On Wednesday, June 24th, I’ll be one of the guests interviewed on Primal Body-Primal Mind, an internet radio show hosted by Nora Gedgaudas. We’ll be talking about the link between carbohydrate addiction and alcoholism.
It’s a great show, and I encourage you to listen to all the episodes.
UPDATE: The show is now available on this page for streaming or downloading.
I occasionally check for reviews of Fat Head by Googling the title and my name. Surprisingly, new reviews still come along now and then.
As you’d expect, some reviewers liked the film, some didn’t. That’s showbiz. I don’t usually fuss over the negative reviews. Art is subjective, and the reviewers are expressing their subjective opinions. I even thought some of the criticisms had merit.
But a couple of reviews that caught my attention require a response – one because the reviewer managed to completely misunderstand the point I was trying to make (in fact, he got it backwards), and the other because he mangled the science about cholesterol levels.
Here’s an excerpt from the “missed the point” review:
A large part of the problem is that Naughton believes the public-especially those who have watched Super Size Me-are stupid. In street interviews, Naughton can’t help but look down his nose at common people and their faulty “common sense” beliefs about fatty food.
This rather interesting interpretation left me flabbergasted. The sequence he’s referring to goes like this:
I recount how Morgan Spurlock was concerned that a nutrition menu listing calorie counts wasn’t available in every McDonald’s he visited.
I point out that nutrition information is easy to find online, in books, etc., and wonder if people are really getting fat on fast food without knowing why.
I conduct a series of street interviews in which I show people a double quarter-pounder with cheese, a large order of fries and a large Coke, then ask if that’s a high-calorie meal or a low-calorie meal. They all say it’s a high-calorie meal – which it is. When I ask what would happen if you ate a meal like this all the time, they all reply “You’d get fat” – which you probably would. I conclude that the ability to recognize high-calorie food seems to be universal.
I point out that people who loved Super Size Me seem to share a common and dearly-held belief that poor people are too stupid to know what’s good for them.
Dr. Eric Oliver appears to say that he was struck by the paternalistic attitude in Super Size Me, and that he disagrees with the idea that poor people can’t think for themselves and need McDonald’s to look after them.
I thought it was clear as a bell that I was criticizing Morgan Spurlock for assuming people are stupid. The street interviews were intended to demonstrate that most people do in fact have common sense – and therefore don’t need Ronald McDonald to inform them that a double-quarter pounder, large fries and large Coke is a fattening meal.
Here’s another quote from the same review:
As expected, people view his tray of fast food as high in fat, but Naughton knows better because he’s done the math and knows his lunch is within the recommended daily intake of calories.
Wowzers. I didn’t ask anyone if the meal was high in fat; I asked if it was high in calories. I also didn’t say this particular meal would fall within the recommended calorie intake, because it wouldn’t. Large fries and a large Coke? Are you kidding me? A major portion of Fat Head is dedicated to explaining the fattening effect of sugar and starch.
Being misinterpreted is merely annoying. Now here’s an excerpt from the review where the writer – who reviewed several films dealing with diet and health – mangled the science:
Naughton also selectively edits out discussion of his LDL (bad cholesterol) both in his baseline and in his final checkup. From the information he does share we can determine that his starting LDL was 170 (231 total cholesterol – 61 HDL = 170 LDL) which is regarded as high risk for heart disease and stroke by the American Heart Association.
I didn’t waste screen time talking about my LDL score because it stayed exactly the same: 156. I also don’t care what my LDL score was, for reasons I’ll explain shortly. But what made me chuckle was the reviewer’s formula:
LDL = Total cholesterol – HDL
That’s not how LDL is determined. LDL can measured directly in a lab, but it requires a time-consuming and expensive test, so most of the time it’s calculated. If it’s calculated, the equation is:
LDL = Total Cholesterol – HDL – (Triglycerides / 5)
This is known as the Friedewald equation. It’s quick and inexpensive, but it’s also nearly meaningless. As Richard Nikoley pointed out in one of his many excellent blog articles, the LDL equation actually rewards you for having high triglycerides – which is a bit nutty, considering that high triglycerides are strongly associated with heart disease.
Suppose your total cholesterol is 200, HDL is 60 and triglycerides are 70. (This happens to be nearly identical to my most recent lipid panel.) In that case, your calculated LDL is 126. Your doctor will probably suggest a lowfat diet and perhaps even a statin … by gosh, that evil LDL should always be below 100!
But if your triglycerides are 300 – which is dangerous – your calculated LDL would only be 80. Your doctor will probably congratulate you, even as your elevated triglycerides are running around your body, torching and burning your arteries and re-enacting Sherman’s march to the sea.
And there’s an even bigger problem with the equation: it can wildly over-estimate your LDL, especially if your triglycerides are below 100 … which mine were, both before and after my fast-food diet.
As I was working on this article earlier today, Dr. Mike Eades happened to put up his own post debunking the LDL equation. (Great minds thinking alike?) Since he spelled it out in detail, I won’t bother – read his article and you’ll get the full scoop. But here are a couple of pertinent paragraphs giving an example of how inaccurate the calculation can be:
This paper is basically a case presentation of a 63-year-old man with a total cholesterol level of 263 (all results in mg/dl), an HDL of 85, a triglyceride level of 42, and an LDL level of 170. The LDL level was, of course, calculated using the Friedewald equation.
For some unexplained reason the authors of this paper decided to repeat the lab results and got the same readings. They then wondered if his very low triglyceride readings might be having an effect, so they measured his LDL levels directly and found that instead of the 170 predicted by the Freidewald equation, his actual LDL levels were only 126.
And even if my LDL really and truly was 170, as the reviewer believed, so what? That’s a meaningless number, despite what the anti-cholesterol hysterics at the American Heart Association believe. (My advice: don’t take advice from an organization that puts its stamp of approval on a box of Cocoa Puffs.) Saying I have too much LDL is like saying I have too many cells in my body. What kind of cells? Brain cells? Muscle cells? Cancer cells?
LDL can be big and fluffy or small and dense. People with small, dense LDL are at risk for heart disease even if the LDL score is low, because the small particles can perforate the arterial wall. Big, fluffy LDL doesn’t do that – in fact, it may even have anti-inflammatory properties and therefore help prevent heart disease.
I explained all this in the film. But after incorrectly calculating my LDL, the reviewer repeated the bologna that high LDL equals bad. Once again, I was flabbergasted. He either took a potty break during that sequence, didn’t understand it, or simply refused to believe it.
The most accurate measure of heart-disease risk is the ratio of triglycerides divided by HDL. The higher the ratio, the more likely you are producing small, dense LDL. Ideally, the ratio should be 2.0 or less. If it’s above 4.0, you’re in trouble. If it’s above 6.0, start putting your affairs in order.
Here are my triglyceride/HDL ratios before the fast-food diet, after the diet, and today: before: 1.15, after: 1.63, today: 1.17.
So my ratio went up a bit after a month of eating fast food that included some starch and trans fats. That’s why I don’t eat them anymore. But even then, my ratio was excellent.
For those of you who haven’t seen the film, eating natural fats (including saturated animal fats) raises your HDL. Frankenstein fats, such as processed and hydrogenated vegetable oils, lower your HDL. Cutting back on sugar and starch lowers your triglycerides. So if you want a good triglyceride/HDL ratio, the simplest way to achieve it is to ignore the American Heart Association and get most of your energy from natural fats.
And whether you’ve seen the film or not, trust me on this: I don’t think the vast majority of you are stupid.
I would guess most of you are frequent readers of Jimmy Moore’s blog, but in case you missed it, I wanted to point out that he recently interviewed one of my favorite medical writers: Dr. Malcolm Kendrick, author of “The Great Cholesterol Con.”
Dr. Kendrick possesses a rare ability to explain medical concepts clearly, while managing to be laugh-out-loud funny at the same time. If you haven’t read his book, I can’t recommend it highly enough. Buy an extra copy and give it to anyone you know who’s in a panic over cholesterol or (worse) taking statins — in fact, buy a copy for your doctor as well.
Well, it looks like President Obama really stepped in it this time. He was callous and cruel, with the whole world watching. At least that’s how that the nutjobs at People for the Ethical Treatment of Animals see it.
In case you haven’t seen it, the president swatted a fly on national television. When the PETArds witnessed this on-air murder, they chided Obama and released this statement:
“We support compassion even for the most curious, smallest and least sympathetic animals. We believe that people, where they can be compassionate, should be for all animals.”
I realize the PETA folks like to blur the distinctions between various life-forms, but flies aren’t animals. They’re insects. They don’t plan for their futures, they don’t fall in love, and they don’t miss their cousin Boo-Boo if he has an unfortunate encounter with a presidential hand. A fly is probably about as intelligent as a medium-sized potato – and therefore only slightly more intelligent than a medium-sized PETA volunteer.
PETA was probably also upset that Obama referred to the fly as a “little sucker.” As anyone who’s at least my age knows, “little sucker” was used to denigrate insects for much of this country’s blemished history – especially back in the days when insects weren’t allowed to sit at the counter at Denny’s. Waitresses and customers alike yelled, “Get out of here, you little sucker!” It’s only been in recent, more enlightened times that the public has been trained to refer insects as “differently-structured animals.”
Hoping to rehabilitate the president, PETA also announced they’re sending Obama a “humane flytrap” that would allow him to capture a fly and then release it outdoors. This is stupid for a couple of reasons. For one, catching and releasing flies is not a good use of Obama’s time. He’s the president, not a border guard. For another, catching and releasing a fly isn’t any fun. But squashing a fly is great fun.
In fact, one of the few things I’ve enjoyed about living in Southern California is the relatively slow reflexes of the flies. I don’t know if they’re a different breed out here or if too much sun just makes them lazy, but for whatever reason, they lack the quickness of their Midwestern cousins.
In Chicago, you need a turbo-charged, spring-loaded flyswatter to splatter a fly on your kitchen counter – and even then, you have to disguise yourself as a houseplant and sneak up on it. One over-eager step, and the fly will launch into a series of evasive maneuvers that Luke Skywalker would envy, then settle on a wall across the room and give you the finger with one of his legs.
But here in La-La-Land, I don’t even need a flyswatter. I can literally walk up to a fly and smack it with my hand. Most of the time, they don’t even move – although once, just before impact, I heard one mumble, “Bummer.”
PETA refers to a fly-smacker like me as a “speciesist.” The “ist” suffix is intended to put the word in the same emotional category as sexist and racist … you know, as if I’m some kind of bigot who believes certain species are inherently superior.
Well, they’ve got me on that one. I do believe my species is superior. If I’m interviewing a human and an antelope for the same engineering job, I’m going to assume the human is more intelligent and the better candidate. I may not even listen to the antelope’s replies – and if I can determine the antelope’s species from his job application, I won’t even interview him. Likewise, if I owned an apartment, I would rather rent to a human than a pig – although if I were a landlord in a college town, I might change my mind on that one.
If the PETArds merely believed in avoiding needless cruelty to animals, I wouldn’t mind them. I might even support them. But that’s not what they believe. They believe humans and animals – and insects, apparently – are all equals and should be afforded the same rights. They actually spout nonsense such as, “A pig is a dog is a boy.”
A couple of years ago, I heard Dennis Prager interview one of the PETArds on his radio show. After several minutes of sparring over animals rights, Prager said, “I’m going to ask you a question, even though I already know the answer: do you have any children?” The PETArd tried to dance his way out of answering, but Prager was insistent. And of course, the answer was no — as everyone listening knew it would be.
If you have kids (and you’re sane), you can’t possibly believe they’re the existential equivalent of rats and pigs. But the childless PETArd insisted that’s what he believes. So Prager asked a clarifying question: If you see a dog and a child both drowning, which do you save?
The PETArd tried dancing out of that one by replying, “I’m a vegetarian, so I’m strong enough to save both of them.” Yeah, right. If avoiding meat was the key to superior strength, the NFL, the NBA, the NHL and the major leagues would be overwhelmingly vegetarian. Pro athletes will do almost anything to gain an edge.
Here’s my answer to Prager’s question: I’d save the child, even if the dog was the schnauzer I loved as a boy and the child was the bully who used to torment my sister. (The bully was also the only human I’ve ever intentionally harmed, and I felt bad about it later, even though he deserved every punch.)
But the PETArd simply refused to answer — because he couldn’t, at least not without looking like a fool. If he answers, “the dog,” he exposes his organization as a bunch of kooks. If he answers, “the child,” he proves he’s a hypocrite.
But course, the PETA folks are hypocrites. It came out in the news some months ago that a PETA chapter in North Carolina relieved the over-crowding in one of their shelters by removing some cats and dogs and killing them. After they were caught dumping the corpses, they said they were very sorry, but they just couldn’t find homes for their little furry friends and had no choice.
Now, try to imagine those same PETA people offering this explanation for a slightly different scenario: “We’re very sorry about the homeless men we euthanized. The homeless shelter was very crowded, and we tried to find families to adopt the men, but people these days don’t have the proper sympathy for alcoholics and schizophrenics, so we really had no choice except to put them out of their misery.”
If they would never, ever do that (which I hope is true), then they’re hypocrites. If they would do that, they belong in an institution – preferably one that only serves pork.
As far as I’m concerned, the PETArds are hypocrites every time they sit down for a nice, yummy, insulin-spiking meal of whole-grain goodness. One of my best friends grew up on a farm. As we were watching the corn being harvested one day, I was stunned at the number of squirming insects and insect parts. (Yes, some of the parts will still squirming.) My friend just laughed at me and explained that all crops end up with insects in them. The FDA even has standards about how many insect parts are allowed in our food.
So if it’s murder to kill an insect, vegetarians are the chief customers and financial supporters of the insect world’s Pol Pots. I just hope they enjoy the extra flavor provided by all those little suckers.
Gary Taubes gave a lecture recently at Dartmouth on fat accumulation. If you haven’t read “Good Calories, Bad Calories,” this is a nice summary of one major topic in the book. (If you have read the book, enjoy the review.) For anyone who believes losing weight is all about eating less and moving more, consider it must-see TV.
Bad news for the bariatric-surgery industry: a Mayo clinic study released this week suggests that people who’ve undergone weight-loss surgery are more likely to break their bones. Here’s the first paragraph from the wire story:
It isn’t just the thunder thighs that shrink after obesity surgery. Melting fat somehow thins bones, too. Doctors don’t yet know how likely patients’ bones are to thin enough to break in the years after surgery. But one of the first attempts to tell suggests they might have twice the average person’s risk, and be even more likely to break a hand or foot.
Given how aggressively the bariatric centers are promoting these procedures, I suspect they’ll put a good spin on this. Pretty soon we’ll be seeing ads that read:
“The last time Mary Blarch broke her pelvis, she spent five miserable months in a size-24 cast. But after shattering both legs in the year following her gastic bypass procedure, she’s practically swimming in her size-6 cast. She only wishes there was more room for people to write their ‘get well’ messages on the plaster!”
I’m glad the study got some media play, but I have a bone to pick with the writer: These people are not ending up with thin bones because they’re “melting fat.” They’re ending up with thin bones because they had weight-loss surgery. That’s a rather important distinction for a medical writer to make.
Here’s another fun paragraph from the article about the study:
A quarter of the 142 surgery recipients studied so far experienced at least one fracture in the following years, Mayo’s Dr. Elizabeth Haglind told the endocrinology meeting. Six years post-surgery, that group had twice the average risk. But in a puzzling finding, the surgery recipients had even more hand and foot fractures than their Minnesota neighbors, three times the risk.
It isn’t all that puzzling. I don’t have a copy of the research paper, and the article doesn’t specify how many of the people studied were the victims of gastric bypass versus the lap-band, but I would guess gastric bypass is far more likely to produce brittle bones. Here’s why:
The lap-band procedure squeezes your stomach down to a fraction of its former size – about the size of a golf ball. You lose weight because you are limited to tiny meals, which (if you’re following the recommended diet) consist almost entirely of proteins and non-starchy vegetables. Yes, that would make it a low-carbohydrate diet.
Gastric bypass is much more radical. The surgeon cuts apart your stomach and uses the top portion to make an itty-bitty stomach. (They call it a “pouch”… isn’t that cute?) The itty-bitty pouch is then connected directly to the middle of your small intestine, bypassing the evil duodenum. And why is the duodenum evil? Because that’s the part of your small intestine that aborbs fat. The surgery centers that sell gastric bypass procedures even brag about this effect:
Gastric Bypass Surgery provides an excellent tool to limit the amount of food eaten and to change how food calories are absorbed. Not only is the stomach pouch too small to hold large amounts of food, but by skipping the duodenum, fat absorption is substantially reduced.
Since people who have gastric bypass can’t absorb fats, they lose weight faster than people who have the lap-band procedure. The gastric-bypass centers are quick to point this out in their literature. Just one little problem: you need fats. Your hair, skin, nails, hormones and bones depend on fats, either directly or indirectly.
As health writers like Sally Fallon and Nora Gedgaudas have pointed out in their books, many essential vitamins are fat-soluble, including A, B12, D, E and K. If you’re not absorbing fat, you’re also not absorbing and using those vitamins — even if you’re filling your itty-bitty pouch with supplements. And if you can’t absorb those vitamins, you also can’t fully absorb the nutrients that depend on them, like calcium. Here are some quotes I found from studies that examined the effects of gastric bypass surgery:
The incidence of vitamin A deficiency was 69%, vitamin K deficiency 68%, and vitamin D deficiency 63% by the fourth year after surgery.
The incidence of hypocalcemia (low calcium levels) increased from 15% to 48% over the study period.
There is a progressive increase in the incidence and severity of hypovitaminemia (low vitamin levels) A, D, and K with time after biliopancreatic diversion and duodenal.
Dolan et al. reported vitamin A deficiency in 61% of patients following biliopancreatic diversion at 28-month follow-up. This was despite an 80% compliance rate with multivitamin supplementation. (Read that again: most patients took their vitamin supplements, but still became vitamin A deficient.)
Despite calcium and vitamin D supplementation after Roux-en-Y gastric bypass, Coates et al. found that within 3 to 9 months after surgery, patients have an increase in bone resorption associated with a decrease in bone mass.
So you end up losing weight, but also become vitamin deficient, and perhaps end up with brittle bones. I’d rather be fat and know I’m able to roll on the floor with my rambunctious girls without snapping a femur.
But of course, you don’t have to become vitamin deficient to lose weight. You can lose weight by cutting out sugar and starch, which don’t contain any nutrients we need – or to be more accurate, they don’t contain any nutrients we can’t get from the foods Mother Nature actually intended for humans to eat.
The lap-band procedure doesn’t block the internal absorption of fat, so it’s less likely to cause vitamin deficiency – and of course, the lap-band surgeons are quick to mention that advantage. But as you may recall from a previous post, you’re still limited to ridiculously small portions. I think it’s unlikely you can get all the nutrients you need from meals that could sit on a golf tee.
In fact, as I was wading through online research to write this post, I was reminded all over again of what an awful existence these procedures can produce. Here are some explanations of the post-surgical effects – and keep in mind, I pulled these from sites that are actually selling the procedures. Their explanations are in bullet points; my comments aren’t.
What is Symptomatic Dumping Syndrome? Dumping is caused by rapid passage of food from the pouch into the small intestine. Before surgery, the stomach has a valve at the top and bottom, and serves as an acid-filled storage tank, breaking food intake down into small, component parts and passing it to the small bowel in increments. After surgery, food passes directly into the small bowel, mixed only with saliva and amylase from the mouth, but no stomach acid. The small bowel responds by diluting what we eat through a process of ‘water recruitment’ into the bowel space. This is referred to as ‘early dumping.’ Suddenly, the heart will pound and beat rapidly; you may feel dizzy, and overwhelmingly tired. The bowels may gurgle and churn, and will feel bloated and gassy. This might be followed by loose stools and even vomiting. It is not dangerous, but it can be frightening to the uneducated patient.
Yes, education is the key here. When I was in college, I saw lots of educated people dumping and vomiting at parties, but they were never overly concerned.
Why is it sometimes necessary to vomit? Your pouch and Roux limb, the two parts of the gastric bypass tool, work like a slow moving sink drain. There is no stopper at the bottom of the sink, but the narrowness of the connection between the pouch and the Roux limb restricts the passage of food out of the pouch and into the Roux limb. Sometimes if a food gets stuck and will not pass into the Roux limb, the only solution is to cough out the offending food to release it from the pouch.
Coughing food out of your pouch … boy, that must make you popular at dinner parties.
Why do some people complain of frothing after the surgery?
They actually gave one of those “it’s nothing to worry about” explanations, but I didn’t bother to copy it because 1) it was medical doublespeak, and 2) I was too busy laughing myself silly, picturing an obese, post-surgical woman frothing at the mouth … and her husband replaying the day’s events in his mind, trying to figure out what the heck he’d done wrong.
What is Steatorrhea? Steatorrhea is the result of fat malabsorption. The hallmark of steatorrhea is the passage of pale, bulky, and malodorous stools. Such stools often float on top of the toilet water and are difficult to flush. Also, patients find floating oil droplets in the toilet following defecation.
So there you are, standing at the toilet, flushing and cursing and flushing and cursing and frothing at the mouth and risking a wrist fracture from all that yanking on the handle with your brittle bones, but your last meal insists on floating atop the water like a gang of pale, bulky, malodorous fishing bobbers. Sure, there are other options besides flushing, but they’re not pretty, even if you believe in composting. And to make matters worse, there are oil droplets floating around the bobbers. Best remember not to toss a burning cigarette butt into the bowl.
If a LAP Band patient nibbles on food all day, he or she can continue eating a high-calorie, high-fat diet without ever feeling full and never lose weight.
Uh, no. If a lap-band patient nibbles on high-fat food, he or she will feel full. If he or she nibbles on carbohydrates, he or she will spike his or her insulin and then he or she will feel hungry and he or she will nibble again … and again … and again.
Also note that hair loss is common – but don’t worry, it usually grows back within a year.
Which gives you plenty of time to color-coordinate your smaller clothes with your new wigs.
If you are a regular coffee, tea, or soda drinker you should be aware that no caffeine is permitted for the first three months after surgery.
So I’ll be nice and thin when I’m sent to prison for aggravated assault. But I’ll also be bald, so maybe I’ll look badass enough to avoid any unwanted romances.
Considering whether to undergo Lap Band surgery requires serious thought. It should only be considered if morbid obesity is a major medical issue and nothing has worked.
Really? I thought you should only consider lap-band surgery if you think dieting sucks.