Archive for the “Random Musings” Category

A doctor from Mexico emailed today to tell me he enjoyed the previous two posts on calories. He apologized for his English (which a lot better than my Spanish), so I cleaned up the spelling and punctuation a bit, but here’s how he views the explanation that people get fat because they consume more calories than they burn:

It’s like saying it rains because water falls from the sky.

Somebody replies, “No, really, WHY did it rain?”

And you shout, “BECAUSE WATER FELL FROM THE SKY! ARE YOU DUMB?”

Yes, it’s true that when it rains, water drops fall from the sky, but that is not WHY it rains. You are simply saying it’s raining because it’s raining. What is the meteorological explanation? What conditions get together to cause the rain?

And later in the email:

In weight gain, the cause in the majority of the cases is the alteration of the hormonal pathway that normally controls that area of the physiology. The human body has multiple mechanisms of regulation. For everything else, scientists have very complex biochemical explanations. But for obesity, all they have is a religious explanation of gluttony and sloth, expressed in a mathematical form.

The hormone that controls the storage of energy is insulin. There are other factors in obesity, but all of them are affecting the hormonal, physiological mechanisms of control.

Well said, Doctor – in any language.

As for those other factors, I thought I’d mention a couple that I left out of the previous posts because the posts were already lengthy.

How many fat cells do you have?

This is an area I hope gets a lot more attention in future research. Apparently scientists have only known since 2008 that the number of fat cells we carry as adults is constant. Here are some quotes from a New York Times article:

Every year, whether you are fat or thin, whether you lose weight or gain, 10 percent of your fat cells die. And every year, those cells that die are replaced with new fat cells, researchers in Sweden reported Sunday.

The result is that the total number of fat cells in the body remains the same, year after year throughout adulthood. Losing or gaining weight affects only the amount of fat stored in the cells, not the number of cells.

“There is a system waiting to be discovered,” said Dr. Jeffrey S. Flier, an obesity researcher and dean of Harvard Medical School.

Dr. Flier and other obesity researchers cautioned, though, that even if scientists knew how the fat cell system worked, it was not clear that it would be safe or effective to treat obesity by intervening. One of the hard lessons of the past couple of decades has been that the body has redundant controls to maintain weight.

Redundant controls to maintain weight? Nawww, this stuff’s simple. If you consume fewer calories, your body goes and retrieves calories from your fat cells to make up the difference, and you lose weight. Works that way for everyone … although I seem to recall writing this in the Fat Head Kids book, in the chapter where we explained that Marty Metabolism, the ship’s chief engineer, is like a super-complicated software application:

Like all important apps, Marty’s code includes something called redundancy. That’s a programmer’s term that means if one block of code doesn’t work, the program switches to another … and another, and another, until the command is obeyed.

Anyway, back to the New York Times article:

“This is a new way of looking at obesity,” said Dr. Lester Salans, an obesity researcher and emeritus professor at Mount Sinai School of Medicine in New York.

“I suspect that the body’s regulation of weight is so complex that if you intervene at this site, something else is going to happen to neutralize this intervention,” Dr. Salans said.

Complex regulation? If you intervene, the body may respond by neutralizing the intervention somewhere else?

Geez, these obesity researchers just don’t seem to get it. It’s a simple matter of calories in vs. calories out, so just cut the calories. No other intervention needed.

There was a time a few decades ago, before the current interest in how the brain regulates how much is eaten, when obesity researchers spent all their time studying and discussing fat cells. Investigators discovered that fat people had more fat cells than thin people and that fat cells shrank with weight loss and bulged with weight gain.

The result was the fat cell hypothesis, a notion that obsessed researchers. Fat cells, the hypothesis said, are laid down early in life and after that, they can change only in size, not in number. When people lose weight and their fat cells shrink, that creates a signal to fill the cells again, making people regain.

There’s more to the article, but here’s the important point: Yes, it appears that when we get fatter as kids, we do so mostly by creating new fat cells. But when we get fatter as adults, we do mostly by enlarging our existing fat cells.

I poked around online for more information and found that some researchers believe (but haven’t proved) the number of fat cells we’re born with is largely genetic. In other words, people with a tendency to get fat easily — a trait that clearly runs in families — may have been carrying more fat cells from birth.

I also found that lean people typically have between 25 billion and 35 billion fat cells, while fat and obese people may have anywhere from 75 billion to 150 billion fat cells. (Another study, by the way, demonstrated that adults can grow new fat cells if they gorge themselves to gain weight quickly, but it’s a few billion, not an extra 100 billion.)

So … let’s suppose I make it to adulthood at a lean 15% body fat and have 30 billion fat cells. Let’s also suppose I’m six feet tall and weigh 200 pounds. That means I’m carrying 30 pounds of fat – one pound for each billion fat cells. Let’s suppose that’s the normal size for fat cells.

Now suppose my best friend is also six feet tall and has about the same lean body mass, but is cursed with 150 billion fat cells, perhaps because of genetics, or perhaps because he became very fat as a kid.  Or perhaps a bit of both.

If his fat cells are the same size as mine, he’ll be carrying 150 pounds of fat. I weigh 200 pounds (170 lbs. lean, 30 lbs. fat), but he weighs 320 pounds (170 lbs. lean, 150 lbs. fat). I’m at 15% body fat, he’s at 47% body fat … but our fat cells are the same size.

If I live on pizza and beer during my 20s and balloon up to 250 pounds, I’m not saying it would easy to lose the weight. But to return to 200 pounds, I’d only have to shrink my overly-large fat cells back to their normal size.

But for my obese buddy to get down to 200 pounds, he’d have to shrink all his fat cells to one-fifth their normal size and keep them shrunk. I’d be very, very surprised if those redundant controls to maintain weight don’t fight against that.

So if change my diet and get back down to a lean 200 pounds, and my buddy changes his diet but only manages to get down to 245 pounds, it still means he shrunk his fat cells to half their normal size, while I merely shrunk mine back to normal. I’d be a bit of a jackass if I judged him a failure because he’s still 45 pounds overweight. His weight loss was almost certainly more difficult than mine, and will be more difficult to maintain.

Gut Bugs

In my review of the 2017 low-carb cruise, I wrote this:

Another lecture I enjoyed was delivered by Erynn Kay, a physician’s assistant who works with Dr. Jeffrey Gerber. She spoke about the importance of feeding our good gut bacteria – a topic I don’t believe gets enough attention in low-carb circles. Our hunter-gatherer ancestors weren’t gathering bacon, after all. They were gathering plants with fibers that feed the gut microbiome.

If you’re trying to lose weight by living on cheeseburgers, bacon, eggs, butter, heavy cream and a bit of broccoli now and then, you’re not feeding your gut bugs. Bad idea. That’s why there’s a chapter in the Fat Head Kids book titled To stay healthy, you need to feed trillions of your closest friends.

One of the low-carb doctors who does write extensively about the importance of feeding the gut microbiome is Dr. William Davis, author of Wheat Belly and, more recently, Undoctored.

Speaking of Undoctored, pardon me while I go on a bit of sidebar rant …

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In Undoctored, Dr. Davis stresses again and again that we can’t simply trust the health-care system (which he points out is a sick-care system that has little to do with health) to take care of us. We have to pay attention and be our own advocates.

We saw another example of that recently. Chareva’s father was hobbled by a stroke many months ago. He’s also an insulin-dependent type 2 diabetic. He recently fell and broke his hip while trying to limp to the bathroom in the middle of the night.

After surgery to repair the hip, he was placed in a rehab center. Someone forgot to tell someone else he’s a diabetic, even though it was written on the admission form. He wasn’t given insulin for four days, and only then because Chareva’s mom asked someone on the staff how his blood sugar was doing. Then, and only then, did a nurse finally check his blood sugar. It was over 600, and had probably been that high since he was admitted.

In an age when one-fourth of all senior citizens are type 2 diabetics, how in the @#$% do you not check a 75-year-old man’s blood sugar?

Don’t just trust the medical staff to pay attention and do their jobs. Ask. Demand.

End of rant.

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Anyway, here’s a video by Dr. Davis I think everyone on a low-carb or keto diet should watch and consider carefully:

In a post back in 2015, I explained why I went back to a high-protein diet. It’s still low-carb, but not VLC, and not ketogenic.  I gave the same explanation, albeit more briefly, during a Q&A session aboard the low-carb cruise later that year.

(Jimmy Moore was so upset with me for explaining why I dropped the keto diet, he bought me drinks in the bar later, encouraged me to give another presentation on the next cruise, and made plans to visit over Thanksgiving. You know how these with me or against me types think.)

Going with a low-carb approach (75 to 100 grams per day, sometimes a bit more) certainly gives me more flexibility. I like that. But more importantly, it means I can eat more of the foods that feed the gut microbiome.

Since I knew I’d be writing this post tonight, I measured and counted the ingredients in two of my meals today instead of just eyeballing them. I looked up the calorie and macro counts. I also checked my blood sugar reactions.

Breakfast was three eggs, two tablespoons of butter, a cup of shredded cheese, and a medium potato — cooked and cooled and then rewarmed. Add plenty of salt, mash it all together, and it’s delicious. It comes out to 770 calories, 37 grams of protein, 32 carbs. An hour later, my glucose peaked at 121. It was at 85 an hour after that.

Dinner was 4 ounces of chicken breast meat, one cup of refried black beans, one cup of shredded Mexican cheese, two tablespoons of sour cream, some hot sauce, and a big scoop of salsa. It comes out to 640 calories, 55 grams of protein, 41 carbs, and – the important part – 13 grams of fiber from the black beans. That’s the feed-the-gut-bugs part of the meal. My glucose peaked at 110.

In a podcast interview with Tim Ferriss, Dr. Peter Attia said most of the patients he put on ketogenic diets did very well. They lost weight and their lab markers moved in the right direction. But he said a dozen or so patients didn’t do well at all. Their markers moved in the wrong direction, and some of them gained weight quickly. So he did the smart thing and took them off the diet.

When asked, he said he doesn’t know why some people don’t get good results. Based on what Dr. Davis explained in the video, I’d say failure to feed the good gut bacteria might be part of the problem.

So don’t do that.  Feed your little friends.

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Can’t say I was surprised a post about calories generated a lot of discussion. Like I said, it’s apparently the issue that will never die. Based on back-and-forth comments on the blog and elsewhere, here are some additional thoughts about the calories debate in no particular order.

Extreme positions.

As someone pointed out in comments, people engaging in the calories debate often have more extreme views than the leaders whose ideas they’ve supposedly adopted. Yup, I agree. (And for the record, I don’t believe I’ve ever written that calories have nothing to do with it. If I have, let me know — I’m not going to go check every post I’ve ever written.)

When I re-read portions of Protein Power (1996) and The Protein Power Lifeplan (2000) to pull some quotes, I was struck by how well both books have stood up over time. I didn’t come across anything that made me think, “Boy, I bet they wish they hadn’t written that.” In fact, I was reminded that Drs. Eades and Eades were way ahead of the curve. They were explaining this stuff in terms of evolution and what our Paleolithic ancestors ate long before PALEO ™ became a thing.

But just to be sure I wasn’t quoting opinions they no longer hold, I emailed Dr. Eades to check. No, he replied, I haven’t changed my mind on how calories figure into it, so quote away. Then he added this:

I do believe that you can cheat the calorie math a little on the low-carb diet front. In another early blog post I guesstimated (an educated guess, but still a guess) that people on low-carb diets could probably get away with about 300 more calories than they could on a low-fat, high-carb diet. A few years later, Ludwig and colleagues came up with almost that same number (theirs was 325 kcal, as I recall) of excess energy expenditure on low-carb diets as compared to low-fat.

Perhaps a bit of a caloric advantage when trying to lose weight on a low-carb diet. That’s a heckuva long way from calories have nothing to do with it. But I wonder how many people who are fans of Dr. Eades insist calories don’t figure into it?

On one of the low-carb cruises, someone asked Dr. Eric Westman during Q&A if calories count. “Yes, calories count,” he replied. “But that doesn’t mean you need to count them.” He went on to explain that if you adopt a diet that lowers insulin to where it should be, your appetite should naturally fall in line with your energy needs, and your weight will normalize without counting calories.

Once again, that’s not the same as calories have nothing to do with it.

Low-carb and overeating.

In the previous post, I quoted Drs. Eades and Eades explaining that they had patients who wanted to know why they weren’t losing weight on a VLC diet. Diet journals showed that these patients were consuming 4,000 or more calories per day. That’s why they weren’t losing weight.  (The pleasant surprise was that they weren’t gaining, either.)

Several studies have demonstrated that people on low-carb diets spontaneously eat less and report feeling less hungry, so what was happening with these people? Why weren’t their appetites reduced?

I remember Dr. Mary Dan Eades telling me over dinner years ago that if anything would torpedo the low-carb movement, it was all the junk-food low-carb products being sold. She explained that when they had patients who were still overeating, diet logs often showed they were stuffing themselves with processed junk that happened to be low-carb.

Unlike a lot of low-carb enthusiasts, I don’t simply dismiss Stephan Guyenet’s ideas about food reward. No, I don’t think it’s the entire answer, but this isn’t an either-or situation. The makers of processed foods don’t hire all those food-flavor scientists for no reason. In fact, for those of you who haven’t read it, here’s a part of chapter seven of the Fat Head Kids book:

The Nautilus was programmed to choose the right fuels and building materials automatically. Inside the FUD hatch, special sensors send messages to The Brain that say This is what the ship needs. You experience those messages as This Tastes Good.

When humans hunted and gathered their food, this app worked perfectly. Our taste for sweets told us to eat fruits and sweet-tasting vegetables like carrots and squashes. Our taste for fats told us to eat olives, nuts, eggs and meats. Our taste for salts told us to eat meats and seafood. Our taste for spices told us to eat plants that were full of vitamins and minerals.

But as we’ve seen, apps are designed for a particular environment. The This Tastes Good app was programmed for The Planet of Real Foods. It still worked reasonably well when we migrated to The Planet of FUD Farms. But when we migrated to The Planet of Industrial FUD, we created a huge mismatch between the app and the FUD in the environment.

The makers of food-like products understand exactly how the This Tastes Good app works. So they add just the right combinations of sweet, fatty, salty and spicy flavors to industrial FUD. When these food-like products enter the FUD hatch, our sensors tell us This Tastes Good. This is what the ship needs. That’s how The Nautilus was programmed.

But of course, these aren’t the foods the ship needs.

We are programmed to find certain flavors highly rewarding. So my guess is that if you’ve been dealing with a dysregulated appetite for years (or even if you haven’t), it’s easy to continue craving and stuffing yourself with oh-so-tasty junk foods – even low-carb junk foods – if they tickle the right part of the brain. After all, people crave and over-consume lots of substances that don’t provide calories or jack up insulin.

That’s just one guess. Another guess is that people who fill up on low-carb junk foods aren’t getting enough protein or micronutrients. As we point out in the book, your body knows what it needs. If you don’t provide what it needs, it will keep triggering hunger in the hope that you’ll eventually stumble across some actual nutrients in your food. In that case, you won’t stop until you’re stuffed. Here’s what we wrote in the book:

Food-like products can satisfy your appetite for awhile – but not because The Nautilus has what it needs. When the belly of the ship becomes full and begins to stretch, special sensors warn Marty to stop running the Get Hungry! program. But by the time that happens, you’ve probably consumed way more FUD than you actually need.

Marty has to do something with all that extra fuel. If you’re one of those lucky people (like my wife) Mary will crank up your metabolism and burn it away. But if you’re not so lucky, Marty will store the extra calories as fat.

Not exactly a calories have nothing to do with it argument, wouldn’t you say?

Why calorie math sucks, part one.

Calories have nothing to do with it is an extreme and unsupportable position. But so is The Piggy Bank Theory with its stupidly simple calories in/calories out math. Suppose you’re overweight and go online looking for advice. Here are some samples of what you’ll find.

From Shape Magazine:

In one month you can reasonably anticipate losing eight to 10 pounds if you follow a pretty strict plan. Losing one pound of body fat is equivalent to 3,500 calories. To lose two pounds per week, you must drop 1,000 calories per day. Elimination can be done by cutting the calories consumed in a day or increasing the amount of calories burned during your workout.

From Good Housekeeping:

If every day you can cut about 75 calories through diet and burn about 75 calories through exercise, you’ll drop between 10 and 15 pounds in a year. It’s practically losing weight in your sleep.

From Eat This, Not That:

On average, a slice of cheese—whether it be atop a sandwich, salad, omelet or burger—has about 70 calories. Eliminate it from just three meals a week to keep 10,920 calories and keep 3 pounds off of your frame over the course of the year.

From the Centers For Disease Control:

Paul is 47 years old and weighs 240 pounds. He’s at risk for type 2 diabetes. His doctor urges him to lose 40 pounds at a rate of 1 pound a week. Losing 1 to 2 pounds a week is a healthy goal for most adults, experts say. This gradual weight loss is the way to make lasting changes. To lose 1 pound a week, Paul needs to burn 3,500 more calories than he takes in each week. That’s 500 calories per day.

The CDC then lists all kind of ways to cut those 500 calories: swap skim milk for whole milk, use reduced calorie margarine on your toast instead of butter, steam your vegetables instead of sautéing in oil, etc., etc.

From Fitness Magazine:

To lose one pound in seven days you need to reduce your net calories by 500 every day. The easiest way to do that is a 250 split: Cut half from your diet and burn the other half through exercise…. Choose one strategy from the diet and exercise columns each day and after seven days you will have cut out 3,500 calories. Losing four sticks of butter has never been such a cinch!

Heck, it’s a cinch, ya see! The article then lists all kinds of ways to cut those calories … switch from a cup of premium ice cream to light ice cream, eat an ounce of soy nuts instead of three ounces of almonds, etc., etc., blah-blah-blah. Simple math.

I could go on and on, but you’ve already seen this advice everywhere.  You’ll hear it from doctors, dietitians, trainers, workout buddies, and countless internet cowboys.  Just cut those calories, and the pounds will drop off in exact proportion to the number of calories you cut.

So people follow that advice and fail to lose weight – because our bodies don’t work like bank accounts.  But that’s just part of the problem …

Why calorie math sucks, part two

Here’s a quote from the Fat Head Kids book, after a section describing the typical “just cut one pat of butter per day from your diet!” advice:

Well, that sounds easy, doesn’t it? So according to these people, if you’re fat, it’s because you’re not willing to eat just a little less — which means you’re a pig. Or you’re not willing to exercise just a little more — which means you’re a lazy pig.

The real problem with The Piggy Bank Theory is that it gives people who don’t know what the @#$% they’re talking about a license to be judgmental jackasses. It allows them to assume that anyone who gains weight or fails to lose weight is simply eating too much and could therefore lose weight by just eating normally. That’s nonsense. Here’s a quote from the book:

In a study from the 1960s, researchers wrote about obese patients who were locked in a hospital and fed just 600 calories each day. That’s about one-fourth as much as most adults eat. And yet the obese patients didn’t lose weight. Is that because of a flaw in their character? Should they only eat 300 calories per day? Or 200?

The researchers, by the way, referred to these people as the resistant obese and thermodynamic paradoxes. They were at a complete loss to explain how anyone could stay fat on 600 calories per day.  But they did.

Here’s another quote from the book:

A documentary I saw called The Science of Obesity featured a woman who was lean until about age 35. Then she suddenly started getting very fat. She cut her calories to just 1500 per day and still got fatter.

So, was she consuming more calories than she was burning? Yes, absolutely. That is always HOW we get fat. But was consuming too many calories WHY she got fat?

No, of course she wasn’t consuming too many calories. But thanks to the belief in Piggy Bank math, doctor after doctor accused her of lying about her food intake, even though she’d been keeping detailed records. By gosh, nobody could get that fat on 1500 calories per day!

Uh, yeah, some people can. And some people don’t lose weight even on low-calorie diets. Of course, pointing that out inevitably leads to some jackass citing …

The concentration camp argument

If there’s one argument that makes me want to smack the person offering it, that’s the one.

Well, no fat people ever walked out of a concentration camp, so that proves it’s all about the calories! Huh? Huh? I bet you crazy low-carbers never thought of that one!

Ehhhhhh …

Yes, we’ve thought of that one. Here’s a quote from Why We Get Fat by Gary Taubes:

Yes, it’s true: If you are stranded on a desert island and starved for months on end, you will waste away, whether you’re fat or thin to begin with. Even if you are just semi-starved, your fat will melt away, as will a good share of your muscle. Try the same prescription in the real world, though, and try to keep it up indefinitely – try to maintain the weight loss – and it works very rarely indeed.

There’s a reason it rarely works: it’s true that no fat people ever walked out of a concentration camp. It’s also true that no healthy, happy people with well-functioning metabolisms ever walked out of a concentration camp. The only reason they could be starved into an emaciated state is that THEY WERE LOCKED INSIDE A CONCENTRATION CAMP, YOU @#$%ING MORON!

There, I think that more or less expresses how I feel about it.

Ancel Keys actually conducted a useful study in the 1940s. To determine the likely effects of food shortages in Europe after WWII, he locked a group of young, healthy volunteers inside a camp and fed them 1500 calories per day for weeks on end. They lost weight. They also lost their energy, their libidos, and in a few cases, their sanity. They were miserable. They were cold. They were obsessed with food. One participant bit off part of his own finger to get out of the experiment.

When the CICO crowd insists that fat people should just starve themselves into being thin, they’re telling them to suck it up and live in a state of constant misery.

Yes, the woman who continued getting fat on 1500 calories per day probably could have starved away the fat at some ridiculously low intake of calories. She also would have been miserable the whole time, and would have had to remain miserable to avoid regaining the weight.

In a speech about what he calls “the fat switch,” Dr. Richard Johnson mentioned what happens in experiments when animals lose weight. When they burn dietary calories, they’re calm. When they start burning their own body fat, most of them remain calm. But when they start burning away lean body mass, most of them become highly agitated. That’s what happens when the body believes it’s starving.

The alcoholic analogy.

We used various analogies in the Fat Head Kids book: Saying people get fat because calories in exceeded calories out is like explaining that Donald Trump is a billionaire because he deposited more dollars in the bank than he withdrew. It’s like a plumber explaining that your toilet overflowed because more water went into the tank than drained out. Those statements are true, but they only explain HOW something happened, not WHY it happened.

Here’s an analogy I’ve used in speeches, but not (for obvious reasons) in a book targeted at kids: saying people become obese because they eat too much is like saying people become alcoholics because they drink too much. That not only fails to provide an answer, it doesn’t even ask the relevant question, which is: WHY do they drink too much? What’s the root cause of the excess drinking? Why do they crave far more alcohol than normal drinkers?

To me, arguments about calories are often as ridiculous as:

“The cause of alcoholism is drinking too much.”

“What?! That doesn’t explain anything. You’re confusing the symptom with the cause.”

“No, no, no. We’ve studied this extensively, and every time an alcoholic becomes drunk, it’s because the amount of alcohol he consumed exceeded his body’s ability to process it. So the cause of alcoholism is obviously drinking too much, and the cure is to stop drinking too much.”

“It doesn’t work that way in real life.”

“Of course it does! We locked alcoholics and normal drinkers inside a prison and gave them each just two drinks per day. At the end of each day, they were all equally sober. So that proves the cause of alcoholism is drinking too much, and the cure is to stop drinking so much. Don’t be anti-science!”

Assuming we live in an alternate universe where we can’t live without alcohol and not drinking at all therefore isn’t an option, any treatment for dealing with alcoholism would have to address the underlying biochemical drive to drink to excess. “You’re a drunk because you drink too much” isn’t an explanation; it’s just a restatement of the symptom.

“To cure your alcoholism, just drink less” would be ridiculous advice.  But it would be equally ridiculous to say “being drunk all the time has nothing to do with the amount of alcohol consumed, so nobody has to count how much they drink.”

Previous posts on the topic.

Someone mentioned in comments that there are probably people who read the previous post, but aren’t long-time readers.  Duh.  I should have thought of that.  So here are links to some posts related to this whole, never-ending debate about calories.

Toilet Humor And The HOW vs. WHY Of Getting Fat.

The Rider and The Elephant explains why we can’t just starve ourselves into being thin.

Puppies and Thermodynamics is about how we have two Rotties who eat exactly the same meals … but one has 35% more body mass, despite being the more active of the two.

Fat Accounts and the Laws of FiscalDynamics is another take on the body-as-bank-account analogy.

I hope that helps.

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Calories. Sheesh, here we go again. Apparently it’s the debate that will never die. Hardly a week goes by without yet another calories count vs. no it’s all about hormones dustup on the Fat Head Facebook group. I’ve addressed the topic many times, but I’ll give it another whack.

In online debates, people seem to take one of two positions: 1) gaining and losing weight is a simple, linear function of how many calories you consume, or 2) calories have nothing to do with gaining and losing weight.

I don’t subscribe to either position.

Hundreds of people have emailed me over the years to tell me after watching Fat Head, they finally lost weight after years of frustration with low-fat/low-calorie diets. I’m grateful for that. But in case you’ve forgotten (or never saw the film), here’s what I said before starting my fast-food diet:

So here’s my plan: using my functioning brain, I did a few minutes of research and found that a man of my size and activity level burns about 2500 calories per day. To create a calorie deficit, I’m setting a target of 2000 calories per day. I’ll also burn a few extra calories by walking six nights per week instead of my usual three. But, here’s the really important part: To make sure my body can burn its own fat for fuel, I’m going to keep my insulin down by limiting my carbohydrates to about 100 per day.

I didn’t pull that plan out of thin air. While researching diets, health and weight loss online, I came across a few posts by some doctor named Mike Eades that made perfect sense. I wasn’t previously familiar with him, so before getting in touch to ask about a possible interview, I read both Protein Power and The Protein Power Lifeplan, the books he wrote with his wife, Dr. Mary Dan Eades.

Both books were very enlightening. I finally understood why I’d failed to lose weight on low-fat/low-calorie diets full of hearthealthywholegrains! and other garbage carbs: I was trying to restrict calories while eating foods that were signaling my body to store fat. When you fight your own body, your body wins. If you want your body to cooperate, you need to get into a hormonal state where it’s willing to burn away stored fat. But willing to burn stored fat isn’t the same as has a need to burn stored fat.

Here’s a quote from Protein Power (bold emphasis mine):

Try to make it a habit to keep good records of what you’re eating, how much you exercise, and how you feel. Having an accurate written record also gives you some hard data to look at if you hit a plateau. Are you simply eating too much? Have you missed exercising regularly?

Protein Power includes a formula for guesstimating your daily protein requirement. Mine came out at around 120 grams per day. Later in the book, there are instructions for moving out of the initial (very low-carb) phase, through a second phase, and finally to a maintenance phase:

Increase your daily carbohydrate intake in 10-gram increments until you reach an amount approximately equal to your daily protein intake – e.g., if your daily protein intake is 75 grams, increase your daily carbohydrate gram total from 55 grams (the Phase II level) to 65 grams and finally to 75 grams.

Protein and carbohydrate roughly in balance … yeah, that sounded good.  So as someone who walked six miles several nights per week, I chose a target of 100 grams or more of protein per day, plus around 100 grams of carbohydrate. Yes, that’s more like a maintenance phase, but I was pretty sure that would get me into a hormonal state of willing to burn fat. Then I chose a target of 2,000 calories to create the need to burn fat.

Here’s another quote from The Protein Power Lifeplan (again, bold emphasis mine):

There are basically seven methods we use in our practice to improve insulin sensitivity, and all the but the last are part of the Protein Power Lifeplan:

1. Decrease carbohydrate intake
2. Decrease calorie intake
3. Exercise
4. Alter the dietary fat profile
5. Supplements
6. Deplete the body of excess stored iron
7. Medications

And later in the same chapter:

Carbohydrate restriction actually aids in the calorie-restriction process. A number of studies have demonstrated that when presented with unlimited quantities of foods containing high, moderate, or low amounts of carbohydrates, the group given the high-carbohydrate foods will eat more calories than the group given the low-carbohydrate foods …

And finally, here’s a quote from one of Dr. Eades’ blog posts, which he forwarded to me today in an email:

Although the lowered insulin and elevated glucagon open the doors to the fat cells allowing fat to come out to be burned, the fat comes out only if it’s needed. If you are meeting all your body’s energy needs with the food you eat, the body doesn’t need the fat in the fat cells. On a low-carb diet your body burns fat for energy. But it doesn’t care where this fat comes from; it can come from the diet or it can come from the fat cells or it can come from both. If you are consuming enough fat to meet all your body’s requirements, your body won’t go after the fat in the fat cells no matter how severely you restrict your carbs. You will burn dietary fat only and no body fat. And you won’t lose weight. It’s that simple.

That’s a pretty far cry from calories have nothing to do with it, wouldn’t you agree? That’s why you won’t see me melting a stick of butter into my morning coffee. I don’t see the point. It’s not going to help with weight loss unless you’re still creating a need to burn body fat by restricting elsewhere. I’d rather eat a few eggs for breakfast and get some protein into the equation.

But wait … haven’t I written a bunch of posts trashing the CICO theory? Why yes, I have.

My beef with the CICO crowd is that they’re constantly pushing a belief that simply isn’t true: namely, that our bodies work like simple bank accounts, with calories substituting for dollars. Cut 500 calories per day from you diet, and by gosh, you’ll automatically burn away one pound of fat per week. Cut 1,000 calories per day from you diet, and by gosh, you’ll double the fat loss to two pounds per week. Start eating an extra 500 calories per day, and by gosh, you’ll automatically gain a pound of fat per week, etc., etc. All based on simple, predictable, linear math.

In the Fat Head Kids book, we call that The Piggy Bank Theory. There are reams of evidence that it simply doesn’t work in real life. We mentioned some of that evidence in the book. You can read up on more of the evidence in The poor, misunderstood calorie by Dr. Bill Lagakos or The Calorie Myth by Jonathan Bailor.

The Piggy Bank Theory doesn’t work because it ignores the fact that the calories-in side of the equation affects the calories-out side of the equation.  Or to stick with a banking analogy, it ignores the decisions made by an account manager who controls all your spending and receives a constant stream of instructions from the bank — many of which are determined by what kind of currency you deposit, not just how much. (I used the account-manager analogy in an early draft of the book before switching to the biological-spaceship analogy.)

If the account manager has instructions to increase your savings account, she’ll probably start by sending you messages demanding bigger daily deposits. But if you refuse, she’ll turn down the thermostat to spend less on fuel. She’ll cancel the daily repair jobs to spend less on construction. Then she’ll take the savings and put them in your account.

Or if the account manager is under orders NOT to increase the size of your account even though you’re making bigger deposits, she’ll ratchet up spending. She’ll turn up the thermostat to spend more on fuel. She’ll spend your extra deposits by hiring construction crews to tear down and rebuild portions of the building, then do it again. She might even take some of the dollars you deposit and flush them down the toilet.

That’s why Piggy Bank math doesn’t work in real life. The account manager receives and follows instructions we can’t control simply by depositing fewer dollars. But that’s not the same as saying the number of dollars you deposit has nothing to do with the size of your savings account.  Of course your deposits affect your balance.

That doesn’t necessarily mean you have to count calories. Lots of people find that when they ditch the sugars and processed carbs, or go full-blown ketogenic, they finally lose weight after years of frustration and failure, even if they’re not counting calories. That’s because the change in diet changed the instructions sent to the account manager. She was informed that it’s okay now to start draining dollars from the savings account. So she kept the spending high and/or requested fewer deposits.

But once again, the fact that many people on a low-carb diet lose weight without counting calories doesn’t mean everyone on a low-carb diet will lose weight without counting calories. Here’s another quote from The Protein Power Lifeplan:

Patients come into the clinic or send us their diet diaries indicating that they have been keeping their carbohydrate intake within the prescribed limits or even lower, and yet they haven’t been losing weight, and they want to know why. We question them or look at their diaries and often find that they have indeed been keeping their carbohydrate intake low but at the same time have been eating enormous quantities of food.

The book goes on to describe how quite often, people eating these large quantities of food didn’t lose weight, but also didn’t gain. Dr. Eades mentioned that again in an email:

If people are extremely calorically restricted, they do about the same on any diet, because the body is using everything coming through the mouth.  Where it gets interesting is at the other end of the spectrum.  When people go on rigid low-carb diets, but overconsume calories, they don’t really gain weight.  They don’t lose, but they don’t gain, either.  Somehow the low-carb diet really ratchets up the energy expenditure when low-carb calories are high.  I’ve seen this in patients (as has MD) innumerable times, and I’ve had a number of readers write to tell me about it.

We know that’s not true for everyone, but it’s certainly been true for me. In fact, that’s what I consider the real gift of a low-carb diet: the resistance to weight gain. I’ve gone on cruises and eaten like a king for a week … bacon and sausage and eggs with hollandaise sauce, meat-and-vegetable salads with bleu cheese dressing, steaks and lobsters and shrimp cocktails, and plenty of butter with everything. Then I step on the scale at the gym when I get home and find I haven’t gained an ounce. Love it.

But that’s not the same as losing weight. So to wrap up, let’s return to The Protein Power Lifeplan:

We can take home a couple of lessons from this example. The first is that although cutting carbohydrates doesn’t necessarily mean you will lose a lot more weight than you would on a high-carbohydrate diet of equal calories, it does mean that if you eat a huge number of calories in low-carbohydrate form, you will be prevented from gaining the weight you would on a high-carbohydrate diet of the same number of calories. The second lesson is that if you want to lose weight, you have to watch the calories – even on a low-carbohydrate diet – particularly if you’re a small person…. To lose weight, you’ve got to create an energy deficit.

Hormones, not calories, determine whether your body wants to burn fat or store fat. But even when your body wants to burn fat, you still have to give it a reason to raid the fat stores.  Some people begin burning and/or excreting more calories than they consume automatically when they go low-carb or ketogenic.  But some people don’t.  I’ve heard from plenty of people who had to combine carbohydrate restriction with some degree of calorie restriction to finally drop the pounds.

So please, let’s stop insisting nobody has to count calories.  It simply isn’t true.

 

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Boy, I was really hoping we wouldn’t be found out. But now that it’s out in the open, I guess it’s time to admit it: I’m a member of a cult. Dr. Steve Nissen, the nation’s statinator-in-chief, exposed the cult in a recent editorial. Here are some quotes from an article in CardioBrief:

A leading cardiologist has unleashed a blistering attack on “statin denial,” which he calls “an internet-driven cult with deadly consequences.”

In an editorial in Annals of Internal Medicine, Steve Nissen (Cleveland Clinic) expresses grave concerns over statistics showing that only 61% of people given a prescription for a statin were adherent at 3 months. “For a treatment with such well-documented morbidity and mortality benefits, these adherence rates are shockingly low. Why?” he asks.

Good question: why are so few people taking their life-saving statins? Since I’ve employed several Svengali-like deception and persuasion techniques in my posts, many of you who read this blog probably think people are avoiding statins because the drugs don’t work as well as the pharmaceutical companies want us to believe.  Or because the side-effects are worse than reported by pharmaceutical companies.  Or because statins damage muscles.  Or because there’s no evidence statins prevent heart attacks in women or the elderly.  Or because statins screw up people’s brains.

But Dr. Nissen (who by pure coincidence receives a ton of money from pharmaceutical companies) has figured out the real reason:

Nissen writes that “we are losing the battle for the hearts and minds of our patients to Web sites developed by people with little or no scientific expertise, who often pedal ‘natural’ or ‘drug-free’ remedies for elevated cholesterol levels.” The anti-statin forces employ two distinct strategies, “statin denial, the proposition that cholesterol is not related to heart disease, and statin fear, the notion that lowering serum cholesterol levels will cause serious adverse effects.” Nissen admits that some patients will have statin-related adverse effects but “intolerance in many patients undoubtedly represents the nocebo effect.”

That is, of course, what happened with my mom. The only reason she experienced awful muscle and joint pains while on statins is that she believed they might cause muscle and joint pains. Granted, she didn’t believe statins could cause muscle and joint pains until she complained to me about the pains and I asked if she was on statins. But that’s the power of cult-like thinking: it can go backwards in time and cause a nocebo effect.

Anyway, now that the cat’s out of the bag, I may as well tell you about the cult. To make the confession more convincing, I clipped some “signs and practices of cults” from the internet as headings.

Authoritarian leadership. Cult members are expected to completely submit to a leader who is seen as a prophet, apostle, or special individual with unusual connections to God.

Our authoritarian leader is, of course, Dr. Uffe Ranvskov. All of us who joined the cult have a 10-foot-tall picture of him somewhere in our houses or apartments. We’re required to bow to the picture six times per day while chanting “cholesterol does not cause heart disease.”

Dr. Malcolm Kendrick is our Maximum Leader’s … uh, I mean Dr. Ravnskov’s second-in-command. His picture is only six feet tall and we only have to bow to it on Sundays. However, we all know that any command Dr. Kendrick issues is coming directly from Dr. Ravnskov and should be treated as such.

Opposition to Independent Thinking. Questioning, doubt, and dissent are discouraged or even punished.

I’m on the email list for THINCS (The International Network of Cholesterol Sceptics), and I can tell you there’s never any debate or discussion among the members. It’s just one email after another agreeing with whatever Dr. Ravnskov says.  This is, of course, exactly the opposite of what happens with doctors, who are constantly debating the risks and benefits of statins while attending seminars sponsored by Pfizer.

And I can attest to that bit about punishment. Remember when I told you all how I banged myself in the head with a t-post hammer while building a chicken yard? Well, that’s not what happened. I made the mistake of wondering aloud if perhaps statins were okay for some people. I was alone in the back pasture and didn’t think anyone was listening. But sure enough, I got a call from Dr. Ravnskov within the hour.

“Listen, doubter,” he told me. “Your brain clearly isn’t working correctly. I want you to go to the tool shed, grab a 16-pound steel hammer, and smack yourself in the skull with it. Do this, or be banished.”

Love Bombing. Cult members show great attention and love to a person to help transfer emotional dependence to the group.

After he ordered me to hit myself in the head with a hammer, Dr. Ravnskov had several cult members drop by and tell me how awesome I looked with a big wound on my head. Then we all played checkers and they let me win every game.  I never felt more loved.

Isolation. Subservience to the group requires members to cut ties with family and friends, and radically alter the personal goals and activities they had before joining the group.

I was hoping all those farm reports including pictures of Chareva and the girls would provide some cover. But the truth is, they left two years ago … perhaps because Chareva asked me why I’m always posting about the dangers of statins, and I offered to smack her in the head with a 16-pound steel hammer to help get her mind right.  Anyway, doesn’t matter.  Those pictures of us working on the farm together are all old.  I now live alone and dedicate all my time and energy to whatever Dr. Ravnskov asks of me.

Group Think. The leadership dictates, sometimes in great detail, how members should think, act, and feel.

Yes, that happens all the time in our cult. I don’t know how I feel about it because Dr. Ravnskov hasn’t told me yet.

Salvation. Members are often promised salvation from an apocalyptic future through association with the group and its Special Knowledge.

I can’t explain this one in great detail. I’ve only reached level nine in the cult, which means I haven’t been given all the details on the master plan. (To reach level 10, I have to start giving them 90% of my income instead of the current 75%.)

I do know, however, that the plan came to Dr. Ravnskov in the form of secret messages in Beatles songs. The gist of it is that if we convince everyone to stop taking statins, the current leaders in society will all die of heart attacks. With a leadership void created, the oppressed masses will rise up and kill all the oppressors and all the good doctors who prescribe statins. The cult members, of course, will be hiding out in the desert until it’s over. Then we’ll emerge from hiding, and the formerly oppressed people will welcome us as heroes and put us in charge. Then we’ll oppress them by refusing to let them take statins and other miracle drugs.

If for some reason the oppressed people decide instead to put themselves in charge and oppress us, we’ll all drink a special concoction of coconut oil and bacon fat, at which point a spaceship will pick us up and take us to another universe, where we’ll be placed on a planet with no human population, but an endless supply of eggs. Then our task will be to eat eggs and populate the planet.

I’m not sure how a planet without humans can be full of chickens to lay eggs, but like I said, I haven’t been given all the details.

Mind-Altering Practices. Meditation, chanting, speaking in tongues, and debilitating work routines are used in excess and serve to suppress doubts about the group and its leader.

I don’t know if we do this one or not. But I have to stop writing now. Dr. Ravnskov just called and told me to go out and mow the entire back of the property, then do it again tomorrow.

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Hey Fatheads!

I know I usually do the right thing and disappear for a few months after commandeering The Big Chair, but this was too good not to share.

I was perusing the local paper of record Monday and there was a story headlined “BEHAVIOR ANALYSIS: Free services offered to children with skill deficits.” It was about a”new intensive feeding clinic” developed by the Southern Illinois University’s Child Behavior Research and Training Lab. Its mission is to help parents use “Applied Behavior Analysis” (ABA) to overcome the dread “picky eater” crisis that’s sweeping the nation.

I’m assuming it must be a crisis, anyway, since one of our main public universities — in a state that is hundreds of billions behind on pension funding, hasn’t passed a budget in over two years, and has put half of the NFP social service agencies out of business — is devoting resources to it and running the program at no charge.

They’re applying some of their expertise from other areas of child behavior. One example, for instance, was how to avoid your kid having a tantrum in the store because you won’t buy them Skittles. So the solution offered by the expert is to give them one Skittle per minute while shopping.

Seriously. These are experts.

I’m accustomed to such credentialed idiocy (as are most Fat Heads, I believe), but another line regarding a predecessor program being used as a template for the picky eater solution had me howling out loud:

“Earlier this spring, Hirst rolled out an intensive, one-day potty training program that incorporates a mix of evidence-based procedures. “

Yep, there it is kids. Pre-adolescent turd disposal has joined the elite ranks of all things evidence-based. So if any of you still thought “evidence-based” had any real meaning, that swishing sound you hear is the last shred of any of the term’s rhetorical value swirling around the bowl.


Don’t worry, Mom — it’s evidence-based!

We now return to our regular programming…

Cheers!

The Older Brother

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Greetings Fat Heads!

Well, still here. Hope you had a great Memorial Day weekend. Special thanks to all vets and their families. Tom and family are back from the 2017 Low Carb Cruise, happily exhausted. I’m looking forward to getting the full report. I told him if he wanted to wait until next week, I’d fill in Thursday with an “evidence-based” rant.

Anyway, when I left off at the last post, Jimmy Kimmel’s son was doing great and I was in a bad mood. Not about Mr. Kimmel’s son of course. That was the wonderful part. The level of care we have available in this time and in this country is beyond the imagination of what was available to the richest people and kings even a few decades ago.

I wasn’t even particularly stirred up over Mr. Kimmel’s making the availability of the miraculous procedure that saved his son somehow tied in with keeping Obamacare intact. Between being a dad just past a major health scare and living in La La Land among the economically illiterate (seldom right, but never in doubt) I’m okay with him calling it any way he wants. I put it in there with the “all brides and babies are beautiful” protocol. It accomplishes nothing to argue, and it’s just plain rude.

The rest of the Idiocracy, however, deserves no so respect. Instead of politely giving Jimmy’s emotional description props and then moving on, they treated his completely sincere and completely uninformed comments on insurance and Obamacare as the Magnum Opus of the health care debate.

At any rate, I stated toward the end “It’s not like we don’t have major issues with the health care system in the good old U.S. of A. But the issues are with the availability of dollars, not doctors, …”

There are issues with dollars. As I mentioned, I was aware of Kimmel’s son’s condition because The Oldest Grandson had the same thing – and the same miraculous treatment – when he was born just about ten years ago (yes—before Obamacare).

His mom, my daughter-in-law, pointed out that back then just his hospital tab was over $300,000, which would break anyone without insurance, not to mention that he’s facing at least two more surgeries. Under insurance as it mostly existed prior to the current debacle, there could be real issues with lifetime spending caps and him trying to get health insurance as an adult with that type of pre-existing condition.

To paraphrase an old politician, $300,000 here, $300,000 there – pretty soon you’re talking real money! Definitely a dollars issue.

So what’s a libertarian to do? Is there a solution other than “I’m sorry, Mr. Kimmel, there’s nothing we can do?” That’s what you would hear in most of those countries where it’s “free.” Don’t we want to save babies in this country? Wouldn’t it be nice to be able to do that and not go broke? How can we do that today, and still be able for that kid to afford reasonable health care later?

Fortuitously, Dr. William Davis’ new book – “Undoctored” came out just recently, and Tom did a book review.

[Confession time – I don’t read Tom’s book reviews any more. When I see he’s written one, I just save myself the time and buy the damned book.]

Now, if you want a great book on the disastrous macro-economics of our health care system, and policy proposals to address insurance and health system availability at a national level, don’t buy this book. That’s totally not what it’s about.

What it is about is you getting control of your health, which Dr. Davis reiterates throughout is not particularly connected to medical care. In fact, unless you get yourself informed and proactive, medical care can often be inversely related to your health. Although he doesn’t do a deep dive on the economic history of the health care system, he does do a great job illuminating how the money and incentives in the current system don’t line up with attaining real health as an individual. Then you’re off on a terrific primer in how to evaluate, improve, and monitor your health, in conjunction with health care professionals who will work with you and at your direction when needed.

Seriously, buy the book.

Okay, so how’s that tie in with the subject at hand? Well, the idea that the medical industry is more responsive to money than patient outcomes was nothing new to me – or probably any Fat Head, really. “Have a $tatin with that hearthealthywholegrain muffin” vs. “have the bacon and eggs and take a walk,” right? So, I was already on board with the concept.

Right in the introduction to “Undoctored,” Dr. Davis noted that we spend (endlessly pointed out with delight by the single-payer cheerleaders) over $3 trillion dollars a year – 17% of our GDP — on health care. Which I also already knew.  But this time when I read it I’d been thinking about Kimmel’s performance, and my daughter-in-law’s point, and then pretty close in to the beginning of the book Davis points out that:

“The system is ready and willing to commit you to a life of taking drugs and injectable insulin for diabetes, … providing “education” designed by people who put commercial interests first, while no one provides the handful of inexpensive health strategies that have been shown to reduce, even fully reverse, type 2 diabetes.”

Once again, nothing I didn’t already know, but it kind of all came together at that point and I thought, “well, just how the hell much do we spend on all of this crap?!?”

So I looked it up.

I tend to do that. I just stopped reading and went Googling for info on how much money we spend on the various medical substitutes for good habits. I’d like to think it’s due to my insatiable inquisitiveness when I’ve got an intellectual conundrum, but it’s probably just ADD.

I struck gold fairly quickly when I found a JAMA paper from 2016 titled “US Spending on Personal Health Care and Public Health, 1996-2013.” They collected seven years of data from 183 sources and sorted them into 155 conditions. The numbers, which, once again, we’ve probably all heard at different times, are stunning when you look at the whole picture.

The total spending for 2013 – the last year in the study – was $2.1 trillion. The estimate for 2014 was $2.9 trillion, so Dr. Davis’ $3 trillion seems to line up well with the reports info, and it would be safe to assume that the numbers I’ve got increased proportionately.  So, pretty much every number I’ve got has likely gone up by 50%. But here are some of the things we see:

Right off the bat, “diabetes had the highest health care spending in 2013, with an estimated $101.4 billion in spending, including 57.6% spent on pharmaceuticals…”

Keep in mind, that’s more like $150 billion today. One hundred and fifty billion dollars. A year. For a “disease” that’s easily 90% treatable by just stepping away from carbs.

Heart disease – the one that Dr. Davis put himself out of business from treating by getting people to change their lifestyles vs. post factum medical treatment — was $88.1 billion, so I’m calling it $130 billion.  I’m not saying no one would ever have a heart attack if we all stopped cooking with vegetable oil and started taking an evening walk, but it wouldn’t be an industry that by itself would rank in the top quarter of the rest of the world’s GDP’s.

Plus, that $130 billion does NOT include treatment for hyperlipidemia (i.e., statins) which earns itself $52 billion ($75B?) all by itself, or high blood pressure.

Here’s some other big ticket items, almost all of which the case studies of folks in “Undoctored” either completely reversed or substantially improved – often within weeks – of making the simple changes that Dr. Davis promotes:

Blood Pressure:  $84 Billion

Back & neck pain (think largely obesity and sedentary lifestyle related, so I’m counting it): $88 Billion

Depression (think mood disorders and gut biome dysbiosis. Not considered are other “mental” health issues – ADD, bipolar, etc): $70 Billion

Dental (tooth decay, inflammation): $66 Billion

Skin conditions: $55 Billion

Alzheimers and other dementias (i.e., Type III diabetes): $36.7 Billion

The 2013 numbers for all of those come up to about $469 Billion, which scales up to over $700 Billion in today’s spending. Mostly avoidable by straightforward, understandable lifestyle modification.

Like I said, some people will still have heart attacks, or pull a back muscle, or get depressed and need some help so you don’t have a 100% savings on the table; but the largest part of these diseases are self-inflicted and self-treatable.

I also left out other categories (Osteoarthritis – $47.9B; Asthma – $32.5B; Endocrine, metabolic, and immune disorders – $19.6B; and cancers, which were disaggregated into 29 separate conditions); so there’s some pickup available from the same lifestyle changes in areas I’m not counting. The point is that nearly one quarter of our health care spending is going to conditions that we have the capability of exerting a large degree of control over. Quickly.

Preterm birth complications, BTW, ranked 73rd at just under $5 Billion, so it seems like if we could get a handle on our grain and industrial foods habit, Jimmy Kimmel’s son and my grandson shouldn’t cause too much financial discomfort to the system.

After thinking about this, I had an epiphany.

I know Tom and many others, including myself, have compared the various and sundry mandatory coverages — dictated via Obamacare and other legislated and regulatory bodies — to requiring your auto insurance provider to include free oil changes, tire rotation, tune-ups, etc.  in your policy. The point being that these are known conditions that are a routine part of automobile ownership. Inclusion in a policy would only increase overhead and incentivize over-utilization, resulting in inevitable, recurring premium increases.

We completely misrepresented the argument. It’s correct as far as it goes, but it stops so short of reality that I count it as a huge error.

Our entire medical cost reimbursement system, as currently comprised, is like requiring that all auto insurance companies include DUI coverage in your policy.

It was stupid that my health insurance covered the two or three doctor office visits for the ear infections we knew The Sons were each going to get each year when they were toddlers. Same for the bottle of pick stuff we’d pick up at the pharmacy after each visit.

But it’s insane that insurance would pay for insulin for the 90% of people who could avoid the pharmacy if they’d stop blasting their system with sugar in all its forms. Same with all those other diseases of civilization driving a quarter of our spending. We’re making it convenient and cheaper for people to engage in behavior that’s harming them.

Add in the USDA budget with its massive grain subsidies and the SNAP (food stamp) program, and it’s like after adding the DUI coverage, we then pass out free booze to the people with the worst driving records.

So what about this — I say we should remove mandated coverage of all of those lifestyle diseases – Type II diabetes, blood pressure, non-emergency heart disease treatment, etc.

Companies would be free to make them available, but they’d be add-on items to a base policy and they’d also be rateable. I’m not interested in preventing someone from purchasing diabetes “treatment” coverage with their insurance, but I don’t want to be forced to “chip in.”

Rateable means they could adjust the premium, for example, based on a periodic A1C, fasting insulin, or some other marker to account for the risk and behavior of the policy owner. Behavior instantly gets coupled to economic consequences.

So people could pay higher premiums for diabetes treatment coverage, pay out of their own pocket for drugs and medical attention, or eat more veggies and fat and cut back on the sugar. I predict immediate, dramatic changes.

I don’t see why we couldn’t reduce medical spending by half a trillion dollars, plus another $100 billion a year by driving a stake through the USDA’s heart.  Putting money aside for just a moment, can you begin to imagine the quality of life improvements people would get?

Of course, I do see why we can’t. Politics. Money. Bureaucracy. Power. The usual suspects. But that doesn’t mean it’s not technically possible or the right thing to do.

It also doesn’t mean that you can’t get started, or step up your game so that you can limit your interaction with the medical system as much as possible. Just because you have to sacrifice them your money doesn’t mean you have to sacrifice your health, too!

Cheers,

The Older Brother

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