Obesity (Again).

Being overweight remains in the news, with bulk of opinion being slanted toward the view that people who are in this state (obesity and the UK) are largely responsible for their own predicament. I not only find that somewhat cruel, but also founded in poor or even bad science.

I've already said in my previous post that is unlikely to be the fault of the 'fatties' but more of those who are advising them to eat a 'healthy diet' which in the DH 'speak' will largely be carbohydrate based and 'low fat'. In the latter's case that will be monounsaturated fats and polyunsaturated fats instead of saturated fats. Plant based oils (generally) then, in lieu of animal fats. This last bit of advice seems to fly in the face of the fact that homo-sapiens have some problems in metabolising some fats with CIS bonds (and even more problems with fats containing trans bonds). Animal fats such as lard, tallow and dripping, also contain quite large amounts of mono and polyunsaturated fats despite their undeserved reputation for being  entirely 'saturated'. Yet, it is patently obvious that this advice to avoid saturated fats and animal fats in particular, has done nothing to reduce the incidence of obesity and the associated risks of Diabetes, CHD, CVD and Cancer, because it continues to increase.

Looking in more depth at Nutrition and it's relationship with obesity we have to consider the mechanisms involved in becoming overweight. 'Hyperphagia' is synonymous with obesity, that is over-eating in simple terms. It can be a result of some genetic disorders or Diabetes, especially in Type 1's who inject insulin. It also manifests itself in Type 11's who are in advanced stages of the disease. High Carbohydrate diets typically can bring about this problem due to increased gene expression of the neuropeptide Y(NPY) in the hypothalamus, and causing a reduction in the expression of the hormone (CRH). What that means is that the brain is increasing its output of orexigenic (hunger generating) agents and decreasing output of anorectic (hunger suppressing) agents. This is how the brain stimulates our nutritional needs of hunger and satiety. So, it is evident that early stage diabetics (metabolic syndrome), Type 11 diabetics and the obese subjects will be permanently hungry. If, however we feed them a diet of fats and proteins and eliminate most carbohydrates, this phenomena is suppressed in a more 'normal' manner and appetite is curtailed at a much earlier stage in eating.

Forcing people then, to eat a 'healthy diet', two thirds of which is carbohydrate based, if we include the vegetables and fruit, is contributing to the obesity that it is meant to be reducing! Once we become 'insulin resistant' as well, we can arrive at a position where almost all intake is rapidly stored as fat, despite the fact that we are hungry, even starving, and our ability to 'feel full' is almost non-existent. Low carb diets, especially in the context of this section of society, are proven to have a considerable success in enabling obese and diabetics to attain an optimal weight and, more importantly, to maintain it. The mechanism is not fully understood, and there is considerable conjecture amongst biochemists that it may be down to ' metabolic advantage' with fats and proteins, or the satiety afforded by this food group actually reducing the calorie intake, or even the fact that increasing saturated fat intake, replaces vegetable/seed oil intake (generally Omega-6's) and that in itself helps to reduce obesity. Many hypotheses are propounded, reputations impugned, the science examined, re-examined and much that is known is based upon animal studies, not humans, but whatever the mechanism, it is certain that for most, a low or minimal diet of carbohydrates does bring about considerable weight loss and a 'normalisation' of blood sugars in most diabetics (Type 11's). Dogmatic views about diet and nutrition, without examining the science involved and ignoring outcomes, is what has brought about the ever rising tide of obesity and diabetes.

Those of us who are 'insulin resistant' respond to this more readily than any other cohort, and it is not a panacea for all, by any means, because all of us reach a plateau with our bodies, some quicker or slower than others. In fact being slightly over weight has some advantage for humanoids and was likely a defence mechanism against famine or periods when food was not abundant. The body in fact conserves energy in fat reserves and is quite loath to give them up, which is why so many dieters fail in their endeavours to lose weight because basal metabolism 'slows' as we begin to diet, especially with low fat/low calorie diets. Your body is attempting to 'save' you from yourself.

Completely Unnecessary Picture of Low Carber J- Lo

So why does mainstream advice for lowering the risk of obesity and the morbidity's that stem from it, continue to advocate measures, that are most likely to fail either in the short or long term? Well having your beliefs undermined, no matter how much evidence exists to prove you are wrong , is hard to bear, even for Doctors and Scientists.Being told what you want to hear, is comforting and reinforces preconceptions at the expense of the truth. Selection bias is something we are all guilty of at some time and I admit to it myself. We should not defend the indefensible but all too often the truth becomes clouded by hyperbole. Scientists delight in the rigour of 'peer review' often tearing quite good studies to pieces because 'they can' rather than due to any poverty of evidence. Equally as well they often lose the ability to reflect that 'correlation (and observation) does not prove causation' in the data they present. Which is why we get 'scare' stories extrapolated from views and opinions of Scientists, rather than hard evidence of harm.

It should not be countenanced and I have always believed that all of us  need to be as objective as possible in our search for truth, even when that truth challenges our basic and long held belief system. 'On the word of no-one' (Nullias in Verba), only the proof, is what we need.

This post has been devoid of links thus far. I've saved them  to the end. I've used some before, so don't be surprised to see them again. They all possess the 'gold standard' of trials, they are RC T's.

1. Brehm BJ, et al. A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women. J Clin Endocrinol Metab 2003;88:1617–1623.
2. Samaha FF, et al. A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. N Engl J Med 2003;348:2074–81.
3. Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr. 2003 Mar;142(3):253–8.
4. Aude YW, et al. The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat. A Randomized Trial. Arch Intern Med. 2004;164:2141–2146.
5. Volek JS, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutrition & Metabolism 2004, 1:13.
6. Yancy WS Jr, et al. A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia. A Randomized, Controlled Trial. Ann Intern Med. 2004;140:769–777.
7. Nichols-Richardsson SM, et al. Perceived Hunger Is Lower and Weight Loss Is Greater in Overweight Premenopausal Women Consuming a Low-Carbohydrate/High- Protein vs High-Carbohydrate/Low-Fat Diet. J Am Diet Assoc. 2005;105:1433–1437.
8. Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and learn Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women. The a to z Weight Loss Study: A Randomized Trial. JAMA. 2007;297:969–977.
9. Dyson PA, et al. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabet Med. 2007 Dec;24(12):1430-5.
10. Shai I, et al. Weight loss with a low-carbohydrate, mediterranean, or low-fat diet. N Engl J Med 2008;359(3);229–41.
11. Krebs NF, et al. Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents. J Pediatr 2010;157:252-8.
12. Summer SS, et al. Adiponectin Changes in Relation to the Macronutrient Composition of a Weight-Loss Diet. Obesity (Silver Spring). 2011 Mar 31. [Epub ahead of print]
13. Daly ME, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes–a randomized controlled trial. Diabet Med. 2006 Jan;23(1):15–20.

5 A Day and Other Urban Myths

In the UK, politicians feel it incumbent upon themselves, to dictate lifestyles and healthcare for their citizens. They develop quangos to promote these objectives and protocols to achieve them, are foisted onto often overworked Doctors in the form of QOF's ( quality outcome frameworks ). The Doctors involved are rarely, if ever consulted to see if these are of value to his/her patient cohort and most will follow the dictat, either because they can't be arsed to check the science, or the money's too good to turn it down.

We also have that illustrious body, the Food Standards Agency, who exhort us to get our '5-a-day', take exercise and eat a 'healthy' balanced diet which shuns virtually all forms of fat. Well, is there any use in doing this or not and where does the information upon which it's based come from ? It was, to all purposes plucked from the ether. The 'balanced diet' advised, is largely based upon  limited protein and large amounts of starches and very limited fats and certainly no saturated fats. This is lunacy of the dangerous kind and all it's likely to achieve, especially for the overweight, middle aged, is a descent into obesity and/or diabetes. It seems that this Agency, with its vast budget for TV and Newspaper advertising, is isolated from the real world and knowledge of  the rising tide of obesity that Western Society is seeing, along with little in the way of a reduction in CHD and CVD (heart disease) together with strokes.

Since this dictat to the proletariat, was formulated in the 1980's to lower these disease factors, things have steadily become worse, yet no one seems to see a causal link. Surely, it's intuitive that if a policy is pursued, that after 30 years is yielding no fruit (sic); in fact is worsening a situation, then is it not time to halt and at least review the position ? Is it not sensible when one is in a hole to cease the excavation process (and review the depth) ?
The arch devil, most hated of all is fat, particularly saturated fat and we are all ordered to cease it's consumption because our arteries are clogging up with it, just like those water pipes in hard water zones. They even use this as an illustration in the advertisement. It's viewed as the ghost at the feast; the elephant in the room and we will suffer long and painfull deaths if we even look at dripping. The elevated lipids (fats) consumed are held responsible for just about everything that goes wrong in the human body, especially CHD, CVD, Stroke and Cancer. This has spawned an industry devoted to low fat products, cholesterol reducing supplements (even magarine!). low or zero fat milk and worst, soya milk!

This is frankly complete and utter tosh and neatly brings us to the belief that fat and cholesterol are the same, which they aren't. Cholesterol is the essential steroid metabolite found in all cells in animals and is transported throughout the body in blood plasma. Without it we are all dead. We could not absorb fat soluble vitamins, manufacture any steroid hormones or have a beating heart. It is more important than almost any other element of our cellular make-up and is largely, but not completely made in the body. Except in incredibly rare cases we all have the correct amount to sustain our lives. Whilst it is associated with LDL and HDL it is not either of these and elevated levels of these lipoproteins does not confer any real indication of health or otherwise.

Before every one starts to nod off  lets get back to fat. Fat does not instantly turn into cholesterol, in fact we could not eat enough of any fat or any food come to that, that would supply our daily needs for cholesterol. It is, in the main, synthesised in the liver, or in fact every cell in our bodies except the brain. If you eat less cholesterol yielding foods your body simply compensates by producing more of it internally. If, however you eat more and more starches (=carbohydrates = glucose) you will in fact become fatter as a result and likely increase your risk of the killer diseases including of course diabetes. This simply is because our bodies cannot tolerate large amounts of glucose yielded by starches without sending them for storage and all storage of energy is in the form of lipids or glycogen. We are in fact quite primitive beings and have not yet evolved to a wholly starch based diet because we are only a spear throw from our ancestors who largely lived on fats and protein. Grains, potatoes,pasta and rice are an anethema, to our metabolism and together, with the vast amounts of sugar and fructose we consume have been largely responsible for the inexorable rise in obesity.

We get fructose from juices, fruit, especially apples, pears etc together with grapes and other exoctics like pineapple and bananas. In small quantities they do little harm to normal diets although fruit juice is a problem because of its concentration of the natural sugar fructose. Now that most soft drinks makers use cheaply produced high fructose corn syrup (HFCS) as a sweetener, the situation is worse. Even sugar (sucrose), being a disaccharide needs to be metabolised by division into glucose and sucrose. Fructose of course already is. So high intakes of fructose, found in juices, soft drinks and of course fruit in varieing quantities is not really a good route to health. This is especially true of juice, as it is not something that was available much in the past, but is now,  by the intervention of modern production methods. It is of course, highly concentrated fructose and is often fortified with additional sugars. So whilst exhorting us to cut down on sugars, we are also told to drink juice and eat fruit which in effect cancels out the effort we make to kurb (our often ) 'sweet tooth'. It is highly contradictory, but the logic seems to escape those that advocate it !

Whilst I would not suggest the abandonment of fruit, I would advocate caution in the extreme. Berries and small fruits like grapes in limited amounts, confer other vitamins and essentials, that are good for you, provided they are used sparingly. Vegetables, generally green leafy types, do the same with little carbohydrate content. Root vegetables as they are pretty much like potatoes, and are very high in starch. The odd apple or pear or bananas too, are useful, especially the latter, if not too ripe, as this increases the fructose considerably. But, 'five-a day' is stretching healthy intake too far.

Primitive Northern humans, did not eat a diet, especially in Winter, high in any carbohydrates especially sugars and prior to the 2nd World War when we still had a very low carbohydrate intake, there was almost no discernable heart disease. Many Doctors went through their whole careers without seeing a single case, unless it was (rarely) triggered by Rheumatic Fever or some other disease. Today, you would be hard pressed to find one that hadn't handled hundreds. Does this 'paradox' together with others in Science, such as the French paradox, not impinge on the pointy heads at the DofH or the Food Standards Agency. Are they so sure of their ground, that they do not need to read the science, the trials, the refuting evidence that continually highlights the facts of the diet-fat-heart hypothesis as being completely wrong ? Or does this dept. and other servants of the people live entirely in a vacuum of denial ?

I suggest that they read some science, especially this;-
http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27725v1

It lists the meta-analysis of  twenty one studies involving 347,747 subjects over 5-23 years and concludes that dietary saturated fats are not linked to an increased risk of CHD or CVD. No doubt no equivocation. It is the most recent in a long line of scientific evidence that tells of the myth that it all is.

So tuck into the bacon and eggs with a light heart and in the knowledge that you 'do no harm' which is more than the buggers that are telling you otherwise do.