Saturday, March 21, 2015

The Nutrition Debate #298: “Obesity in Remission” Part 2

My hopes were up in #297, “Obesity in Remission,” because the powerhouses in obesity medicine whose long comment in Lancet Diabetes and Endocrinology I partially excerpted, appeared to understand the mechanism. Most doctors do not. They also included phrases like “promotes energy overconsumption” (due to habituation and dopamine signaling, palatable foods and reward deficits, etc.), and “increases fat storage capacity” (suggesting the importance of the hormone insulin). I was soon to be disappointed. Apparently, these guys have first-class cabins on the Titanic, and they’re not giving them up
They’re right of course about all the things that promote “energy overconsumption,” so long as the energy referred to is carbohydrates. But they do not mention that word even once in their long comment. Alas! Would that they explain why!

The human body has two main sources of energy, both in food ingested and stored: Carbohydrates and fat. Carbs can be eaten (to make glucose) or can enter the blood as glucose from glycogen stored in the liver from previously eaten carbs. Fat can be eaten or enter the blood from triglycerides broken down from stored fat when serum insulin is low either because of fasting or when blood glucose is low. This includes people with a disregulated glucose metabolism (Type 2 diabetics, pre-diabetics and carb addicts, i.e. people who have Carbohydrate Intolerance from years of over consuming carbohydrates).

Protein is not considered a primary source of energy for the body because it cannot be stored. But it is needed and used every day for essential functions. The amino acids that protein breaks down into, that have NOT been “taken up” within 4-5 hours of being eaten, go to the liver and are later used to make glucose (blood sugar) in a process called gluconeogenesis.

However, the authors of the Lancet comment do not mention dietary fat as an energy source, much less one to be used for weight reduction since they associate its caloric density (9 calories per gram vs. 4 calories per gram for both carbs and protein) with weight gain and thus advocate avoiding “calorically dense food” as part of a weight reduction strategy. Maybe they’re afraid of saturated fat and cholesterol. If so, they have been wearing blinders and are out of touch with the evolving world of nutrition, perhaps dining in the first class salons as the Titanic continues on its course in the frozen North Atlantic
They get SO close. They say, “Because sustained obesity is in large part a biologically mediated disease, more biologically based interventions are likely to be needed to counter the compensatory adaptations that maintain an individual’s highest lifetime bodyweight.” Okay, a candidate biologically based intervention would be carbohydrate restriction, allowing serum insulin levels to drop and thus triglycerides (body fat) to be broken down, enter the blood stream, and be used for energy.

But no. They say, “Current biologically based interventions comprise antiobesity drugs, bariatric surgery, and…intermittent intra-abdominal vagal nerve blockade.” (I suspect this 3rd method is so new it may have been what this is all about.) “These interventions do not permanently correct the biological adaptations that undermine efforts for healthy weight loss but do, during use, alter the neural or hormonal signaling associated with appetite to reduce hunger and caloric intake.” Well, that’s exactly what Carbohydrate Restriction does! “During use,” it “alters the neural and hormonal signaling associated with appetite” and “reduces hunger and caloric intake.” And improves lipid profiles and other CAD and CVD risk markers!
And it does all these things without risk of surgery or the side effects of drugs. What don’t these people understand?

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