Wednesday, December 31, 2014

The Nutrition Debate #275: “The Weight of the Nation”

I learned recently that among our neighbors in this valley community is producer John Hoffman, Founder and CEO of HBO’s “The Public Good Projects.” Among its noted productions is the 2012 series, “The Weight of the Nation.” On the chance that I might meet Mr. Hoffman at a holiday party, I decided to watch all four “Main Films.” In anticipation I took copious notes to share some good news with my readers as we embark on the New Year. Sadly, I was largely disappointed.

These feature-length films, all available now on YouTube, are: Consequences, Choices, Children in Crisis and Challenges. Each feature is divisible into finite chapters capable of being linked and shared. Each film is very well produced and deals thoroughly and comprehensively with “the problem” – in the sense that it accurately portrays the obesity epidemic in America, and accurately depicts the timeline in which it developed. There’s also a small segment of very good science on the “ancestral” POV, so again, I was hoping that the producers would reach the logical conclusion and make “the turn.”

I was hoping that, given the agreed-upon time line for the start of the dramatic upswing in weight, and this “ancestral” perspective, the producers would correctly “nail” the problem: Government’s insistence since 1977 (“The McGovern Commission Report”), and 1980 (the first iteration of the “Dietary Guidelines for Americans”), that we eat a low-fat (high carb) diet. The well-meaning bureaucrats and their minions had begun the largest public health experiment in history, encompassing virtually every American. Palpably, it has been a catastrophic failure.

My hopes were high. That pre-disposition is always my bias. Besides, if I don’t lean that way, the tsunami of bad nutritional advice out there would “swamp my boat.” So, my ears perked up when I heard, “What makes me frustrated bordering on angry is the fact that this [obesity epidemic] is preventable.” I think it was said by Robert Lustig, MD, the pediatric endocrinologist whose 2009 YouTube video, “Sugar: The Bitter Truth,” went viral. Other quotes of his were, “…insulin is not working well at the level of the cells,” “…juice and juice drinks are as bad as soda,” and “sugar is where you start.” He also asked, “What changed in the last 30 years to make this obesity epidemic happen?” His answer: “In the last 30 years our DNA has not changed, but our environment has.” I waited for him to amplify, but alas, neither he nor I produced this film.

Lustig was practically the only ray of hope I saw in this four-plus-hour presentation. The preponderance of experts said stuff like, “The reason we have government in the first place is to solve problems collectively that we can’t solve individually.” (Thomas Farley, NYC Health Commissioner); “We could have eaten better. We don’t have to have steak, and we don’t have to have roast beef,” and “Eat less, exercise more, eat a balanced diet.” (Francis Collins, head of the National Institutes of Health); “For all intents and purposes, a calorie is a calorie is a calorie; energy-in equals energy-out.” (Rudolph Leibel, Co-Director of the NYC Obesity Research Center at Columbia University); and “Follow a medically advised diet.” (Kelly Brownell, PhD, Director of the Rudd Center for Food Policy and Obesity at Yale University).

My favorite “quote” from my scribbled notes was from Courtney Rowe, Deputy Communications Director of the by-definition-compromised USDA: “While it is unfortunate that some in Congress choose to bow to special interests, the USDA remains committed to practical science-based standards for school meals that improve the health of our children.” N.B.: Rowe was Communication Director for the Senate Agriculture Committee when Dems controlled the Senate.

It would be less ironic if this political-pot-shot from Rowe in “Children in Crisis” (Part 3) hadn’t been followed in “Challenges” (Part 4) with these facts: 1) Government subsidy programs are heavily tilted toward the large commodity crops of wheat, corn, sugar and dairy, 2) livestock and poultry feed are subsidized indirectly by cheap feed: corn, soy and other grains, 3) “it is government policy to overproduce what we are already overeating,” and 4) 50% of U.S. farmland is planted in corn and soybeans). I think these points were made by David Wallinga, MD, at the Institute of Agriculture and Trade Policy, who deserves to be promoted (or fired). Eric Finkelstein, an economist at Duke University, added, “Obesity rates correlate with corn and soy production.” (low-cost HFCS and soy-based fats and oils).

But this “Documentary” (Commercial?) concludes with Daniel Glickman, former Secretary of Agriculture and current Chair, Committee on Accelerating Progress in Obesity Prevention, saying in a voiceover, “To be healthy we need to eat healthy and exercise more.” The video clip shows a guy on a treadmill saying, “I needed to do something” (about weight). I think it was Mayor Dean of Nashville, TN, who added greenways for cyclists and parks in poor neighborhoods.

The old saw, “Your zip code matters more than your genetic code,” has now evolved to, “Being wealthy is not nearly as protective against obesity as it used to be.” I like it because it brings us back to how what we eat has changed, and again to David Wallinga: The increase in calories in our diet, he says, is attributable to “25% added sugars from corn, 25% added fat from soy, and 50% refined grains from corn starches, wheat, and the like.” The result: food costs ↓; health costs ↑.

N.B. “The Weight of the Nation” was produced by a partnership of “HBO Documentary Films and the Institute of Medicine, in association with the Center for Disease Control and Prevention, the National Institutes of Health, the Michael and Susan Dell Foundation, and Kaiser Permanente.” That means they paid for these films. At least it wasn’t Cargill and ADM, directly

Saturday, December 27, 2014

The Nutrition Debate #274: “Should Everyone Take Metformin?”

I had to laugh. Of course, by “everyone” the title of this Medscape piece meant, I thought, as the “Initial Choice of Oral Glucose-Lowering Medication” for [treatment of type 2] Diabetes Mellitus.” But for a moment I thought that the authors meant “everyone everyone.” That’s the way the new guidelines for prescribing statins are being interpreted, at least for everyone over 39 years of age (and under 76), and that for the very dubious, almost exclusive purpose of lowering LDL-C. But if you want to read about that, you can go to The Nutrition Debate # 180, “The AHA/ACC Cholesterol Guidelines.”

No, this story, published in JAMA Internal Medicine, was an “observational cohort study [that] sought to determine the effect of initial oral glucose-lowering class on subsequent need to additional anti-hyperglycemia therapy.” The 15,516 participants, none of whom had previously been treated for diabetes, were started on 1) metformin, 2) a sulfonylurea, like glyburide or glipizide, 3) a TZD like Avandia, or 4) a DPP4, like Januvia and Onglyza. “The primary outcome was time to treatment intensification, defined as initiation of a different class of oral glucose-lowering medication,” Medscape said.

“Secondary outcomes included time to composite cardiovascular event (coronary heart disease, congestive heart failure, unstable angina, ischemic stroke, acute myocardial infarction [heart attack], or a revascularization procedure), congestive heart failure alone, an emergency department visit or hospital visit for hypoglycemia, and any other diabetes related emergency department visit.” That’s one heck of a scary list of secondary outcomes. Something to think about…

“The Winner, and Still Champion: Metformin,” the Medscape sub-head declared. Well, there should be no surprise there. But if you are now pre-diabetic, or when first diagnosed a type 2 diabetic, you aren’t (weren’t) started on Metformin, you might want to print this post out – better yet, go to the Medscape and JAMA Internal Medicine links above, print them out, and give them to your doctor and ask why you were not. I’d be interested to hear his or her answer.

The FINDINGS: “58% of the patients began therapy with metformin, 23% with a SU [sulfonylurea], 6% with a TZD and 13% with a DPP4.” During the “median follow-up of slightly more than 1 year, subsequent treatment intensification differed significantly by drug class. Of patients prescribed metformin, 25% required a second oral agent, compared to 37% of SU recipients, 40% of TZD recipients, and 36% of patients taking a DPP4.” This implies significantly different effectiveness.

The Medscape piece amplifies this finding: “Relative to metformin uses, the risk of treatment intensification was 68% greater among SU users, 61% greater among TZD users, and 62% greater among DPP4 users.” That’s really significant.

As to the “secondary outcomes,” Medscape states this simple but dramatic finding: “Also relative to metformin, SU use was associated with an increased risk for composite cardiovascular events, congestive heart failure, and hypoglycemia.”

Then this Medscape analysis of comparative effectiveness took an interesting turn. It began with this question, posed by another study: “Can People With Type 2 Diabetes Live Longer Than Those Without? A Comparison of Mortality in People Initiated With Metformin or Sulphonylurea Monotherapy and Matched Non-diabetic Controls.” This British study, which appeared in Diabetes Obesity and Metabolism, essentially asked, “Does Metformin Reduce Mortality?” Hmmm… Maybe the title of the Medscape piece was intended to mean “everyone everyone.” I read on to find out.

In this study, “patients initiating metformin therapy were compared with those initiating treatment with a SU, and both diabetic groups were compared with their matched nondiabetic controls.” Subsequent mortality was tracked for up to 5.5 years. The FINDINGS: “Crude death rates were substantially lower for metformin users that SU users” and, “All subgroup comparisons favored metformin over SU and were statistically significant.” But here’s the zinger.

“Perhaps the most striking finding was that survival time for controls [the non-diabetics who were not taking metformin] was 15% shorter than for matched metformin users. This finding was consistent across all subgroups, nearly all of which demonstrated statistical significance, and was particularly strong among patients with high comorbidity.”

“The protective effect of metformin relative to SUs was not a surprise,” the Medscape piece says. The remarkable finding was an apparent protective effect of metformin compared with nondiabetic individuals. Because of metformin’s favorable results among people with diabetes, it has been postulated that the drug may also provide benefit to people without diabetes.” Sort of like statin therapy… What are they saying? What am I saying? Everyone should take metformin??

Wednesday, December 24, 2014

The Nutrition Debate #273: Insulin Resistance = Carbohydrate Intolerance

As I write this (on December 7th), I’m thinking my readers will get this message in their inbox on Christmas Eve. I don’t know about you, but I’ll be busy with family, eating a wonderful smorgasbord and watching grandchildren open presents (from family). They will wait until morning to open others that arrive “down the chimney” later that night. So, I’m thinking my message should be one of comity and “on earth, peace to men of good will” (Luke 2:14; Codex Sinaiticus translation).

We live in a world increasingly rent by division, and this applies to the world of nutrition policy as to any other field of human endeavor. Accordingly, this column frequently positions itself fervently in opposition to the perceived wisdom in broad areas of public policy respecting a “healthy diet.” We (in the royal sense) were originally motivated to take on the establishment view after the premature death of a friend. He was an insulin-dependent type 2 diabetic who happened also to be my pharmacist. His death, from one of the comorbidities of type 2 diabetes, was tragic and unnecessary.

Out of this sense of his loss I was motivated to begin writing this column over 4 years ago. I later wrote about my pharmacist in The Nutrition Debate #114 here. And I also wrote “an appreciation” (#95 here), upon learning of his death, of the doctor who introduced me to the Very Low Carb Way of Eating, i.e. VLC WOE. Doc just wanted me to lose weight, but he said, with his hand on my shoulder as he walked me down the hall, “It might just help your diabetes too!” That was 12½ years ago. Little did he know how profoundly it would change my life. It changed everything, really. I seriously don’t think I would be alive today…had I not taken his advice…and lost 170 pounds.

Everything else changed too, most notably my blood markers. My triglycerides dropped by 2/3rds (to around 50mg/dl); my HDL-C more than doubled (from 39 average to 84 average); my A1c dropped (originally) to the mid 5s (they’re starting to creep up recently though); and my hs-CRP, an inflammation marker, has been between 0.1 and 2.7mg/L (aver. of 13: 1.4). In addition, I feel GREAT! I always have LOTS OF ENERGY, and I have no joint, back, hip or knee issues. Even early signs of arthritis, which began to appear about the time I started this WOE, have disappeared. And my body “tags” all dropped off.

Then yesterday, at our local Christmas season concert and tea, I saw an old friend. He’s been reading this column for years. He was of “good cheer,” a jolly old soul indeed, but alas I’m afraid I quashed his spirit because I lectured him (and his wife). He is still as plump as Saint Nicholas himself, and I am dispirited. I am forlorn because I worry for him. It’s tough to accept sometimes that the best I can do to help people is sometimes just not enough. I need to remind myself of the American theologian Reinhold Niebuhr’s Serenity Prayer:

“God, grant me the serenity to accept the things I cannot change,

The courage to change the things I can,

And the wisdom to know the difference.”

So, my “Annunciation to the Shepherds” message is simple; it is one of “good tidings of great joy, which shall be to all people” (Luke 2:10; King James Version) who would listen:

Insulin Resistance = Carbohydrate Intolerance

If you are rotund, the “expression” of your genotype is undoubtedly characterized by a progressive condition called Insulin Resistance (IR). And if you have IR, you are CARBOHYDRATE INTOLERANT. If you want to live a long, happy and healthy life, you need to give up most of the carbohydrates in your diet. There’s a week left in the year to consider whether this would make a good New Year’s resolution. If you agree, we will guide you. Read our twice-weekly blog posts and write to me using the Blogger link or email me directly at I will do my best to support your decision and lifestyle change.

In any case, whether you decide to transform your life or not,


We wish you a merry Christmas
We wish you a merry Christmas
We wish you a merry Christmas
And a Happy New Year
Good tidings we bring to you and your kin,
We wish you a merry Christmas and a Happy New Year.

Merry Christmas to all, and to all a good night.

Saturday, December 20, 2014

The Nutrition Debate #272: Falling asleep at the wheel?

An article in The Washington Post caught my attention: “Falling asleep causes 1 in 5 auto crashes.” The finding is based on new research of 14,268 crashes from 2009-2013 in which one vehicle was towed from the scene. The AAA Foundation for Traffic Safety analyzed the data and commented, “Like distraction, there are limitations in relying on crash-involved drivers to realize, remember and willfully report their level of impairment.” Therefore, the AAA investigators said, “This study leveraged findings from trained crash investigators, as opposed to police reports, as a source of data.”

Okay, as a practiced debunker of bogus or biased “research,” I could take issue at the “overreach” of their study design, the “factors” taken into consideration, the “confirmation bias” of the AAA and their “public health” agenda and advocacy disposition, but I won’t. The reason this caught my attention is that I could relate. In years past I almost killed myself (and sometimes another) on numerous occasions – too numerous to recount – by nodding off behind the wheel.

The reason, however, was not “fatigue” (lack of sleep) in the usual sense; it was low blood sugar (NOT hypoglycemia). Now it’s true that I have been a diagnosed type 2 diabetic for 28 years, which means I have probably been a type 2 for 30 to 35 years (since I was in my late 30s). This also means I was undoubtedly a pre-diabetic or 5 or 10 years before that, going back to my late 20s or early 30s. Why is this relevant? I will cite a source for the “history” of the development of type 2 diabetes – the mechanisms – a little later, but first I’ll cite some examples of common behavior that everyone can relate to.

In a few days we are going to celebrate Christmas. In our house, some adults eat almost as many Christmas cookies (and other baked goods full of sugar and butter) as the children do. We give ourselves “a pass” a few times a year to indulge in the goodies we would normally pass on. We also have fresh in our memories a similar feast of Thanksgiving just a few weeks before when we ate loads of starchy vegetables and stuffing and gravies passed around the table “family style.” It’s a wonderful tradition. And it’s equally a tradition for some overstuffed family members to “feel sleepy” after a “big meal.” Others go for a walk in the brisk late-fall air to increase their peripheral circulation and stave off that sleepy feeling.

Now we all know that we (most of us, except the cook!) are not suffering from a lack of sleep, or even a few stressful days leading up to the big meal. We are suffering from a lack of blood in the peripheral areas (arms and legs) and brain while the blood concentrates in the central areas to process, digest and absorb all the “energy” we ate. The extremities get short shrift, as they should. The body does this autonomically. It’s natural. Animals like big cats take a long nap after devouring enough of their catch to carry them days or even longer until they are fortunate enough to make another.

But the “big meal” syndrome is only part of the picture. People who have, or almost imperceptibly are beginning to have, a compromised glucose metabolism – like I was in my late 20s and early 30s – are simultaneously experiencing a different physiological phenomenon: our blood sugar routinely becomes elevated (“spikes”) above the normal +/- 140mg/dl after a meal. People with a healthy glucose metabolism never have a blood sugar above 140mg/dl, even after a big meal. But people with a compromised glucose metabolism, who eat a lot of carbs, always spike higher.

This is the result of the loss of the 1st insulin response in which the pancreas produces a spurt of insulin in anticipation of and at the onset of eating and the beginning of insulin resistance in which the destination cells (muscles, etc.) for the glucose circulating in our blood have developed resistance to the insulin that is transporting the glucose. The result is that the glucose is not “taken up” as quickly. It continues to circulate and we have “high blood sugar.” Then, slowly, for the prediabetic (but not the un-treated T2), what goes up must come down. Your blood sugar crashes, and you “feel tired.”

If you’re interested, the mechanism of how someone who is genetically predisposed to having a dysfunctional glucose metabolism, and who eats the Standard American Diet (SAD), is explained by the 2008 ADA convention keynote speaker and Banting Award winner Ralph DeFronzo, MD, in The Nutrition Debate #99, “Natural History of Type 2 Diabetes.”
But for the less technically inclined, just know this: If you’ve gained weight eating the diet recommended by the USDA’s Dietary Guidelines, and the medical establishment (ACC/ADA), and their members who have no training in nutrition, then consider that it may be that your glucose metabolism is starting to unravel. If you “feel sleepy” after a big meal, it may be more than just all your blood rushing to the stomach to deal with your excesses. It may be a sign that you need to cut back on sugars and starches (i.e. on all dietary carbohydrates) that you eat. The life you save may be your own, or your family’s.

Wednesday, December 17, 2014

The Nutrition Debate #271: Treating Obesity Today

Among the myriad missives that arrive in my inbox daily are offers of Continuing Medical Education (CME). This half-hour video (with transcript) from Medscape LLC is worth 0.50 AMA PRA Category 1 Credits and was supported by an educational grant from Takeda Pharmaceuticals and Orexigen Therapeutics (drug makers).  “This activity,” Medscape says, “is intended for primary care clinicians, endocrinologists, diabetologists, and other allied healthcare professionals who manage patients who are obese.” I am always interested in how the medical profession manages to mangle this subject, so I watched it.

“The goal of this activity,” Medscape avers, “is to focus on the global public health crisis of obesity and to demonstrate how motivational interview techniques can be used by clinicians to help patients who are overweight or obese establish a partnership with their clinician and foster patient adherence to an individualized weight loss management plan.”

To recapitulate, here’s the plan: Scare the patient with the obvious – the prevalence of obesity and its unhealthy consequences and co-morbidities; then, if they are ready, help them by using “motivational interview techniques.” Do this by “partnering” with them to “foster” adherence and develop an “individualized weight loss management plan.”

Motivational techniques can help, I suppose, but “public health statistics” wouldn’t motivate me. Besides, everybody already knows that. The key is the patient has to be of a frame of mind to be ready to 1) personally want to try (again) to lose weight, and 2) the patient has to have a level of confidence that the weight loss plan will work. The two critical points are 1) “are you ready?” to lose weight and 2) the weight loss plan itself. It’s a critical one-two combination punch.

That being said, some of the questions the video posed to assess the motivational readiness of the patient were good. Absent the readiness on the part of the patient before the interview, this type of questioning might be fruitful.

     How important to your health is getting your weight under control?

     What is your biggest barrier to losing weight?

     What do you think you could do to lose weight?

     How confident are you in your ability to lose weight?

So, whether you come to your doctor’s appointment already motivated (as I was – see the penultimate paragraph of #260), or whether your doctor thinks he cajoled you into trying to lose weight again, the key is having a level of confidence that the weight loss plan you follow will work. This is where the video fails miserably and utterly to produce a knock-out punch. In fact, I would say the medical doctor who gave this advice should never even have put on gloves and gotten into the ring.

The match started to “go south” when in response to “what do you think you could do to lose weight?” the video suggests “exercise” and “eat smaller portions.” And instead of “eating a lot of high calorie foods” (that would be fat, right?), the doctor prompts you to “eat more vegetables” (all carbohydrates!). This doctor may know something about “motivational techniques,” but he clearly knows nothing about effective (“efficacious” in pharmaceutical- talk) weight loss plans.

He suggests seeing the patient once a month for 6 to 12 months to “create a partnership” and “foster adherence” to the “individualized” plan that you formulate together. He also suggests using this time to “direct the patient in the direction you’d like them to go.” And there’s the rub. All clinicians who treat the overweight and obese know that that so-called “individualized” direction – to “exercise more, eat smaller portions, eat less fatty food and more vegetables,” is doomed to fail. Their patients are going to be hungry all the time. They are not going to lose weight or keep it off. (What do they think you’ve been trying to do all this time?)  So what then? Weight loss drugs? Hmmm… I’m beginning to see the value of pharmaceutical companies providing “educational grants” so that, if all else fails, having “fostered” a relationship, you can “partner” the patient “in the direction you’d like them to go.”

“Upon completion of this activity,” Medscape says, “participants will be able to:

1.       Identify health consequences of untreated obesity and its association with the development and progression of comorbidities.

2.       Translate techniques of motivational interviewing to increase provider-patient discussions regarding obesity management.

Okay, I got the “scare the patient” part. It’s the “translate” part that doesn’t work for me. “Drug speak” is not the way to manage obesity. Nutritional counseling to cut out carbohydrates is, however, an effective weight loss management plan.

Saturday, December 13, 2014

The Nutrition Debate #270: “The Skinny on Fats”

Long before I started writing this column – but years after I discovered the Low-Carb, High-Fat (LCHF) Way of Eating (WOE) – I discovered an article called “The Skinny on Fats” and saved the link as a “favorite.” My link still works, as do links to other articles, “The Oiling of America” and “The Truth About Saturated Fat,” by the same authors.  The authors are Sally Fallon Morell and Mary G. Enig, PhD. Sally is the founding president of the Weston A. Price Foundation. Mary, co-founder and vice president, died a few months ago. An appreciation by Kaayla Daniel, PhD, her successor, appears here.  The website is worth a look.

The article “The Skinny on Fats” so influenced me that I cleaned out our kitchen cupboards. This article is also the first chapter of Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats.” That cookbook has now sold upwards of half a million copies. Now, a new book, The Skinny on Fats, by David Brownstein, MD, and Sheryl Shenefelt, CN, has just been published. It was reviewed with a “thumbs up” by Sally Fallon Morell in the Fall 2014 edition (pg. 69) of Wise Traditions, the WAPF quarterly publication. Morell’s full book review is reproduced below:

The subject of fats and oils is complicated and fraught with misconceptions – so much so that explaining the myths and truths about fat can be long and complicated. People’s eyes glaze over when you try to explain it all, even though information on fats and oils can be life changing and life saving. Brownstein and Shenefelt have solved these hurdles with this very well put together book on fats and oils.

The authors start with a summary of surprising facts about fats:

1.       We need fat in our diet to live!

2.       Fat does not make us fat!

3.       A low fat diet is not healthy!

4.       Fat performs many essential functions in our bodies!

5.       Some dietary fats are better than others!

6.       Saturated fat is not the enemy!

7.       Saturated fat and cholesterol do not cause heart disease!

8.       Dietary fat is not the culprit of disease!

9.       Canola oil and other refined vegetable oils are not healthy for you!

10.   Low-cholesterol food does not do your body good!

Even if readers go no further than this short introductory section, they will be much wiser than before. But for those who want more information, there follows chapters that detail the structure of fats, the different types of fats and oils, the role of cholesterol in the body and problems with low fat diets. Particularly interesting are discussions on your brain’s absolute dependence on fat and how eating fat can assist with weight loss. The authors point out that getting enough fat affects mood and behavior, cognitive function, mental acuity, focus and clarity. Low fat diets can lead to depression, reduced mental capacity and behavior problems. Cholesterol is concentrated in the myelin sheath so attempts to reduce cholesterol can lead to serious degenerative disorders of the nervous system, including multiple sclerosis and dementia.

Brownstein and Shenefelt devote a whole chapter to the subject of fats and children – for it is our children who are paying the greatest price for the anti-saturated fat, anti-cholesterol folly. Children’s brains need lots of fat and cholesterol for proper development. Children need butter, eggs, cream, cheese and meat fats, not margarine, spreads and low fat products.

The book ends with a nice collection of recipes dripping with butter, cream and cheese. Thumbs up.”

The message here, and in The Nutrition Debate #269, (just below) and in #20, “Know Your Dietary Fats,” and is #23, “The Benefits of Saturated Fats,” is that saturated fats are not only good but necessary fats. The fat soluble vitamins, A, D, E and K, require fat to absorb optimally. Message Two is that the refined vegetable oils, which are manufactured from primarily polyunsaturated fats, are bad for you; Read #21, “The Dangers of Polyunsaturated Fats.” But if you read nothing else, please read the Enig and Fallon article, “The Skinny on Fats.” If you take it to heart, as Morell says, it will be life changing and potentially life saving.
N.B.: A Senior Membership in the Weston A. Price Foundation is just $25 (Regular Membership $40). It’s a good thing.

Wednesday, December 10, 2014

The Nutrition Debate #269: “Eat Good Fat”

In bold black letters on a yellow field, the post-card-sized thank you note said, “Eat Good Fat.” It was packed with my 32oz jar of Ancients Organics ghee. I eat a dab of ghee on salted radish halves, a sometimes snack before supper. It helps to get my supper k/g (ketogenic) ratio above 1.5, a desired ratio which I easily achieve at breakfast and lunch. I prefer Ancient Organics brand, although expensive, for its “delicious sweet and nutty flavor” and its “incredible caramelized aroma.” It’s also “cooked in small batches over open flames” and made from “milk of grass fed and pastured cows.” It’s really good fat!

But this is not a column about ghee. It’s about the roiling transformation in the world of nutrition concerning dietary fats in general and saturated fats in particular. Saturated fats are enjoying a Renaissance everywhere except in government and “public health” circles, principally the USDA and ACC/AHA. The reason simply is that these institutions have been bought and paid for by their commercial interest supporters. But this column is not another rant about that either. It is about two major scientific papers in influential medical journals that deserve more attention.

The first study was a really large mostly British meta analysis (643k participants), published last March in the Annals of Internal Medicine, of 49 observational studies and 27 randomized controlled trials, in part funded, by the way, by the British Heart Foundation. The title: “Association of Dietary, Circulating, and Supplement Fatty Acids with Coronary Risk: A Systematic Review and Meta-analysis. The CONCLUSION: “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”

The second study appeared in the British Medical Journal (BMJ) in 2013 and was titled, “Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: Evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis.” (“Secondary prevention” is to prevent a heart attack in those who already have heart disease. “Primary prevention” is for those who do not already have Coronary Heart Disease (CHD).) This Australian study concluded:

Advice to substitute polyunsaturated fats for saturated fats is a key component of worldwide dietary guidelines for coronary heart disease risk reduction. However, clinical benefits of the most abundant polyunsaturated fatty acid, omega 6 linoleic acid, have not been established. In this cohort, substituting dietary linoleic acid in place of saturated fats INCREASED THE RATES OF DEATH FROM ALL CAUSES, CORONARY HEART DISEASE, AND CARDIOVASCULAR DISEASE. An updated meta-analysis of linoleic acid intervention trials showed no evidence of cardiovascular benefit. These findings could have important implications for worldwide dietary advice to substitute omega 6 linoleic acid, or polyunsaturated fats in general, for saturated fats.” (Emphasis added by me, obviously. I wish I could just SHOUT IT FROM THE ROOFTOPS!)

The reference to “advice to substitute polyunsaturated fats for saturated fats” as a “key component of worldwide dietary guidelines” and “these findings could have implications for worldwide dietary advice” couldn’t be more pointed. The U.S. Dietary Guidelines Advisory Committee, currently preparing the 2015 update, is expected to double down in the coming months on their advice to substitute polyunsaturated fats from processed vegetable and seed oils. Alice H. Lichtenstein, D. Sc., Vice-chair, “2015 Dietary Guidelines Advisory Committee, U.S. Department of Agriculture/U. S. Department of Health and Human Services,” is in charge and is also the lead author on the AHA’s current “Diet and Lifestyle Recommendations.”

Lichtenstein also served on the AHA committee in which Robert H. Eckel, M.D., was co-chair and lead author of the “2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk, A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.” Together, they are a formidable force.

The current 2010 Dietary Guidelines state (pp. 24-25), “Saturated fatty acids contribute an average of 11 percent of calories to the diet, which is higher than recommended. Consuming less than 10 percent of calories from saturated fatty acids and replacing them with monounsaturated and/or polyunsaturated fatty acids is associated with low blood cholesterol levels, and therefore a lower risk of cardiovascular disease. Lowering the percentage of calories from dietary saturated fatty acids even more, to 7 percent of calories, can further reduce the risk of cardiovascular disease.”  That’s the status quo ante.

Now, there is rampant speculation that the new 2015 Dietary Guidelines for Americans will recommend “a dietary pattern that achieves a macronutrient composition of 5% to 6% saturated fat, 26% to 27% total fat, 15% to 18% protein, and 55% to 59% carbohydrate.”  Why? That is the further reduction in saturated fat consumption that Eckel and Lichtenstein, et al., teamed up to recommend in the ACC/AHA Practice Guidelines, as published in Circulation, the organ of the American Heart Association. “Strength of evidence: high,” they said (Table 10, pp 17-18). Such is the current state of affairs in U. S. dietary matters. Does it sound eerily like the world of domestic politics? And we have to vote every day with the food choices we make. So, choose wisely and remember the roiling transformation is trending away from PUFAs and toward SFAs.

Are you afraid to “go against” the “Dietary Guidelines” or the practice guidelines your doctor is required to follow? Do you avoid whole eggs, full-fat milk, yogurt and cheese, or red meat? Ask yourself why? You doctor is trapped, but you’re not…

Saturday, December 6, 2014

The Nutrition Debate #268: “Help with Cravings”

‘John,’ the ‘bot who (that?) is the “coach” I selected at, sent me my first “coach email” a few days ago. (Fit2Me is a website that I learned about through a TV ad and signed up for. It is sponsored by AstraZeneca, the drug company.) So, I thought I would read it and offer this critique of ‘John’s’ approach to mentoring me. It’s a fairly short email, with introductory paragraph, three bullet paragraphs, and a summary wrap-up with some rah-rah encouragement.

“Cravings can be tough,” John begins. “It’s not just because the food is right there, but many times it comes out of nowhere and that’s really hard to handle. That’s why I thought I would reach out to you with some suggestions.”

Cravings. What are they anyway? For me cravings fall into 2 categories: 1) hunger cravings, which I never, ever have; and 2) ideas about eating something, which I frequently have, usually before or after supper. I am excluding opportunistic eating from the category of cravings. That is when I see food. My eye and my brain then conspire against me to eat food, usually too much. The buffet falls into this category too. The solution is simply to control the beast. I’ve not always been successful.

Hunger craving are non-existent because I eat a Very Low Carb, high-fat diet. When you eat this way, you will not be hungry. You will have no “need” (from hunger cravings) to snack between meals because your blood sugars will be stable.

     “It’s not easy,” John says, “but a little preparation can really help deal with temptation. Keep some type 2 diabetes friendly snacks with you. There’s plenty at Fit2Me. These can really come in handy when you are tempted because it is much easier to say ‘no’ when you have something to say ‘yes’ to.”

This makes no sense at all to me. First, if you eat LCHF, you will not be hungry so the only thing you will be “tempted” to do is to eat an unnecessary snack just because you know you have it with you! In fact, you are not saying ‘no’ at all; you are actually saying “yes.” You are actually caving into temptation, not hunger. That is not the best way to control the beast.

     “If you’re going out to eat with friends or the work crowd, look ahead at the menu and know what you are going to order. It really helps to keep you from having to choose on the spot, plus it gives you more time to hobnob with the ‘in crowd.’” (That’s funny. In social network theory, our type 2 diabetic person would appear to be an outlier.)

Once again, ‘John’ (I’m talking to a robot!), I think this is a bad idea. If you look ahead at the menu you are just going to be thinking about food too much. Everyone on a diet knows this. It is easy to obsess about food. It is better to just pick up the menu, select an appetizer or a salad and be done with it. Just avoid all fried foods and most prepared salad dressings.

     “Remember your trade-offs. If you think you are going to be in a situation where you have to eat more than you want to, just try to keep the portions small, plus plan on how you’re going to burn off some of those extra calories with an exercise. There are lots of activities to use to trade-off some calories on Fit2Me,” ‘John’ says.

Oh great! Plan to fail. Plan to be in a situation where “you have to” eat more than you want, and then rationalize this planned indulgence with a “Hail Mary” around the track. Does anyone think that exercise is a good way to lose weight? Penance is great, but penance doesn’t shed weight; it just sheds guilt. To repeat, the solution is simple: control the beast.

John’s summation: “Temptation comes in a lot of forms and at all times of the day. Stay ahead of temptations by planning ahead. Use your meal planner, build an activity plan to help you with trade-offs, and keep some healthy snacks ready. It’s all there with Fit2Me. After all, we know that you are going to have to deal with cravings, and that’s why we built Fit2Me to be all about you. Remember, I am behind you every step of the way.”

Now we’re talking “temptation” again. That’s a different subject from “cravings,” whether “hunger cravings” or just ideas about snacking before or after supper, where ‘John’ and I began. Temptation is still tough for me. I am a trough feeder. But cravings are easily managed: 1) eat LCHF and you won’t get “hunger cravings,” period. You won’t need to snack, honestly.
Then, if you want a drink (and a snack), and have a habit of having them before supper, (as I do)) pick a LCHF snack like radishes with salt and butter. And after supper, to break the habit of “nervous eating,” simply control the beast. Just plant another idea in your head (if a “snack” impulse comes up), e.g. think about that fasting blood sugar you will have in the morning if you resist the temptation. Last week most of mine were in the 80’s and 90’s. I even had an 82 one morning!

Wednesday, December 3, 2014

The Nutrition Debate #267: A “High Energy Breakfast Shake”

“The world’s healthiest foods” ( ) is a popular website that came to my attention a few years ago for their “in-depth nutrient profile” of the recipes they feature. Some of my favorite recipes are stovetop poached fish and vegetable dishes. There are no meat recipes, however, keeping with their altruistic mission “to help make a healthier you and a healthier world.” It’s otherwise a good site, so I can live with their bias – except when I think they are misleading us.

This morning's recipe for a “High Energy Breakfast Shake” on their site is described as a “quick-and-easy, nutritious and delicious addition to your Healthiest Way of Eating. And a great way to start the day!” Here are the ingredients:

     1 medium banana

     ½ cup whole strawberries

     1½ cups of low-fat milk

     2½ Tbs almond butter

     2 Tbs ground flaxseeds

     1½ Tbs blackstrap molasses

Blend all ingredients until smooth. Serves 2. (I dare you to make this shake and not drink the whole recipe yourself!)

One “serving” (HALF the recipe) contains 363 calories, 11.22g protein, 18.71g fat and 42.50g of carbs*, of which 27.17 are sugars. The full recipe is 85 grams of carbs. The shake is lowest in saturated fats, moderate in polyunsaturated fats and highest in monounsaturated fats. The “high energy” comes from the “sugar” jolt, and not just the simple sugars. The total carbs includes polysaccharides (long glucose chains) that are “predigested” by the blender to make them a liquid.

Quoting from “How do energy drinks work?” in the Science section of How Stuff Works, “Energy drinks are supposed to do just what the name implies -- give you an extra burst of energy. As it turns out, most of that ‘energy’ comes from two main ingredients: sugar and caffeine.” Well, the “High Energy Breakfast Shake” contains no caffeine. It’s all sugar.

But if this shake did contain caffeine (as in a Red Bull “energy drink” with 76.5mg), “Caffeine works by blocking the effects of adenosine, a brain chemical involved in sleep. When caffeine blocks adenosine, it causes neurons in the brain to fire. Thinking the body is in an emergency, the pituitary gland initiates the body's ‘fight or flight’ response by releasing adrenaline. This hormone makes the heart beat faster and the eyes dilate. It also causes the liver to release extra sugar into the bloodstream for energy [emphasis added].Caffeine affects the levels of dopamine, a chemical in the brain's pleasure center. All of these physical responses make you feel as though you have more energy,” according to How Stuff Works.

I’m writing this on the day after Halloween (All Hallows’ Eve, October 31st). The kids who went door-to-door in costume last night came home laden with candy, both in their baskets and their tummies. As we all know, sugar gives you that “extra burst of energy” because it is digested first and quickly. And everyone who gets a sugar jolt sees their blood sugar rise. If your metabolism is working well, your serum insulin also rises and carries the “sugar” into your cells where it is used or stored. What isn’t used or stored in muscles returns to the liver to be stored as glycogen and your “sugar” drops.

So we expect that binging on sugar, and sugary drinks especially, will certainly produce “high energy.” We joke that kids on sugar highs behave like “Energizer Bunnies” until they crash and fall asleep. Adults will too, especially if you start your day with this “high energy” breakfast shake. By mid-morning you will be in a slump… and hungry again. You are a sugar addict.

And if you have or are developing a slightly compromised glucose metabolism (or worse), then you no longer have the 1st insulin response. You also now have fewer functioning beta cells in the pancreas to produce insulin, and your destination cells have developed insulin resistance, which is to say they do not “take up” the glucose that the insulin is circulating in your blood. As a result, your blood sugar spikes through the roof and stays high, and the continuously circulating “sugar” damages your beta cells and starts to cause the dreaded complications.

Overloads, especially from liquids like orange juice and this “high energy breakfast shake,” although the latter certainly has more “nutritious” ingredients than the former, are definitely not a “great way to start the day.” Besides, remember that the sugars in bananas are 50% fructose. And that the liver makes fat (including a fatty liver) from big slugs of fructose.
* Compared to 24 grams of total carbs for 1 pack (2 “cups”) of Reese's Peanut Butter Cups or 33 grams for a Snickers bar.