Sugar? Fructose? Carbs? What's the Difference!

A friend asked about the difference in impact between blood sugar that is created from excess consumption of carbs that are not sugar, and from carbs that are sugar.  That is to say, why does high carb intake absent a high sugar intake seem to have a different impact than does the high carb/high sugar combination?

First, two facts:
There are islanders who eat at least 60% of their calories as starchy carbs, but they have very little sugar intake.  About 95% of the men smoke.  They have no heart disease.
Additionally, when studied it is often observed that there are healthy fat folks and non-healthy fat folks.

What happens in a very abbreviated answer is that fructose is processed via the liver, and when consumed in excess it seems to make the liver insulin resistant.  This seems to be a stage in development of full insulin resistance.  Insulin resistance is detected as metabolic syndrome, a precursor to diabetes, and a strong predictor of disease in and of itself.

You can find more about various elements of fructose ingestion here:
Fructose link: http://fireofthegodsfitness.blogspot.com/search/label/Fructose

Also, at Gary Taubes blog Gary summarizes three studies on this topic here:
Taubes summary of the three:  http://garytaubes.com/2011/11/catching-up-on-lost-time-–-the-ancestral-health-symposium-food-reward-palatability-insulin-signaling-and-carbohydrates…-part-iib/

The best, most solid science on this topic includes this study:
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0057873 ... which is summarized well here:
http://opinionator.blogs.nytimes.com/2013/02/27/its-the-sugar-folks/?_php=true&_type=blogs&_r=0

So here's my concept of the progression:

First, we find those who eat too many carbs, and store them as excess fat, but they are not insulin resistant, do not develop metabolic syndrome, and are healthy by most measures.
Second, we find those who eat "too much" sugar (too much is different by individuals for a variety of reasons like ethnicity, activity level, alcohol consumption, etc) and become insulin resistant.  For these folks, all carbs now become a driver of excess blood sugar, inflammation, and often progress to metabolic syndrome and diabetes.  Once sugar and carbs are reduced, these folks often become normal in their tolerance of non-sugar carbs.
Lastly, we find those with metabolic syndrome and diabetes.  Because they have become insulin resistant, often any kind or dose of carbs will make them fatter and sicker.

The implications for this model include the idea that eating meat, vegetables, nuts and seeds, little fruit or starch and no sugar/wheat is a strong preventative for progression through these stages.  I would bet that it is not possible to eat enough of the above prescription to become insulin resistant.  Once one is in stage 2 or 3 as described above, it may take a more careful approach that includes measured carb restriction, and perhaps induction of ketogenic metabolism.

Simplest Change

Each of our clients wants to lose fat, except maybe one.  Most are already working within the paleolithic model of nutrition.  Some are having spectacular results, and that is putting smiles on both of our faces.  Some are stalled out.  Today's post is about the simplest change one can make to reaccelerate fat loss.

That change is to have a breakfast of only protein (some, 15-30 grams) and fat (a lot).  Why will this help?

First, let's get into how you body fuels itself.  The number two metabolic priority (in terms of urgency) is getting sugar to the brain.  The brain needs approximately 600 calories worth of fuel daily.  That's about 25% of the total caloric requirement for most folks.  If the brain does not get the necessary fuel, it will cease to function, you will fall down, and the ghost might leave the machine, depending upon how fuel deprived the brain is.  To keep this from happening, you were engineered with a redundant fuel system, that allows you to make brain food from fat, carbs or protein.

Most of your body runs best on fat as fuel.  The engineer's intent seems to have been that you would not need to eat or store much sugar, and that the sugar (not in large supply until very recently) you ate or stored would be used primarily by the brain.  The first contingency for lack of available carbs/sugar is that your liver will convert fat into ketone bodies, which can be an alternate fuel for the brain (in fact, there's some evidence the brain is most healthy when fueled by both sugar and ketones).  This system is what lets a person survive day after day with no food available (remember those stories of 60+ days in a life raft?).  If you ever face that situation, the body will also catabolize muscle to make protein and sugar for the brain.  So in all you have three ways to store energy - fat is the biggest source and the best fuel.  Sugar is the smallest source and is a preferred fuel for the brain.  Muscle is the desperation fuel, "for emergency use only."

Now let's get back to why keeping carbs out of your breakfast will help you to burn fat.  First, all night long, since you are not eating, your body has to start converting to fat burning (you know people have a serious sugar problem when they cannot sleep through the night without sugar cravings).  When you "break your fast", if you give the body sugar, it will stop running on fat.  If you give your body too much sugar, it will get busy converting that sugar into fat.  If you give yourself a moderate protein, high fat breakfast, this can keep your hunger at bay but let the body keep burning stored fat for brain fuel.

So the easiest, simplest, change to start burning more fat is to have a carb free breakfast.

If you want to take this one step further, stop eating by 7 or 8 PM.  That way, you may go as long as 12 hours from last meal of the day until first.  That also invites your body to get good at burning fat, and if you don't eat carbs until lunch, that's a 14-16 window of no "carbage".  This kind of carb fasting is very useful for those who want to get healthy and lean.  Why does this help with health?  In short, the number one driver of disease in our nation is metabolic syndrome, which is characterized by loss of glycemic control (that is to say cycling high and low blood sugars).  The above described carb fast interrupts the cycle of excess sugar/carbs, and restores normal blood sugar levels for many who are dangerously close to metabolic syndrome.

This is also why exercise alone does not work for fat loss or health - if you continuously over-eat sugar and carbs, you will not get glycemic control and you will not have your best health no matter how intense your daily workouts are.

If you want to take this another step beyond a carb fast, push your breakfast back by one hour each day, until you can go food free for 14-16 hours.  This path can be risky for some, so if you want to do this, come talk to me first.  You can also search this blog to find prior posts about how to start intermittent fasting.

Are you ready to make the simplest change?  If so, get going and let me know what you learn!

Notes to a Friend

It's invaluable to have a doc you can trust and yet, doctors have been saying cholesterol and fat intake is the problem in our diet, and that is factually incorrect. The medical profession lost their authority when they abandoned science, which never confirmed that cholesterol CAUSED heart disease.  Cholesterol is a weak predictor of disease, there is almost no benefit to mortality reduction from fat restriction.  The benefits of carb restriction are no longer disputable. I don't know how to help you except to say doctors are as human as any of us, and they no longer have access to more info than you and I do. I know you want to trust your doctor. I would to.

There are two things that may affect the "want a cookie" experience.  One is falling blood sugar - that probably triggers a habitual need for something to stop that from proceeding to blood sugar crash.  That's part of the sugar addiction cycle.  The other part is just an association to pleasure.  The unconscious mind (UCM) always wants to feel pleasure, avoid pain, that is what it does for you.  If cookies distract from pain (and think of the whole cookie eating experience is loaded with guilt, pleasure, surprise, taste, disappointment if its a bad one, etc - these are all great distractions), anytime the UCM can get away from pain by having you eat a cookie.  Obviously that's a short term win, long term loss for "net pain."  

In either case, the way to attenuate the impulse is to have something you can eat that does not derail your blood sugar, but that you like.  This can take a while to find since it's so different for each person.  I use coconut/macadamia nut in a spoon, or coconut and sunflower seeds.  When I'm as lean as I am now, I use coconut on dark chocolate (70% or more).  Sometimes, an egg or avocado will do it (avocado, with salt and champagne vinegar).  Bacon is good too!  Anything that is high in fat and tastes good to you will work.  Over time, this does two things.  One, you don't pit yourself against your hunger or your UCM - that's a losing formula.  Two, you dilute the association between pleasure and cookies.  Three, by not eating cookies it gives your liver time to heal and start processing carbs like it is supposed to

Q: Why would blood sugar be an issue when I'm eating good food?
A:  Hard to know.  Possibly - body expects a sugar bomb every time you eat, prepares by pumping insulin.  That's just a body habit like pavlov's dog, it will stop after eating "right" for long enough

There's a whole part of physiology that goes wrong for folks who eat carbs and especially sugar habitually.  Fat burning enzymes are a use it or lose it prospect, just like everything else in the body.  Your muscles and other tissues run well on fat except for the brain and a few other tissues.  When you don't use fat burning enzymes, the stores of these enzymes decrease.  Then, when you don't eat for a while, you can't convert to fat burning for very long.  The trick to get these stores back up to normal is to deprive your body of exogenous sugar for long enough that the body has to run on fat and rebuild the stores of enzymes in the process.  This can take 1-3 weeks.  It can also feel bad - plus, as you reduce your carb intake, your chronic insulin levels go down, and that allows your tissues to flush excess fluids.  That cycle means you can get low on electrolytes like potassium, sodium and magnesium.  Even moderate dehydration can make a person hungry.  As you eat for health, initially, you have to deliberately drink more water with electrolytes (Smart Water is a good commercial product that does this).  

This is why the "extreme" low carb diets work especially well for reversing metabolic syndrome/diabetes - they keep blood sugar levels so low for so long that the body regains insulin sensitivity, and the liver can get rid of excess liver fat.  This allows the liver to regain insulin sensitivity too.  However, the dehydration/electrolytes issue can be very uncomfortable.  I wouldn't necessarily recommend this for you - your body needs the break from carbs so it can heal, but the heart rhythm issues could be worse in the short term due to electrolyte fluctuations.  You'd need to sip smart water all day long.  Once you get through the 3 week fat burning adaptation period, the appetite regulation, blood sugar regulation, better sleep, rapid weight loss (and all while eating a high fat snack anytime you feel hungry or just feel an impulse to eat) is amazing.  But it's super hard to do by yourself or if you have other demands (work, for example).  Much easier if you are doing this with others.  This is why CF can work so well for lifestyle change - community.

Part of the reason this is important to know is it explains why the idea of no bread no beans no corn tortillas seems so hard - you probably cannot burn fat so you have a true metabolic need for exogenous carbs.  That doesn't always have to be that way, getting fat adapted changes that.

Eat meat, vegetables, nuts/seeds, little fruit/starch, no sugar/wheat, and all the fat you can shove down your pie hole.

It's the Reporting, Stupid

Meanwhile, bears have figured out how to be healthily obese and then lose massive amounts of weight without problems.

"I want to learn how the grizzly bears work their magic," Dr. Kamb says.

Dr. Corbit, who says he had worked "exclusively on mice" before joining Amgen in 2011, says his studies of fat and blood samples suggest the bears respond to excessive weight gain differently than many people.

The bears seem to adjust their sensitivity to the hormone insulin that controls how much the fat and sugars in food are broken down and stored for energy. The bears are more sensitive to insulin while putting on pounds for hibernation. When hibernating a few weeks later, the bears shut off their insulin responsiveness entirely.

http://online.wsj.com/news/articles/SB10001424052702303330204579246003604081632?mod=trending_now_2

Oh, the embarrassment of the researchers after reading this.  Humans are sensitive to insulin when they are healthy.  Humans likely become insulin resistant when fasting too, we have many of the same mechanisms as animals that hibernate.  The question, unless you are looking for a new drug, is "what is it that makes the exquisitely well adapted human mechanism for storing and losing fat go wrong such that people can be fat, feel lethargic, and be hungry when they are not calorie deprived?"

However, the article isn't really supposed to be an enlightening piece about fat loss and health, it's supposed to be about the fascinating idea that we may be learning from bears.  Reporters generally don't seem to know enough about metabolism to write informative articles, but it's easy to entertain with a piece written about bears.

Taubes: Thought Experiment

“If this effect is tiny, say, five calories worth of fat get trapped in A's fat cells every day, he'll still put on ten pounds of fat over the 20 years of the experiment and weigh 10 pounds more than his genetically-identical brother eating his almost identical diet. If this fat-trapping amounts to 20 calories a day - still less than one percent of the calories A is consuming - that would amount to forty pounds of excess fat over the course of the experiment. It would still be too subtle of an effect to be observable in the relatively short-term experiments done to date on sucrose consumption.”

http://garytaubes.com/2012/11/what-would-happen-if-thoughts-and-thought-experiments-on-the-calorie-issue/ - comment-19997

In other words, if you miss the calorie estimate by any amount, you'll be obese.  What's the solution?  Don't pretend the human conscious mind was built to control the human animal's intake.  No animal needs conscious intervention to avoid obesity WHEN IT EATS THE FOOD IT EVOLVED TO EAT, the human animal included.  

Why some eggs heads decided we should eat wheat and industrial seed oils, while avoiding the most natural human food on the planet - saturated animal fats - is beyond description.

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

Elevated Visceral Fat: "Nobody Wants That"

The language that follows is the language of observational/epidemiological studies:

"among obese adults, visceral fat was associated with more than a twofold increased risk of developing incident diabetes (odds ratio 2.42, 95% CI 1.59 to 3.68).  In addition, developing either condition was also associated with markers of insulin resistance including elevated fructosamine levels (OR 1.95, 95% CI 1.43 to 2.67) and elevated fasting blood glucose (OR 1.88, 95% CI 1.38 to 2.56).

But there were no associations with general markers of obesity, including body mass index (BMI) or total body fat."

In other words, "these are interesting correlations."

Not that I would disagree with their conclusions:

"Our study may have implications for understanding differences between metabolically healthy and pathologic obesity."

This is interesting because not everyone that's fat is insulin resistant, and those who are develop illness as much higher rates than those who are not.

This is also interesting:

"In participants without diabetes at baseline, a number of factors were significantly and independently associated with incident diabetes in obese adults:

• Elevated visceral fat: OR 2.42, 95% CI 1.59 to 3.68 (P<0 .001=".001" li="li">
• Elevated systolic blood pressure: OR 1.26, 95% CI 1.07 to 1.48 (P=0.006)
• Elevated fructosamine levels: OR 1.95, 95% CI 1.43 to 2.67 (P<0 .001=".001" li="li">
• Elevated fasting blood glucose: OR 1.88, 95% CI 1.38 to 2.56 (P<0 .001=".001" li="li">
• Weight gain from baseline: OR 1.06, 95% CI 1.02 to 1.10 (P=0.002)
• Family history of diabetes: OR 2.32, 95% CI 1.25 to 4.29 (P=0.008)

"There were no associations for BMI, total body fat, or abdominal subcutaneous fat, they reported." 

Many of the same factors correlated with the development of insulin resistant in those not obese when the study began.

http://www.diabetesincontrol.com/index.phpoption=com_content&view=article&id=13578&cacatid=1&Itemid=17

All in all, this fits a well recognized pattern of illness - high fructosamine levels/high fructose intake, visceral fat, high blood pressure, elevated fasting glucose, weight gain, and family history of diabetes.  

Lucky for us, most of these symptoms are treatable through carb restriction - I recommend starting out at 25-50g/day to stop these symptoms, and after weight/fat/symptom normalization, many will be able to eat more carbs but maintain their wellness.  Eat meat, eggs, vegetables, nuts and seeds, little fruit or starch, no sugar/wheat.

Elevated Sugars Linked to Brain Shrinkage

"Numerous studies have shown a link between type 2 diabetes and brain shrinkage and dementia, but we haven't known much about whether people with blood sugar on the high end of normal experience these same effects. " The study involved 249 people age 60 to 64 who had blood sugar in the normal range as defined by the World Health Organization. The participants had brain scans at the start of the study and again an average of four years later.

Those with higher fasting blood sugar levels were more likely to have a loss of brain volume in the areas of the hippocampus and the amygdala, areas that are involved in memory and cognitive skills, than those with lower blood sugar levels. 

Interesting note:

A fasting blood sugar level of 180mg/dl.(10.0 mmol/l) or higher was defined as diabetes and a level of 110mg/dl(6.1 mmol/l) was considered impaired, or prediabetes. 
This part is the language of an epidemiological study:

After controlling for age, high blood pressure, smoking, alcohol use and other factors, the researchers found that blood sugar on the high end of normal accounted for six to 10 percent of the brain shrinkage. 

http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=13511&catid=1&Itemid=17

These are interesting results, in that they correlate with the widely held view that high blood sugars are injurious to the nervous system.  In fact, for a while it was fashionable to cause Alzheimer's "Type III Diabetes" or "Alzheimer's of the brain."  However, as the authors noted, epidemiological studies only suggest a possible cause, and prove nothing.  Whether or not the effect is as dramatic as showing a loss of brain tissue in four years, there are many reasons to fear high blood sugar's negative impacts on your health, and zero negative side effects of eating for glycemic control.

Low Carb For ... Endurance?

http://www.thelivinlowcarbshow.com/shownotes/6413/588-south-african-running-legend-tim-noakes-embraces-high-fat-low-carb-living/

Ever wonder how you could use a low carb strategy for endurance running?  Jimmy talks to a running legend who got fat and sick, and then fixed himself using low carb.  Genius!

The Art and Science

In 2007, Gardner et al published a randomized, controlled trial called the A-to-Z Study involving 4 diets lasting a year given to groups of obese women[43]. At one end of this diet spectrum was the ‘Ornish diet’ which is very high in complex carbs and very low in fat. At the other end was the ‘Atkins diet’ (i.e., low carbohydrate). After 6 months, the women on Atkins had lost significantly more weight, but after 12 months they were still lower but not significantly so. Interestingly, blood pressure and HDL cholesterol were significantly better on low carbohydrate than any of the other diets, and this beneficial effect remained significant out to 12 months.
  
After publishing this initial paper in JAMA, Dr. Gardner went back and examined his data based upon the subjects' insulin levels before they stared dieting.  When the women on each diet were divided into three subgroups (turtles) based on baseline insulin resistance, the results were striking.  In the low carbohydrate diet group, weight loss was similar in the most insulin sensitive (11.7#), and insulin resistant (11.9 #) women.  HOwever weight loss with the high carbohydrate (Ornish) diet was much greater in the insulin sensitive (9.0 #) than the insulin resistant (3.3 #) women.  


Thus the most insulin sensitive sub-groups of women experienced a similar weight loss when assigned diets either high (9.0 lbs) or low (11.7 lbs) in carbohydrate In contrast, the sub-groups that were insulin resistant fared very poorly when assigned a diet high in carbohydrate (3.3 lbs lost) compared to a low carbohydrate diet (11.9 lbs). Specifically, those women with insulin resistance lost almost 4-times as much weight when dietary carbohydrates were restricted[44]. Simply put, insulin resistance strongly influences how we respond to different diets. This validates the concept that insulin resistance in essentially an expression of carbohydrate intolerance.  Dr. Gardner's data clearly demonstrates that rather than forcing an insulin resistant body to deal with a macronutrient it can't handle well this condition is best treated with a diet that limits carbohydrate.
The Art and Science of Low Carbohydrate Liv...


This book is a great read, as the authors are into the same puzzle I am of sorting out metabolic derangement - but they are full time researchers and much further down the road than I am.  They have a lot to teach!  I suspect I will read this book multiple times as I did Gary Taubes' "Good Calories Bad Calories".


I count the analysis above as another shot at the "calorie is a calorie" concept of weight loss - clearly, the hormonal state of the eater has an effect on what the body does with carbohydrate calories consumed.


Here's Dr. Gardner - his study was referenced above - in a video taped summary of his study; you know it's a good study when a vegetarian tests the atkins diet and finishes by wondering "if grains may be a problem."

Here's the abstract of his study:
http://www.ncbi.nlm.nih.gov/pubmed/17341711

USA Today on JAMA "Metabolic Advantage" Intervention Study

A study was published in JAMA that addressed the effectiveness of a variety of diets for weight loss maintenance.  The question was:  we know that folks can demonstrate a reduction in metabolic rate after weight loss that makes it more likely for them to regain weight; which diet minimizes this effect?  The study wasn't large, but it was an intervention study and the technology utilized for measuring the results was relatively uncommon in these types of studies and significant.  The answer was clear:  carb restriction worked best.

I think the fact that this study was done might be attributable to Gary Taubes' work, as it appears to be designed to test the hypothesis he re-discoverd and advocated in his books, "Good Calories Bad Calories" and "Why We Get Fat" (available in my aStore, by the way).

When I see a study published like this one, I get excited.  This one will draw comments from all of my favorite carb restriction bloggers.  This one is a shot in the face of the "calorie is a calorie" reductionists (who are correct and all wrong; correct about the physics and incorrect in their linear application of it to a human body as if it was a bomb calorimeter).  There will be some interesting attempts from the "C is a C" crowd to explain this one away.  Squirming and hemming and hawing will ensue as they try to deal with a cognitive dissonance they will be unable to reconcile.

What was the study?
The research finds that dieters who were trying to maintain their weight loss burned significantly more calories eating a low-carb diet than they did eating a low-fat diet.  But some experts say these findings are very preliminary.  The study, funded by the National Institutes of Health, was designed to see if changing the type of diet people consumed helped with weight maintenance because dieters often regain lost weight.  So scientists had 21 obese participants, ages 18 to 40, lose 10% to 15% of their initial body weight (about 30 pounds). After their weight had stabilized, each participant followed one of three different diets for four weeks. Participants were fed food that was prepared for them by diet experts. The dieters were admitted to the hospital four times for medical and metabolic testing.
http://www.usatoday.com/news/health/story/2012-06-27/calories-low-carb-weight-loss/55843134/1

I love this "reporter speak":  Some experts say the results are very preliminary.

Can study results be "very preliminary?"  That phrase makes me chuckle as I remember a high school teacher who directed that I "completely eliminate redundancy" and then lined through the word "completely."  Point taken.

And if they are "very preliminary" what does that mean anyway?  Was it a well done study or not?  If it is, what sense do you make of the study, Mr. Expert?  Those would have been some of the good questions to ask, but ones not asked so much by the "newspaper blah blahs" I suppose.

Here's the link to the JAMA report:
http://jama.jamanetwork.com/article.aspx?articleid=1199154

So why do I feel so smug about the result?  Why would I indulge in the "I told you so" routine to those who represent what I think of as 40+ years of bad science?  Mainly because their work has hurt people.  They have advanced the low fat message like an item of religious faith in spite of the lack of science to support it, while claiming they were speaking with scientific authority.  They projected their strongly held beliefs, and pretended it was a fact.  In short, they did what all humans do, but they did what they did from positions of power and authority, and their discipline was unequal to their power to influence.  I'm not saying "They lied, people died."  I don't mean to imply they deliberately deceived anyone.  They deceived themselves and didn't have the discipline to just say "This is what I think but it's not proved yet."  What they did is something to be angry about.

You can safely predict there won't be too many from the "calorie is a calorie" crowd who say "well, I guess I was wrong about low carb, sorry."  Not too many will say "Gee, I guess that Taubes guy isn't a money grubbing buffoon after all."  None will apologize to Dr. Atkins or the Eades or Loren Cordain.  In other words, there will be very few who swallow their pride and admit this one is a direct contradiction of what they thought they knew.

Here's the "titular head" of the "calorie is a calorie" crowd, cited as an "expert", to whom we are supposed to pay attention:

George Bray, an obesity researcher at Pennington Biomedical Research Center in Baton Rouge who has also studied this topic and who wrote the accompanying editorial in JAMA, says that other studies "show that you can do well on any diet as long as you stick to it. Adherence is the major key for weight loss and maintenance. There is no magic in any diet."

This is the same guy that has said diets don't work due to the toxic food environment and there's really no hope short of pharmaceuticals.  He's also ignoring the fact that low fat diets are hard to stick to because of the resulting hunger.  And he's pretending not to notice all the research that shows exactly what this JAMA study shows - low fat dieters who lose weight commonly suffer a reduced rate of metabolic activity (this was a featured component of the recent NYT article which said, essentially, "there's no hope for long term weight loss because the body compensates for weight loss by reduced metabolic rate").  And this is also a guy from the camp that has said that we all need to just walk or move enough to  burn 50 kcal/day or so to use up the extra "energy" we all tend to consume - now after a study that shows a 300kcal/day metabolic advantage, all he has to say is (to be fair, all he's reported to have said) "diets are great, just follow one".  From my completely inconsequential perspective, Dr. Brey's long career and his significance as a researcher has been to advocate a linear relationship, uncomplicated by hormonal and individual variances, between food intake and energy expenditure and weight gain/loss.  So, I wouldn't expect him to be confused by the facts since what the facts of this study say are "you were wrong". 

Eric Westman, a Duke University researcher who has conducted several studies on the low-carb diet and is co-author of The New Atkins for a New You, says this study documents that the "lower the carbohydrates, the better the metabolic effects. People burn more calories if they eat fewer carbohydrates."

What he should have said was "I told you so."

Marion Nestle, a nutrition professor at New York University, says longer studies conducted among people in their own environments, not with such controlled meals, have shown "little difference in weight loss and maintenance between one kind of diet and another." More research is needed to show that interesting results like these are applicable in real life, she says.  "In the meantime, if you want to lose weight, eat less." (emphais mine)

Part of what she says is a BFO - no one study is compelling in science, and oh by the way, things are different in the real world than for those eating prepared foods during a controlled experiment.  Gee, thanks for the insight.  Thanks also for the smug advice at the end, too, Professor N, that provides us all the information we need to know about the obesity/health care crisis in the US.  Message from Professor N to anyone that is overweight - "You are fat because you are gluttonous and lazy, get off your butt and starve yourself.  Your bad character is wrecking our health care system, knock it off."  Does she think that repeating that message for another 30 years is going to work better than it has for the last 30 years?  These people are a joke except there's no punch line - there's a nation of sick people and much of the dietary confusion of the last 30 years could be blamed on folks like Professor N and Dr. Brey. 

Or you could skip the blame and just accept the pathetic low fat pseudo science of the last 30-40 years and get over it, which I will endeavor to do after this article is complete.

In ten years, the blah blahs at the newspapers, however, will be writing about this study and more that will follow as if the superiority of a carb restricted diet has always been a well known fact.

Here's a blurb for those wary of the sin of epidemiology (which is to say confusing correlation with causation):

The authors note a downside to the low-carb diet: It appears to raise some risk factors for heart disease.

This is the high fat bias on display.  The article author - a newspaper blah blah for sure - had to find something bad to say about a study which shows a stunning finding in favor of high fat diets.

So, what does the study say about how high fat diets will kill you faster than drinking 16.1 ounce sodas in New York City?  "Risk factors" is the epidiological language for "factors which correlate to disease that we would like to think we know are causative." 

But for actually predicting heart disease, for example, the best numbers available are either:
-Ratio of LDL to total cholesterol (what my insurance company uses to figure out how soon I'll die)
-Ratio of triglycerides to HDL

Interesting results for study participants:
*Serum leptin was highest with the low-fat diet (mean [95% CI], 14.9 [12.1-18.4] ng/mL), intermediate with the low–glycemic index diet (12.7 [10.3-15.6] ng/mL), and lowest with the very low-carbohydrate diet (11.2 [9.1-13.8] ng/mL; overall P < .001) (Table 3)
In other words, leptin levels are higher with a high carb/lowfat diet, which is known to result in increased hunger and decreased metabolic output - leptin resistance anyone?

*Regarding components of the metabolic syndrome, indexes of peripheral (P = .02) and hepatic (P = .03) insulin sensitivity were lowest with the low-fat diet. Comparing the low-fat, low–glycemic index, and very low-carbohydrate diets, serum HDL cholesterol (mean [95% CI], 40 [35-45] mg/dL; 45 [41-50] mg/dL; and 48 [44-53] mg/dL, respectively; overall P < .001), triglycerides (107 [87-131] mg/dL; 87 [71-106] mg/dL; and 66 [54-81] mg/dL, respectively; overall P < .001)
In other words, low carb is great for HDL and triglycerides (already known, so essentially these stats validate the test protocol)

*CRP tended to be higher with the very low-carbohydrate diet (median [95% CI], 0.78 [0.38-1.92] mg/L for low-fat diet; 0.76 [0.50-2.20] mg/L for low–glycemic index diet; and 0.87 [0.57-2.69] mg/L for very low-carbohydrate diet; P for trend by glycemic load = .05). Blood pressure did not differ among the 3 diets.
This is not a good indicator, but the significance of CRP compared to the other markers, which are more positive, is not known.

The study conclusion:
The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective.

Hell yes they do!  Eat meat, vegetables, eggs, nuts and seeds, little fruit or starch, and no sugar/wheat.

(Minor edits June 27, 2012, 16.44)

Inexcusable

Here's an interesting statement, in which correlation and causality are confounded:
A condition like high blood pressure is sneaky. You don’t feel it, and it generally doesn’t cause any outward signs or symptoms. Yet it silently damages blood vessels, the heart, kidneys, and other organs.

So let's think for a moment about causality - if folks with hypertension also are more likely to have blood vessel damage, does that mean it is caused by the high blood pressure?  Obviously, not.  There could be a third factor that's causing both.


So the authors move on:
High blood pressure — also known as hypertension — isn’t a disease. It is a sign that something is wrong in the body. In some people with hypertension, the culprit is a narrowing of the arteries supplying the kidneys (renal artery stenosis), or an overactive thyroid gland (hyperthyroidism) or adrenal glands (aldosteronism). When these are treated, blood pressure drops back to normal. More often, though, doctors find no underlying cause for high blood pressure. This condition is called essential hypertension.

So, in this analysis from the smart folks writing this magazine for Harvard, the fact that 80% of those with hypertension can reduce their BP back to normal by restricting carbs isn't even worth mentioning.  That is inexcusable.  It is not a secret, it's a treatment that requires no medication, and has as side effects the following:  proven superior results (by interventions studies up to one year) for weight loss, lipid profile improvement, reduction of gout, and reduction of NAFLD.  In short, there's absolutely no drawback to this treatment.   


Back to the causality v. correlation issue:
High blood pressure contributes to the development of stroke, heart attack, heart failure, and kidney disease. In the United States, it directly accounts for about 60,000 deaths a year and contributes to another 300,000.

This is statistical gymnastics - neat tricks but only as accurate as the assumptions of those doing the calculations.  The fundamental question - is high blood pressure a cause of or a correlate with the other diseases of civilization? - has not been answered to my knowledge aside from the fact that it seems to be a correlate.  The evidence of that is that the best intervention for controlling HBP is also the best intervention for treating the other correlates of HBP, which are also correlates of metabolic syndrome, all of which get worse when folks are sick enough to be diagnosed as "diabetic."  IOW - did those folks suffer from the HBP or did they suffer from the underlying problem - lack of glycemic control - for which HBP is only one of several correlates?

Interesting study, but hopefully, upon review, you will see the baked in correlation v. causality issue here:
These researchers looked at the 1,007 men and women admitted to the hospital over a 10-month period for any potentially heart-related problem. These ranged from chest pain and fainting to heart attack, heart failure, atrial fibrillation, and pericarditis. In this group, 69% had been diagnosed with high blood pressure before being admitted to the hospital. Each person was followed for one year. At the end of that time, 17% of those with high blood pressure had died, compared with 9% of those with normal blood pressure. Rehospitalization for a cardiac problem followed the same pattern: 31% of those with high blood pressure, and 18% of those without (American Journal of Cardiology, published online, Aug. 24, 2011).

But, the smart folks writing this magazine want you to know there's hope:

But there is actually good news about high blood pressure: there is a lot a person can to do help keep it in check, and even prevent it from occurring in the first place.

How? The National Heart, Lung, and Blood Institute; the Centers for Disease Control and Prevention; and the American Heart Association offer these recommendations:

• Achieve and maintain a healthy weight for your height.
• Exercise regularly.
• Eat a diet that is rich in fruits, vegetables, and whole grains.
• Limit sodium intake to under 2,300 milligrams a day (one teaspoon of salt), and get plenty of potassium (at least 4,700 mg per day) from fruits and vegetables.
• Drink alcohol in moderation, if at all.
• Reduce stress.
• Monitor your blood pressure regularly, and work with your doctor to keep it in a healthy range.

(sarcasm alert!)...and when all that doesn't work, keep on popping those pills.  It frankly wouldn't take all those big dollar, big brain, high credentialed organizations to give you this kind of nearly pointless, assinine advice.  I could have done that for a lot less than they have been paid over the years. (This ends the sarcasm alert)

In a follow up post, I'll throw out a bit of speculation about the "lies, damned lies, and statistics" aspect of the high blood pressure concern. 

Blog: War On Insulin

While I appreciate the author's perspective, I would have named the blog differently.  Insulin saves us from neurological damage when blood sugars go too high, and those with no insulin die a cruel wasting death, as insulin is necessary to get vital materials into cells in order to sustain life.  BUT - the fact that the science of the last thirty years has focused so much on fat intake (and dislipidemia) as the cause of disease, and by extension accumulated body fat as the cause of disease, while almost ignoring how necessary insulin is in the accumulation and maintenance of excess body fat, has resulted in a generation of weird science (much of which you and I funded via the NIH). 

So, as blog author Petter Attia says: 
My mission is to demonstrate that insulin — not calories — is at the heart of the most pervasive chronic diseases: obesity, heart disease, and even cancer. Suppressing the secretion of insulin is the key to running your body on your own fat, which leads not only to weight loss, but also to what I call “chronic health” and peak performance.
http://waroninsulin.com/nutrition/the-fat-trap-nyt-magazine-article-thoughts-and-comments

I think I would pick a minor nit and say it's the excess carb intake - that makes hyperinsulinemia a short term necessity, and a long term death sentence - that's killing us.  You could eliminate the body's ability to generate high insulin output, but if you still ate a high carb "heart healthy whole grain" low fat diet, you'd still be dead from excess blood sugars, and sooner rather than later.

Attia addresses Tara Parker Pope's "The Fat Trap":
I fully agree with Ms. Parker-Pope’s assertion that obesity is categorically not an issue of weak will, and I’m encouraged that she feels a sense of renewed optimism in her own journey.
There were two aspects of this article, however, that disappointed me. First, it focused a great deal on hormones that almost certainly play some role in obesity – leptin, peptide YY, ghrelin – but not once in over 5,000 words was the hormone insulin mentioned.  The reason this disappoints me is not because I fixate on insulin, and therefore assume others should.  It’s because I’m reminded of how confused mainstream nutrition and obesity research is.  All of these other hormones – leptin, peptide YY, ghrelin – are reported to play a role in appetite.  The notion that “the answer” to treating obesity lies in manipulating these hormones suggests folks still think obesity is a disease of over-eating rather than a disorder of abnormal fat accumulation.  This distinction is not subtle, as I try to point out in the posts The great medical disconnect and Revisit the causality of obesity.  If you believe obesity is caused by overeating then it makes sense to study hormones that govern hunger.  Certainly hunger matters, and a person who is constantly hungry is likely to overeat, but the fact that this article doesn’t even suggest a role for elevated insulin levels strikes me as missing something.

It's more than missing something, the author is trying to be polite.  It's an astonishing oversight.  It's proof that the scientists Mr. Pope counts on in her reporting are off the reservation.  It's an indictment of a generation of scientists who assumed they could reduce human metabolism to the simplicity of a bomb calorimeter and now are completely at a loss for what to try next (except pharmaceutical intervention) - but still have not confronted the reality that they have taken a dead end street. 

Those same scientists who's work is rejected by their failure to either understand or treat obesity are the ones who control much of the funding for research into diet, obesity and health.  Strangely, they don't want to spend much money trying to prove they have been wrong all these years.  Gee, I wonder what to make of that.

If it is sad that someone like Tara Parker-Pope, who has such a potentially potent stage, is still trailing through the scientific boonies with the lost generation of science, the awesome thing is so many people like Peter Attia are on to the "alternative hypothesis".  These folks are treating their patients, and spreading the word, and empowered recipients are recovering their health and their futures.   Their scientific results can be measured in smaller waists, eliminated medines, and by the fact that they look, feel and perform better.  This is science you can do.  Eat meat, vegetables, nuts and seeds, little fruit or starch, no sugar/no wheat.

Eades: What Makes You Tick

How does your body deal with the multitude of problems associated with an unpredictable food supply, varying food quality, and the feast or famine nature of the environment in which our genome was refined over time? 

In one of my all time favorite blog posts, Mike Eades describes the process here in incredibly few words:
http://www.proteinpower.com/drmike/ketones-and-ketosis/metabolism-and-ketosis/

BLUF:  you store excess energy from fat and carbs as triglycerides.  You store excess protein in the "amino acid pool" and in muscles (of the two, it's better if you use fat first, muscles only in desperation).  Most of your cells run well on either fats, glucose, or ketones.  Certain cells, brain tissue for example, run well on glucose or ketones only (the heart, by the way, reportedly runs extremely well on ketones).  If you are not ingesting enough food, the glucose hungry brain still needs sugar, and obviously keeping the brain well fed is a metabolic imperative.  Thus, the liver will begin a process of converting amino acids to glucose.  To power this transaction, the liver takes energy from fatty acids, and in the process creates ketones.  Since ketones serve as a glucose proxy, the process of gluconeogenesis (making new sugar from amino acids, which come from muscle tissue or ingested protein) helps alleviate blood glucose short falls via both glucose and ketone production.  The fact that the body can transform both fat and protein into glucose or a glucose substitute is a reflection of the criticality of feeding the brain.  Here's the rub - this process can only keep you running if most of your cells are fat adapted, which is to say, they run on fat often, and thus at the cellular level adequate stores of fat oxidizing enzymes are maintained.  If you are chugging down carbs all day, you've given yourself a totally different metabolic emergency - sugar disposal.  To help with that, your tissues will burn sugar instead of fat when sugar is present in excess.  If you are only sugar adapted, when food intake is delayed or not sugary enough, you will not be able to maintain adequate levels of blood sugar - and that feels bad.  You will be highly motivated to eat more.  And you will eat the kind of food that most rapidly becomes blood glucose, which will likely sustain your metabolism in "SUGAR DISPOSAL EMERGENCY MODE."

So, if want to be more lean, or need to get control of glucose levels, stop downing the mountains of "healthy whole grains" and processed high carb foods and modern frankenfruits like apples/bananas/corn/oranges and etc.  The unfortunate belief that magic carbs are protecting you with phyto nutrients, anti oxidants, and vitamins is the health equivalent of "penny wise pound foolish".  Restrict your carb intake to vegetables, preferably cruciferous gems like broccoli and brussel's sprouts, and become the fat burning machine you were meant to be.
_________________________________________________________________________
No, I don't think a banana or apple a day will kill you if your total carb intake is 100g/day or less.  But you could also just eat a Snickers bar or Dr. Pepper unless you like bananas better; until you get your blood sugars under control, there's not much difference.
_________________________________________________________________________
After you fat adapt, your body will still need something like 150g/day of glucose to feed your brain, but since your other tissues won't be competing for glucose, your liver will make that 150g for you from ingested proteins, as well as from ingested fats and fat liberated from adipose tissue.  Of note, fat adapted people rarely feel hungry because they can run 14-16 hours before they burn up the amino acids in the "amino acid pool" - and all the while with a stable, normal blood sugar level.  In other words, fat adapted people aren't hungry because they have all the fuels their body needs, there's no biological reason for hunger.

With no hunger you also get the liberty of eating according to when you want to eat, vice eating to stave off hypoglycemia - or in response to your body's "this is a sugar crisis feed me now dammit" demands which will put you on the high carb express to crazy town.

There's every reason to believe there's nothing more significant for your long term health than glycemic control.  The people with the worst glycemic control - diabetics - are the sickest population on the planet, short and long term.  They are vulnerable to every disease of civilization at rates higher than non-diabetics, and they age about ten years more rapidly than the rest of us. 

Carb restriction gives you excellent glycemic control, because the liver will make the glucose that you need - but not more.  Along with glycemic control, you will see improved measures of every health marker and improved (improving) body composition.   Eat meat, vegetables, nuts and seeds, little fruit or starch, and no sugar/wheat.  Live long and prosper.

Glucose Control? Pick Up Heavy Stuff

The link below will take you to the abstract of an interesting prospective study.  As always with these studies, it would be impossible to assert cause and effect relationships.  At least, it shows that having more muscle mass is not bad for you, and that perhaps sustaining activities which result in creating and sustaining muscular strength are healthful as regards glycemic control.

Conclusions: Across the full range, higher muscle mass (relative to body size) is associated with better insulin sensitivity and lower risk of PDM. Further research is needed to examine the effect of appropriate exercise interventions designed to increase muscle mass on incidence of diabetes.

http://jcem.endojournals.org/content/96/9/2898.abstract

Gout from Taubes

Ever had gout or known someone that did?  Ever heard the line about excess purines being the cause?  Consider this:
Because uric acid itself is a breakdown product of protein compounds known as purines – the building blocks of amino acids – and because purines are at their highest concentration in meat, it has been assumed for the past 130-odd years that the primary dietary means of elevating uric acid levels in the blood, and so causing first hyperuricemia and then gout, is an excess of meat consumption.
The actual evidence, however, has always been less-than-compelling: Just as low cholesterol diets have only a trivial effect on serum cholesterol levels, for instance, and low-salt diets have a clinically insignificant effect on blood pressure, low-purine diets have a negligible effect on uric acid levels.
http://www.fourhourworkweek.com/blog/2009/10/05/gout/

That's right - eating foods with less purine content does not help with gout.  How can that be true, you may wonder.  The answer is that eating foods lower in purine content does not reduce the intake of purines enough to matter; even vegetarians can have relatively high rates of gout.  What matters is why your body stops clearing the purine fueled uric acid, which, at high blood concentrations, results in accumulation of destructive crystals in (most commonly) the joints.
About that, Taubes comments:
... there’s the repeated observation that eating more protein increases the excretion of uric acid from the kidney and, by doing so, decreases the level of uric acid in the blood.(7) This implies that the meat-gout hypothesis is at best debatable; the high protein content of meats should be beneficial, even if the purines are not.
The alternative hypothesis is suggested by the association between gout and the entire spectrum of diseases of civilization, and between hyperuricemia and the metabolic abnormalities of Syndrome X.
In other words, there's really no reason to think that gout is "caused" by anything other than what causes all of the clusters of diseases known as the diseases of civilization.  In fact, the treatment that works best for gout is carbohydrate restriction, generally, with particular attention paid to fructose consumption. 

Uric acid is cleared from the body via the kidney, but with the metabolic derrangement that results from high carbohydrate diets, the kidney becomes overloaded and uric acid clearance becomes secondary. 
... a series of studies in the 1960s, as clinical investigators first linked hyperuricemia to glucose intolerance and high triglycerides, and then later to high insulin levels and insulin resistance.(14) By the 1990s, Gerald Reaven, among others, was reporting that insulin resistance and hyperinsulinemia raised uric acid levels, apparently by decreasing uric acid excretion by the kidney, just as they raised blood pressure by decreasing sodium excretion. “It appears that modulation of serum uric concentration by insulin resistance is exerted at the level of the kidney,” Reaven wrote, “the more insulin-resistant an individual, the higher the serum uric acid concentration.” (15)

Second, fructose directly raises uric acid levels. 

Third, fructose, which is broken down in the liver in a manner similar to that of alcohol, can over task the liver and contribute to accelerated insulin resistance, which exacerbates all of the symptoms of metabolic syndrome. 

In other words, just like statins and blood pressure medications treat symptoms of metabolic syndrome, but don't cure it, gout medications treat the symptoms of gout but don't deal with the cause.

I recommend you read the article linked above, but for treatment, all you need do is eat meat, vegetables, nuts and seeds, little fruit or starch, and no sugar or wheat as you pursue vigorous health vice relief of symptoms.

I'll include more on why fructose consumption should be moderate in following posts.

Fat Is Fuel, Fat Is Good

There are two ways to sustain adequate blood sugar levels.  Because the brain shuts down when deprived of glucose, producing and sustaining blood glucose levels is a primary driver of metabolic processes.  Given the significance of maintaining blood glucose, it would be no surprise that the body has more than one way to get the job done.

That said, how many times have you experienced, or known folks who experienced, hypoglycemia?  This is characterized by feeling droopy, irritable, and hungry - for anything but often especially for carb foods.  Most folks experience this as "reactive hypoglycemia", in which the "victim" eats a large amount of carbs, resulting in a blood sugar spike, to which the body reacts with an insulin surge, after which, blood sugar levels fall too far.

Normally, as blood sugar levels fall, the body compensates by making blood sugar in the liver, and by producing ketones, which allow the brain to use less sugar.  Also, most non-brain cells run well on fatty acids, which is why we store energy as fat.  In short, it should be very hard to achieve "hypoglycemia" in a healthy person.  Strangely, it's so common that folks speak of it often and even plan for a mid morning or mid afternoon snack to avoid the "sugar low light."

The reason for that is that the body has a finite and relatively small capacity for glucose storage, and folks who eat a big dose of carbs are giving themselves a glucose management problem.  The body is equipped for glucose management, but it appears to be the case that when the body has to deal with glucose management problems routinely, it does not sustain the process well.  One reason is that cells will burn sugar inside the cells preferentially, so if the body is always stuffing cells full of sugar, the cells so rarely burn fat for fuel that they begin to maintain very low levels of fax oxidizing enzymes.  In short, repeated high carb intake makes you both sick from the excess sugar, fat, and at the same time, dependent on exogenous sugars as your body's fat burning systems atrophy from lack of use.

Based on the above described cycle, it's no wonder that folks who eat a lot of carbs all the time often get fat - except for the ectomorphs (tall and lean) who seem less capable of using fat for fuel in general.

The question then, is "what do I do about it?"  That's a question we can answer next time.

Kresser: Stressed, Diabetic, Obese

A huge – and I mean huge – amount of research over the past two decades shows that stress causes both obesity and diabetes in a variety of ways. Studies also show that stress makes it hard to lose weight.
When stress becomes chronic and prolonged, the hypothalamus is activated and triggers the adrenal glands to release a hormone called cortisol. Cortisol is normally released in a specific rhythm throughout the day. It should be high in the mornings when you wake up (this is what helps you get out of bed and start your day), and gradually taper off throughout the day (so you feel tired at bedtime and can fall asleep).
Recent research shows that chronic stress can not only increase absolute cortisol levels, but more importantly it disrupts the natural cortisol rhythm. And it’s this broken cortisol rhythm that wreaks so much havoc on your body. Among other effects, it:

• raises your blood sugar
• makes it harder for glucose to get into your cells ¹
• makes you hungry and crave sugar
• reduces your ability to burn fat
• suppresses your HPA-axis, which causes hormonal imbalances
• reduces your DHEA, testosterone, growth hormone and TSH levels ²
• makes your cells less sensitive to insulin
• increases your belly fat and makes your liver fatty
• increases the rate at which you store fat
• raises the level of fatty acids and triglycerides in your blood

Each one of these consequences alone could make you fat and diabetic, but when added together they’re almost a perfect recipe for diabesity.
http://chriskresser.com/10-ways-stress-makes-you-fat-and-diabetic

So, just get rid of stress, problem solved, right?  R-I-G-H-T!!
Best concept of stress management available is here: 
http://activinsight.com/
http://www.psychologytoday.com/blog/the-myth-stress/201004/the-myth-stress-revealed
http://www.forbes.com/sites/marcbabej/2011/06/02/the-myth-of-stress-a-concept-worth-reading-about/
http://www.amazon.com/Myth-Stress-Really-Happier-Healthier/dp/1439159459

Kresser: Diabesity

Obesity, insulin resistance, metabolic syndrome and type 2 diabetes have reached epidemic proportions. There’s not a person reading this article who isn’t affected by these conditions, either directly or indirectly. Yet as common as these conditions are, few people understand how closely they’re related to one another.
It is now clear that not only do these conditions share the same underlying causes – and thus require the same treatment – they are 100% preventable and, in some cases, entirely reversible.
Because of these similarities, Dr. Francine Kaufman coined the term diabesity (diabesity + obesity) to describe them. Diabesity can be defined as a metabolic dysfunction that ranges from mild blood sugar imbalance to full-fledged type 2 diabetes. Diabesity is a constellation of signs that includes:

• abdominal obesity (i.e. “spare tire” syndrome);
• dyslipidemia (low HDL, high LDL and high triglycerides);
• high blood pressure;
• high blood sugar (fasting above 100 mg/dL, Hb1Ac above 5.5);
• systemic inflammation; and,
• a tendency to form blood clots
• http://chriskresser.com/diabesity

This isn't just a US problem, it is worldwide, and affects an astronomical number of people.  We sell a lot of drugs to a lot of folks to offer treatment of the symptoms.  Strangely, those drugs are totally un-needed - because the disease is a dietary disease, and all of the symptoms can be treated by un-frocking one's diet.  But our government, inexplicably, recommends a diet which does not help with diabesity and for most, makes it worse.  The Brit government has one upped that, and made statins available over the counter.  It sometimes feels like reverso world.

Thin Equals Well?

Many overweight and obese people are metabolically healthy, while large numbers of slim people have health problems typically associated with obesity, a new study shows.

The findings, based on national health data collected from 5,440 adults, shows that weight often is not a reliable barometer for health. In addition to looking at height and weight, the study, published this week in The Archives of Internal Medicine, tracked blood pressure, “good” cholesterol, triglycerides, blood sugar and an inflammatory marker called c-reactive protein, all of which are viewed as indicators of cardiovascular health.

Overall, thin people were still metabolically healthier than people who were overweight or obese. But being a normal weight was not a reliable indicator of health. In the study, about 24 percent of thin adults, or about 16 million people, posted unhealthy levels for at least two of the risk factors.

By comparison, among the overweight, about half the people had two or more of the risk factors. But half of them were also metabolically healthy. And nearly one out of three obese people were also metabolically fit.

While it’s long been known that it’s better to be fit and fat than being thin and sedentary, the new data are believed to be the first time researchers have documented the unreliability of body size as an indicator for overall health.

http://well.blogs.nytimes.com/2008/08/13/for-health-body-size-can-be-misleading/?pagemode=print

This is another report documenting the "fat but healthy" population, which has been reported on in various studies for at least five years.  The challenge is that with epidemiological studies - the assumption define the results.  If you decide that people with blue warts are more likely to die, aka blue warts are a risk factor, then fat people with blue warts are not "healthy".  Does that mean they are really more likely to die?  Who knows  - because most of the "risk factors" are the results of sophisticated calculations that are very rarely confirmed via intervention studies.  That said, Mike Eades (www.proteinpower.com/drmike) published a post recently that explains how the "skinny fat/unhealthy" idea could very well be true.

The basic idea is that we each become insulin resistant on a different genetic template.  Suppose a person's fat cells are the last part to become insulin resistant - if they are eating poorly, they can continue to sock away excess blood sugar in their fat cells (after conversion, by the action of insulin, to fat).  In fact, these folks can and will accumulate more fat than the rest of us, and it seems to have almost a protective effect - because they can continue to sequester excess blood sugar long after many of us would not be able to.

On the other end of the spectrum, imagine a person who's fat cells become insulin resistant at essentially the same time as other tissues - these folks will not be able to buffer their excess blood sugars, and will wind up with a large quantity of visceral fat, which is "associated" with higher mortality.  They will suffer more damage from their overconsumption of carbs and the resulting high blood glucose.

What's the bottom line?  There's no getting around the fact that a large abdomen and high blood sugars are signals of damage and causes of damage respectively.  This is why carb restriction is such a powerful tool for those already wrestling with the damage the results from too many years of a typical neolithic diet.

Taubes Times Sugar

Taubes Sugar NYT
This is a long (14 page) survey of what the current thinking is on sugar.  I have not finished it yet, but since I've read GT's book about four times, I'm mainly curious to find out what if anything he's modified in his perspective since GCBC was published.  If you have kids or any hint of diabetes, you should read this.

The viral success of his lecture, though, has little to do with Lustig’s impressive credentials and far more with the persuasive case he makes that sugar is a “toxin” or a “poison,” terms he uses together 13 times through the course of the lecture, in addition to the five references to sugar as merely “evil.” And by “sugar,” Lustig means not only the white granulated stuff that we put in coffee and sprinkle on cereal — technically known as sucrose — but also high-fructose corn syrup, which has already become without Lustig’s help what he calls “the most demonized additive known to man.”

It doesn’t hurt Lustig’s cause that he is a compelling public speaker. His critics argue that what makes him compelling is his practice of taking suggestive evidence and insisting that it’s incontrovertible. Lustig certainly doesn’t dabble in shades of gray. Sugar is not just an empty calorie, he says; its effect on us is much more insidious. “It’s not about the calories,” he says. “It has nothing to do with the calories. It’s a poison by itself.”