record Keeping

When I first started Low Carb Dieting in 2002 (Atkins Induction), I knew I needed to keep track of my carbs. The Induction Phase of Atkins, which I followed religiously for nine months, losing 60 pounds (1 ½ lbs a week), required that I eat no more than 20 grams of carbohydrate a day. To be sure that I followed this prescription, I created a chart in Excel and recorded everything I ate each day, estimating the carb content of each food. An example of one of these early charts that helped me get started on Low Carb Dieting (from Nov. 2006) can be seen here. In addition, I also weighed myself daily and took fasting and postprandial blood glucose readings to see how various foods affected my blood sugar.

There were two important aspects to this activity: 1) I acquired a knowledge base of what foods contained carbs and how many, 2) by recording everything I ate, I kept myself honest. I call these two aspects “accountability.” I continued to do this for the entire time I was on strict Atkins Induction and, on and off, for several years thereafter. Eventually, however, I slackened off with the inevitable result that I gained back some (12lbs.) of the 60 that I had lost.

By that time I had become interested in on-line forums (Dr. Bernstein's Diabetes Forum in particular), and had read several books (including 2 of Dr. B’s), and I learned that I had to keep track of more than just carbs. So, I subscribed to one of the on-line calculators and started keeping track of calories, protein and fat, as well as carbohydrate grams. This further increased my knowledge base and accountability. I learned among many other things that a large amount of the protein we eat can become glucose (through a secondary process called gluconeogenesis) and that therefore protein also needed to be limited. After some further research, I figured out how much protein I should eat with each meal.

I also learned that even if I am eating Very Low Carb ( 20g/day of carbs), if I eat too much fat to the point where I am not in negative energy balance, I will not lose weight because I am not burning body fat – just dietary fat (the fat I eat).  This learning and record keeping paid off. I started on the Bernstein Diet and lost 100 pounds in 50 weeks (2lbs/week).

Many people who try Low Carb Dieting don’t lose weight and complain they are not cheating, honestly. When I ask them what they are eating and they tell me, I point out that this and that are carbs, or that they really don’t need to snack, or that they are just eating too many calories. They respond either that they didn’t know that, or that they just “cannot” give up this or that food. Okay. That’s a choice, but they cannot say they were eating a restricted calorie Very Low Carb diet. If they were, they would lose weight. “You can’t fool Mother Nature” (your biological system’s metabolic balance).

I suppose you have to be a certain kind of person to keep detailed records. Some would say an obsessive-compulsive; but an O-C personality that channels that trait in a positive way will benefit from doing it. Honesty is a slippery bugger. I think I’m pretty smart and pretty honest. Note both words are qualified. I guess I think I’m also smart enough to fool myself. I think most of us are. For us the only check on doing that are the facts, “just the facts m’am” (a la Jack Webb). Keeping a chart, and recording everything you eat – even the “cheat” after dinner or the candy bar at the gas station when you fill up – will remind you of the price you paid. It’s pretty easy to “forget” otherwise. That’s how smart we are.

I’ve been doing this Very Low Carb dieting for 11 years, on and off. When I’m on, I’m losing weight. When I’m off, I’m staying “pretty flat” or gaining a little. “Pretty flat” really means “creeping up ever so slowly.” Gaining 1/3 of a pound a week for 4 years is 70 pounds. That’s what happened to me. Now I am moving down again, but at what price did I gain? Along with my weight my A1c’s, blood pressure and LDL cholesterol also crept back up.  We’re talking about my health here, folks. So, there’s more at stake than just weight. Maintaining the weight loss and all the health benefits that accrue to it are equally important. In fact, isn’t that the best reason for losing weight in the first place?

PS: After 10 years of acquiring a solid base of knowledge and experience, and having much better control of my impulse to eat carbs and snack before and after dinner, I am now losing weight without charts. The “trick” is keeping honest.
Are you more likely to tell the truth to others, than to yourself?

Wednesday, July 24, 2013

The Nutrition Debate #128: Sugary Drinks and Added Sugars

This “dead horse” has been beaten enough that I don’t need to do it, so...oh well, maybe once more. It’s different. Twenty years ago my doctor (who died recently – see #95, an Appreciation) employed a dietitian to help his patients lose weight. Her ‘prescription’ was, then as now, to eat less (of a balanced diet – in other words, starve – and exercise more. Needless to say, it didn’t work. But one thing she said still sticks in my memory: “Don’t drink orange juice. They’re just empty calories.” Of course, she was not saying don’t eat fruit (even though she knew I was then, as now, a type 2 diabetic). She was saying that I should eat the whole fruit instead of fruit juice. She counseled that I wouldn’t eat as many calories as I would drink (#100 “Liquid Calories”), I would get extra benefit from the fiber, and that the real fruit would trigger different hormones signaling that I had eaten real food, not drunk the more easily digested liquid form.

I remember that it all made sense to me at the time. But that was before I discovered Very Low Carb dieting to lose weight and control my blood sugar. Today, I avoid eating virtually all fruit and many other foods that contain fructose because of the effect of that simple sugar on my overall health. See #97Fructose in Foods,” #29Fructose, formerly known as Fruit Sugar,” #30Is Fructose a Liver Toxin?” and #31Carbohydrates and Sugar.” If you haven’t seen it, you should also watch the viral video (3.7 million hits) of Dr. Robert Lustig’s lecture, “Sugar: the Bitter Truth.”

Somehow this message has escaped our nation’s food policymakers. To them, real fruit juice is a permitted beverage because it contains enough of the body’s required nutrients to be “allowed.” The recommended portion size, although it’s not mentioned in the latest Dietary Guidelines for Americans (2010), is 6 ounces, or about 72 grams of carbohydrate, assuming no added sugars. The message from the dietary Dictocrats is that the added sugar in the enumerated sugary drinks – “soda, energy drinks and sports drinks” and “fruit drinks” – is not nutritious. But fruit juice is alright? Even though the Guidelines admit, …the body’s response to sugars does not depend on whether they are naturally present in food or added to foods”? Where is Nanny Bloomberg when you need him? Wait a minute! When did he become expert?

The Guidelines do include a fairly comprehensive list of added sugars: “Added sugars include high fructose corn syrup, white sugar, brown sugar, corn syrup, corn syrup solids, raw sugar, malt syrup, maple syrup, pancake syrup, fructose sweetener, liquid fructose, honey, molasses, anhydrous dextrose, and crystal dextrose.” But wait, where is “organic malted barley”? What’s that you say? How is that an “added sugar”? Well, it is, although well concealed I must admit. It is the third ingredient listed, after “organic sprouted wheat” and “filtered water” in a loaf of Food for Life 7 Sprouted Grains bread. Who’d o’ thunk it? This “healthiest” bread has added sugar as its 3rd listed ingredient! Feel snookered? Join the crowd. That’s Agribusiness for you. You try to walk the straight and narrow, and you get sandbagged.

What is “malted barley”? It’s a malted grain. According to Wikipedia, “Malting grains develops the enzymes required to modify the grain's starches into sugars, including the monosaccharide glucose, the disaccharide maltose, the trisaccharide maltotriose, and higher sugars called maltodextrines. It also develops other enzymes, such as proteases, which break down the proteins in the grain into forms that can be used by yeast. Malt also contains small amounts of other sugars, such as sucrose and fructose, which are not products of starch modification but were already in the grain.” And just in case I am not being clear: Every single one of those chemical compounds (other than protease) in the “malted barley” will quickly digest to a single-molecule sugar, pure and simple.

What’s the point of this? Well, Chapter 3 of the Policy Document from the 2010 Dietary Guidelines for Americans points out that of the “Refined Grains in the Diets of the U. S.  Population,” “yeast breads” are by far the largest category (25.9%), according to the NHANES study (2003-2004) footnote of the National Cancer Institute. And according to the NHANES study (2005-2006) footnote, “yeast breads” constitutes 2.1% of the “Added Sugars in the Diets of the U. S. Population.” Yet, nowhere in the Dietary Guidelines are we guided not to eat bread. I guess this refined grain with added sugar is just too engrained (sorry) in our culture to be shunned. But I challenge you to find any loaf of bread on your supermarket shelf that does not contain some form of sugar as the 3rd ingredient by weight, after flour and water. Even Pepperidge Farm, Arnold or any so-called “whole grain” (flour) bread. It’s my challenge to you. Check it out.
I don’t mean to pick on Food for Life or any processed or refined food manufacturer. I mean to pick on all of them. If you want to avoid becoming a victim of clever and deceptive marketing, take a chemistry class, or just eat whole foods: grass fed and grass finished meats, eggs from free-range pastured chickens, seafood (both fin and shell), especially sardines, wild salmon and other cold water fish, and non-starchy vegetables. Avoid all wheat, excessive fructose, and excessive Omega 6s from liquid vegetable and seed oils. Eat butter, olive oil and coconut oil. Pay no attention to your government or to the media. They are hopelessly misinformed, misled and misguided. Finally, read this blog regularly. I will always try to share with you the best and most reliable information for living a long and healthy life. That’s what I intend to do.

Saturday, July 20, 2013

The Nutrition Debate #127: Fighting Sleep?

“Fighting sleep has become a national pastime,” the headline roars in a November 18th story by syndicated columnist Mitch Albom. And to make the story more topical the lead is, “I have never gulped a 5-hour energy (drink).” Not to be mistaken for a product placement, even the other caffeine-loaded drink, Monster, is mentioned. And, not to neglect the older newspaper-reading demographic, the columnist even mentions popping NoDoz himself in years past. But this opinion piece is not about caffeine drinks, or even about the need for a good night’s sleep, which I don’t dispute. It is about why many people feel sleepy or drowsy a few hours after eating a meal. Let me be clear: I do not, ever, anymore.

The reason why people feel sleepy a few hours after eating a typical meal is physiologic. It is very real. I know because I experienced it frequently myself for most of my life. And it is related to energy, particularly available energy. The body manages homeostasis by summoning energy from available sources. That’s why we eat – to replenish our level of available energy by ingestion, digestion and absorption into the blood stream of nutrients to replace the ones we have used. These are required both to maintain our basal metabolism and to support the activity levels above those requirements. Our body also stores energy for this purpose; however, this stored energy is not always available for use.

There are three macronutrients: protein, carbohydrates and fat. Protein is the only one that does not store energy that can be called upon as a fuel when needed. When protein is digested, it breaks down to amino acids which circulate for 4-5 hours to be taken up by muscle, for repair, and many other uses in the body.  The balance of amino acids, if any, then goes to the liver for storage where they can later be used to synthesize glucose, which is a good thing, generally.

 Carbohydrates (both simple sugars and complex) digest more quickly, in just minutes for highly processed carbs found in most food products in today’s marketplace (especially liquid and refined forms), and just one to two hours for virtually all the rest. All carbohydrates are digested ultimately into single molecule form, almost all of them to glucose, some to fructose, and a few to galactose. When glucose is digested and absorbed, it raises the level of “sugar” in the blood precipitously. Normally, we need just under one teaspoon of sugar in our bloodstream. A meal with 100 carbs is equivalent to 13 teaspoons. Our blood sugar “spikes.” This “quick energy” doesn’t last. The reason many people feel sleepy or drowsy a few hours after eating a meal loaded with carbohydrates is that their blood sugar level “crashes.”

When high levels of glucose are detected in the blood, the body secretes insulin to take it to where it is needed, to the muscles for example. That’s what exercisers call “carb loading.” After replenishing the cells, the balance of circulating glucose goes to the liver to be stored as glycogen. And when the liver gets overloaded with glycogen, especially when it is deluged with a load of liquid sugar (as in soft drinks and fruit juice), it converts the excess to fat by a process called lipogenesis. That’s right; the sugar overload in your soft/juice drink converts to body fat. See

The body does this to protect itself from sugar because the fructose molecule in sugar is toxic when it is over consumed.  That’s why fructose goes straight to the liver. One of the liver’s functions is to detoxify things. The liver then converts the fructose to fat, and some of this fat is stored in the liver. Non-Alcoholic Fatty Liver Disease (NAFLD) is near-epidemic. Fructose is a large part of the food supply. It is 50 percent of table (cane) sugar, 55% of the sweetener HFCS used in soft drinks and 42% in bread and many other processed food products. And fructose is 67% of the sugar in an apple or pear.

Fat, the third macronutrient, is the densest in terms of food energy. It has 9 calories per gram versus 4 for both protein and carbohydrate. This makes it ideal for “long term” storage. The body is designed to “put it away” in storage to make available when needed. But since protein circulates and can be used for its special purpose for only 4-5 hours, and ingested carbohydrates get used for quick energy almost immediately and at most in 1-2 hours, what does our body use for energy after 1-2 hours? The answer is glycogen, the storage form of carbohydrates in the liver and muscles. It will meet our energy needs between meals. We are designed to have enough in storage for that purpose.

What happens when our glycogen storage is exhausted (or non-existent)? Do we have a reliable back-up system? You bet we do. We burn our body fat. This happens every night (14 hours from dinner to breakfast for me), when my body shifts from the “fed” to the “fasting” state. When I am in this ketogenic state, which I strive to be in continuously while I am trying to lose weight, my body burns fat as its primary fuel source. As a consequence, my blood sugars are relatively stable all day long. My blood sugar doesn’t spike after a meal and it doesn’t crash a few hours later. I do not feel sleepy or drowsy between meals. I don’t need to snack for a “pick-me-up.” I do not need 5-hour or Monster or NoDoz or even coffee. Caffeine “treats” the symptom, not the cause of sleepiness. The cause of sleepiness is unstable blood glucose from carb binging and crashing. I have a high, stable energy level all day long. Then I get a really good night’s sleep.
How do you feel after meals?

Wednesday, July 17, 2013

The Nutrition Debate #126: Do You Live to Eat or Eat to Live?

Do you live to eat, or eat to live? I love to eat, but I eat to live. I used to live to eat, and I paid a big price for it. Over many years my body changed. The way it processed food changed. “Somehow,” I developed a disregulated metabolism. The carbs I ate, both simple sugars and complex carbohydrates, were the only fuel my body was using. Fat was carefully stored away in copious quantity. I was a sugar-burner running “high” on glucose to prevent “crashes.” And I became insulin resistant. The insulin my body made could no longer get nutrients into my cells. The fat I ate wasn’t burned for energy because my blood insulin was too high preventing access to my fat stores. Year after year I got fatter and fatter.

I also became a Type 2 diabetic. I was diagnosed 27 years ago, but I was probably fully diabetic many years before that. Over the years, as I got fatter, my diabetes got worse – until 2002 when my doctor suggested that I try Atkins to lose weight. I lost a lot of weight, eliminated virtually all my oral anti-diabetes medications, dramatically raised my HDL, lowered my triglycerides, and lowered my blood pressure. These are the cluster of risk factors known as Metabolic Syndrome, which I had, and they are all gone now! A doctor today would not know that I am (and always will be) a type 2 diabetic. Once you have a disregulated metabolism, there’s no fixin’ it. You have it for life. You have to “live with it.”

Accepting this fact is not as difficult as you might think. All you have to do is change the food you eat. The hardest thing about dieting is being hungry. Traditional “balanced” diets are just slow starvation. You eat less than you body needs for energy balance, and your body reminds you of this frequently. It’s an exquisite machine, continuously assessing its options to maintain homeostasis. It regulates and shifts resources around via a complex system of signaling from the brain, liver, stomach, intestines, the fat stores, the blood and all the other organs. Everything works in harmony. If you are hungry, your body is telling you to eat because it doesn’t have access to your fat reserves. It is ‘available’ (around your waist) but it is not accessible. Why? Because, with high circulating insulin, your body thinks “sugary foods” (carbs) are plentiful, so it should preserve your body fat for leaner days (winter, famine, etc.) So, how then do you lower your circulating insulin? You stop eating most carbohydrates. That will “free” or “release” your body fat to be used for fuel and you will not be hungry. Your body will not send you a signal to eat because it will be satisfied with the energy it is getting. Your body fat will be feeding your body. How cool is that?

So, as much as I love to eat, I now eat to live. I am currently eating less to lose weight. I eat very few carbohydrates (less than 20 grams a day), so I am not hungry. I let my body tell me when to eat. If I’m not hungry, I don’t eat.  Frequently I go from breakfast to dinner without any food at all. I eat a good breakfast: 2 fried eggs, 2 strips of bacon and a big cup of coffee with heavy cream or ghee. If I do eat lunch, I eat a can of sardines packed in olive oil. That’s all. Dinner is just meat, fish or fowl and a low carb vegetable with butter or tossed and roasted in olive oil. Weight loss, without hunger!

You could say that my diet is limited. By restricting my choices to certain foods, though, I do not feel “deprived.” Would you feel deprived if you could not eat poison? That’s what carbs are to a diabetic’s body. Carbs are “toxic” to a Type 2 diabetic or prediabetic. Type 1s have to inject insulin to live. If they don’t, the sugar in their blood will kill them quickly! Sugar is toxic to Type 2s too, just in a chronic rather than an acute way as long term hyperglycemia damages the body.

All carbs are toxic to Type 2’s. If you’re a Type 2 and follow your doctor’s or dietician’s advice to eat a “balanced” diet with 45-60 grams of carb per meal, your treatment will progressively include more and more medications to control your blood sugar. Why? Because the 2013 ADA guidelines for “good control” call for an A1c of <7.0 and blood glucose level under 180 after meals. Unfortunately, damage to organs, nerves and arteries, particularly in the feet, kidneys and eyes, begins when BG is above 140. And heart attack risk steadily rises as the A1c level goes above 5.5, for everyone, diabetic or not. The risk is doubled with an A1c of 6.0.

For diabetics, cardiovascular disease is almost a given, as heart disease or stroke are the most common causes of death for a diabetic. As heart attack risk rises, so does the risk of other conditions such as erectile dysfunction, hearing loss, dementia and many cancers (particularly colon, bladder, liver and breast, 4 of the most common cancers in the US). Eventually many diabetics will go on to add drugs for co-morbid conditions and to inject insulin as well. And then to collect “the dreaded complications”: neuropathy (amputations), nephropathy (end-stage kidney disease), and retinopathy (blindness), or one of many chronic diseases of the Western Diet, including cognitive decline (Alzheimer’s).
This is the prospect you face: The medical establishment will tell you T2 diabetes is a progressive disease, and it will be if you allow them to treat you with a “one size fits all” “balanced” diet. But you do have a choice. You can treat your carbohydrate intolerance by avoiding carbs, use your meter to set goals, and take charge of your own health. Eat to live!

Saturday, July 13, 2013

The Nutrition Debate #125: Dietary Dictocrats Double Down

The latest Executive Summary of the Dietary Guidelines for Americans (2010) makes what I infer is an admission of neglect and attempts to make up for it in that update. The admission: “Dietary Guidelines recommendations traditionally have been intended for healthy Americans ages 2 years and older” (emphasis mine). Previously, I infer from that, their recommendations applied only to “healthy Americans ages 2 years and older,” not to the “other than healthy,” as for example the insulin resistant, overweight, obese and Type 2 diabetes populations.

This new interest in all of us was further clarified for me by their next statement: “However, Dietary Guidelines for Americans, 2010 is being released at a time of rising concern about the health of the American population. Poor diet and physical inactivity are the most important factors contributing to an epidemic of overweight and obesity affecting men, women and children in all segments of our society. Even in the absence of overweight, poor diet and physical inactivity are associated with major causes of morbidity and mortality in the United States. Therefore, the Dietary Guidelines for Americans 2010 is intended for Americans ages 2 years and older, including those at increased risk of chronic disease.” To repeat, that’s all of us “unhealthy” Americans.

When I read this 2 years ago, I had hope of change. I hoped they would address the special needs of that segment of society that is insulin resistant, overweight and obese. I hoped they would recognize some special dietary restrictions, i.e. carbohydrates, for this population. I was disappointed. They do address the overweight and obese, but they do not associate it with what is the likely cause of most obesity: insulin resistance. And they do not associate overweight and obesity with pre-diabetes or Type 2 diabetes. In fact, they don’t even mention Type 2 diabetes or the association of the epidemic of overweight or obesity with the Type 2 diabetes epidemic.

In summary, on the next two pages they prescribe the same-old “fix” for the “unhealthy” overweight and obese population as they do for the healthy population: Calorie restriction, with macronutrient balance, and exercise.

“People who are the most successful at achieving and maintaining a healthy weight do so through continued attention to consuming only enough calories from foods and beverages to meet their needs and by being physically active.” This is of course patently untrue. It is a “diet delusion,” as anyone who’s done it knows.

“To curb the obesity epidemic and improve their health, many Americans must decrease the calories they consume and increase the calories they expend through physical activity.” The “calories in – calories out” redux.

Then, the “Key Recommendations” begins with “Balancing Calories to Manage Weight”

·         Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors.

·         Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages.

·         Increase physical activity and reduce time spent in sedentary behaviors.

·         Maintain appropriate calorie energy balance during each stage of life – childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age.

The USDA and HHS, who jointly created this document, are jointly in denial. They decided to just double down.

They also recommend we eat less “sodium” (salt), less “dietary cholesterol” and less “solid fats” (read saturated ) and added sugars, and less “refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium.” Notice their associations of saturated fats with sugars. Also, there’s not a word about carbs!

Food and food components to increase: monounsaturated fats like olive oil (okay) and polyunsaturated fats, like corn oil and soy bean and other seed oils (not okay!), fruits, vegetables, lean meats and fat-free or low fat-dairy.

The only specific population groups for which they have special recommendations are women capable of getting pregnant, women who are pregnant or breastfeeding, and individuals ages 50 years and older. For the latter, it recommends foods fortified with vitamin B12. Again, no mention of the pre-diabetic or Type 2 diabetic obese.
I know this is all “old news,” but I write about it again to illustrate institutional denial. As long as the dietary Dictocrats in Washington, together with the major medical associations and abetted by the self interest of agribusiness with its powerful lobby, continue to promote these recommendations, and the media trumpets it, we are left to go it alone. Self-treatment then becomes the modality of choice. Eventually, by culling, survival outcomes will reveal the wisdom of our course of action. Sadly, for millions it will be too late. Don’t let it be you!

Wednesday, July 10, 2013

The Nutrition Debate #124: A Lamentable Confusion Between Diets

From my perspective there are two popular movements on the ascendancy among the alternative diets. They are very broadly speaking Low Carb and Paleo. Lamentably I think there is confusion among  neophytes as to which is “right” or “best” to follow and for what reasons. I will attempt to explore the differences and communalities to clarify the options.

The modern era of the low carb diet is largely associated with Dr. Robert Atkins. Beginning in the early 1970s his diet was associated with a regimen in which carbohydrates were severely restricted (only 20 grams a day in his Induction Phase). The purpose of the diet was weight loss. It worked very well but was widely criticized, unjustly in my opinion, as dangerous. Other physicians, notably Dr. Richard K. Bernstein, developed specialized practices in which the low-carb diet was specifically tailored to diabetics, both Type 1s and Type 2s.

In July 2002 award-winning science writer Gary Taubes revived the Atkins controversy and substantially broadened the debate with his influential piece in the NY Times Sunday Magazine titled, “What If It’s All Been a Big Fat Lie?” In 2007 he produced his seminal tome, “Good Calories – Bad Calories” (“The Diet Delusion” in the UK), that further explicated his “Alternative Carbohydrate Hypothesis.” Among Taubes’s 10 “certain conclusions” (pg. 454) was, #2: “The problem is the carbohydrates in the diet, their effect on insulin secretion, and thus the hormonal regulation of homeostasis – the entire harmonic ensemble of the human body. The more easily digestible and refined the carbohydrates, the greater the effect on our health, weight and well-being.”

There are many practicing clinicians and researchers and bloggers out there today who espouse a low carb or even a very low carb diet for those diagnosed with Metabolic Syndrome, insulin resistance, carbohydrate intolerance, impaired glucose tolerance and any glucose control issue having to do with a disregulated metabolism. Severe restriction of dietary carbohydrates will improve glucose regulation and regularize your metabolism very effectively. It will also result in easy, hunger-free weight loss and greatly improved blood lipids, especially triglycerides and HDL lipoproteins, and, as a consequence of weight loss, improved blood pressure.

The low carb diet can still also be used as Atkins originally intended, which is principally for weight loss.  All of the attendant benefits (improved glucose regulation and blood lipids, and improved blood pressure after weight loss), will accrue. Frankly, I would recommend the principles of the Atkins diet to the entire U. S. population.

The modern Paleo movement in the U. S. came along much later than Atkins and about the time of Taubes’s 2002 seminal NY Times piece. In a few short years it has made a very big splash (in a certain niche: the “real food” crowd). An early proponent was Loren Cordain. Rob Wolf, an exercise physiologist who worked with Cordain, followed. Michael Pollan’s “Omnivore’s Dilemma” (2006) gave it a big boost. My favorite in this area is Dr. Kurt Harris, who came along a little later. He had an epiphany after hearing Taubes and reading his book (GC-BC). His Archevore program, originally dubbed Pa-Nu, is to avoid the Neolithic Agents of Disease (NAD): wheat, excess fructose and excess linoleic acid (Omega 6s). Several Paleo researchers, among them Paul Jaminet (PHD diet), Stephan Guyenet, Peter D. (Hyperlipid), J. Stanton (, and Chris Kresser blog regularly. Many Paleo fans regularly debate the issues at the PaleoHacks website.

The Paleo movement has also benefitted recently from a little organizing. The Ancestral Health Society held two wildly popular symposia (2011 in San Diego and 2012 in Cambridge, MA), the latter one selling out many months in advance. All of the major “players” were there, and YouTube videos of the various sessions are now available. The next AHS meeting will be in Atlanta, GA, August 15-17, 2013.

The Paleo movement, like low carbing, has many variants. However, it is not a program designed for glucose regulation, for people whose glucose metabolism is “broken,” or who need to regulate their blood sugar by diet. It will not produce the benefits needed if you are insulin resistant, carbohydrate intolerance, have Metabolic Syndrome, or are pre-diabetic or have been diagnosed with Type 2 diabetes. Many of the Paleo diet variants, for example, permit root vegetables (very starchy carbohydrates!) and even white rice! Rice is a non-wheat grain and therefore gluten-free, but it is still a very starchy food. For people who have insulin resistance and are carbohydrate intolerant, root vegetables and white rice will cause your blood glucose to go through the roof!

To summarize, Paleo is an appealing approach to eating a healthy diet, if you have a healthy glucose metabolism. I would definitely follow it if I did, but you have to know if your metabolism is “broken” before you decide. Get to know your health markers and don’t be in denial; if you are pre-diabetic, eat to your meter. If your metabolism is “normal,” then go “whole hog” with Paleo. Eat “real” (unprocessed) food, the way we all used to!
Do you have a meter? Have you tried any Paleo type meals? What are your favorite low carb or Paleo websites?

Saturday, July 6, 2013

The Nutrition Debate #123: Intermittent Fasting and “The 23-hour IF Diet”

“IF” is not a conjunction introducing a conditional clause.” As most dieters know, “IF” means Intermittent Fast or Intermittent Fasting. Intermittent Fasting is a well-known method of dieting that is very popular with those who can tolerate it. They are generally people who are keto-adapted, which permits them to do it easily without hunger. It is also used by some who are able to endure hunger or even like to feel a little hungry, perhaps on the theory that denial is virtuous and demonstrates self-control. It appeals and “feels right” to others as a throwback to ancestral times when food was generally scarce, and hunters and gatherers ate less in the winter and more “in season” and bountiful times.

 “Intermittent” means “coming and going at intervals,” “not continuous,” or “occasional.” It is open to interpretation. Duration and frequency of intermittence are also not defined. “Fast” is also open to interpretation but generally means a period in which no calories are consumed during the fasting period. In common usage when applied to the human diet, that definition is sometimes stretched to include water and low-calorie beverages such as black coffee and plain tea. Personally, only breakfast coffee and water “cuts it” with me.  Then, I “gird my loins” and “go whole-hog,” to horribly mix my metaphors. But just skipping dinner once or twice a week can have miraculous effects without much effort.

According to the Wikipedia entry, “There is evidence suggesting that intermittent fasting may have beneficial effects on the health and longevity of animals – including humans – that are similar to the effects of caloric restriction.” For more on CR, see The Nutrition Debate #79 , #81 , and #82. The myriad health and longevity benefits have mostly been seen in animals (e.g., rats and worms). They include: reduced serum glucose and insulin levels, increased resistance of neurons to stress in the brain, reduced blood pressure, increased insulin sensitivity, and increased heart rate variability; also: increased resistance of heart and brain cells to ischemic injury and age-related deficits in cognitive function. As with CR, IF has often been associated with increased lifespan ranging in one study (male rats fasting 1 day in 3) of 20%. Another study in worms increased lifespan from 40% to 57% for alternate day fasting and 2-in-3 day fasting, respectively.

Intermittent fasting has mostly been adopted by humans as a weight-loss tool. There are, however, myriad ancillary benefits. Check out this Wikipedia entry on Calorie Restriction. Historically, periodic fasting is also an important part of various religious traditions. Recall Ecclesiastes 3: 1: “There is a time for everything, and a season for every activity under the heavens…” My favorite bible quote though is from Luke 4:23. Jesus said “Physician, heal thyself.” Hippocrates, who centuries before Christ created the Physician’s credo “First, do no harm,” must be dizzy from rolling over in his grave.

Are the benefits of Intermittent Fasting a direct consequence of the period of fasting, or from the decrease in overall calories consumed?   According to the Wikipedia entry, recent studies have shown it is the former: fasting has its own specific benefits related to the body’s multiple biochemical adaptations to maintain homeostasis. To greatly oversimplify, the body engages in Hormesis, a process of renewal and repair.  These mechanisms are not fully understood, but they are, let’s face it, wondrous!  It never ceases to amaze me how “happy” my body is, physiologically speaking, in every particular when I am in both the “fed” and the “fasting” states.

As a weight loss tool, two specific forms of IF are commonly practiced: the alternate day or third day fast in which no food whatsoever (my version: excepting water, black coffee or plain tea) is ingested for one whole day. This is actually a 38-hour fast, from dinner one day to breakfast the day after. The other form is more moderate and has increasing currency. It is commonly referred to as the 8/16 hour fast in which all food in a 24-hour period is consumed within an 8-hour window. One such example is described in The Nutrition Debate #83 here. For an office worker, this could be done by skipping breakfast (except for black coffee), eating a light meal in mid-morning break (10:30AM), a light lunch at 12:30 (hungry?!) and dinner at home at 6:30PM, all within the 8-hour window, and then you begin the 16-hour fast.

I have a favorite 3rd version of Intermittent Fast that I would like to popularize; I call it “The 23-hour IF Diet.” I start with a cup of coffee with heavy cream or ghee. There is nourishment here (I just never developed a taste for black coffee or plain tea), so this beverage is the beginning of my 1-hour eating window. Then, when my spouse arises and prepares breakfast, I eat 2 strips of bacon and 2 fried eggs. On weekends it might be “hold the bacon and substitute 3 eggs scrambled, with a little cream and/or shredded cheese, or smoked salmon tidbits, mixed in. This is a variation of my “1-2-3 Diet” described in #90 here. Then, after this 1-hour long breakfast, I fast for the next 23. No lunch, no dinner, no snacks. Drink a little water if you’re thirsty, but if you’re not, don’t. Do what your body tells you. (You won’t be hungry.)
I created “The 23-hour IF Diet” spontaneously a while back to deal with weight creep. I did it for two days in a row – just breakfast, nothing else for two days. First, I was not hungry. I was already in a fat-burning state, a mild level of ketosis. So, there was no glycogen in storage, and I was not running on “sugar” (carbohydrates, which almost all become glucose in the blood). It worked. I lost 5 pound in the first day, 7 total by the 2nd day, and 9 total in five days. As I say, it worked.

Wednesday, July 3, 2013

The Nutrition Debate #122: Macronutrient Ratios and Calorie Restriction

Macronutrient ratios cannot be intelligently discussed without reference to both calories and food weights. Ratios are usually described in percentages of calories and weight in grams. Percentages will differ dramatically from weight since the caloric energy of fat is 9 calories per gram whereas the caloric energy of protein and carbohydrate is just 4 calories. That is why fat is such a good storage vehicle. It is more than twice as dense in energy as either protein or carbohydrate.

This is a big subject, so to include both macronutrient ratios and calories (as is necessary because they are dependent), it will be assumed for this discussion that all food ingested will be whole foods (no processed foods), and all foods will avoid, in Dr. Kurt Harris’s words, the Neolithic Agents of Disease (NAL): wheat, excess fructose, and excess linoleic acid (Omega 6s). Since I am long-time Type 2 diabetic, I will also attempt to avoid all starches (even so-called “safe” starches) and all sugars, even “natural” sugars that are found in fruits and certain vegetables such as beets, peas, corn and carrots.

For a baseline reference, I will use the Standard American Diet (SAD) conveniently found on the HHS/USDA’s “Nutrition Facts” panel on processed food packaging. Macronutrient ratios are based on a 2000 calorie diet which is what women of a certain age need to maintain their weight. (A man is supposed to need 2200 calories.) The “% Daily Value” is based on the recommendation to eat 300 grams of carbohydrate a day.  That’s 1200 calories (300 x 4) or 60% of 2000 calories. Surprised? The protein recommendation is 50 grams, which is 200 calories (50 x 4) or 10% of 2000 calories. The fat recommendation is 65 grams or 585 calories (65 x 9) which is <30% of 2000 calories. 1200 + 200 + 585 = 1985, say 2000.

I consider this reference standard to be very high carb, low protein, low-to-moderate fat. Although the government hasn’t revised the Nutrition Facts standards, they do appear in recent permutations of the “Dietary Recommendations for Americans” to be lowering the carb percentage a little (without explicitly saying so), but they also want you to lower your fat intake (at least saturated fat and cholesterol), and now refer to fat simply as oils, by which they explicitly mean vegetable oils (corn, soy bean, sunflower, safflower, Canola, etc.). It is these specific oils that I and like-minded thinkers are recommending be completely avoided due to instability(#21 here). My cooking oil preferences in fat are coconut oil, butter and ghee (and tallow and lard) – all saturated fats – and olive oil, a monounsaturated fat, for non-cooking use.

Another “reference standard” that may be closer to the currently recommended level of macronutrients that the government appears to advocate is represented by the contents of the NestlĂ© Nutrition product, Optifast. Their 510kcal (2.1MJ) serving contains 46.4% carbs, 32.5% protein and 20.1% fat. That is lower in both carbs and fat but much higher in protein than the SAD. As a further reference, in actual practice surveys show that American men eat 16%, and women 15%, of calories from protein. Most nutrition experts recommend no more than 30% of calories should come from protein, and then only when eaten with fat, and then only with blood tests that show no evidence of kidney disease.

What then are the other ranges of macronutrients? What, for example is considered low-carb? There is no definitive percentage but many people now consider 50 to 100 grams/day to be low-carb (vs. 300g in the SAD). Fifty grams is 200 calories or 10% of a 2000 calorie diet. 100g is 20%. That’s much better than 300g and a sure way to lose weight. Very low carb would be less than (<) 50g/day. Personally I eat about 15g/day but only 1200 calories total, so 15 x 4 = 60 calories which is only 5% of 1200. There is no minimum requirement for carbs, so some days I eat 5g with breakfast, zero at lunch, and 10 with dinner. If I skip dinner, I really lose weight. When I eat almost all fat and protein, I don’t get hungry.

That’s where calorie restriction comes into play. If you seriously restrict calories and eat a “balanced diet” of carbs, protein and fat, you WILL feel starved because your body IS being starved. You have limited the energy ingested and you have limited your body’s ability to access the stored fat on your body by eating carbs. Your body “notices” you have access to “quick energy” from readily available carbs (fruits and vegetables which seem to it to be “in season”), so it asks for (as in “craves”) more sugar. As long as you are a “sugar burner,” it “reasons,” you don’t need to access the dense fat reserves stored around your midriff. Insulin, the hormone secreted by your pancreas to transport glucose (the “sugar” broken down from all carbs) to your cells, is “telling” your fat cells to stay put and wait for the impending famine. Your body is doing you a big favor, it “thinks.” No matter how hard you try, it won’t let you burn your precious fat stores. You’re going to need it later, it says. It is going to protect you. It’s wants you to survive the winter that never comes….
So, the only way you can restrict calories without hunger, if you want to do that to lose weight, is to restrict carbohydrates very severely. The number of grams and percentages of total calories will vary from person to person, due to differences in size and activity levels and hormonal issues (thyroid, or pregnancy, just for example). So will the number of days that it will take your body to get the message that the quick energy foods are no longer “available” – their season has passed – but when it does, it will use the fat it has safely put away for you. Your body is a beautifully designed machine, tuned to do just what you want it to do, if you ask it in a nice way. When you do, you are both happy.