Wednesday, December 11, 2019

Retrospective #298: “Obesity in Remission” Part 2

My hopes were up in #297, “Obesity in Remission,” because the experts in obesity medicine whose long comment in Lancet Diabetes and Endocrinology I 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 they understood the importance of the hormone insulin in fat storage. 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,” is as far as the energy referred to is carbohydrates. But they do not mention that word once in their long comment. Would that they explain why!
The human body has two main sources of energy, carbohydrates and fat. Carbs can be eaten and converted to glucose, or can enter the blood as glucose from glycogen stored in the liver and muscle from previously eaten carbs and fat. Fat can also be eaten or enter the blood from triglycerides broken down from stored body fat when liver glycogen is exhausted and serum insulin is low either by eating Very Low Carb or from fasting.
These two energy sources – carbs and fat – and the mechanisms for utilizing them, apply both to healthy people and those with a disregulated glucose metabolism (Type 2 diabetics, pre-diabetics and carb addicts, i.e. people who are Carbohydrate Intolerant from years of overconsuming refined carbohydrates and have developed Insulin Resistance.
Protein is not considered a primary source of energy for the body, but it is needed every day and used for essential functions. The amino acids that protein breaks down into, that have NOT been “taken up” and used within 4-5 hours of being eaten, go to the liver and can be used later to make glucose by a process called gluconeogenesis.
However, the authors of the Lancet comment do not even mention dietary fat as an energy source, much less the one to be used for weight reduction. Instead, they associate its caloric density (9 calories per gram vs. 4 calories per gram for carbs and protein) with weight gain and thus advocate avoiding “calorically dense food” as part of a weight loss strategy. Apparently, they’re afraid of saturated fat and cholesterol. They have been wearing blinders and are out of touch with the evolving science of nutrition, dining in the first-class salons as the Titanic continues on its course in the frozen North Atlantic. It’s tough to change course. But, as Max Planck said, science advances one funeral at a time.
But these obesity “experts” got SO close. They said, “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, one such candidate for a 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. The body then loses a biologically dense “food,” its own fat!
But no. They say, “Current biologically based interventions comprise antiobesity drugs, bariatric surgery, and…intermittent intra-abdominal vagal nerve blockade.” Hmmm. That 3rd one is a new to me. “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 (cholesterol) profiles and other CVD risk and inflammation (CRP) markers too!
And it does all these things without risk of surgery or the side effects of drugs. What don’t these people understand? But I’ve never travelled first class on an ocean liner. Maybe that’s the “lifestyle modification” that’s hard to give up.

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