GERD? Low Carb

The Blog of Michael R. Eades, M.D. http://www.proteinpower.com/drmike

Over my many years of using a low-carb diet to treat patients with various disorders, I noticed that almost all who happened to have GERD found their symptoms resolved. I never started out treating GERD with a low-carb diet, but the huge numbers of patients finding relief told me that somehow carb restriction was helping. They would ask why their GERD went away, and I would have to confess that I didn't really know. I thought and thought about a possible biochemical or physiological mechanism that would explain why a low-carb diet almost always got rid of GERD, but I could never come up with a reasonable explanation. So, I just told patients who had GERD that if they ate low-carb, their GERD would probably go away. But I also told them I didn't know why.

Then a few years ago I ran into a microbiologist named Norm Robillard who had a theory on the cause of GERD that explained the results I had been seeing and made perfect physiological sense.
GERD: Treat it with a low- or high-carb diet

The short version of Dr. Eades' description:
High carb diets, especially those with high fiber, enable bacteria to grow where they shouldn't, in the small intestine.  These carbs can also be fermented, which produces mucho gaseoso, which yields SIBO (small intestine bacterial overgrowth).  This gas back pressurizes the GI tract, in effect driving gas into the esophagus.

The really bad part of this deal is that the current Rx for this problem is to keep eating that high fiber diet (because everyone knows fiber is GREAT for you, although I don't know why they know that) and suppress acid production with the various pills that do that sort of thing.  Well, when you reduce the acid levels in a bacterially overgrown gut, you get more bacteria, and not the ones you want to have.  So the acid reducing pills only work for a while, and then things are worse than when you started taking them.

Dr. Eades continues:
You can find more information about Dr. Robillard's work on GERD and IBS in his books Fast Tract Digestion: Heartburn http://www.amazon.com/gp/product/0976642530/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=0976642530&linkCode=as2&tag=proteinpowerc-20 and Fast Tract Digestion: IBS http://www.amazon.com/gp/product/0976642557/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=0976642557&linkCode=as2&tag=proteinpowerc-20 both of which contain pages of tables showing the FP of numerous foods.

Crazy CrossFitters - They Want Results from Workouts ... and Liberty

“Our leadership is pretty avowedly libertarian,” said Greene, a libertarian himself. To him, this is just common sense. “We’ve got over 7,000 affiliated gyms. … Don’t you think it would be unnatural if these small businesses were lukewarm about free enterprise?”

The effect of free-market ideology extends even further beyond the personal preferences of the organization’s leadership to the company’s structure and attitude.

CrossFit runs a web of thousands of loosely controlled affiliate gyms that are independently owned and operated. Affiliates are charged an annual fee, as opposed to a paying a cut of their profits as traditional franchises do, but they also control how their operations run, like their hours and prices. Further, the organization’s staff is scattered across the country, with offices in San Diego; Santa Cruz, Calif.; Arizona and Washington, D.C.

“It’s the libertarian idea of free markets,” Greene argues. “You don’t need centralized control.”

http://washingtonexaminer.com/crossfit-openly-exercises-its-libertarian-views/article/2536381?utm_campaign=Fox+News&utm_source=foxnews.com&utm_medium=feed

"I'm a rabid libertarian," says Greg Glassman, 56-year old founder of the worldwide fitness phenomenon called CrossFit.

Glassman opened the first CrossFit gym (or "box" in CrossFit lingo) in the mid-1990s in Santa Cruz, California. Today, there are more than 7,000 CrossFit affiliates around the world. These affiliates are not franchises, they're independently operated boxes owned by entrepreneurs who pay $1,000 to get certified as a CrossFit trainer and then pay $500-$3000 annually for the right to use the CrossFit brand. Each affiliate is free to innovate, which makes CrossFit a kind of open-source fitness community. Despite - or because of - its unconventional approach, CrossFit is projected to generate $100 million in revenue this year.
http://reason.com/reasontv/2013/07/20/fitness-renegade-greg-glassman-and-the-c

Rhabdo Is A CrossFit Unsecret

This article (https://medium.com/health-fitness-1/97bcce70356d) has all of the limitations associated with one person's limited knowledge of a very large and complex topic, which CrossFit is - at least from my view. The hook of the article, that rhabdo is CrossFit's "dirty little secret", is contradicted in the article's own quotes. There are 7,000 affiliates at this point, as I hear, and each of them has several Level I Trainers, and each of those trainers has been taught about rhabdo, because it is rare but potentially lethal, and CrossFit has been sounding the alarm about rhabdo for years.

From the author's uninformed but proud perspective:
"And here we have arrived at CrossFit's dirty little secret. The coach was unusually familiar with what is normally a very rarely seen disorder. It's so rare that one study reported the overall annual incidence of rhabdomyolysis to be 0.06%. That represents single digits of cases out of hundreds of thousands of patients. How, I wondered, is it possible that the layperson exercise instructor is on a first-name basis with a serious, yet rare medical condition?"

I repeat myself, but rhabdo is no secret in CrossFit. CrossFit has been sounding the alarm about rhabdo publically for years, starting in 2005. Here are the articles from journal.crossfit.com from which you can learn about rhabdo:

http://journal.crossfit.com/2005/10/crossfit-induced-rhabdo-by-gre.tpl

http://library.crossfit.com/free/pdf/CFJ_Wright_Rhabdo.pdf

http://library.crossfit.com/free/pdf/CFJ_Ray_rhabdo1.pdf

http://library.crossfit.com/free/pdf/33_05_killer_workouts.pdf

Back to "CrossFit's Dirty Little Secret" (a secret perhaps only to this author):
"Is this a thing with CrossFit? It turns out it is.
A quick search of the Interwebs reveals copious amounts of information about rhabdo purveyed by none other than CrossFit trainers. Scouring the scientific literature in mainstream medical journals, however, reveals a only a few peer-reviewed papers. The science confirms that exertional rhabdomyolysis, as this form is sometimes referred to, is uncommon and normally reserved for the elite military trainee, ultra-endurance monsters, and for victims of the occasional psychotic football coach. Rhabdomyolysis isn't a common condition, yet it's so commonly encountered in CrossFit that they have a cartoon about it, nonchalantly casting humor on something that should never happen."

If you read the articles, I think you would agree CrossFit has not been nonchalant about rhabdo.  I had a class mate at US Navy Aviation Officer Candidate School who rhabdo'ed himself in the pool.  We had to swim a mile.  He was a terrible swimmer.  Tony was mortified of failing the mile swim, which we took towards the end of our commissioning program.  He absolutely worked like an animal and passed the swim with little time to spare, but had pushed himself so hard, he wound up in the hospital a day or two later.  I never knew what he had until I found CrossFit and learned about rhabdo.  In one study, about 40% of those who graduate from US military boot camps have rhabdo, but to a degree that does not require hospitalization.  Apparently about 7 folks annually die from running marathons, and some of these are from rhabdo.  So, his stats above are both right and wrong - rhabdo to the degree that it requires hospitalization is as uncommon as he describes, but it is part and parcel of heavy exertion and there are no stats for those who work hard and have "normal" levels of rhabdo.

The author terms CrossFit's recent discussion of female urinary incontinence during workouts "glorification" of urinary incontinence, but I see it as a continuation of what CrossFit has done ever since I have been associated with it - tell the truth about CrossFit, the good and the bad. CrossFit was so devoted to that concept that they had an injuries thread on the message boards so folks could talk about their injuries with each other. CrossFit has been blunt about the fact that when you exercise for performance, you get results and you get injuries. The perspective has been consistent from the beginning - you get to choose the risk/reward relationship you want. Is it safe to drive? No. But you can drive anyway if you choose. Is it safe to work as a police officer? No. But you can choose that. Is it safe to fly military aircraft fast into enemy territory or low through the mountains on a training mission?  No. But we pay you for that. You name something that you really love to do, and I'll bet you there's an associated risk of death or serious injury - you choose to do it anyway, and you should.
The essence of CrossFit is that it has chosen to offer a fitness program with a different reward/risk curve, and people choose to pursue CrossFit for the rewards. This is only wrong if CrossFit were to be deceptive about the risks.  CrossFit has not been deceptive, which is largely proven by the author's limited quotations in this very short, and limited article. CrossFit is more like the "unsecret" of the fitness industry, and rhabdo is the unsecret of CrossFit.

The article has a gem of a quote, from another article, which goes:
"If you ask a CrossFit coach, the injuries were all my fault. In a culture that drives you to go as hard and fast as possible, it's difficult not to get caught up in the hype. You're supposed to push yourself to the limit, but when you hit the limit and pay the price, you're the idiot who went too far."

That's because you are the idiot who went too far.

Or does that person think you become a child who gives up responsibility for yourself when you enter a gym? If you abdicate the responsibility for what you choose to do, you are the idiot, plain and simple. But let me correct myself; you are not an idiot when you "go too far". You are choosing to test your limits. What would make you an idiot in my view is if you choose to test your limits, and then decide it was the coach's fault that you chose that.  I was chasing performance and testing my limits in many arenas long before I started CrossFit - injuries and martial arts, for example, go together like a hand and glove. Bench pressing, which I used to do but seldom do now, kills about 12 people annually.  Runners have a reported 75% injury rate (nevermind being hit by a car). Cyclists - how many cars pass you, when out for a ride, at speeds that would be fatal if the driver were to make the slight miscalculation that would result in collision? Football? Soccer? Basketball? These sports have very high rates of injury, some fatal or crippling. Shooting? Hunting from a tree stand? Mountain climbing? Drinking booze in a bar? Mowing the grass?  You folks are adults in and outside of a gym, and get to name your poisons.

And just because it highlights the human capacity to discount the high risks we always endure while accentuating (freaking out over) the low risks that are novel too us, let me remind you that every two years, humans kill themselves/each other in automobiles at a rate that exceeds the total casualties from ten years of war in Viet Nam. The vast majority of the rest of us kill ourselves with sugar (or at least "lifestyle driven disease" even if you would quibble about whether sugar/carbs are the killer).

You cannot live unless you choose the risk/reward curve for life every day. Please do not pretend that self responsibility stops when you walk into a gym. Please do not get high and mighty if you make an observation that is as obvious as "you can seriously hurt yourself doing CrossFit." Dude, get a clue, you are about seven years late to that dance.  I have been choosing CrossFit since 2007, and I have been injured from CrossFit workouts - extreme soreness, probably a case of rhabdo or three, back pain, knee pain, shoulder pain, torn skin on my hands, and shredded shins - which is much like what I experience doing martial arts, football, skiing, and bodybuilding.  The different is, I've also been in the highest peak of performance during these last six years that I have ever experienced.  I can do anything I would dare attempt.  It's worth the risk for me, and each year I learn how to throw myself into CrossFit with less and less injury.  My clients will all benefit from my pain.

The author's conclusion:
"Exercise is just about the best thing you can do for your body, but in the case of Crossfit, we're left to ponder the question, is this workout worth the risk? "
This person, as ignorant as they are about CrossFit, wrote an entire article only to arrive at this question, which is entirely germane and applies to everything you do in life at least after you reach age 18. But he reaches his climactic point as if he had never considered it before. It invites one to make comments about removing craniums from rectal orifices.

Because it is clear this author isn't the only one ignorant about the dangers of exertional rhabdo, or the risk/reward consideration inherent throughout one's life, I'm glad he wrote this article. I hope it encourages people to learn about the dangers of rhabdo in CrossFit, marathoning, endurance cycling, and the other inherent risks of each life activity (or inactivity).  I hope it helps people to realize that they can do a lot to reduce their rhabdo risk by tending to the basics (like managing hydration).

What I see in CrossFit is the best gyms let people choose their own intensity level, and do not spend any time exhorting people to "push harder", or any of that cheerleader/drill instructor style of "pushing" people. You work as hard as you choose for your own reasons, and frankly that's the way it should be since IT IS YOUR BODY.  CrossFit attracts intense people who want to compete, who want to push, who want to test themselves.  That is all good with me.

The Easiest Change

Starting with my first experience with the Zone Diet in 1996 or so, and my intermittent success from then until 2007, one of the strongest tools for health maintenance is also a simple one. It involves breakfast, carbs, metabolism, and habits.

Most folks think of breakfast as a carb fest - cereal with sugar, bagel, toast, jelly, milk, and banana. Don't forget the plain yogurt with no additional sugar (yeah right! Four people on the planet eat yogurt without sugar added). A few people, but too few, may add a token dose of fat/protein via sausage/bacon/eggs - which is a hangover I presume from the government's recommendations over the last 30-40 years to avoid fat and eat more carbs. After all, carbs have only 4 kcal/gram whereas the evil of all mankind, dietary fat, has more than twice as many! Therefore you can eat more food, feel more full, eat fewer kcal, and not be hungry.   Pretty simple, if dead wrong.

But let us take a look at a few numbers. The government says you need 2000 kcal/day if a female, and 2700 kcal/day if a male (these numbers are estimates and highly variable by individual, so they are just a starting station for this train of thought). The government also says you need low fat, 30% of kcal or less, low protein, 15% or so, and thus you'll get the other 55% as carbs. You carb dose then is 275-370g/day respectively (by gender). If you get 30% of that dose at breakfast, your carb intake will be 82.5g/111g. This my friends is a fairly hefty dose of carbs, all of which will be metabolized to glucose (unless some of your breakfast is fructose, such as table sugar, or an HFCS flavored fake OJ of some kind, and to a lesser degree, OJ too). This dose of sugar, will rocket your blood sugar higher (which you can easily measure for yourself), especially for those of us old or fat enough to care about our diets. Blood sugar is both essential to keeping your brain working, and a neuro-toxin when above a certain concentration in the blood - about 160mg/dl.  Those with out of control blood sugar, aka diabetics, lose their vision and peripheral nerves, if they don't die from cardiovascular disease, kidney disease or cancer first.

The body is not well equipped to dispose of large quantities of blood glucose, but it has an emergency mechanism, insulin secretion from the pancreas, to help the body pack away sugar where it can, and to turn the rest into fat via the work the liver does in the presence of high insulin levels. This emergency mechanism works in many of us like most emergency mechanisms - it does too much too fast and leaves a mess. One consequence is that many of us have crashing blood sugar levels after we overeat carbs and suffer the insulin response. In the presence of falling blood glucose levels, we feel hungry, because keeping the brain fed is a very high metabolic priority.

We learn by experience we can rapidly restore glucose levels via ingestion of high carb snacks.

So the high carb crazy train starts with a high carb breakfast followed by a "see food" diet in which we often perpetuate the high carb/insulin/hunger cycle. In the later stages, we feel "mind fog", grumpy, and often cold as the body reacts to falling blood sugar just as it would to starvation. In short, this is no way to live.

So, there's an obvious solution - skip the carbs in your breakfast. You actually don't need any breakfast carbs, although most of us will do better if we break our fast rather than skipping the morning meal. Instead of the Neolithic monstrosities that we think of as "breakfast", I recommend you start the day with a serving of protein and fat. Keep protein/fat snacks handy throughout the morning, and eat when hungry. Have a lunch plan that will allow you to eat some good quality carbs - a big salad for example, or a grapefruit/avocado.

When you are sleeping, great stuff is happening for your metabolism. By eating on fat/protein for breakfast, you allow these metabolic health and healing stages to continue. You make room for your body to store any excess carbs you eat for lunch/dinner/snack, and allow insulin levels to fall, restoring the possibility for insulin sensitivity. Most importantly, you set up a situation that puts a demand on your body to provide its own fuel, from its primary storage source, fat. AND, you keep up the demand for your body to make enough fat oxidation enzymes (at the cellular level) to keep your cellular fires well stoked all day long.

Any day that you follow this pattern is a day your body is allowed to move towards a normal metabolic state, without excess insulin and all the related consequences of the high carb crazy train. Once you are very comfortable running your body's fuel system this way, you can consider skipping breakfast altogether, a state termed intermittent fasting (more on which I will write later; and you can check the archives for info about IF).

IOW - if you want to make the easiest change towards a thriving you, a leaner you, a healthier you, skip the carb fest in the AM, and enjoy some bacon, sausage or eggs (or all three!) with your coffee or water tomorrow morning. 

Wolf on Low Carb Paleo - Or Not?

Slowly I realized, both by experimentation and by really looking at the literature: CALORIES MATTERED MORE THAN CARBS FOR BODY-COMP.

I have to say this was a pretty big shake-up for me. I’d assumed one could eat as much fat as one desired and STILL get leaner. As I mentioned above, when I first started eating LC, or more specifically, cyclic low carb (CLC) I was leaner than ever in my life. I know based on blood work and fat deposition that I had insulin resistance while vegan, and CLC helped with this immensely, but it was my new-found energy and activity level that drove my leanness, not an inability to store fat in the absence of significant insulin. I think this is one of the most damaging messages that comes out of the LC camp to this day, I was duped by this, so I’m not going to do what a lot of other recovered LC writers do and make folks out to be idiots for still believing this…but, it is time to face facts. In every damn study it is clear that for fat loss we’d like adequate protein, and a calorie restriction scenario. LC is fantastic for this in that one typically feels satisfied on high protein, moderate fat, loads of veggies. If one is insulin resistant, this approach can be nothing short of miraculous. HOWEVER! If one manages to cram enough cheese, olive oil and grass-fed butter down the pie-hole, this is in fact, a “mass gain” diet.

http://robbwolf.com/2012/12/19/carb-paleo-thoughts-part-1/

I think there were a few of us that thought this was true, but we all learn - low carb is like magic for rapid weight loss when one is fat, insulin resistant and sick.  Low carb done with good precision can make it easy to be healthy - 10-15% body fat and insulin sensitive - but that won't get you to epic leanness and magazine cover ready.  And that's just fine, we should probably have known better anyway.

Strangely, body builders use low carb to get that epic low fat at the end of their cycle because they are not low carb otherwise - so there seems to be an efficiency factor - those who do low carb all the time get better at using fewer calories than those who are new to low carb.  If you are trying to lose fat and regain lost health while attack correlates of poor health like gout, hypertension and reactive hypoglycemia, low carb is of course the heavy weaponry at your disposal.

All that being said, it is still easier to eat less on a carb restriction plan than on any other approach I have tried because of the excellent appetite control.

Exercise and LIVE

In this study, researchers looked at tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), and leptin as chronic inflammation markers.

Leptin is known primarily for its role in appetite suppression, but it can also show inflammation, and these two roles are related.

In this study, subjects showed a 29% decrease in TNF-α, 33% decrease in CRP, and an 18% decrease in leptin after resistance training for 12 weeks.

The control group showed no similar change. Knitting and general socializing didn't alter the inflammatory proteins.

IL-6: A different story
Unlike the other inflammatory markers studied, there was no overall change in IL-6. However, IL-6 is a bit of a special case. That's because, depending on where it originates, it can be either pro-inflammatory (i.e. it increases inflammation) or an anti-inflammatory (i.e. it reduces inflammation).

IL-6 deriving from immune cells (macrophages) is pro-inflammatory, while IL-6 from muscle cells (myocytes) is anti-inflammatory. Contracting muscles (as in exercise) produce IL-6 that is anti-inflammatory, causing a huge spike in muscle-produced IL-6.

In this study, exercisers showed a 40-60% increase in IL-6 immediately after exercise, which was expected. But training for 12 weeks didn't result in an overall change.

Here's another interesting result: There was also a 20% increase in IL-10 (interleukin-10), an anti-inflammatory protein.

Quick recap.

Inflammatory markers: decrease

•TNF-α: 29% less
•CRP: 33% less
•Leptin: 18% less
Anti-inflammatory marker: increase

•IL-10: 20% more
Another cool finding:

There was an inverse relationship between strength and inflammation. The stronger the women were, the lower their CRP and leptin.

Conclusion
Understanding how chronic inflammation works and how to stop it is crucial, because chronic inflammation is at the root of most lifestyle disease, from Alzheimer's to cancer to stroke to everything in between.

http://www.precisionnutrition.com/research-review-inflammation-exercise

In other words, exercise is to have a good long and active life, exercise is to feel good.  Don't exercise to burn calories, be active and exercise to be alive while you are living.

CFJ: The Benchmark WODs

The workouts of the first group, Angie, Barbara, and Chelsea, are super simple (being comprised entirely of common calisthenics), very tough, dramatically reinforce the pull-up, and yet each presents a different metabolic challenge.
Angie and Barbara, contain pull-ups, push-ups, sit-ups, and squats. Chelsea contains pull-ups, push-ups, and squats but no sit-ups.
For each of these three workouts the pull-ups clearly present the greatest challenge. And, in the workouts' aftermath, most athletes expressed surprise at their significant lat, rear delt, and biceps soreness. At CrossFit the pull-up is sacrosanct and everyone needs more. Angie, Barbara, and Chelsea support these values and aims.
http://library.crossfit.com/free/pdf/13_03_Benchmark_Workouts.pdf

I don't know how many times I have read this article, but I am always surprised to find how much I forgot when re-reading the original CFJ articles.  Good stuff!

T NATION | Most Beneficial Exercises

http://www.t-nation.com/free_online_article/most_recent/most_beneficial_exercises

Interesting article - I most appreciate his "economy of movement" point.  Everything you do in the gym has a cost, just as not doing it has a cost.  Being keen on the outcome desired is everything, as is knowing how to get it with the least time spent.

Attia: If You Want Better Answers, Ask Better Questions

The wrong question is being asked.  “Is sugar toxic?” is a silly question.  Why?  Because it lacks context.  Is water toxic? Is oxygen toxic? These are equally silly questions, I hope you’ll appreciate.  Both oxygen and water are essential for life (sugar, by the way, is not).  But both oxygen and water are toxic – yes, lethal – at high enough doses.

What did the APAP example teach us?  For starters, don’t confuse acute toxicity with chronic toxicity.  Let’s posit that no one has died from acute toxicity due to massive sugar ingestion.  But, what about chronic toxicity?  Can eating a lot of sugar, over a long enough period of time, kill you (presumably, through a metabolic disease like diabetes, Alzheimer’s disease, cancer, or heart disease)?

Even among a healthy population (i.e., people without overt liver disease), toxicity is a distribution function.  What’s toxic to one person may not be toxic to the next.  This is true of APAP and it’s true of sugar.  It’s true of most things I can think of, actually, including tobacco, alcohol, cocaine, and heroin. Ever wonder why “only” about one in six smokers dies of small cell lung cancer? Maybe it’s the same reason some people (e.g., me) get metabolically deranged from even modest doses of sugar, while others (e.g., Jill, my wife) can mainline the stuff and not appear to suffer many adverse effects.

I posit that Jill and I are both outliers on the distribution of susceptibility, probably driven mostly by genetic difference (rather than, say, exercise as we both exercise a lot).   So, I offer you a framework to consider this question.  I know some of you just want an answer to the question, Is sugar toxic or not? But I hope this slightly more nuanced response can help you figure out what you should be asking: Are you like me? Like Jill? Or like an Average Joe somewhere in between us?

http://eatingacademy.com/nutrition/is-sugar-toxic

In Attia style, he examines the snot out of this issue, covering terms, concepts and research on the topic.  If you read the whole post, you'll be smarter or at least feel like you are.  I like his conclusion - if your body is healthy, you feel great, and life is too good to be true, the dose of sugar you are on is likely not toxic.  If you are hungry, carry too much fat, have a nasty lipid profile (and/or gout, hypertension, or high pain levels), you are probably eating too much sugar.  As Taubes describes in "Good Calories Bad Calories", we were relatively healthy when average annual consumption of sugar was 20 pounds per capita - that was back in the days when sugar was costly and a treat vice a staple of the US/Western diet.  Now, at 100 pounds annually or more, many of us are ingesting toxic levels of sugar.  

Taubes in Scientific American

In the September 2013 issue of Scientific American, the topic is nutrition.  One of my heroes in the nutrition science wars is Gary Taubes, and he authored an article in this magazine.

Taubes frames up the critical debate about how to be healthy and lean between two camps -
1. Calories in, calories out, or "a calorie is a calorie", or "just eat less and move more", which is essentially a moral story - "people get fat because they are gluttonous and lazy."
2.  The carbohydrate or alternative hypothesis, or the "hormone hypothesis of obesity" - consumption of excess carbohydrate leads to a cycle of high blood sugar leading to high insulin levels which biases the body towards storage of ingested carbs as fat, but also makes us hungry and makes us feel lethargic.    In other words, "People feel lethargic, and accumulate body fat, because they induce hormone dis-equilibrium through excess carbohydrate consumption."

There are folks in both camps who are quite persuasive, but of course, that's the rub - if the science on the matter was conclusive, there would be no need to persuasiveness!  Let me provide what I see as the main lines of argument from the two camps:

The laws of thermodynamics are clear - for a body to gain or lose energy (aka fat which is stored energy), the body must ingest more energy than is expended, or ingest more energy than is expended.  In other words, it is a simple matter of mathematics - reduce caloric intake and increase caloric expenditure to induce an energy imbalance.  Anyone who is gaining weight, or cannot lose unwanted weight, is simply too lazy or too gluttonous.
And, we get sick because being fat makes us sick, so diseases such as insulin resistance, metabolic syndrome, and ultimately type II diabetes result from the obesity created by an energy imbalance that lazy, gluttonous populations routinely create for themselves.

Some things that might be worth considering to fully consider this perspective:
-Just because a gram of fat creates 9kcal of energy when combusted in a bomb calorimeter, does that mean it always adds 9 kcal of energy to our bodies every time we eat a gram of fat?  Ditto for carbs and protein - do we really know how many of the potential units of energy we receive from each gram of the various macronutrients we ingest?  Interestingly, there's an article in the same Scientific American which seems to indicate the answer is "no".  In other words, a potential calorie in food is not always a calorie of energy in the body.
-If a "calorie is a calorie" is such a simple matter of mathematics, why in all of the studies done on such matters has no one every lost the forecast amount?
-If a "calorie is a calorie" is in fact the guiding principle of fat loss, we are all screwed; if we miss our calorie calculation each day by 20 kcal, which for me would be an error of less than 1%, we will gain a pound of fat per year.  Considered from this perspective, as Taubes has pointed out, it's a miracle we are not all carrying the spare tire.
-All fat people are not sick; why?  Some people who are relatively skinny are sick in the same way as sick fat people (loss of glycemic control); why?
-In many intervention studies which test low carb v. high carb diets, folks on a carb restricted diet spontaneously reduce caloric intake.  In correlation with carbohydrate restriction, many sick people begin to get well before they get lean; gout, hypertension, and non-alcoholic fatty liver disorder, for example, can be reduced in as few as 3 days of carb restriction.
-We can observe that folks accumulate excess fat differently.  For example, endomorphs always have more sub-cutaneous fat than ectomorphs - if fat accumulation is just a matter of calories in, calories out, why do bodies allocate fat differently based on phenotypes?
-Why do pregnant ladies and people in puberty eat more?  Certainly no one would suggest their appetites changed because they became lazy and gluttonous.
-How is it that we could have such excess "energy" stored as fat, but still feel hunger?
-How could we interpret the well known phenomenon of caloric restriction over time leading to the "starvation effect", in which the metabolism slows, and fat re-accumulation is nearly inevitable?

Here are some answers which may be tested via Taubes' NuSI - the Nutrition Science Initiative, which was founded to test these two hypotheses - to see if science, despite the incredible challenges of doing it well on the human animal, can point to one or the other as more correct for more people.
-Sick fat people are those who have glycemic dis-regulation, healthy fat people have not lost glycemic regulation, because they are not insulin resistant.  Why these people are fat isn't clear, it could be they ate too many carbs for a time and now are at a "maintenance intake" of carbs but not a fat loss intake.  However, it is possible to discern a healthy fat person from a sick fat person just by looking (at least in some cases) at their faces.  You can see this in the "Biggest Loser", as the contestants all arrive with their fat, sick faces but soon their faces shift to the "healthy but fat" face.  If you've seen that show, you know what I mean.
-How come I could eat anything I wanted when young but now I can't?
I think this question may be where fructose comes into play. There's some evidence that fructose pushes us over the edge into insulin resistance, by essentially forcing the liver to work too hard processing fructose, so that it cannot do what insulin commands it to do.  As the body secretes more insulin to get the liver into gear, other cells in the body risk damage due their responsiveness to insulin.  They seem to protect themselves through insulin resistance.  That creates a re-inforcing loop for insulin and blood sugar levels that seems to drive us towards metabolic syndrome.  Metabolic syndrome leads to everything bad - diabetes which then is a predictor for gout, hypertension, stroke, alzheimer's, heart attack, etc.

One way or the other, due to Taubes' passion and his unrelenting focus on how much the existing science does not answer, but could, I think Gary will end up fundamentally changing how science and nutrition are pursued in our lifetimes.  We may be only a year or two away from preliminary results from NuSI's first experiments.  That's amazing!

The stakes are enormous. Between the insanity in the way our government tries to provide and regulate health care, and the remarkable and accelerated pace that our population is getting sick, and the vast array of medications that our health care system will provide to people to keep them alive while sick; our health care system is wrecking the fiscal health of our federal government.

Every day, I see and confront an amazing amount of mis-information about what a "healthy" diet is or is not.  If the science could get us to the point of all knowing what makes us sick, it would be an incredible step forward. Go Gary go!

Confessions of a Low Carb, Paleolithic Model Advocate

Here's the truth, which I freely confess.

I drink raw cow's milk, in violation of USDA recommendations.
I never take multi vitamins.
I avoid flax seeds and flax seed oils, "heart healthy" industrially produced polyunsaturated fats, wheat germ, cholesterol lowering oatmeal, and heart healthy whole grains for the same reason I avoid rat poison.
I don't really care what my cholesterol numbers are, because if they were high I wouldn't try to lower them.
I eat eggs most days, unless I'm not hungry, then I throw out the whites but eat the yolks.
I eat chocolate 5 days a week, and drink bourbon every other day.
I add salt to food and water.
Fat, mostly saturated, makes up 60-80% of my caloric intake.
Just to make sure I get enough saturated fat, I add butter to my coffee, and I look at veggies as a good way to eat more butter.  Butter like cheese, strait up, as a snack?  Guilty!
I also supplement with coconut oil - sometimes for cooking, sometimes with dark chocolate or nuts. Man is that good!
I eat red meat and "artery clogging saturated animal fats" like it is going out of style, which it used to be, by the way.  I mean I'm knocking back stuff like bacon or sausage or hamburger, every day.
I eat processed foods like salami and sausage whenever I like.
I eat veggies once per day at most.
I generally eat fruit a max of once per day, except in summer time when I enjoy it a bit more.
Have no idea how many calories per day I consume - more than 2400, less than 3000, most days, based on a two week sample I made three years ago.  Whatever.  I eat when I'm hungry.  I eat a little extra when I train hard.  Sometimes I eat for fun, but mostly just for hunger or because I know after 10-14 hours, I need food.
I drink coffee - a minimum of five cups/day, and load most of those cups with heavy cream.
I smoke cigars when I want one.
You know that "most important meal of the day"?  I almost never eat breakfast.
On a typical week I may never exceed 100g/day of carbohydrate, or perhaps I do but only once.
I brush my teeth once per day, max, and never floss.

What kind of carnage am I wreaking on my health, appearance, and performance?

Well, I'm 49 years old, I'm six feet, 2 inches tall and weight 205 pounds.  At 42 years of age, I was 225 and weaker than I am now.  I could not tell you last time I had a cavity, it has been since 1997 at least.  I have shifted from being a sugar craver who couldn't walk past a doughnut to being a sugar agnostic. I get sick sometimes, but it is unusual.

I never do cardio and I have no idea how many calories I burn when I work out, because I could not care less about burning calories.  I work out to develop the physical capacities I would like to have or improve.

I train with barbells several times a week but I have no idea how many inches my arms or legs are, I never feel the pump and don't measure my success in terms of the mass of muscles.
On any given day, you could tell me to:
Run 6 miles
Deadlift 375+
Compete in the CrossFit Games Open WODs in top 30% in the world for my age, and top 50% for any age
Do a pullup - with 75+ pounds
Box jump 40+ inches
Clean 225 pounds
Climb that rope hands only, or climb that rope 25 times for time
I could most likely do it.  If I couldn't do it that day, I could do it within a week with a few practice sessions.

The changes I've experienced since I learned my way of eating - high fat, high nutrition, low carb, and moderate protein - include near elimination of IBS (pun intended), my teeth feel better, harder and cleaner, I have reduced my ibuprophen intake from an average of 1600mg/day to perhaps a monthly dose after a mis-step that sets my knee off.  I used to inhale steroids to keep my nasal passages closed at night, now I just remember how nice it is to not have to do that.  My ear canals are not chronically irritated, and I'm not spending the extra fifty cents for the dandruff shampoo.

My blood pressure runs about 120/70, much better than when I was a college athlete. My triglycerides vary between 25 and 75, HDL is around 70, and LDL is estimated at 114 (meaning it is actually lower given my triglycerides), with a total cholesterol around 200.  Waist tapes out around 36 inches, and body fat percent is 10-12 percent (who really knows this anyway).

Am I trying to brag about being a bad ass?  I would if I could, but in the CrossFit world, I'm just another athlete, there's nothing I can brag about.  I'm more interested in making a point, as dramatically as I can for today, that they've been lying to you.

They said you need low fat, high carbs and compulsively high cardio.  They said cut back on cholesterol, move more, eat less, and eat whole grains.  It is just not the truth for most folks.  Most of you need fat for fuel with a little protein and some high quality vegetables.  If you are already skinny, eat more carbs if you like them.  Ratchet way back on fructose intake (meaning sugars, which are generally 50% fructose), and if you want to lose your belly, also cut out the beer.  You don't need to move more and eat less, you need to eat real food (or as the man Sean Croxton puts it, JERF: Just eat real food).

The best advice you've ever received about health and diet was never proved by science - because good science is so hard to do on humans that it has not been done.  We're feeling around in the dark.  The best you can do is eat a certain way long enough to evaluate the effect, and refine from there.  There is one thing you can bank on though - no one with out of control blood sugar is healthy.  There are folks with low cholesterol who die young every day, and there are folks with "high" cholesterol who live long and well.  There are folks with too much body fat who live long and well, and those who are "skinny" who die young from vascular diseases and cancer.  The common denominator for most if not all of these who are not heathy is they have wrecked their glycemic control, generally from eating too many carbs, or too many carbs in combination with too much sugar.

So should you be an unapologetic low carb paleo model eating whacko like I am?  I don't know.  It's up to you to decide.  Give it a shot.  See if you like not being hungry, and see if you belly gets smaller and your blood sugars get under control.  See if you feel good, and perform well.  If these things line up  you will have run the best and most scientific test that can be run for your own health and well being.

Processed Food

I saw this loaf of no kidding "whole grain" bread in the local superstore last night.  Most of the 

"experts" will at the same time encourage you to avoid processed foods (they are the latest iteration of "the devil"), but eat all the "whole grains" you can stuff into your pie hole.  

Well, I'm still waiting for their explanation for why this isn't a processed food.  

Because you know, I know, and anyone with an IQ above the average lineman's jersey number knows you will never eat this crap as a bud from a wheat plant.  And the reason every culture since the start of agriculture removed the part of the wheat that is removed to make "refined wheat" is that it goes bad, quickly.  IOW - the whole part of the whole grains has a shelf life that is short, so if you want it to be edible at all on a supermarket shelf you have to preserve through processing.  

And after a lot of searching I can still find no credible explanation for why whole grains are such a great thing to eat - the claimed benefit in glycemic load?  Mythical, as any glycemic index chart will show.  There's some crazy stuff in the nutrition world, and the whole grain issues is right up there at the top of the list of what is bass ackwards.

Disclaimer - if you like this stuff and enjoy how it makes you feel, good for you.  My intended audience is those folks who want to make a change because they are no longer happy with how they feel or look or perform.  No offense intended to those of you who are happy processed whole grain gluttons.