Archive for June, 2012

Two studies involving low-carb diets made headlines this week.  One suggested a low-carb diet may provide a metabolic advantage, while the other suggested a low-carb diet may kill you.

Let’s start with the good news:

Low-carb diet burns the most calories in small study

A new study is raising questions about the age-old belief that a calorie is a calorie.

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.

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.

The diets had the same number of calories, but the fat, protein and carbohydrate content varied. Those diets:

•A low-fat diet which was about 20% of calories from fat and emphasized whole-grain products and fruits and vegetables.

•A low-carb diet, similar to the Atkins diet, with only 10% of calories from carbohydrates. It emphasized fish, chicken, beef, eggs, cheese, some vegetables and fruits while eliminating foods such as breads, pasta, potatoes and starchy vegetables.

•A low-glycemic index diet, similar to a Mediterranean diet, made up of vegetables, fruit, beans, healthy fats (olive oil, nuts) and mostly healthy grains (old-fashioned oats, brown rice). These foods digest more slowly, helping to keep blood sugar and hormones stable after the meal.

Findings, published in this week’s Journal of the American Medical Association: Participants burned about 300 calories more a day on a low-carb diet than they did on a low-fat diet. “That’s the amount you’d burn off in an hour of moderate intensity physical activity without lifting a finger,” says senior author David Ludwig, director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital.

Now, before we all jump up and down and yell “Hallelujah!” we should keep in mind that a study population of 21 is pretty small.  The smaller the study population, the more likely a significant difference in the results is due to chance.  That’s just basic statistics.  If I flip a coin four times and it comes up heads three times, I can’t declare that my coin will come up heads 75% of the time.  My sample size was too small.  If it comes up heads 750 times out of a thousand, now we’re talking.

With that caveat out of the way, it was a controlled clinical study and does suggest a low-carb diet might provide a metabolic advantage.   That would certainly fit with my experience.  I always found it difficult to lose more than 10 pounds on a low-fat diet, and I had to put up with being hungry most of the time to achieve even that modest result.

I wasn’t hungry while losing weight on a low-carb diet, and this study hints at what I believe is the reason:  fuel availability.  If you burn more calories on a low-carb diet than on a low-fat diet, even at the same caloric intake, then your body is either storing less of what you eat or tapping more of what you’ve already stored.  Either way, your cells are getting more fuel, which means your body is less likely to slow your metabolism in response to what it considers a fuel shortage.

I think it’s significant that the dieters had already lost an average of 30 pounds before being divided into the three diet groups.  To keep your blood sugar within the biologically safe range, your body needs to switch between storing fatty acids when blood sugar goes up (so you’ll burn the excess glucose first), then releasing fatty acids as blood sugar goes down (so it doesn’t drop too low).

I believe what some people call a set point is related to our ability to release fatty acids at a rate sufficient to supply us with fuel when blood sugar begins to fall.  Obese people release as many fatty acids on average as non-obese people, but here’s the kicker:  they require more fat mass to do so.  Each unit of fat releases fewer fatty acids, so they need more body fat to release the same number of fatty acids as a thin person.  So at some point, shrinking the fat mass means releasing fewer fatty acids than the body needs to keep blood sugar stable.  That’s when the body rebels and slows down the metabolism (and ramps up hunger) instead of allowing the glucose/fatty-acid balancing act to go all out whack.

Obese people who’ve already lost 30 pounds are more likely to be approaching the point of biological rebellion than people who just started dieting.  That’s where the low-carb diet might provide a metabolic advantage.  By keeping insulin levels lower, the low-carb diet would enable a dieter’s shrinking fat mass to continue releasing fatty acids at the necessary rate.  No fuel shortage, no cellular-starvation response, no slowing of the metabolism.

Naturally, The Usual Suspects don’t agree:

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.”

Fuel availability isn’t about magic, Dr. Bray.  It’s about biochemistry.

George Bray is what I’d call an intelligent imbecile. He’s been promoting high-carb and low-salt diets for years and plays games with his study designs and data to support his beliefs.  It was Bray, for example, who declared that macronutrient ratios make no difference for weight loss –  after he conducted a study in which protein and fat intake were altered, but carbohydrate intake stayed the same.  (Uh … wouldn’t you want to try messing with that variable too?)

It was also Bray who conducted the study of salt and hypertension that I mentioned in my Science For Smart People speech.  He put two groups of people on two different diets.  One diet was high in sugar and other junk, the other was more like a Mediterranean diet with lots of vegetables and no sugar.  Bray had each group consume a lot of salt with their diets for several weeks, then measured their blood pressure.  Then he had each group consume very little salt with their diets for several weeks and measured their blood pressure again.  Within each group, the average drop in blood pressure after severely restricting salt was slightly less than three points.  Whoopie.

That wasn’t the result Bray wanted, so in the study’s conclusions he compared blood pressure readings for the junk-food dieters after their high-salt phase to the blood pressure readings for the Mediterranean dieters after their low-salt phase, found a significant difference, and declared it evidence that salt causes high blood pressure.   That’s like comparing the livers of heavy drinkers who consume a lot of salt to the livers of moderate drinkers who consume very little salt and declaring that salt causes liver damage.

But enough about Bray.  There’s more bad science to dissect in the other study that hit the news this week:

‘Atkins’-Type Diets May Raise Risk of Heart Problems

Women who regularly eat a high-protein, low-carbohydrate diet may be raising their risk of heart disease and stroke by as much as 28 percent, a new study suggests.

Although the absolute increase in risk is small — four or five extra cases per 10,000 women — many young women try the Atkins diet or similar regimens and could be setting themselves up for cardiovascular problems later in life, the researchers noted.

“Low-carbohydrate, high-protein diets are frequently used for body-weight control,” said lead researcher Dr. Pagona Lagiou, assistant professor of epidemiology at the University of Athens Medical School in Greece. “Although [the diets] may be nutritionally acceptable if the protein is mainly of plant origin, such as nuts, and the reduction of carbohydrates applies mainly to simple and refined [carbohydrates] like unhealthy sweeteners, drinks and snacks, the general public does not always recognize and act on this guidance.”

That’s because we recognize the guidance as bull@#$%, Dr. Lagiou.  People weren’t living mainly on plant proteins back when rates of heart disease were much lower.

For the study, Lagiou’s team collected data on the diets of more than 43,000 Swedish women who were between the ages of 30 and 49 at the start of the study.

Over an average of 15 years of follow-up, there were more than 1,200 cardiovascular events, including heart disease and stroke. There were more of these events among the women who followed a high-protein, low-carbohydrate diet than among women who didn’t, the researchers found.

Compared with women who veered furthest from the high-protein, low-carbohydrate diet, women who followed the diet most closely increased their risk by 28 percent, even after other risk factors, such as smoking, drinking, hypertension, exercise and fat intake, were taken into account, the researchers noted.

I’m sure you’ve already spotted this study for what it is:  an observational study (strike one) based on food-recall questionnaires (strike two).  We don’t know if the participants accurately recalled what they’d been eating over the years (not likely), we don’t know what kinds of fats the so-called Atkins dieters consumed, and we don’t know if the people on the “high protein” diet ate a lot of meat because they believed it was good for them, or if they’re don’t-give-hoot types who believed red meat is bad for them but ate it anyway.  Those are two totally different types of people.  Since this study began 15 years ago, long before the low-carb/high-fat craze took off among health-conscious Swedes, I vote for the latter.

Another expert, Samantha Heller, an exercise physiologist and clinical nutrition coordinator at the Center for Cancer Care at Griffin Hospital in Derby, Conn., said “the results of this study are not surprising.”

Popular high-protein diets inevitably include an abundance of cheese and red and processed meats, and a dearth of healthy carbohydrates such as whole grains, vegetables, legumes and fruits, she said.

First off, Ms. Heller, the low-carb diets most advocates recommend aren’t “high-protein.”  They’re high-fat.  And secondly, why it is “inevitable” that those diets will include an abundance of cheese and processed meats?  I eat a bit of cheese and almost no processed meat whatsoever.  And if you believe whole grains are “healthy carbohydrates,” I suggest you read Wheat Belly.

Someone sent me a link to the full study, so I read it.  Here are some interesting numbers if we choose to assume (for no apparent reason) that the food-recall questionnaires were an accurate accounting of what people ate.

The researchers divided the women into groups based on carbohydrate and protein intake, but not fat intake.  So their scale went from high-carb/low-protein to low-carb/high-protein.  The researchers declared that the Atkins-type diet increased risk of heart disease and stroke, but the figures for strokes are laughable.  In the high-carb diet group, there were 3.1 ischemic (blood clot) strokes per 10,000 women.  In the high-protein group, there were 5.2 per 10,000 women.  So the actual difference (as I like to pound home in Science For Smart People) is 2.1 ischemic strokes for every 10,000 women.  If we take those odds and express them as percent, here’s what we get:

High-carb diet:  0.031%
High-protein diet:  0.052%

Yee-ikes, my Swedish lady friends.  (Yes, Katarina, I’m talking to you.)  Better lay off the “high-protein” foods.  Your absolute odds of an ischemic stroke will go up by two one-hundredths of one percent.  Oh, and your absolute odds of a hemorrhagic (vessel-bursting) stroke will also go up by one one-thousandth of one percent, according to the study data.  Expressed as the relative risk that researchers love to toss around, that’s a 12% increase (0.9 per 10,000 vs. 0.8 per 10,000), so I’d be worried if I were you.

Since the headlines were about the increase in risk for heart disease, let’s look at those numbers.  In the high-carb group, there were 8.4 cases of heart disease per 10,000 women.  In the high-protein group, there were 12.6 cases per 10,000 women.  So expressing the odds as percentages:

High-carb diet:  0.084%
High-protein diet:  0.126%

Even if you accept that the food-recall questionnaires were accurate, that the “high-protein” diet was actually an “Atkins-like” diet (not just people eating a lot of processed meat), and that these figures are actually telling us something about cause and effect (which an observational study cannot do), we’re looking at an absolute difference in the odds of about four one-hundredths of one percent.

In order to stay lean and continue feeling strong and energetic, I’ll roll the dice and take those odds.  I have a feeling I can beat them.

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When someone orders a DVD or t-shirt through the blog, I receive an email notification of the order from PayPal.  At least that’s how it’s always worked.

In visiting our PayPal account today to find order information for someone who requested it, I discovered that we’ve received quite a few orders in the past 10 days or so that never made it into my email inbox.  Strangely, a few others did.  I thought we were just having a slow week, but apparently somewhere in the flow of information from PayPal to our web provider to me, the emails either weren’t generated or ended up getting blocked.

I’ve been calling tech-support people to track down the problem.  In the meantime, I’ll copy and paste the order information from our PayPal records into our mailing program and get them all out the door ASAP.

I apologize for the delay, and as always I’m grateful for all the orders.

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I’ve mentioned before that when doctors or nurses ask me what prescription drugs I’m taking and I answer “none,” they seem surprised.  A couple of you made the same observation in comments.  That got me wondering what percent of people, say, over the age of 50 are taking some kind of prescription medication on a regular basis.

It took a little more digging than I expected to find an answer.  The first source that popped up in my Google search was a CDC report on what percent of Americans have taken at least one prescription drug in the past 30 days.  The answer was nearly half, but that’s a useless bit of data for answering my question.  I’m taking a prescription drug right now to treat an infection, but I don’t take one on a regular basis.

The same CDC report also suffered from useless statistical groupings.  For example, it grouped the population by age like this:

0-11
12-19
20-59
60 and over

Going from the 20-59 group to the 60 and over group, prescription drug use in the past 30 days jumped from 48% to 88%.  Wow … we must really fall apart after we turn 60, right?

No, of course not.  Lumping 57-year-olds together with 22-year-olds is ridiculous when it comes to reporting on prescription drug use.  The people I know who take prescription drugs on a regular basis started doing so sometime after age 40.

I finally found relevant data about regular drug use in US News article and in a report published by the AARP.  It isn’t a pretty picture.  As US News reported:

Today, a full 61 percent of adults use at least one drug to treat a chronic health problem, a nearly 15 percent rise since 2001.  More than 1 in 4 seniors gulp down at least five medications daily.

An adult, of course, is anyone over the age of 18.  That doesn’t narrow it down much.  AARP had better figures for people in my age bracket, i.e., adults over the age of 50:

The vast majority of Americans age 50+ (85%) say they have taken a prescription drug in the past five years, and three-fourths (76%) say they are currently taking at least one prescription drug on a regular basis.

So yes, those of who make it past age 50 without taking at least one prescription drug on a regular basis are in the minority, if not exactly unusual.  That’s sad.  The figures are even more depressing for the over-65 group:

Americans age 65+ (87%) are even more likely to say they take a prescription drug on a regular basis than those between the ages of 50-64 years (67%).

Yee-ikes.  Gather up a group of 10 retirees, and the odds are that nine of them are taking some kind of drug every day.  I plan to the one who doesn’t.

Those who say they are currently taking prescription drugs regularly say they take on average four different prescriptions drugs daily.

Scratch what I said above.  Gather up a group of 10 retirees, and the odds are the most of them are taking several drugs every day.

Overmedicating is a particular problem for seniors, more than half of whom take three or more medications per day. “The drug-drug interactions can be worse than the disease,” says John Morley, director of geriatric medicine at the St. Louis VA Medical Center. And too often, he adds, “doctors seem to suspend common sense” when devising a treatment plan. For example, they prescribe Aricept for Alzheimer’s patients and then treat a frequent side effect, urinary incontinence, with an anticholinergic like Enablex or Ditropan whose side effects include delirium, confusion, and memory loss. A current concern among public health experts is the use of antipsychotics in nursing homes to treat anxiety, confusion, and irritability, all frequently triggered by other medications.

Yup, people are taking drugs to treat the side effects of taking drugs.  Here’s one the US News article didn’t mention:  nearly 45% of Americans over the age of 60 are on a statin.  How many of those people are also on a painkiller to treat muscle and joint pain that their doctors haven’t traced to the statin?  I don’t have data on that, but my guess is that it’s rather a lot.

You could make a credible argument that statins are beneficial for one particular group of people:  men under the age of 65 who already have heart disease.  (And then I’d argue in reply that most of those men could achieve greater benefits with a change in diet.)  But there’s no way on God’s Green Earth that 45% of the people over age 60 are benefiting from beating down their cholesterol.  Most are wasting money at best, and paying to suffer needless side effects at worst.

Many medications serve an important purpose, as I was reminded this week.  If you’ve got a bacterial infection, an antibiotic is a blessing.  Some people will require drugs to control high blood pressure, high glucose, pain, seizures, etc.  no matter which diet they adopt.

But when nearly nine out of 10 seniors are taking prescription drugs, that’s not a blessing.  That’s a medical system treating lipid panels instead of heart disease.  That’s a medical system largely treating the effects of sugars, grains and processed seed oils in our diets — not the natural effects of living for more than 65 years.

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As you can see from the slightly fuzzy picture below, the infection seems to be in rapid retreat.  The infected area is just as large, but the swelling has gone down considerably and the redness has faded to a soft pink.

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Since a couple of you asked for progress photos:

(Wednesday evening, above.)

(Friday morning, above.)

You can see how much farther the infection has spread down my arm since I took the first photo on Wednesday.  That, along with the throbbing, is what convinced me to stop assuming it would just go away.  On a positive note, the redness appears less intense to me this morning, 12 hours into my antibiotic treatment.

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I finally decided to see a doctor about the post-sting swelling in my arm. I’m not a big fan of running to the doctor for every little thing, but when the red area spread past my elbow and my arm began to throb, I was convinced.  So I left work early and went to a Vanderbilt-run clinic.

Conversations with the nurse before seeing a doctor are always fun:

“What medications do you take?”

“None.”

“Did you say none?”

“Yes, none.”

“Who’s your primary doctor?”

“I don’t have one.”

“Mr. Naughton, are you some kind of weirdo?”

“Yes, ma’am.”

Okay, she didn’t ask that last question, but I saw the look.

The doctor said the bright red patch is probably an allergic reaction to a sting, while the swollen (and expanding) red-pink area is definitely an infection. Apparently when nasty little insects sting us, they sometimes push bacteria into the wound.

“I don’t like taking antibiotics.  What’s the danger of waiting this out?”

“The infection could move into your lymphatic system, and then the treatment will be a lot worse than taking pills. You don’t want to risk that.”

So it was off to a Walgreens for the antibiotic and a steroid cream. I had to wait awhile for the prescription to be filled, so I grabbed a copy of their free magazine for diabetics to read.

Ugh. No wonder people are confused. Most of the articles were written by the same two authors (a nurse and a nutritionist), and I’m not a fan of either one. Here’s a gem from an Ask The Expert column:

Why is diabetes so common today?

It’s true that diabetes is more common than it used to be. People are getting type 2 diabetes at younger ages, even children. No one really knows why, but part of the problem is that as a country we are heavier and less physically active than ever before.

Seriously? Diabetes is characterized by an inability to process carbohydrates … don’t you think perhaps the dramatic change in the number and quality of the carbohydrates we consume today has something to do with the sudden rise in diabetes? And how do you explain people like my father-in-law, a very physically active guy who became a type 2 diabetic without ever gaining weight or becoming fat?

Is it common to have mood swings?

Many people with diabetes say that as their blood glucose levels go up and down, so do their mood swings.

In that case, I’m thinking perhaps a diet that doesn’t cause glucose levels to go up and down would be a good idea.

To their credit, one of the articles suggests limiting between-meal snacks to foods that contain no more than 15 carbohydrates per serving. So they recognize (sort of) that diabetics shouldn’t be loading up on carbs.

Then the guaranteed-to-confuse advice shows up elsewhere. One article mentions that carbohydrate meals can raise your mood. Another promotes (of course) low-fat diets.

The recipe section includes meals with up to 38 carbohydrates per serving. Now, perhaps that’s not a major carb-overload for some diabetics out there, but the meal only provides 315 calories. I sincerely doubt many adults are satisfied with a 315-calorie dinner. It’s more likely that someone will follow the recipe, eat 600 calories’ worth, and end up consuming more like 70 carbohydrates in one sitting.

Naturally, a good number of the pages are full-sized ads for diabetes medications.

Here, folks, follow this nutrition advice. And when that doesn’t work, take these drugs.

 

 

 

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