NIH Test Supports Low Carb, High Fat

People who avoid carbohydrates and eat more fat, even saturated fat, lose more body fat and have fewer cardiovascular risks than people who follow the low-fat diet that health authorities have favored for decades, a major new study shows.

The new study was financed by the National Institutes of Health and published in the Annals of Internal Medicine. It included a racially diverse group of 150 men and women — a rarity in clinical nutrition studies — who were assigned to follow diets for one year that limited either the amount of carbs or fat that they could eat, but not overall calories.

"To my knowledge, this is one of the first long-term trials that's given these diets without calorie restrictions," said Dariush Mozaffarian, the dean of the Friedman School of Nutrition Science and Policy at Tufts University, who was not involved in the new study. "It shows that in a free-living setting, cutting your carbs helps you lose weight without focusing on calories. And that's really important because someone can change what they eat more easily than trying to cut down on their calories."

http://www.nytimes.com/2014/09/02/health/low-carb-vs-low-fat-diet.html?_r=0

Who's left to fight for the benefits of the world's most unnatural fad diet - the low fat diet?

Better Late Then Never, NIH Figures It Out

Results: Sixty participants (82%) in the low-fat group and 59 (79%) in the low-carbohydrate group completed the intervention. At 12 months, participants on the low-carbohydrate diet had greater decreases in weight (mean difference in change, −3.5 kg [95% CI, −5.6 to −1.4 kg]; P = 0.002), fat mass (mean difference in change, −1.5% [CI, −2.6% to −0.4%]; P = 0.011), ratio of total–high-density lipoprotein (HDL) cholesterol (mean difference in change, −0.44 [CI, −0.71 to −0.16]; P = 0.002), and triglyceride level (mean difference in change, −0.16 mmol/L [−14.1 mg/dL] [CI, −0.31 to −0.01 mmol/L {−27.4 to −0.8 mg/dL}]; P = 0.038) and greater increases in HDL cholesterol level (mean difference in change, 0.18 mmol/L [7.0 mg/dL] [CI, 0.08 to 0.28 mmol/L {3.0 to 11.0 mg/dL}]; P < 0.001) than those on the low-fat diet.

Limitation: Lack of clinical cardiovascular disease end points.

Conclusion: The low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet. Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors.

Primary Funding Source: National Institutes of Health.

http://annals.org/article.aspx?articleid=1900694

I'm glad they finally got around to doing this since it's too obvious for anyone to still ignore, but they could have done this 40 years ago.  And they should have.

Fat Trap or Cognitive Dissonance?

http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-fat-trap.html?pagewanted=all&_r=0

For 15 years, Joseph Proietto has been helping people lose weight. When these obese patients arrive at his weight-loss clinic in Australia, they are determined to slim down. And most of the time, he says, they do just that, sticking to the clinic’s program and dropping excess pounds. But then, almost without exception, the weight begins to creep back. In a matter of months or years, the entire effort has come undone, and the patient is fat again. “It has always seemed strange to me,” says Proietto, who is a physician at the University of Melbourne. “These are people who are very motivated to lose weight, who achieve weight loss most of the time without too much trouble and yet, inevitably, gradually, they regain the weight.”

Anyone who has ever dieted knows that lost pounds often return, and most of us assume the reason is a lack of discipline or a failure of willpower. But Proietto suspected that there was more to it, and he decided to take a closer look at the biological state of the body after weight loss.

Beginning in 2009, he and his team recruited 50 obese men and women. The men weighed an average of 233 pounds; the women weighed about 200 pounds. Although some people dropped out of the study, most of the patients stuck with the extreme low-calorie diet, which consisted of special shakes called Optifast and two cups of low-starch vegetables, totaling just 500 to 550 calories a day for eight weeks. Ten weeks in, the dieters lost an average of 30 pounds.

At that point, the 34 patients who remained stopped dieting and began working to maintain the new lower weight. Nutritionists counseled them in person and by phone, promoting regular exercise and urging them to eat more vegetables and less fat. But despite the effort, they slowly began to put on weight. After a year, the patients already had regained an average of 11 of the pounds they struggled so hard to lose. They also reported feeling far more hungry and preoccupied with food than before they lost the weight.

While researchers have known for decades that the body undergoes various metabolic and hormonal changes while it’s losing weight, the Australian team detected something new. A full year after significant weight loss, these men and women remained in what could be described as a biologically altered state. Their still-plump bodies were acting as if they were starving and were working overtime to regain the pounds they lost. For instance, a gastric hormone called ghrelin, often dubbed the “hunger hormone,” was about 20 percent higher than at the start of the study. Another hormone associated with suppressing hunger, peptide YY, was also abnormally low. Levels of leptin, a hormone that suppresses hunger and increases metabolism, also remained lower than expected. A cocktail of other hormones associated with hunger and metabolism all remained significantly changed compared to pre-dieting levels. It was almost as if weight loss had put their bodies into a unique metabolic state, a sort of post-dieting syndrome that set them apart from people who hadn’t tried to lose weight in the first place.

“What we see here is a coordinated defense mechanism with multiple components all directed toward making us put on weight,” Proietto says. “This, I think, explains the high failure rate in obesity treatment.”

This is one of the most interesting articles on fat loss I’ve ever read - I’ve read it several times - that does nothing to help anyone lose weight or be healthy.  The point of the article seems to be “it’s hopeless, you may as well not even bother.”  

And that is an experience with weight loss many people encounter, some many times in their lives.  As I read it, I try to stack up my own experience - that my body weight is very responsive to carbohydrate restriction and to “eating quality food”, and that I’m 35 pounds lighter than I was 8 years ago when I was 42, and that I know I’m not working out more or exercising generally more than I was then.

The article is lengthly and detailed and describes what is known at the starvation response - the tendency of the body to increase appetite and decrease activity when it is subjected to caloric deprivation over a long enough period of time.  One of the story’s protagonists is getting all scientific about the mechanisms that enable the body to conserve energy, but to me there’s a huge pink elephant in the article - at no time does the author delve into the question of what type of diet the researchers are using to get their fat loss-to-starvation-response cycle?

Here’s why this is a pivotal question to me.  Nearly every study on the topic shows that those who lose weight by restricting carbohydrates have lower appetites and spontaneously reduce food intake.  So if you and your buddy both diet, and the buddy goes with caloric restriction (and perhaps exercise), and you just cut carbs (smartly) and sit on the couch texting with your significant other, you very well may lose as much fat, and with less hunger.  

The author of the article is an interesting study - to the best of my knowledge, she avoids the topic of low carb because she hob nobs with the scientists who have been in vogue over the last ten years or more who advocate a low fat diet for health and weight loss.  When our society went all fat crazy starting about forty years ago - we began to tell people not to eat saturated fats (“bad for your heart”), and to tell people to eat industrially produced polyunsaturated fats (“heart health fats”) - we also began a long experiment with the “a calorie is a calorie” idea.  That is to say, we looked at the first law of thermodynamics, which states that energy may not be created or destroyed it simply changes forms, and extrapolated that the human body worked like a bomb calorimeter.  

If you stuff a quantity of fat, protein or carbohydrate into a steel ball, and ignite the contents, and measure the change in heat that results from the incineration, you can derive that fat yields 9 kcal/gram, and protein/carbohydrates yield 4 kcal/gram.  With this nifty bit of data, folks decided that fat loss should be a simple proposition - eat less, move more.  

If you combine these two unproved propositions - fat is bad and has more calories - then fat loss and health should magically result when we eschew fats and exercise more.  After all, people who exercise are leaner than those who do not.  

Only one problem - systematically depriving an overfat person of calories via a low calorie and low fat diet with exercise only works for a while.  And if you read the whole article above several times, that is the stunning conclusion.  And the prestigious scientists the author quotes are figuratively scratching their heads like the clowns in the Monty Python skit trying to sort it all out, since it doesn’t fit their “calorie is a calorie” paradigm.  They have cognitive dissonance - “we’re doing everything right, we have to figure out why these peoples’ bodies are fighting so hard to regain the lost fat so we can create a drug to circumvent that.”  

The question for me is - are they asking the right question?  Are they really doing everything right?  What if the problem is just this simple - they are feeding humans low quality food they were not meant to eat (IOW low cal low fat), and humans are reacting with predictable problems.  What if a simple restatement of the topic of this very long, and very detailed article published in the new york times is “We fed people a small amount of stuff they were never designed to eat and it didn’t work out so great.  They acted like they were starving.”

The section of this article - which in some ways seems to be a lengthy defense for why the NYT editor for a wellness blog is 60 pounds overweight - which is most resonant for me is the portrait of a lady who has taken the calorie in calorie idea to its natural conclusion.  She spends what seems like every waking moment making sure she gets only the right amount of calories and the right amount of exercise, every single day of her life.  Her story is an amazing show of discipline and determination.  This lady is used by the author to kind of illustrate how nearly impossible it is to lose fat and keep it off.  

For the record, I think it is in fact just about this impossible to lose fat and keep it off for some people.  Fat storage is a function of hormonal and other responses that have been refined over the entirety of animal existence on this planet.  The human genome you have was developed to make sure you had just the right amount of fat stored on your body to optimize your chances for survival through reproduction (and survival of your offspring).  It is an impossibly well developed system, that worked nearly without fail until we starting eating the crap we eat now.  I’m not sure it is possible to undo a lifetime of eating like we eat, at least not for all people, and not in terms of getting to an keeping an idea body weight.  

And the problem is not just what we eat.  It’s how we sleep or don’t sleep, and how our hormonal cycles seem to have been disrupted by the ways we no longer live as we were designed to - the novelty of lights, the sleep disruption, the non-optimal food, and the loss of seasonal food variation, the practice of fasting and seasonal carb restriction; and who knows what else.  I’ve recently been around a female who is working to get her hormones optimized - better living through chemistry - and the way her body deposited fat changed over night.  So, yes, I think there’s more to the “fat trap” than just the “low calorie, low fat, more exercise” hoax.  

“Well, how will you wrap this one up Paul?”  Here’s the wrap up - start out by eating for healthy blood sugar levels.  Attack the problems that remain one by one.  Body fat - there are things you can do if you find that just eating good food isn’t enough to get lean.  Sicknesses?  There are things you can do to to heal the gut and for many that addresses autoimmune and inflammatory processes.  The road that has worked for me is chasing improvement over time, which for me started in about 1996, but didn’t really become consistent in my life until 2007, when I found a way to eat that I could live while I stayed/became more healthy.  Prioritize health, and get better day after day, week after week.

Dietary Cure for Acne: Interview with Dr. Loren Cordain by Robb Wolf

I understand you have some projects relating to intermittent fasting and autoimmunity. Can you share any tidbits about those or any other projects in the works our readers should know about?

Meal timing and frequency are poorly studied topics. Despite the almost complete lack of scientific evidence, many nutritionists and physicians as well believe that many small meals are more healthful and may help to promote weight loss than fewer larger meals. Once again I look to the evolutionary template to help unravel difficult diet/health questions. We have preliminarily compiled data from hunter-gatherers, and their meal patterns typically involve a single large meal at the end of the day and sometimes a light morning meal. They almost never eat three large meals a day with snacking in between—a pattern that seems to have become the norm in the U.S.

Experimentally, we have on our plates a project that will examine whether or not dietary lectins (in particular, wheat germ agglutinin [WGA]) can cross the intestinal barrier and enter the bloodstream. We suspect that dietary lectins may play a key role in certain autoimmune diseases like rheumatoid arthritis, irritable bowel syndrome, multiple sclerosis and others.

http://www.catalystathletics.com/articles/article.php?articleID=14

This is a great and short read.  When a dietary change affects something as pernicious and obvious as acne, that's is what you might think of as "a clue".  

The Right Nutrition for You - No One Knows

The links that follow tell an interesting story.  The author makes the case that very low carb is not a good formula for fat loss for a female CrossFitter who is perhaps over training, who is not consistent yet in low carb (binging occasionally on carbs/booze), and who is therefore hungry.

I think her advice is solid, but if the client really needed to be low carb, there's an option that was apparently not tried - using blood measures of beta-hydroxy butyrate (ketones).  If the athlete were able to fly right for 3 weeks, and thus convert to a therapeutic production of ketones, she may find her physical performance would improve, and her appetite would be moderated even while losing fat.

The other option to test is an AM carb fast (just protein/fats for breakfast), with minimal carbs for lunch, and a generous portion of carbs for dinner.  This may also generate a therapeutic level of ketone production, and deliver this athlete from her hunger and poor physical performance.

But there's no way to be sure without testing!  Different folks will have different needs and preferences.  This is why the food prescription based on the paleolithic model is so potent.   Eat meat, vegetables, nuts and seeds, little fruit or starch, no sugar/wheat/industrial oils.

http://paleozonenutrition.com/2013/02/10/crossfit-and-low-carb-paleo-why-isnt-this-client-losing-weight/

http://paleozonenutrition.com/2013/02/20/low-carb-paleo-crossfit-not-losing-weight-my-recommendations/

Just Another Observational Study

"Drinking more than four sweetened beverages a day, especially diet soda, doesn't appear to be good for one's mood, a study by the U.S. National Institutes of Health found.

"In a study of more than 200,000 older adults, those who drank more than four cans of soda a day had a 30 percent greater risk of depression than those who consumed none. The same amount of fruit punch was tied to a 38 percent higher risk, according to research released today by the American Academy of Neurology. The risk was even greater for people who consumed diet drinks, whether soda, punch or iced tea.

The study, one of the first to look at sweetened beverages and depression, doesn't explain the connection, so it's still unknown how the drinks may be tied to mental health, said Honglei Chen, one of the study's researchers. One theory is that the drinks have been linked to diabetes and obesity, which in turn can lead to the mood disorder, he said."

http://www.bloomberg.com/news/2013-01-08/sweetened-drinks-linked-to-depression-in-u-s-soda-study.html

We didn't need another observational study, but these things get funded so they do them.  The study can't answer the important question:

Does drinking soda/diet soda make you depressed?

Because the answer very well could be that depressed people drink more soda of any type to make themselves feel better.

However, there's a good reason to think that drinking this stuff does in fact make you depressed, because the best model for depression is based on inflammation as the cause.  In other words, the same chronic inflammation that is caused by a diet that features high blood sugar spikes, high chronic insulin levels and systemic chronic inflammation causes depression in some or many of those on this diet.  

Ever see a depressed person socking away avocado?  Lard?  Or bacon and eggs?  More likely, they are eating cookies or other sweets (processed foods made from wheat, soy, HFCS, and omega 6 laden industrial "vegetable oils"), along with their cola (diet or otherwise).  

Eat meat, vegetables, nuts and seeds, little fruit or starch, no sugar/wheat.

Oatmeal: Heart healthy. . . or Not?

Is this true? Is oatmeal heart healthy because it reduces LDL cholesterol?

I don't think so. Sure, oatmeal can reduce LDL cholesterol modestly. But try this: Have a serving of slow-cooked (e.g., steel-cut, Irish, etc.) oatmeal. Most people will consume oatmeal with skim or 1% milk and some dried or fresh fruit. Wait an hour, then check your blood sugar.

If you are not diabetic and have a fasting blood sugar in the "normal" range (<100 1-hour="" 150-180="" a="" and="" be="" blood="" but="" can="" dl-that="" dl="" effect="" even="" everybody="" frightening="" glucose="" have="" high.="" instant="" it="" majority="" mg="" not="" o:p="" oatmeal="" of="" or="" quick="" response="" s="" show="" sugar="" the="" this="" try="" typically="" very="" will.="" will="" with="" worse.="" you="">

If you have mildly increased fasting blood sugars between 100 and 126 mg/dl, after-oatmeal blood sugars will easily exceed 180 mg/dl. If you have diabetes, hold onto your hat because, even if you take medications, blood sugar one hour after oatmeal will usually be between 200 and 300 mg/dl.

www.healthcentral.com/cholesterol/c/7986/106385/oatmeal-heart?utm_content=buffer63c7a&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Some folks with high LDL are sick and don't live well.  No one with out of control blood sugar is healthy and living well.  Skip the oatmeal and have some meat, vegetables, nuts and seeds, little fruit or starch, and no sugar/wheat.

Minger Hits the Bullseye

This is the same description of this process that is elegantly described in the Art and Science of Low Carbohydrate Living, and which ties together the conjectures about the risks of carbs and/or fats:

More robust evidence exists for the "food depends on context" argument, and the data continues to mount in this direction.
A 2011 review in The Netherlands Journal of Medicine evaluated our collective body of research on saturated fat, carbohydrate, and cardiovascular disease, proposing an intriguing hypothesis about the behavior of saturated fat under different dietary circumstance.  Though more research is needed to test it, the theory may reconcile the inconsistencies popping up between clinical studies and epidemiology.  The review found that the modern diet tends to promote chronic, low-grade inflammation - response triggered by damage to your body's tissues.  The inflammation then cripples the body's ability to protect itself from other damage.  Basically, that chronic inflammation sets the stage for disease.
The paper's authors suggest that dietary saturated fat -while not a health-harming entity in and of itself-may become problematic if it's dumped on top of a soup of inflammation and excess carbohydrate.  Such a situation can lead to a buildup of saturated fatty acids in the body, notably as higher levels of free fatty acids in plasma lipids. (Those excess free fatty acids have long been linked with conditions like insulin resistance and diabetes, largely contributing to saturated fat's blacklisted status in the nutrition world.)
Explaining the phenomenon, the authors wrote:

"The adverse effects of high SAFA (saturated fatty acid) intake on lipid metabolism are particularly noted when SAFA are combined with a high CHO (carbohydrate) intake.  Under these conditions, dietary SAFA are preserved, while the surplus of the consumed CHO is converted SAFA by hepatic de novo fatty acid synthesis.  Taken together, SAFA accumulate:  1) under eucaloric conditions in normal weight subjects who consume a CHO-rich diet with high glycaemic index; and 2) under hypo caloric conditions in subjects with the metabolic syndrome and non-alcoholic fatty liver disease who consume CHO-rich diets.  Thus CHO, particularly those with a high glycemic index, and pre-existing insulin resistance are confounding factors in the discussion on the relation between CVD (cardiovascular disease) and dietary SAFA."

Death By Food Pyramid, Denise Minger

In short, if you eat an amount of carbohydrate that exceeds your body's tolerance for carbohydrate consumption, your blood will be loaded with a large quantity of fat (long standing knowledge that blood triglycerides are rapidly reduced with carb restriction).  The fat accumulates because the body prioritizes disposition of excess sugar over disposition of excess fat.  In the individual chronically overcoming carbs, the body not only doesn't burn fat often, it loses the ability to burn much fat (simple use it or lose it adaptations).  This cycle of excess carb consumption causes a host of problems, including the above referenced chronic low level inflammation.

In this storm of problems that results when too much carbohydrate is ingested, eating fat will add to the body's problem of fat disposition, further loading the blood with fat.  So, the perfect storm for high fat in the blood is a high fat, high sugar/carb diet.

This is also the root of the explanation for why there are some folks who are fat but healthy, and others who are not.  Excess body fat is a correlate of metabolic derangement - which means you are sick - but some have excess body fat but are not metabolically deranged.

Eat meat, vegetables, nuts and seeds, little fruit or starch, no sugar/wheat.

Harder the Second Time Around?

We all get older every day.  Sadly, with aging, all systems deteriorate.  Some slower, some faster, but all get a little older and a little less functional every day.  If you achieve success on a low-carb diet and find yourself 70 pounds lighter, you’ll also find your self five or six months older.  If you regain that lost weight, then decide to start another low-carb diet to re-lose it, you will probably be a couple of years older than you were when you tried your first low-carb diet.  Just as it’s a little more difficult to pick up tennis at age 46 than it is at age 44, it’s a little more difficult to get everything moving with a low-carb diet when you’re a couple of years older.

Built-in survival mechanisms

Although most dietary recommendations are fairly simplistic, our bodies are unimaginably complex.  Not only do we have a complicated metabolism centered around and directed by the liver, we have multiple neurological and endocrinological feedback pathways between the liver-directed metabolic system and the central nervous system.  And we have gut hormones that get into the act sending signals of fullness or lack thereof.  It is an intricate system designed to allow us to survive on all kinds of food and to keep us alive as long as possible in the face of famine.  I like to think of this entire interconnected system as having its own memory.  It will allow you to fool it once or maybe twice, but then it gets wise.

http://www.proteinpower.com/drmike/low-carb-diets/why-is-low-carb-harder-the-second-time-around/

I feel lucky when I read this.  It took me from 1996 until 2007 or so to figure this game out in a way that satisfied me.  In all that time, I must have nuked my body with huge sugar bombs at LEAST weekly, probably much more often than that. But right now, I can more or less effortlessly keep my body fat in the healthy range by eating the foods I like, and the foods I used to think I couldn't live without, I just don't like them as much.  

The takeaway?  There's probably a limit.  There's no bad time to stop nuking yourself with carbs, but there may be a limit for being able to regenerate and be as lean and well as you could have been had you stopped poisoning yourself with sugar ten years ago.

"Hey, Who's In Charge Here?"

"This rogue elephant scenario is what Dr. Haidt thinks happens to us from time to time.  Our rider (the conscious part of us) wants us to do something, but the elephant part of us doesn’t want to, and so the rider just hangs on for the ride while the elephant goes wherever it wants to go.  We can put this in dieting terms.  Our rider decides that the elephant needs to go on a diet.  As long as the elephant is up for it, the diet hums along.  But if the elephant has other ideas, the rider becomes an ornament.  If things are going well, the rider has the appearance of control; if things aren’t going well, i.e., we had to put Mom in the hospital, then the elephant takes over.  And the rider accepts it.  He says, hey, I couldn’t control this beast because we had to put Mom in the hospital, and you know how he gets when we have to put Mom in the hospital.  He wants to eat, and I, the rider, have to go along with him.

"Yale psychologist Paul Bloom presents another way of looking at this situation in an enlightening article in the November 2008 issue of The Atlantic.  He puts forward the idea that we all have multiple selves that we’re constantly dealing with, arguing with and trying to fool.

"Let’s say that we’ve dined large late at night and are headed for bed.  As we crawl into the sack with belly distended from a carb overindulgence and lie flat, we start getting the ol’ acid reflux feeling.  We sit up, burp, drink some water, rub our chest and grab for the Tums.  The self that is suffering says, ‘That’s it, I’m dieting tomorrow.  I can’t stand feeling like this, not for one more night.’  The next morning the self that wakes up is a different person who isn’t experiencing reflux, doesn’t have a distended belly and is hungry.  And, by God, hungry for some waffles, at that.  The feel-good morning self may not abide by the rules laid down by the refluxing self the night before."

http://www.proteinpower.com/drmike/lipid-hypothesis/why-is-low-carb-is-harder-the-second-time-around-part-ii/

This model of human behavior fits my experience of human behavior very closely.  The human animal is subject to much more unconscious control that we'd like to admit - why we don't like to admit that, I don't know.  Mike Eades does a nice job of delving into the topic and how it relates to changing one's eating patterns.  

As I have seen these patterns play out in more and more folks, I have been surprised to find that I keep seeing a few basic models from my college psychology courses:

1.  Approach avoidance conflict - you see something you want, you move towards it, as you get closer, some element of the encounter become fear producing (think of a squirrel taking a peanut from you hand).  You and/or the squirrel cycle back and forth through the zone between fear/attraction.  You want the cookie (beer, chips, whatever the high reward food is for you), you fear the obesity/sickness/death that you also associate to eating that food.  It may be at a party or the office, you resist mightily but have to keep struggling to stay away from the food, and it's tiring.  Eventually, approach wins out over avoidance, you eat the thing.  It doesn't even taste that good - you wonder why you put yourself through this stupid shit over a worthless piece of crap like a cookie/chip/beer - but over a lifetime, you've rewarded yourself with this food so many times, and the UCM's association to pleasure and that food is so strong, that it doesn't matter.  Like the folks pulling the arms of slot machines (no pleasure there, why do they keep doing it?), the pleasure experience of having won previously is great enough that you'll pull the damned arm 100 times with no reward, all the while driven by your unconscious mind's focus on getting the next dose of pleasure.  

2.  Learned helplessness - at some point, you have tried so many times to change that you think you cannot change; so why fight it?  

3.  The gambler's reward percentage - in this battle of your will (the rider) against the unconscious mind's associations (the elephant), there's a combination of rewards and pain.  IOW - the UCM's attraction to something, once it is strong, it isn't erased by one or even by ten negative experiences.  The gambling houses had it figured out long before the psychologists did.  There're a certain number of painful transactions you will go through (feeding quarters into a machine and pulling the arm only to not get anything), if the original pleasure reward was strong enough.  From memory, it seems like the ratio was around 40% of the time, if you get a reward, you'll keep pulling the slot machine arm.

In other words, the basic mechanism of the unconscious mind is to seek pleasure and avoid pain.  Anyone who's had to do serious battle with their unconscious mind knows the difficulty of head to head battles; you can win, but only when it's the foremost thing in your mind.  Eventually, not eating the crappy food isn't that, and you revert to the old crap eating self.

The question for an adult who wants to take charge of their behavior then is - how do I train the "elephant"?  To have success you have to treat your unconscious mind like a dog or child and provide it with pleasure when you do the things you want to do more often, and no reward or pain as close in time as possible to the behaviors you don't want.  The former is much easier to do than the later.   

Everything you do or want or feel is a result of this internal pas de deux between your conscious and unconscious mind.  Getting your kids to do what you think is best for them is a "simple" matter of getting them to associate more pain to not doing it, and more pleasure to doing it - which is why we say "good job" when they pick up their clothes.  It's also why we interrupt them when they are doing something fun, and make them pick up their clothes, so they think "crap, wish I'd have just put this junk in the hamper in the first place."  Likewise, if you say "good dog" every time your dog sits and holds the posture with food in their face, the dog will associate the pleasure of "I'm about to eat!" with the sound "good dog".  Then, you can use "good dog" as a reward for anything the dog does that you like. 

If you can learn to train yourself in this way, you can get yourself to do anything, probably right up to the point of drowning yourself by sticking your head into a bucket and holding it there (not that I'm an advocate for that).  I'm not saying that learning how to train your elephant is easy or particularly fun, but like many things in life, it is a necessary pursuit, for which the rewards are high.  

I hope you have associated some pleasure to this idea.

Tips for Proper Weight Management This Holiday

• The average American gains close to one pound during the six-week period from Thanksgiving through New Year’s Day, while those who are overweight or obese gain an average of five pounds
• Simple tips, such as planning out what you’ll eat at the start of each day, eating your protein at the beginning of your meal, going for a walk or reprograming the way your brain responds to high-sugar foods can help keep your weight in check
• Intermittent fasting can also help you avoid weight gain and also normalize hormones related to weight and metabolism, such as insulin and ghrelin
• Achieving and maintaining your ideal weight isn’t something to think about exclusively during the holidays; it should be more of a year-round consideration

http://articles.mercola.com/sites/articles/archive/2013/11/29/6-holiday-tips.aspx?e_cid=20131129Z1A_DNL_art_1&utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20131129Z1A&et_cid=DM34199&et_rid=352303968

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.

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!