Sunday, June 16, 2019

Retrospective #121: “Behavior Change is Incredibly Difficult.”

That’s the conclusion of an article by Jason Vassy in “Personalized Medicine” that came up on a 2013 Medscape alert. He was referring to the outcome of two trials that examined whether genotype information was helpful in motivating health behavior changes in a population that was genetically susceptible to Type 2 diabetes. It was “hoped” that knowledge of one’s genetic susceptibility might be a “clinically useful tool” in targeting “primary prevention strategies before the onset of certain diseases,” e.g. Type 2 diabetes and morbid obesity.
Sadly, Vassy concluded: “At present…genetic testing for T2D risk likely does not improve preventive health behaviors in today’s diabetogenic environment.”  Quelle surprise! It also will come as no surprise that this column was one of the least popular with readers that I wrote. Everyone knows this. Behavior change is incredibly difficult.
Vassy hastens to point out, though, that “This [greater susceptibility to T2D risk] contrasts with the much larger effect-sizes of family history: T2D in one or both parents multiplies one’s risk by up to two- and six-fold, respectively.” He does not point out, however, that the association with family history goes far beyond genetics or ethnicity; it includes diet, economics, cultural practices, and many other environmental factors generally too complex to reliably isolate in even large epidemiological studies.
Behavior change, however, was the hoped-for outcome of these two studies and this author’s commentary. They were all disappointed but, I suspect, not surprised. The medical establishment has come to expect failure. Vassy expresses that outcome succinctly: “These results will not surprise clinicians, whose efforts at counseling patients for weight loss and improvement in diet and exercise habits often fail.” The implication is it’s the patient’s fault. The patient is “non-compliant” with the “prescription” because, they say, “behavior change is incredibly difficult.”
It never seems to occur to the practitioner that that expected outcome failed to materialize because of the wrong prescription. A large percentage of the world’s peoples are apparently genetically predisposed and therefore susceptible to both Type 2 diabetes and obesity. The trigger for both is eating a Westernized diet. We become fat not because we eat too much fat and cholesterol (and are too sedentary), but because we (those of us who are genetically susceptible) eat too many sugars and processed carbohydrates. Our metabolism becomes “broken.”
We make and store fat as a consequence of eating sugars, processed carbs and fat. The body uses the sugars and processed carbs for energy and stores the fat for the inevitable famine that it is designed to expect and for which it prepares us. The trouble is the famine never comes. We live in a world oversupplied with cheap carbohydrates in the form of manufactured and processed “foods products.” They taste good, and we eat them for convenience.
This is in contrast to the animal-based dietary of protein and fat, plus seasonal fruits and vegetables (unprocessed carbohydrates), that our ancestors ate. Instead, we now graze on processed carbohydrates all day long as though we lived in a veritable cornucopia (“corn-utopia” ©), LOL. Which, in fact, we do.
If we eat Low Carb or Very Low Carb, and just two or three small meals a day of moderate protein/high fat over an 8 or 10-hour period, and then fast for 16 or 14 hours, we will be living much the way our ancestors did. For most people, the outcome of this Way of Eating is weight loss, high energy levels, improved health markers (even before weight loss), wellbeing, and longevity. But this “prescription” doesn’t occur to our health care providers.
Their “hopes” are still pinned on weight loss following their “prescription” of a “balanced” (high carb), restricted-calorie diet, with less saturated fat and dietary cholesterol, and more exercise. But that’s not what Vassy’s two studies called for: “Overall, participants did not change their dietary fat intake or exercise habits over the study period, although most already had ‘good’ habits at baseline.” (My quotes added on ‘good.’)
Behavior change is incredibly difficult, when it is the wrong lifestyle modification. The right one, Very Low Carb, is easy to follow. Good outcomes – weight loss and improved health, without hunger and without exercise, follow.

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