Your Fat (no, not YOU'RE Fat)

While attending medical school at the University of Cincinnati back in the 1970s, the faculty would occasionally warn us that “…about half of what we’re teaching you will be proven wrong in five years.” In hindsight, although that was a bit of an exaggeration, they were making an important point: knowledge grows, insights multiply, and soon science and medicine evolve to new understandings and practices. In other words they were saying, never be complacent and think that the answer has been found. Science is a process, not a religion.

One particularly good example of a changing scientific landscape is our knowledge and understanding of body fat (also know as adipose tissue). Three decades ago we were taught that fat was a dumb tissue unlike those making up sophisticated organs like the kidney, brain or heart, and it merely served as a depot for energy storage. The cells making up this tissue are called adipocytes and we now know they are far from dumb, and further, when enough of them gather together in certain places in your body this fat can actually control your destiny...no foolin'!

Please see illustration below:

Graphic from hypericum.com

The midsection fat (slang terms abound, e.g., jelly belly, beer gut, front porch, muffin top, bay window, love handles) is actually composed of two very different types of fat: the subcutaneous fat that lies just below the skin and pictured as light blue and the visceral fat which lies underneath the abdominal wall (which includes the muscle layer) and is pictured in dark blue. The subQ fat is the soft material that you can easily grab and hold--that is, unless you have a near-perfect six-pack or "washboard" set of abdominal muscles.

Below you can see two abdomens...the guy above has essentially NO subQ abdominal fat whereas the guy below looks like he put a few pounds on since college.


The image above is from here, and the one below is from here.

What has been learned in the past two decades is that the visceral fat, that is, the adipose tissue within your abdominal cavity actually acts as an endocrine organ and can have a significant effect on your metabolism. This intra-abdominal fat significantly increases the risk for cardiovascular disease, hypertension and diabetes.

One reason that the visceral fat has such a profound effect on our metabolism and disease risk is that the blood from this visceral fat drains directly into the liver, our master metabolic organ. Through the hormones that this fat secretes, it controls--among other functions--how our body reacts to the insulin that our pancreas puts out. Increased visceral fat increases the cell's resistance to the action of insulin; the pancreas senses this, and then ratchets up the amount of insulin it secretes. When the pancreas cannot keep up with the increased demand for insulin caused by this insulin resistance, type 2 diabetes develops.

The distribution of body fat is dependent on several variables including genetics, metabolism, hormonal balance, the presence of certain diseases, aging and sex. For example, when women go through menopause their fat distribution shifts from the periphery to the center, and they often get belly fat similar to that of overweight men.

Ok...so what does this all mean?

• First, understand that sit-ups will not give you a spot-burn and get rid of belly fat; you cannot tighten up what you can grab above the muscle layer--you must lose it through negative calorie balance


• If you distribute excess fat more or less evenly over your body and do not concentrate it in your abdomen you are less at risk for diabetes and cardiovascular disease


• You will lose fat in the order that you put it on--last on, first off


• If you have a family history of diabetes, hypertension, heart attacks or other cardiovascular disease, reducing abdominal fat should become a serious personal goal

© Copyright 2009 Doctor's Weekly Commentary

May not be reproduced whole or in part without citation and/or link to this site

The Wrath of Grapes

The Bible warned about it in Isaiah and Homer wrote of its most unfortunate effect, accidental death. It is the hangover, that acute post-alcohol morning-after illness that many of us first experience as undergraduates. The hangover differs, of course, from the effects of acute alcohol intoxication ("I promise...God...if you stop the room from spinning I'll never drink this much again") in that it occurs later on when your blood alcohol is zero and would pass a sobriety test. It also differs from the infamous post-red wine headache that is not related to the morning-after alcohol effect discussed here.

It is likely that the hangover is older than recorded time, in that it was first experienced in prehistory many times amongst peoples on different continents when they independently discovered (by accident) that fermented carbohydrates produced a substance that made you feel...how shall we say...unusual.


Moving from the Neolithic to the present, my good friend Donna N. asked me to try and separate out truth from fiction regarding this phenomenon. And the fact that Donna asked me about this subject does not indicate that she repeatedly drinks herself into a sorry state only to awaken the next morning feeling miserable; Donna is a modest drinker who nonetheless suffers these symptoms.


This illustrates an important point that will often run through these columns, namely that we all have highly individual reactions to environmental determinants of both our short- and long-term health. That's right, although "we're all different" sounds trite, it is certainly true when it comes to health and disease. So, while some of us will be "hungover" after two glasses of wine the night before, others can bolt out of bed at 6:30 the next morning--after having had three shots of tequila, two scotches and a brandy nightcap the night before--and get to the gym with no problem. On the other hand, there is evidence that the more one drinks, the more likely the occurrence of a hangover (what pharmacologists call a dose response), but this rule does not work for everyone.

The Symptoms

About 2/3 of sufferers will have a headache and just feel lousy overall ("poor sense of general well-being"). One-third will have diarrhea, whereas one in five individuals will have either loss of appetite, tremulousness or fatigue (though these symptoms can occur together). Ten per cent also complain of nausea (this seems a bit low to me!). These numbers come from a table in an article in the Annals of Internal Medicine that forms the main basis for this column.

Where do the Symptoms Come From?

One long-standing theory has been that the acute alcohol hangover is the first stage of alcohol withdrawal; that is, the syndrome alcoholics suffer when they abruptly stop drinking. While the hangover and withdrawal do share some symptoms (e.g., headache, fatigue and feeling lousy) this theory has been discounted; however, this hypothesis has likely contributed to the legendary "hair of the dog" treatment for hangovers (that is, having some alcohol the morning after) that should not be tried!

Alcohol ingestion decreases the secretion of an important hormone that helps control our body's water content, namely antidiuretic hormone. Therefore, if levels of this hormone decrease, water is lost through the kidneys since unopposed diuresis now occurs and dehydration results--with resulting symptoms.

Acetaldehyde, a product of alcohol metabolism, may also be responsible for some of the symptoms. Individually, we all produce varying rates of acetaldehyde depending on the genetically-programmed levels of the necessary enzyme that we possess. Another possible cause of hangover symptoms are compounds related to alcohol called congeners, and these are specific to the process whereby individual spirits are produced. Since "see-through" spirits (gin, vodka and rum) have less than the dark liquors and wine, it is thought that the former are better than the latter for avoiding hangovers.

Further suspects for the hangover symptoms are hormonal derangements, altered glucose metabolism and neurologic dysfunction. We likely will never know for sure what the most important cause(s) is (are) since this is not a high research priority of the NIH or the pharmaceutical industry.

What to Do

First, do not drink to excess; but, if a long night of festivities cannot be avoided, make sure you eat! Food in ones' stomach during times of ethanol ingestion has been associated with less in the way of hangover symptoms. Second, drink plenty of water (the water mixed in with the Scotch does not count) during your drinking, or at least before you go to bed that night. This will help offset the morning headache that is likely the result of the aforementioned dehydration. This should be especially adhered to whenever the drinking environment is independently associated with water loss (a long flight, a hot afternoon at the company picnic or a day at the beach).

Propranolol, a beta-blocker, has been tested to no avail for the treatment of hangover; glucose solutions have also shown no effect. Positive effects have been shown for certain NSAIDS (drugs in the ibuprofen/Advil class) and B-vitamins.

Recommendations

All right: you've awoken with a dreadful hangover. What to do?

• Have 8 ounces of water
• 20 minutes later, have another 8 ounces of water, this time accompanied by an NSAID (Advil or equivalent ibuprofen or the longer-acting Aleve; dose of ibuprofen 400 to 600 mg; be sure to take with at least 8 oz water for stomach protection)
• Do not take Tylenol or equivalent; not good for liver with the alcohol in the rear view mirror
• Take a multi-vitamin or B-complex (there is a small study that showed a positive effect here; at any rate, as my grandma would say: "It couldn't hurt")
• As soon as you feel up to it, have a banana, cereal or eggs over easy and some toast
• Continue to rehydrate with water

Here's to ya!

© Copyright 2009 Doctor's Weekly Commentary
May not be reproduced whole or in part without citation and/or link to this site

Thoughts on Swine Flu

Since the explosion of swine flu in Mexico and confirmed cases in California, Texas, New York, Ohio and Kansas, we need to take notice and calmly evaluate what we might want to do over the next few weeks as the situation evolves.

Description

Swine flu affects pigs and usually does not infect humans. This particular strain is a new one and contains genetic material from the avian flu virus as well as human inflenza. This newness presents a problem since the more unique a virus is, the less humans have been exposed to it in the past and the longer it takes to mount an effective immune response. For example, a significant outbreak of Hong Kong type A flu (designated by protein type H3N2) occurred in 1968, and I will never forget how ill it made me; however, that past infection will give me protection from future H3N2 flu appearances.

Bird or avian flu is H5N1, and this new swine flu is H1N1. The H and N are designations for specific proteins that are on the surface of the virus:




Symptoms

Many people call usual upper respiratory infections ("colds") the flu, although that is incorrect. Influenza is very different from the sniffles, mainly in how systemic symptoms predominate (fever, headache and muscle aches). It is said that this strain appears to have more gastrointestinal symptoms (vomiting and diarrhea) than the usual flu. Swine flu has a short incubation period (2-4 days) and an affected individual's contagious state will continue for several days even after the peak symptoms are over.

In Mexico, the most severely affected were people between 25 and 45 years of age, and this likely signifies that this age cohort has not been exposed to viruses that carry portions of the protein antigens that this particular virus contains. However, all of us are vulnerable.

It is also interesting to note that the 20 or so individuals affected in this country so far have manifested milder symptoms than the Mexican cases, but this is a small sample so far and things could change rapidly.

Finally, the flu shot you got this year is likely of no help at all with this strain.

What To Do

First: obtain prescriptions for either Relenza or Tamiflu so that you will have it and avoid the rush in case things get worse. Relenza is administered by inhalation (not recommended for asthmatics or those with other types of chronic lung disease) and Tamiflu is a pill. Both are administered twice a day for five days as therapy.

In areas where cases have been reported, wearing a painter's or surgeon's mask should be considered if attending an event with crowds. Wash hands after contact with people, and don't kiss hello or goodbye. If you're ill with possible flu, stay home (another good reason for filling the scrips now).


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May not be reproduced whole or in part without citation and/or link to this site

Those "Health" emails: What to Do if You Have a Heart Attack

Last week, my dear Cousin Cookie sent me a new “health” email, this one offering lifesaving information: how to give yourself CPR if you’re alone and having a heart attack.

A few weeks back I examined the claims made in an email about bananas, and now after reading this new one on cardiac emergencies, I realize why these "health advice" emails annoy me so much (aside from sometimes giving out dangerous advice): It’s their tone. The writers of these pseudo-informed pieces seem to say “The answers to these health-related issues are so simple; unfortunately, professionals like physicians, nurses, public health officials, drug companies, etc., aren’t going to give you this great information, so I have to.” There’s an all-knowing smugness that infiltrates these emails that compels me to look into their claims.

Here's the one Cookie sent (I had actually seen it before, but was happy she sent it now), with my comments in blue within. I have tried to maintain the colors and composition of the original email (which actually was a Power Point slide show complete with pictures, but I left them out):




Heart Attack Slide Show—Worth 45 Seconds of Your LIFE [email subject heading]



Let's say it's 6.15pm and you're driving home (alone of course) after an unusually hard day on the job.

You're really tired, and frustrated……

YOU ARE REALLY STRESSED AND UPSET ….

Okay...let's stop right here. The immediate implication is that being "stressed and upset" contributes to having a heart attack. This is the Hollywood effect--we have been taught over the years by TV and movies that psychological stress can give you a heart attack. But, we know that most people who have very severe psychological distress never get a heart attack, and while stress may contribute to some heart attacks, there is much evidence to suggest that it plays no part in the majority of their occurrences.

Most heart attacks occur in the morning, as do other cardiovascular events as seen in the slide below which came from Medscape:

However, it is thought that the higher incidence in the morning is due to the physical stresses of increased blood pressure and heart rate that occur at this time of day, rather than any emotional or psychological stress.

It is also interesting to note that there is a syndrome known as Takotsubo cardiomyopathy found mainly among depressed postmenopausal women that is associated with chest pains and symptoms of a heart attack, but is ultimately a benign condition. Okay...back to the email:

Suddenly you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw.


This is pretty good, but could have been better. The pain is often described as "crushing" but can also be felt as just chest "discomfort." It can radiate into your jaw, and certainly down your left arm, but need not, since chest pain alone is enough to raise a red flag.



You are only five miles from the hospital nearest your home.

Unfortunately you don't know if you'll be able to make it that far

WHAT TO DO ???

YOU HAVE BEEN TRAINED IN CPR, BUT THE GUY THAT CONDUCTED THE COURSE DID NOT TELL YOU HOW TO PERFORM IT ON YOURSELF !!!


Really? The writer knows that you were trained in CPR (when only a tiny minority of people ever receive that training). But, that dumb instructor didn't tell you how to do it to yourself! And why is that? Because it's IMPOSSIBLE, that's why.

When someone is in need of CPR (cardiopulmonary resuscitation) their heart has ceased pumping blood and their lungs have stopped inflating and deflating (i.e., they've stopped breathing). Your chest must be compressed over your heart with enough force to pump the blood out and you must inflate the lungs with a mask and bag or via mouth-to-mouth (they will deflate on their own) in order for the oxygen/carbon dioxide exchange to take place. You simply cannot do this on your own since by this time you're practically dead.


HOW TO SURVIVE A HEART ATTACK WHEN ALONE?

SINCE MANY PEOPLE ARE ALONE WHEN THEY SUFFER A HEART ATTACK, WITHOUT HELP, THE PERSON WHOSE HEART IS BEATING IMPROPERLY AND WHO BEGINS TO FEEL FAINT, HAS ONLY ABOUT 10 SECONDS LEFT BEFORE LOSING CONSCIOUS

WHAT TO DO ??
ANSWER:

DO NOT PANIC, BUT START COUGHING REPEATEDLY AND VERY VIGOROUSLY.

Do not panic is good advice, but if you think you're having a heart attack, the first thing to do is call 911! The SECOND thing you do is take a regular aspirin (NOT Tylenol or Advil, but aspirin). See here for the steps taken when a heart attack is suspected.

A DEEP BREATH SHOULD BE TAKEN BEFORE EACH COUGH, THE COUGH MUST BE DEEP AND PROLONGED, AS WHEN PRODUCING SPUTUM FROM DEEP INSIDE THE CHEST.

A BREATH AND A COUGH MUST BE REPEATED ABOUT EVERY TWO SECONDS WITHOUT LET-UP UNTIL HELP ARRIVES, OR UNTIL THE HEART IS FELT TO BE BEATING NORMALLY AGAIN.

DEEP BREATHS GET OXYGEN INTO THE LUNGS AND COUGHING MOVEMENTS SQUEEZE THE HEART AND KEEP THE BLOOD CIRCULATING. THE SQUEEZING PRESSURE ON THE HEART ALSO HELPS IT REGAIN NORMAL RHYTHM. IN THIS WAY, HEART ATTACK VICTIMS CAN GET TO A HOSPITAL

There are three basic outcomes for your heart's functioning when you have a heart attack (doctors call this myocardial infarction, but the spectrum of heart-attack like syndromes is referred to as acute coronary syndrome and differ mainly in how much of the heart muscle is damaged). First, your heart may have stopped beating completely, and back in my hospital days as a medical student we were taught to give the patient a sharp rap on the chest with the fist. We were told that this sometimes would get things going again. Therefore, there is no harm in doing this to yourself.

The second thing that your heart may be doing is called ventricular fibrillation and this is an electrical disturbance secondary to the heart attack that causes the ventricles of the heart to fire in an uncoordinated manner (the heart looks like a "bag of worms") and is incapable of pumping blood. This is the condition in which the chest is shocked with a defibrillator to restore normal rhythm.

The third thing that may happen is that the muscle is so damaged by the heart attack that although the heart pumps, the pumping is ineffective since the damaged area is large and does not contract. Again, the most important things to do are 1) call 911 and 2) pop an aspirin.

ARTICLE PUBLISHED ON N.º 240 OF JOURNAL OF GENERAL HOSPITAL ROCHESTER

This is just a lie. There was never any article about anything remotely tied to this topic by any journal from the Rochester Hospitals (see here for another discussion of this email and the false reference).

TELL AS MANY OTHER PEOPLE AS POSSIBLE ABOUT THIS.

IT COULD SAVE THEIR LIVES !!! DON'T EVER THINK THAT YOU ARE NOT PRONE TO HEART ATTACK AS YOUR AGE IS LESS THAN 25 OR 30. NOWADAYS DUE TO THE CHANGE IN THE LIFE STYLE, HEART ATTACK IS FOUND AMONG PEOPLE OF ALL AGE GROUPS.

Utter nonsense. The incidence of heart attacks has fallen dramatically over the past 50 years or so. When anyone under the age of 50 gets a heart attack, they essentially always have some particular genetic issue that separates them from others and greatly increases their risk.



BE A FRIEND AND PLEASE SEND THIS ARTICLE TO AS MANY FRIENDS AS POSSIBLE

What you might do is send this deconstruction to anyone you might have sent the original email. And, the best way to avoid heart attacks? Keep your BMI at 25 or below, stick with the gay caveman diet and work out at least 20 minutes for three times per week. If you're at special risk, speak to your doc about your possible need for a daily baby aspirin, lipid-lowering agents, etc.

© Copyright 2009 Doctor's Weekly Commentary

May not be reproduced whole or in part without citation and/or link to this site

Preventive Medicine 1: Diabetes

Within the past few weeks two good friends suggested topics for this column: Ruby Z. asked for an explanation of the differences between juvenile and adult-type diabetes, and Len K. suggested a discussion on which diseases can truly be prevented by dietary and/or other environmental manipulations. Since they are excellent suggestions, I will deal with both of these issues, which actually overlap in some important ways.

The two main types of diabetes have undergone several changes in nomenclature over the years: juvenile diabetes became insulin-dependent diabetes which then became type 1 diabetes; adult-onset diabetes became non-insulin dependent diabetes which finally became type 2 diabetes.

There were reasons for these changes (for example, although non-insulin dependent diabetes meant that persons with this type of disease did not depend on insulin therapy in order to continue living [unlike the insulin-dependent patients], it seemed confusing since about one-quarter of the so-called non-insulin dependent patients were indeed injecting themselves with insulin). Thus, the American Diabetes Association changed the names of these conditions over the years to minimize confusion.

We will use T1D to denote type 1 diabetes (the old juvenile type) and T2D as the short form for type 2 diabetes (the old adult-onset type). Persons with T1D are typically diagnosed as children at any age through teenage. They usually present with weight loss, increased thirst and urination, fatigue, glucose (sugar) in the urine, but will sometimes first come to medical attention in the emergency room in a semi-comatose or comatose state with a metabolic disorder secondary to the T1D known as diabetic ketoacidosis. Children under the age of two years are more likely to first be seen with this serious condition. Because individuals with T1D have no insulin at all, their blood sugars are sky-high when they are diagnosed.

Insulin, the master metabolic hormone that does much more than merely control blood sugar, is produced in special cells located within the pancreas known as beta cells. In T1D, these beta cells are destroyed by an autoimmune process, likely the result of a genetic susceptibility coupled with exposure to a specific viral infection or some other trigger (researchers have yet to identify the viruses or other infectious agents responsible for setting off the immune cascade). Without insulin, the T1D patients are unable use their blood sugar for energy, and need to switch over to burning fat for this essential process; as a byproduct of this fat-burning, they produce chemicals called ketones which can eventually lead to the ketoacidosis mentioned above.

In T2D, there is no autoimmune destruction of the insulin-producing beta cells; the T2D patients usually have normal or even elevated levels of circulating insulin, so absence of beta cells is not the problem. So, why do they get diabetes?

Most of these T2D individuals have what is labeled as insulin resistance. This is a condition where the cellular targets of insulin action (mainly the liver and muscle cells) require more insulin than is circulating to get the job done. This cellular resistance to insulin action signals the body that it needs more insulin in circulation, thus calling on beta cells to make more. Increased insulin resistance can arise in different ways, for example, certain medical conditions (e.g., testosterone deficiency) and certain drug therapies (for instance, some HIV/AIDS drugs) can cause it, but by far, the most common reason is obesity and associated physical under activity. And this is precisely why we now have an epidemic of T2D.

But wait just a minute, you might say: I know plenty of obese, sedentary people who do not have diabetes—what about them? And further, I know some non-obese adults who became diabetic later in life—what about them? The answers to both of these questions lies in genetic diversity. For the obese non-diabetic, it seems that these people are able to keep up with the increased demand that their bodies make on their beta cells for more insulin, while the obese diabetic cannot keep up, so they have a relative insulin deficiency even though they are still able to produce it.

The non-obese T2D patient appears to have a genetic predisposition towards either increased insulin resistance or (more likely) a defect in the ability of the beta cell in secreting insulin.

Well then, how do we prevent diabetes? For T1D, we do not know. Since it was known to be an immune-based condition, the National Institutes of Health (NIH) funded a large, expensive study which gave small amounts of oral or injected insulin to high-risk relatives of patients with T1D hoping to produce blocking antibodies and “immunize” them against T1D. These tactics failed.

Prevention of T1D is likely 5-10 years away, using information based on either genetic, immunologic or infectious disease findings. For T2D, it is a different story. One needs only maintain proper weight and exercise for just 20 minutes three times per week for the vast majority of Americans who are at risk for T2D. That’s it.

Now please read The Gay Caveman Diet I and II in order to prevent diabetes…

© Copyright 2009 Doctor's Weekly Commentary
May not be reproduced whole or in part without citation and/or link to this site

The Gay Caveman Diet: Part II

Last week we established that obesity has become a global problem and this may be related to the disconnect between the natural or wild-type diet meant for our species and what we eat now. And, as also mentioned last week, experts in nutrition, cardiology and diabetes recommend a diet even farther away from our natural, species-specific menu than what we would eat left to ourselves!

So, let’s see what’s happened in the 30 or so years ending in 2000 since the experts demonized fat and worshiped at the altar of complex carbohydrates:

As you can see, since the mid 70s, the proportion of fat in our diets has dropped significantly and the proportion of carbohydrates has increased significantly (the figure above is for men, but the graph for women is essentially identical). Now look at this graph, concentrating on the top line which shows the overweight plus obese American adults (overweight is defined as a body mass index [BMI] greater than 25; obese is defined as a BMI over 30; go here to quickly and easily calculate your BMI) :

The graphs are practically super-imposable. Think these trends might be related? It certainly does seem that when our dietary carbs began to move from about 41% of our caloric intake to about 49%, we started gaining weight (however, caution must be used because, as noted previously, association does not prove causality). With that being said, I do believe they are related. Why? Well, there are some corroborating points: reducing carbs might lead you to eat less total calories since low carbs and higher protein and fat are more satisfying so you experience less hunger and eat less than on a higher carb diet; for example, see here. And, there are positive metabolic changes that a low carb diet induces. Or, see here. But I digress…

The reason I began writing these two diet-related columns a few weeks ago was that a study published in the New England Journal of Medicine reportedly showed no difference in weight loss from diets containing low vs. high amounts of carbohydrates. In other words, calories are the only things that count. The popular press dutifully reported this (for example, see here and here) with the implication, of course, that the Atkins Diet (or any other low-carb diet) was mere hype and the only thing that counted were the total calories.

Here’s the primary author, Dr. Frank Sacks of Harvard interviewed in the NY Times:“It really does cut through the hype,’’ said Dr. Frank M. Sacks, the study’s lead author and professor of cardiovascular disease prevention at the Harvard School of Public Health. “It gives people lots of flexibility to pick a diet that they can stick with.”

Well, I guess that settles it, eh? You would have imagined that Dr. Sacks rigorously tested the most popular low-carb diets against the standard "balanced" calorie-restricted diets that nutritionists recommend and found them all equal. If you did, you would have been wrong; it is Dr. Sacks who is the party involved in "hype" here, hyping his study which sheds absolutely no light on the question dieters want answered: do low-carb diets work? What Sacks did was use diets where the lowest carb percent was 35% of daily calories, a percent not close to the Atkins’ number which is about 5% on induction (i.e., less than 20 grams of carbs/day for the first two weeks).

What makes this particularly galling is that neither Sacks nor any of the reporters differentiate their “low carbohydrate” diet from Atkins and just leave the implication out there that they tested the Atkins diet or one similar to it. In the Sacks study, he and his colleagues refer to studies that did show the Atkins diet superior to other diets (for example, here in the New England Journal of Medicine and here in the Journal of the American Medical Association), but they do not even hint that the carb content of the successful diets only contained about one-sixth the percent carbs as the lowest carb diet in his study. So, Sacks and the people that reported on his study all grossly misrepresented what was found by what they left out, i.e., the low carb diets tested bore no relationship at all to the Atkins and other very-low carb diets.

Why would they do this? What are their agendas?

Well, here’s what I think: dietitians, nutritionists and their physician fellow-travelers have all heavily invested in a few (purportedly) God-given truths about diet that they have pushed on us for decades. The most sacred tenets of this nutrition religion are:
I. Calories that cometh from any source (be they from fat, carbohydrates or proteins) are the same as they relate to thine weight and metabolism (The Holy Doctrine of the Immutable Calorie)
II. Complex carbohydrates are sacred (The Shrine of St. Pasta of Linguini) and fats are evil (for example, saturated are really Satan-ated fats and must be demonized at every turn) and
III. Raising the proportion of dietary fats and lowering dietary carbs will cause your cholesterol to go dangerously high (The Diet of (af)Firms (affirms what we believe, that is).

And, it turns out that just the opposite occurs with serum lipids when on Atkins.

This sclerotic thinking has helped lead Americans to be fatter than ever. And, the Academic Nutrition/Food Industrial Complex has so much invested in these Eternal Truths that they seem to feel that if they back down at all at this point their credibility will collapse. For example, the American Diabetes Association (ADA) recommends 45-60 grams of carbohydrates per meal. That is, about 600 calories of carbs three times/day, not counting snacks. If followed closely, that could result in more than 60% of calories from carbs (the ADA recommends 55-60% of total calories from carbs).

So what does this all mean? We're going to look at this in two separate parts: losing weight and maintaining weight loss (or normal weight). Maintenance of weight loss has been shown in study after study to be extremely difficult. Whatever method is used to lose weight, the great majority of people gain it back in a year or so: this is the greatest problem faced by dieters with good intentions.

So, I will dispose of the weight-loss part quickly: if you want to lose weight, that is, if you have flipped the switch in your head and agreed with yourself to really do it, use whichever method is most compatible with you. Whether it's the Atkins or South Beach, the Cookie Diet or NutriSystem, Weight Watchers, or even just staying on a 1200 cal/day diet, DO IT! Atkins works best for me, but they ALL work if you apply them with discipline. For maintenance, however, it's the Gay Caveman Diet (I mean Cavewoman too, but caveman is easier than caveperson.

Okay: first the gay angle. Back in the seventies there was a movie based on an off-Broadway show about a party held by a bunch of gay guys in NYC entitled The Boys in the Band. This was a mainstream, successful movie that was very funny, but sad and poignant at the same time. In one scene, one of the characters was verbally going after another, and during the tirade, he mentioned how Harold would starve himself only to eat like crazy at a weekend party. This stuck in my mind. So, here is the strategy for the Gay Caveman’s Diet:

During the week, eat like a caveman ( Loren Cordain's Paleo Diet is the one to look at) and stay away from dairy products, breads, pastas, cakes, cookies, pies, cereals, etc. Eat nuts, meats, fish, veggies, fruits, seeds. And on the weekend, have a slice of pizza, have that bagel, order the key lime pie or chocolate cake for dessert Saturday night....you get the idea. Caveman during the week, but a bit more self-indulgent on the weekend, applying the five-day discipline and two-day indulgence that some in the gay community use.

Now, you needn't be as strict as Dr. Cordain during the week, and you can modify your approach to cavemanism. For example, for a snack during the week before dinner, I have some cheese and pistachios, so overall, my Sunday night through Friday lunchtime is a cross between Atkins and the paleo diet.

And yes...no more daily bagels for breakfast during the week. And use low carb wraps or wheat bread for lunch sandwiches and stay away from Kaiser rolls--during the week. Take a bit from the gays and the cavemen and you may just be able to beat the odds and maintain your weight loss.

Full disclosure: Dr. Mennen has no financial interest in any of the diets, programs or issues mentioned in this column

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May not be reproduced whole or in part without citation and/or link to this site

The Gay Caveman Diet: Part I

Many Americans—and now, people all over the world—are literally eating themselves to disease and early death. Think for a moment about the people you know who lived or who are now living into their 80s or 90s: was—or is—there a fat one in the group? Probably not, and there’s a good reason for this: the overweight and obese do not usually live that long. You can go here and read an article in the New England Journal of Medicine that lays out the data that show the clear association between excess weight and higher death rates.

Obesity has now overtaken hunger as the number one nutritional problem worldwide. The December 11, 2003 issue of The Economist put it best:

”When the world was a simpler place, the rich were fat, the poor were thin, and right-thinking people worried about how to feed the hungry. Now, in much of the world, the rich are thin, the poor are fat, and right-thinking people are worrying about obesity.”

Why is there now an epidemic of obesity? Simply put (and I know you’ve heard this before) too much energy in (that is, we eat too much) and too little energy out (that is, we do not get enough activity). True enough, but it’s not quite the whole story. While calories in and out are certainly key issues, the types of foods (that is, the ultimate mixture of carbohydrates, proteins and fats, the macronutrients) we eat also play a significant role in setting various switches in our bodies, switches that control rates of metabolism, whether we burn carbs or fats for energy and importantly, our hunger level. So, how do we figure out what the right proportion of macronutrients should be in our diet? What should we eat?

A good place to start would be to consider what our species was built for, or put another way, what were our factory settings?

To answer this question, we turn to the late Ukrainian-American biologist Theodosius Dobzhansky who famously said:

Nothing in biology makes sense except in the light of evolution.

Therefore, if we’re trying to figure out what is natural for our species to eat, we need to look at the environment that we evolved into, the one that shaped us as a species and that we’ve lived in for the greatest time as a species.

Figuring out the proper diet for capuchin monkeys or polar bears or bullfrogs, we need only look at what they eat in their natural environments, be they rainforests, glaciers or Alabama lakes, and extract their wild diet from information gained by observation. However, for our species, Homo sapiens, things aren’t quite so easy. Because of our intelligence, we were able to evolve culturally and move away from the environment and behavior that evolutionary forces set for our genetic and biochemical machinery. The period of our species’ life that occupied more than 99% of our time on Earth was spent as hunter-gatherers, and not as moderns who do their hunting and gathering in supermarkets. Further, it was not even spent as agriculturalists, raising corn, rice or wheat; agriculture is only about 15,000 years old for us, a drop in the bucket compared to the 2.5 million years we spent as hunter-gatherers.

We cannot, however, teleport ourselves back, say, 300,000 or one million years and see what our forbears were eating, so we need to do the next best thing and catalog what modern hunter-gatherers eat and infer our natural diet from those data. Luckily, this has already been done. (Clicking on the link will take you to a site where the original article will automatically download). What these investigators found when they examined the diets of 229 hunter-gatherer tribal societies was a menu vastly different from what organizations such as the US Department of Agriculture, the American Diabetes Association and the American Heart Association recommend. Hunter-gatherers get about 25% of their calories from carbohydrates and about 30% from protein (although variation exists among different tribal societies depending on where they live).

For example, the American Heart Association recommends 15% of energy from protein, 55% from carbohydrates and 30% from fat. It would have been impossible for a hunter-gatherer to achieve this mixture of macronutrients because there is no way in the wild to get concentrated forms of carbohydrate. That ability only came recently, with the advent of agriculture, where we could grow wheat or corn, grind it up, and make tortillas or bread and get a big dose of carbs.

Not only are processed carbs unnatural (defined as coming from anything other than unprocessed fruits, vegetables, grains, nuts or legumes), but so are all dairy products! Cavemen and women did not drink milk, churn butter or produce cheese.

Okay, you may say, I see where you’re going with the caveman bit, but what does gay have to do with anything? For that and whether Dr. Atkins was right or wrong, and how the nutrition establishment reacts to all of this you will have to come back here next week.

Acknowledgement to Bob Hodgen for calling our natural state “factory settings” which I used above

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