Doctor Pierce's Notebook

Evidence for Why the Scale (and BMI) is Deceptive

Same woman, same scale weight. Jason at Everyday Paleo uses one of his clients to demonstrate that the scale is a virtually meaningless data point. Also note that her BMI would also be the same, and it is the standard used in most studies of obesity and nutrition, as well as by physicians and insurance companies.

You would also do well to note that the muscle layer replacing her fat layer is not only firmer, leaner, and more attractive, it improves insulin sensitivity rather than decreasing it, it maintains a higher metabolic rate for her even at rest, and it doesn't secrete hormones that may increase her likelihood of developing female cancers.  

Jason writes: 

"Faced with the facts above, basing your goals – or even worse, your happiness – on the number on your scale is absolutely ridiculous."

 

Clinical Experience of a Diet Designed to Reduce Aging

Clinical Experience of a Diet Designed to Reduce Aging

Nutrition is funny--it is probably the single most important factor in our health, yet it is one of the least studied or understood in medical circles.

Everyone thinks she's an expert on food--reading blogs and even premiere news outlets on nutrition are filled with misinformation and snarky, ignorant sniping against concepts that are either willfully misrepresented or simply misunderstood. (I recently read a blog post attacking Dr. Atkins that reported that his diet included fat marbled steak and an ice cream sundae every night. Had the writer even READ a sentence of Dr. Atkins' books?)

But the clinical evidence in favor of high-fat, adequate protein, low-carbohydrate nutritional plans keeps pouring in.

This study shows that the nutritional approach we favor reduces markers associated with aging and age related disease--independent of caloric intake. Which is another one of my mantras: calories are nearly meaningless.

In this study, body weight, serum leptin, insulin, fasting glucose, triglyceride, and free T3 significantly decreased as well as the triglyceride/high density lipoprotein ratios.

Dr. Oz's Report on Diet and Genes

via www.doctoroz.com

Dr. Oz recently did a show on genetics and weight loss--nutrigenomics, which was a combination of really good information and some not so good information.

There is something to the idea that your genetic make-up has a lot to do with what kind of diet you will respond to and how. While isolating the particular genes that identify which diet is best for you is somewhat new, the general hypothesis has been around for awhile in the form of both anthropological and ethnographic nutrition. Which is to say: we've often looked at our human ancestors in general, and our specific ancestors and their places of origin in order to determine what diets suit which people best.

This is the foundation for the paleolithic diet--eat only what the cave men ate, nuts, berries, leafy greens, and meat--and for the real food movement, which basically says, if it has a food label, you shouldn't eat it.

The nutrigenomic idea is slightly misleading--the report suggests you have a gene that tells us exactly what you should eat.  This is not exactly the case.  You have genes that tell us what sort of disease processes and metabolic tendencies that you've inherited.  What diet that means you should have is, at best, a hypothesis, (what I like to call a SWAG, a scientific, wild-ass guess) much of it based on faulty premises, like the idea that low-fat dieting has a positive effect on stroke and heart-attack, or the idea of a calorie and its relationship to nutrition and obesity. 

For that is the most potentially misleading part of Dr. Oz's report: the idea that the bottom-line is "calories in, calories out"--the laws of thermodynamics tell us that this is not the case. It takes more energy to process a protein "calorie" than a carbohydrate "calorie". I use calorie in quotes, because even the concept of a calorie is rather bizarre and very flawed.

Quality of calories matter more than quantity, and it seems that all calories are not created equal.

It's not just calories in, calories out.  Not by a long shot. 

Low-fat diet vs. Low-Carb: Which Makes You Hungry?

From Edward Lear's The Book of Nonsense

Ghrelin, A New Gastrointestinal Endocrine Peptide that Stimulates Insulin Secretion: Enteric Distribution, Ontogeny, Influence of Endocrine, and Dietary Manipulations -- Lee et al. 143 (1): 185 -- Endocrinology

One of the popular claims of the low-carb diet craze is that there is no hunger. For a long time people accepted that hunger was just a part of weight reduction--it turns out that it may only be a part of weight reduction that involves inadequate fat and protein.

Ghrelin, one of the hormones involved in regulation of appetite, is decreased by a high-fat diet, and increased in the presence of a low-protein diet. Furthermore, intravenous gherlin stimulates insulin secretion.

All of which supports the popular claim that low-carbohydrate eating actually suppresses your appetite. Or rather than suppressing it, it likely returns your appetite to its natural state.

Who Gets to Define Low-Carbohydrate Diets?

OBJECTIVE Low-fat hypocaloric diets reduce insulin resistance and prevent type 2 diabetes in those at risk. Low-carbohydrate, high-fat diets are advocated as an alternative, but reciprocal increases in dietary fat may have detrimental effects on insulin resistance and offset the benefits of weight reduction.

via diabetes.diabetesjournals.org

So hold on--what's this? Low carb diets might have DETRIMENTAL EFFECTS on insulin resistance? Let's take a closer look.

Look at this sample menu below.  You'll see that in the "low-carbohydrate" they have included, bread, white potatoes, bread crumbs, carrots.  All foods that provoke insulin response.  So what they've determined is that "calories in and calories out" works no matter what the quality of those calories are. Both diets reduced overall body mass and both diets resulted in increased insulin sensitivity.   

This is not a low-carbohydrate diet in any sense of the term as it is understood clinically.  Furthermore, it is a pro-inflammatory diet as it includes gluten, white potatoes, and high-glycemic vegetables.  

Their conclusion that the insignificant findings on arterial health may become significant is speculative--and even more to the point, the pro-inflammatory effects of fat are only present in the presence of carbohydrates.  While including pro-inflammatory foods like gluten, white potatoes, and carrots, you've tested nothing but the pro-inflammatory effects of those foods. 

What is going on?  When will they test a truly low-carbohydrate anti-inflammatory diet without reservation? 

TABLE 1

Sample menus for a typical day on each intervention diet

Meal	Low-carbohydrate diet (7.7 MJ)	Low-fat diet (7.6 MJ)
Breakfast	Scrambled eggs (40 g); bacon rasher, fat trimmed, grilled (20 g); hash brown, grilled (45 g)	Cornflakes (40 g), bran-based cereal (7 g), semiskimmed milk (200 g), pineapple juice (250 g)
Lunch	Wholemeal bread (72 g), cooked ham (30 g), mayonnaise (25 g)	Wholemeal bread (72 g); cooked ham (60 g); mayonnaise, reduced calorie (13 g); cheddar cheese, reduced fat (20 g)
Dinner	Potatoes, in skins, boiled (145 g); chicken breast in crumbs, baked (140 g); peas, boiled (95 g); carrots, boiled (70 g); gravy instant granules (4 g)	Potatoes, in skins, boiled (260 g); chicken breast in crumbs, baked (120 g); peas, boiled (50 g); gravy instant granules (5 g);
Additional foods	Peanuts, roasted and salted (40 g); Brazil nuts (30 g); butter (21 g); cheddar cheese (44 g);	Chocolate mousse, low fat (55 g); apple (153 g); jaffa cake (13 g); cola (150 g); chewy cereal bar (23 g); fruit yogurt, low fat (150 g); white bread, toasted (27g); strawberry jam (10 g); semiskimmed milk (300 g)

More on Animal Protein

This study explains the possible link between saturated fats and inflammatory processes which are linked to several diseases.  Note that it is not so much the fat itself but the ratio of "bad fats" to good fats. 

For the past century, changes in the Western diet have altered the consumption of omega-6 fatty acids (w6, found in meat and vegetable oils) compared with omega-3 fatty acids (w3, found in flax and fish oil). Many studies seem to indicate this shift has brought about an increased risk of inflammation (associated with autoimmunity and allergy), and now using a controlled diet study with human volunteers, researchers may have teased out a biological basis for these reported changes.

Anthropological evidence suggests that human ancestors maintained a 2:1 w6/w3 ratio for much of history, but in Western countries today the ratio has spiked to as high as 10:1. Since these omega fatty acids can be converted into inflammatory molecules, this dietary change is believed to also disrupt the proper balance of pro- and anti- inflammatory agents, resulting in increased systemic inflammation and a higher incidence of problems including asthma, allergies, diabetes, and arthritis.

Floyd Chilton and colleagues wanted to examine whether theses fatty acids might have other effects, and developed a dietary intervention strategy in which 27 healthy humans were fed a controlled diet mimicking the w6/w3 ratios of early humans over 5 weeks. They then looked at the gene levels of immune signals and cytokines (protein immune messengers), that impact autoimmunity and allergy in blood cells and found that many key signaling genes that promote inflammation were markedly reduced compared to a normal diet, including a signaling gene for a protein called PI3K, a critical early step in autoimmune and allergic inflammation responses.

Relating to the previous post, the balance of these fats is significantly altered in a positive direction when animals are freely pastured, eat a natural diet of grass, and treated humanely.    Eat grass fed beef whenever possible and make sure to eat cold water fish twice a week.  Non meat-eaters and meat eaters can also use free-range eggs, brussel sprouts, nuts, and flax seed as a natural supplement, or take three fish oil capsules a day.  Note: inflammation is also related to CAD (coronary artery disease).  

Protein and Fat: the Basics

from aftb's photo stream in Flickr.  Used here under a Creative Commons License.

Fat and protein are the essential macro-nutrients for optimal health and wellness.  By essential, I mean they are absolutely necessary--we can live without carbohydrate (thrive, in fact) but if we do not get enough fat and protein, we cannot maintain proper cellular function and the result is certain disease and eventual death.  

So a diet that uses meat as a fat and protein source is close to being optimal and, certainly, our paleolithic ancestors subsisted on bursts of feeding upon the fat and protein of wild game, interspersed with periods of gathering nuts and berries.  

That being said, we can't just turn a blind eye to the fact that meat and animal fat also present health risks.  We now know that dietary fat does not build up in the arteries the way we once thought; once we no longer have to worry about where our next meal is coming from, a grain-based diet, low in essential fatty acids creates an inflammatory state that puts one at higher risk of heart disease. However, the Archives of Internal Medicine recently published a study that shows a small increased risk of coronary artery disease (CAD) in those who report frequent meat eating.  The question is: why?  This is what we call a correlational study.  It demonstrates a relationship but does little to analyze cause and effect.  Here are several possible hypotheses that have yet to be thoroughly studied: 

• It could be something inherent to meat, in any form
  
  
• It could be something inherent to cooking the meat (see prior post on grilling)
  
  
• It could be due to the widespread use of antibiotics and growth hormones in commercial meat industries
  
  
• It could be due to the pro-inflammatory grain (ie, corn) diet we force on these animals in place of their natural diet (grass, clover, etc.)

The last two are interesting to me in terms of health and medicine but also in terms of philosophy and ethics.  When animals are "factory farmed" and treated inhumanely, the nutritional value of their meat is compromised.  When fed, for instance, the instantly fattening, cheaply produced corn and grain-based diet, it increases the ratio of saturated fat to oleic acid and increases the inflammatory properties of meat.  So the question is, would these findings have been different if these were either a.) wild game animals or b.) pastured, humanely treated, domesticated animals?  

Though these are still only working hypotheses my family and I have been slowly converting to the "locavore" philosophy of eating, focusing on locally grown produce, wild caught fish, locally raised, free-range poultry, eggs, and grass-fed beef.  It is certainly difficult and costly to make these switches--but as our friend Rebecca is fond of saying, we vote with our dollars, so it is something we continue to work on, making small changes in our choices of food and where we buy it.   

While the evidence remains to be gathered and tested, it certainly seems rather poetic that being good stewards of the earth, and treating animals humanely, would have broad-ranging health benefits for those who make those choices.  It has a kind of symmetry that makes this nutritional philosophy intuitively the best choice for those seeking optimal health and wellness for themselves and compassionate living for the good of their community.  And in the meantime, I'm working out the details of dietary choices for those who wish to entirely opt out of animal protein for the ethical reasons stated here.  It's difficult because animal protein and fat are optimal sources of our essential macro-nutrients--but there is likely a way that vegetarians and even vegans can eat the low-carbohydrate way, receive optimal nutrition, and live in harmony with their ethical choices.  

Low-Carbohydrate Nutrition

Laura Dolson's Low-Carb Food Pyramid from About.com

Why Low-Carb?

Since 1998, I have supported low-carb nutritional protocols for the treatment of multiple health problems, and for the management of obesity.  

The Low-Fat Hypothesis has been so prevalent it takes what someone once called a paradigm shift for people to fully understand how little it is based in valid data.  Doctors are no exception.  As a group we are poorly educated in nutrition to begin with, and the Low-Fat Hypothesis was just as pervalent inside medical schools as it was in the mainstream media.  It wasn't until 11 years ago, that I realized just how wrong "conventional wisdom" can be.  

I was trained by and worked for the United States Air Force for 12 years.  In 1998 I was stationed in Panama, at Howard Air Force Base.  There was a male nurse that worked in my unit.  He told me about his father.  His father was the classic "apple" type body shape--all his obesity was abdominal (he was all gut with skinny arms and legs).  He was in his 60s 5' 3" and 271 pounds.  He had so far suffered one heart attack, he had high triglycerides, a low HDL (high-denisity lipid) in his cholesterol reading.  The nurse in my unit told me that his father was prescribed a low-carb diet, and that his father had undergone a complete transformation.  He lost 100lbs and all indices of good health--blood pressure, cholesterol, triglyceride levels improved dramatically.  

Interested, I began researching the idea of Metabolic X Syndrome or insulin resistance and I was persuaded that refined carbohydrates, particularly grains, are the source of many of our Western health problems.  I also began to cease thinking of certain pathologies as diseases but as adaptive traits that turn against the human body in the presence of prosperity; what once enable a robust survival in the context of hardship, now can work against us amidst abundance.  At the time the book I first read was by the Doctors Eades, Protein Power, which you can find in the book column at the last.  I actually began buying dozens of his books and handing them out to patients.  

Since that time, many other studies and mainstream books have surfaced about low-carbohydrate eating which support the findings of the Eades (which you can also find on the right).  And of course, Dr. Atkins who preceded them, was prescient of the current clinical findings on the benefits of low-carbohydrate diets.

There will be more posts on this. Stay tuned.