January 7, 2012 · 3:24 AM

Food Reward versus Carbohydrate/Insulin Theory of Obesity

 

God, help us figure this out

A few months ago, several of the bloggers/writers I follow were involved in an online debate about two competing theories that attempt to explain the current epidemic of overweight and obesity.  The theories:

  1. Carboydrate/Insulin (as argued by Gary Taubes)
  2. Food Reward (as argued by Stephan Guyenet)

The whole dustup was about as interesting to me as debating how may angels can dance on the head of pin.

Regular readers here know I’m an advocate of the Carboydrate/Insulin theory.  I cite it in Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet and The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer (2nd edition).  But the Food Reward theory also has validity.  They’re both right, to an extent.  They’re not mutually exclusive.  The Food Reward theory isn’t as well publiziced as Carbohydrate/Insulin.

Dr. Guyenet lays out a masterful defense of the Food Reward theory at his blog.  Mr. Taubes presents his side here, here, here, here, and here.  If you have a couple hours to wade through this, I’d start with Taubes’ posts in the order I list them.  Finish with Guyenet. 

You’d think I’d be more interested in this.  I’m still not.

Moving from theory to real world practicality, I do see that limiting consumption of concentrated refined sugars and starches helps with loss of excess body fat and prevention of weight regain.  Not for everbody, but many.  Whether that’s mediated through lower insulin action or through lower food reward, I don’t care so much. 

Any thoughts?

Steve Parker, M.D.

h/t Dr. Emily Deans

 

5 Comments

Filed under Carbohydrate, Overweight and Obesity

Tagged as , , , , , ,

January 5, 2012 · 4:45 AM

Paleo Diet Improves Glucose Tolerance and Blood Cholesterol

  A Paleolithic diet improved metabolic status with respect to cardiovascular and carbohydrate physiology, according to a 2009 study at the University of California San Francisco.

Here are the specifics, all statistically significant unless otherwise noted:

  • total cholesterol decreased by 16%
  • LDL cholesterol (“bad cholesterol”) decreased by 22% (no change in HDL)
  • triglycerides decreased by 35%
  • strong trend toward reduced fasting insulin (P=0.07)
  • average diastolic blood pressure down by 3 mmHg (no change in systolic pressure)
  • improved insulin sensitivity and reduced insulin resistance; i.e., improved glucose tolerance

Methodology

This was a small, preliminary study: only 11 participants (six male, three female, all healthy (non-diabetic), average age 38, average BMI 28, sedentary, mixed Black/Caucasian/Asian).

Baseline diet characteristics were determined by dietitians, then all participants were placed on a paleo diet, starting with a 7-day ramp-up (increasing fiber and potassium gradually), then a 10-day paleo diet.

The paleo diet: meat, fish, poultry, eggs, fruits, vegetables, tree nuts, canola oil [?], mayonnaise [?], and honey.  No dairy legumes, cereals, grains, potatoes.  Caloric intake was adjusted to avoid weight change during the study, and participants were told to remain sedentary.  They ate one meal daily at the research center and were sent home with the other meals and snacks pre-packed.

Compared with baseline diets, the paleo diet reduced salt consumption by half while doubling potassium and magnesium intake.  Baseline diet macronutrient calories were 17% from protein, 44% carbohydrate, 38% fat.  Paleo diet macronutrients were 30% protein, 38% carb, 32% fat.  Fiber content wasn’t reported. 

I’m guessing there were no adverse effects.

Comments

This study sounds like fun, easy, basic science: “Hey, let’s do this and see what happens!”

I don’t know a lot about canola oil, but it’s considered one of the healthy oils by folks like Walter Willett.  It sounds nicer than rapeseed oil.

I agree with the investigators that this tiny preliminary study is promising; the paleo diet (aka Stone Age or caveman diet) has potential benefits for prevention and treatment for metabolic syndrome, diabetes, and cardiovascular disease such as heart attack and stroke.

The researchers mentioned their plans to study the paleo diet in patients with type 2 diabetes.  No published results yet.

Are you working with a physician on a medical issue that may improve or resolve with the paleo diet?  Most doctors don’t know much about the paleo diet yet.  You may convince yours to be open-minded by trying the diet on your own volition—not always a safe way to go—and showing her your improved clinical results.  Or show her studies such as this.

I’m considering the paleo diet as a treatment for diabetes.  If interested, follow my progress at my PaleoDiabetic blog.

Steve Parker, M.D.

Reference:  Frassetto, L.A., et al.  Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.  European Journal of Clinical Nutrition, advance online publication, February 11, 2009.   doi: 10.1038/ejcn.2009.4

9 Comments

Filed under Uncategorized

December 26, 2011 · 8:15 AM

Got Spare Time?: Track Your Omega-3 and Omega-6 Fatty Acid Consumption

One of the major changes in the Western diet over the last century has been the increase in our consumption of omega-6 fatty acids, primarily in the form of industrial seed oils.  Examples include oils derived from soybeens, corn, and rapeseed (canola oil).  Omega-6 fatty acid consumption in the U.S. increased by 213% since 2009.  This may have important implications for development of certain chronic diseases like cancer and heart disease.  Excessive omega-6 consumption may be harmful.  On the other hand, omega-3 fatty acid consumption may prevent or mitigate the damages.  Hence, the omega-6/omega-3 ratio becomes important.

This’ll improve your omega-6/omega-3 ratio!

I haven’t studied this issue in great detail but hope to do so at some point.  Evelyn Tribole has strong opinions on it; I may get one of her books.

I saw an online video of William E.M.Lands, Ph.D., discussing the omega-6/omega-3 ratio.  He mentioned free software available from the National Insitutes of Health that would help you monitor and adjust your ratio.

You can see the video here.  Dr. Lands’ talk starts around minute 12 and lasts about 45 minutes.  He says it’s just as important (if not more so) to reduce your omega-6 consumption as to increase your omega-3.  And don’t overeat.

Steve Parker, M.D.

5 Comments

Filed under cancer, coronary heart disease, Fat in Diet

Tagged as , , , , ,

December 23, 2011 · 7:13 AM

Quote of the Day

Merry Christmas to all!

He who enjoys good health is rich, though he knows it not.

                                                      —Italian proverb

Comments Off on Quote of the Day

Filed under Quote of the Day

December 16, 2011 · 2:52 AM

Rapper Fat Joe Loses 100 lb on Low-Carb Diet

Rapper Fat Joe is in a YouTube video talking about his 100-lb (45 kg) weight loss by eating low-carb.  He’s not doctor, but he knows a lot about preventing diabetes and heart disease.  He’s livin’ it.

Steve Parker, M.D.

h/t Tom Naughton

4 Comments

Filed under Inspiration

Tagged as , , , ,

December 14, 2011 · 3:30 AM

What About “The Biggest Loser”?

Probably not watching The Biggest Loser

Dr. Barry Sears (Ph.D., I think) recently wrote about a lecture he attended by a dietitian affiliated with “The Biggest Loser” TV show.  She revealed the keys to weight-loss success on the show.  Calorie restriction is a major feature, with the typical 300-pounder (136 kg) eating 1,750 calories a day.  On my Advanced Mediterranean Diet, 300-pounders get 2,300 calories (men) or 1,900 calories (women). 

Although not stressed by Dr. Sears, my impression is that contestants exercise a huge amount. 

Go to the Sears link above and you’ll learn that all contestants are paid to participate.  In researching my Conquer Diabetes and Prediabetes book, I learned that the actual Biggest Loser wins $250,000 (USD).  Also, “The Biggest Loser” is an international phenomenon with multiple countries hosting their own versions, with different pay-off amounts.  A former Biggest Loser, Ali Vincent, lives in my part of the world and still has some celebrity status.

This TV show demonstrates that the calories in/calories out theory of body weight still applies.  Including the fact that massive exercise can help significantly with weight loss.  In real-world situations, exercise probably contributes only a small degree to loss of excess weight.  The major take-home point of the show, for me, is that you can indeed make food and physical activity choices that determine your weight.

Most of us watch too much

I know losing 50 to 10o pounds of fat (25–45 kg) and keeping it off for a couple years is hard; most folks can’t do it.  Do you think you’d be more successful if I gave you $250,ooo for your success?

Steve Parker, M.D.

5 Comments

Filed under Exercise, Weight Loss

Tagged as , , , ,

December 7, 2011 · 4:50 AM

Your Tax Dollars At Work: FDA Warns HCG Marketers

 

"It's been three months. That HCG should kick in right about now."

Ooooh!  I’m sure they’re shaking in their boots.

I ran across a patient in the emergency department a couple months ago who coincidentally happened to be taking over-the-counter HCG oral drops for help with weight loss.  She didn’t ask my opinion, so I didn’t give it.

Now the FDA has sent a stern warning letter to seven HCG diet marketers to cease and desist.  I started seeing ads for homeopathic oral HCG at least a year ago.  And the FDA is just now getting around to the letters?

The Science-Based Medicine blog can teach you about homeopathy.

Here’s a snippet from the first FDA link above:

Miller explains that HCG was first promoted for weight loss in the 1950s. “It faded in the 1970s, especially when it became apparent that there was a lack of evidence to support the use of HCG for weight loss,” she says.

The diet has become popular again and FDA and FTC are taking action on illegal HCG products. “You cannot sell products claiming to contain HCG as an OTC drug product. It’s illegal,” says Brad Pace, team leader and regulatory counsel at FDA’s Health Fraud and Consumer Outreach Branch. “If these companies don’t heed our warnings, they could face enforcement actions, legal penalties or criminal prosecution.” 

You think these HCG marketers didn’t know from the git-go that what they were doing was illegal?

I’d have thought the FDA already had enough poop to start enforcement actions.

But what do I know?

Steve Parker, M.D.

 

4 Comments

Filed under Drugs for Diabetes, Weight Loss

Tagged as , , , , ,

December 5, 2011 · 2:00 AM

What About Insulin Pumps?

Ever wonder what it’s like to get your insulin via a pump?  Tim at Shoot Up or Put Up shares his year’s worth of pump experience with the world.  Tim must have type 1 diabetes. He lives in the U.K., so you’ll see blood sugar levels in mmol/l instead of the U.S. standard of mg/dl.  To convert mmol/l to mg/dl, multiply by 18.

Steve Parker, M.D.

4 Comments

Filed under Drugs for Diabetes

Tagged as ,

December 3, 2011 · 12:35 AM

Does Olive Oil Protect Against Stroke?

Older adults with high olive oil consumption have a lower risk of stroke, according to French investigators.

The Mediterranean diet, rich in olive oil, has long been linked to lower rates of stroke and other health benefits.  The French researchers wondered stroke prevention might be attibutable to higher olive oil consumption.  Triglyceride esters of oleic acid comprise the majority of olive oil, and oleic acid blood levels reflect olive oil consumption. 

Have you heard of monounsaturated fatty acids?  Oleic acid is one.

Methodology

Over 7,000 older adults without history of stroke were surveyed with regards to olive oil consumption.  Oleic acid plasma levels were measured in over a thousand of the study participants.  Over the course of five years, 175 strokes occurred.

Compared with those who never used olive oil, those with the highest consumption had a 41% lower risk of stroke.  The researchers made adjustments for other dietary variables, age, physical activity, and body mass index.

In looking at the plasma oleic acid levels, those in the highest third of levels had 73% lower risk of stroke compared to those in the lowest third.

Comments

Results suggest that the olive oil in the Mediterranean diet  may help explain the diet’s protection against stroke.  They also support my inclusion of olive oil in the Low-Carb Mediterranean Diet and Advanced Mediterranean Diet.

Steve Parker, M.D.

Reference:  Samieri, C. et al.  Olive oil consumption, plasma oleic acid, and stroke incidence: the Three-City Study.  Neurology, Published online before print June 15, 2011, doi: 10.1212/WNL.0b013e318220abeb

3 Comments

Filed under Health Benefits, Mediterranean Diet, olive oil, Stroke

Tagged as , , ,

December 1, 2011 · 7:11 AM

The Wonders of Olive Oil

Laura Dolson has posted a good article on olive oil: health benefits, types, selection, storage, and cooking tips.

–Steve

2 Comments

Filed under olive oil

Tagged as ,