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?
Vitamin D lack can prompt lost bone thickness, which can add to osteoporosis and breaks (broken bones). Extreme nutrient D lack can likewise prompt different ailments.
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