More A to Z Diet Trial Data

Readers may recall that last year, in March 2007, a study was published from a dietary trial comparing four dietary approaches for weight loss: Atkins, Ornish, LEARN and Zone – the A to Z Weight Loss Study.

Many reading through the findings cried foul – those in the Ornish group hadn’t reduced their fat sufficiently, those in the Atkins group consumed more carbohydrate than recommended, and so on.

In my blog post I noted “…this study failed to achieve compliance out of the gate!”

I also noted that “We have before us is a study that really does indicate carbohydrate restriction can work well over a period of one year. Without sub-group analysis to evaluate results tied to compliance (hey, some of the participants had to be doing the various diet right, dontcha think?) we can’t know just how effective doing Atkins or any of the diets is with good compliance though since the researchers didn’t take their data to that level of analysis in this paper.”

Ask and ye shall have an answer!

A follow-up paper was published in the International Journal of Obesity – Dietary Adherance and Weight Loss Success Among Overweight Women: Results from A to Z Weight Loss Study.

As the researchers note in the background of their abstract: “Dietary adherence has been implicated as an important factor in the success of dieting strategies; however, studies assessing and investigating its association with weight loss success are scarce.”

Their objective?

“We aimed to document the level of dietary adherence using measured diet data and to examine its association with weight loss success.”

And so they performed a secondary analysis on the data from the trial and lo’ and behold, those who closely adhered to the dietary recommendations of their assigned diets were found to have greater weight loss when compared with those less compliant with their dietary recommendations.

The researchers found that “within each diet group, adherence to score was significantly correlated with 12-month weight change.”

Atkins rs= 0.42 p=0.0003
Zone rs= 0.34 p=0.009
Ornish rs= 0.38 p=0.004

When comparing the highest level of compliance with the lowest the researchers noted significant differences in weight loss in the Atkins group!

Atkins
Highest compliance = 8.3kg
Lowest compliance = 1.9kg
p = 0.0006

Zone
Highest compliance = 3.7kg
Lowest compliance = 0.4kg
p = 0.12

Ornish
Highest compliance = 6.5kg
Lowest compliance = 1.7kg
p = 0.06

The researchers concluded, “Regardless of assigned diet groups, 12-month weight change was greater in the most adherent compared to the least adherent tertiles. These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss.”

The Other Side of the Obesity as Disease Debate

Obviously the debate about classifying obesity a disease is not a new idea, for years various researchers, special interest groups and organizations have debated the merits of defining obesity as a disease, with each round of reasoning and review of the evidence leading to the determination that obesity is not a disease unto itself, leaving it to remain categorically a health issue – a risk marker and a condition one is better to address than to ignore, but not a disease in need of specific medical intervention per se, but a condition with treatment options at the discretion of those within the medical community treating obese patients.

This distinction is important – while medical interventions are available, they are not the sole option for those who are obese; nor are all individuals with a BMI of 30 or greater automatically deemed to have a chronic disease in need of treatment by licensed healthcare professionals. If someone is obese, they are clearly able to seek medical treatment if they desire that option, just as they can opt instead to join Weight Watchers, read and follow the South Beach Diet on their own, or, gasp!, do nothing if their obesity is not causing them other health problems.

In order to fully understand the implications of the current position foisted in the Obesity Society white paper, it’s important to look at the arguments as they’ve developed over the years. One exceptionally well written paper was published in October 2001 in the International Journal of Obesity – Is Obesity a Disease?

In that paper, the authors take time to review and discuss the “characteristics of obesity to determine if they fit the common and recurring elements of definitions of disease.” They utilize a sample of definitions of disease taken from “authoritative English language dictionaries” to determine a common understanding of what defines “disease” and from there, examine if obesity fits the definition.

They tell us, “we identified the following common and recurring components:

(a) a condition of the body, its parts, organs, or systems, or an alteration thereof;
(b) resulting from infection, parasites, nutritional, dietary, environmental, genetic, or other causes;
(c) having a characteristic, identifiable, marked, group of symptoms or signs;
(d) deviation from normal structure or function (variously described as abnormal structure or function; incorrect function; impairment of normal state; interruption, disturbance, cessation, disorder, derangement of bodily or organ functions)

Then ask, “[h]ow well does obesity fit the definition of disease?”

Using the above criteria for disease, they evaluate whether defining obesity as a disease can be accomplished within the definition of disease.

There should be little disagreement that obesity satisfies conditions (a) and (b) above. That is, (a) an excess accumulation of fat can certainly be thought of as a condition of the body, and as for (b), the list of potential causes is so extensive that the causes of obesity must surely be found there.

Condition (c) poses a problem. Indeed, obesity can be diagnosed visually from physical proportions, or with the help of height and weight measurements. In cases of doubt, body composition methodologies offer numerous methods to measure body fat to the required degree of precision. However, there are no signs that inevitably characterize the condition other than the excess adiposity, which is the definition of obesity. The causes of obesity are numerous and diverse, ranging from and including combinations of environmental, behavioral and genetic aspects of energy intake, partitioning and expenditure. Its common accompaniments¾impaired glucose tolerance, dyslipidemia, hypertension¾are not inevitably present. Thus, condition (c) is met, but only in a circular or tautological sense: the only characteristic (pathonomic), identifiable sign of obesity is also the characteristic which defines obesity, ie fatness.

Condition (d) is even more problematic. The deviations specified range from simple deviation from normality, to impairment, interruption or cessation of vital functions. Moreover, what is meant by deviation from normality is not clear¾it can imply undesirable variation or simple statistical rarity.

Evidence for impaired physical and social functioning in severe obesity (eg BMI>40) clearly exists. In these cases, excess fat is usually accompanied by various signs of impairment and it can be argued that severe or extreme obesity would usually meet condition (d) for most definitions of disease, including those which specify impairment of function.

However, impairment is not inevitable or even usual in most persons who meet the present BMI or percentage fat criteria for obesity. In contrast to severe obesity, mild obesity only ‘threatens’ eventual impairment inasmuch as a risk factor, by definition, confers a greater probability of some future adverse event. Yet its association with these events is, at our present state of understanding, probabilistic. We cannot foretell who will develop an obesity-related health problem. In fact, some persons who meet the criteria for obesity will live long lives free of any of the morbidities known to be influenced by obesity. We are therefore placed in the conceptually awkward position of declaring a disease which, for some of its victims, entails no affliction.

Many obese persons are competent, functioning members of society. Nor do these persons necessarily subjectively consider themselves impaired, except perhaps insofar as they feel themselves victims of social discrimination. They might fail to meet some arbitrary standard of physical fitness (eg climbing stairs, running) but such a standard would also exceed the capability of many non-obese but sedentary individuals. While physical fitness is desirable, its absence has not generally been considered an impairment. It would be possible to set an arbitrary standard of fitness which many obese and non-obese people would fail to meet, and to consider this as evidence of impairment; however the present criteria for obesity do not do so.

A further conceptual problem arises when obesity occurs in a disease such as Cushing’s Syndrome. Obesity is one of the components or signs of that syndrome. Is the obesity which is a sign of Cushing’s disease, itself a separate disease?

In sum, to call obesity defined solely on the basis of a BMI or percentage body fat in excess of some threshold a disease leads immediately to the following problems:

• the only sign or symptom may be the excess fat which is also the only defining feature of the condition¾there are no other inevitable clinical or subclinical signs;
• many obese persons suffer no impairment as a consequence of their obesity;
• it ignores the probabilistic nature of the relation between obesity and consequent adverse events which is accurately conveyed by the term risk factor;
• it poses conceptual problems, eg is the obesity which is a sign of a disease, itself a disease?

They continue on, at great length about the various ethical issues involved – from the creation and fostering of a victim ‘mentality’ of the obese, to the issue of responsibilities that range from patient behaviors to obligation to provide medical treatment, from the problems of vested interests leading the cause to declare obesity a disease to determining who pays for treatments.

They come full circle and conclude, “None of the foregoing is meant to argue that obesity is not a public health problem of the first magnitude. However, it would be a mistake to attempt to label it a disease in the traditional sense in order to emphasize its importance if it does not meet reasonable criteria for such diseases. Conceptual clarity is a cardinal virtue in science and philosophy and it should not be sacrificed to expediency.

Finally, it seems neither logically necessary nor tactically essential to have obesity labeled a disease in order for it to be taken seriously. Public health measures and preventive medicine often receive generous funding (eg annual physical examinations, immunization programs, smoking cessation campaigns, promotion of exercise and active lifestyles). Whether and how our institutions and organizations pay for obesity treatment should ultimately depend on what health outcomes we value, how much we value them, and the cost of achieving them, not on whether obesity is labeled a disease.”

Is Obesity a Disease?

I left readers with photos of three incredibly fit men on Friday – each is an elite athlete in the octagon, practicing mixed martial arts, at the top of their game.

I asked one question, aside from the UFC, what do they share in common?

Many answered they all share the common BMI classification “obese” – although that is correct, the answer I was going for was they’re all “diseased” and in need of medical treatment for their obesity according to the authors of a new white paper published by the Obesity Society.

That’s right, if the opinions expressed in this white paper are adopted, the men pictured would all be considered suffering a chronic, debilitating disease which needs treatment by healthcare professionals.

The committee that drafted the position paper took the unusual step to discard the evidence-based (forensic) model and opted for a philosophical argument from a utilitarian perspective.

While they credit themselves for taking this approach because “there can be no higher authority than reason,” they ignore the important qualification for something to be declared a disease – is it a disease?

This abandonment of evidence, data and scientific inquiry undermines their approach by simply skirting the true purpose to determine if something is rightly, indeed, a disease state. To get around this wee inconvenience, instead they argue “…the utilitarian argument can address the question “should obesity be declared a disease?” as opposed to “is obesity a disease?”

The ramifications of this mind-bending mental-gymnastics are far-reaching, the authors ignore the moral and ethical can of worms opened if their position is adopted, with their beliefs trumping evidence as they remain steadfast in the belief that it doesn’t matter *if* obesity is a disease, it should be declared one anyway because,

“Many obese people are desperate for treatment – the number of people who self-treat and those treated by commercial programs is larger than the number currently treated by the medical establishment. If obesity were considered a disease and entitled to the same considerations given to other diseases, treatment paradigms would change fundamentally…If treatment were covered, more physicians would be likely to engage patients in treatment protocols. The FDA would come under pressure to approve obesity drugs, and physicians would be more likely to use obesity drugs in treatment…With this increased attention, medical treatment options, especially drug treatment, likely would become more aggressive. Medical treatment and obesity surgery would be given more attention by physicians, health administrators, insurance companies, and employers, resulting in greater access by patients to higher quality care.”

For those unaware of the various philosophical approaches, Utilitarianism is the idea that the moral worth of an action is solely determined by its contribution to overall utility, that is, its contribution to happiness, satisfaction, preferences or pleasure as summed among all persons affected. This is a form of consequentialism – the moral worth of an action is determined by its outcome – the ends justifies the means.

Because it is an ‘ends justifies the means’ line of thinking, it can be characterized as a quantitative and reductionist approach to ethics. And to be sure, this issue has far reaching ethical and moral implications – in the stroke of a pen, this perspective potentially takes 1/3 of our population and defines them as diseased, in need of medical intervention and treatment, by way of the crudest measure of obesity – the BMI.

As the three men in Friday’s post highlight, obesity as defined by BMI is unreliable, thus flawed as a measure to determine if one is obese. This flaw isn’t news, it’s well established in the medical and research community as problematic, which is a reason why many continue to suggest the utilization of more refined measures, like waist-hip ratio and/or an actual measure of body fat percentage.

But even this well known flaw does not stop the authors from even suggesting the BMI standard be LOWERED to classify obesity! That’s right, not only do these folks think we should abandon medical standards and wax lyrical about how obesity should be declared a disease, they also feel the BMI needs to be lower too!

Sandy Szwarc at Junkfood Science has a well written article about the paper already, so I’ll skip the points she already made. I’ll note here that one sentence bears repeating about why the philosophical approach in this paper is wrong, “By this logic, or course, poverty could be a disease… Black or ethnic minority a disease… Old age a disease… Homosexuality a disease… Ugliness a disease… Low intellect or literacy a disease.”

In addition to the points made by Sandy, a big issue remains – what about the legal issues and medical ethics involved if obesity were declared a disease?

First and foremost is that should obesity be declared a disease, therefore a chronic medical condition, it would then follow that only licensed healthcare professionals would be qualified to treat obesity. The treatments would, of course, include a handful of diet pills, lifestyle interventions and/or bariatric surgery. Fully medicalized as a disease, obesity would no longer be ‘treated’ outside the licensed medical community because anyone offering services to the obese would be practicing medicine without a license since all disease treatments are the protected domain of licensed healthcare professionals.

More importantly however, is the problematic position “declaring obesity a disease” becomes for the healthcare professional. We’ll explore these issues throughout the coming week.

What do you think? Should obesity be declared a disease? Why or why not?

What Do You See?

Other than being UFC fighters, what do these three men, Shane Carwin in the top photo and Cain Velasquez to the left and Brad Morris to the right in the bottom photo, share in common?

Guess in the comments and I’ll explain on Monday!

Dr. Westman: Yet Another Possible Explanation

After reading the findings comparing the Masai, and the rural and urban Bantu in Tanzania, Dr. Eric Westman penned a reply to the British Journal of Sports Medicine:

Yet another possible explanation
Eric C Westman, researcher Duke University

Thank you for this contemporary assessment of dietary intake among the Masai pastoralists. Through the paradigm-shifting lens of a recent comprehensive summary of the lack of science to implicate saturated fat as a cause for heart disease [1], and new studies which suggest carbohydrate to be more worrisome than saturated fat for atherogenesis [2-4], there is a simple explanation for why the Masai do not develop atherosclerosis despite consuming a high-fat diet that the authors did not consider: high-fat diets (not containing man-made fats) are not atherogenic.

1. Taubes G. Good Calories, Bad Calories. Knopf Publishing, 2007.
2. Krauss RM et al. Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr 2006;83:1025-31.
3. Mozaffarian D et al. Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women. Am J Clin Nutr 2004;60:1102-3.
4.Volek JS et al. Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res 2008;Mar 15 (Epub ahead of print]

Blood Sugar Control Useless?

In what has to be one of the most irresponsible reporting on study data I’ve ever seen, the New York Times today headlined Tight Rein on Blood Sugar Has No Heart Benefits, penned by Gina Kolata.

Throughout the entire article we find statements without qualification as to how study participants were attempting to lower blood sugars:

Two large studies involving more than 21,000 people found that people with Type 2 diabetes had no reduction in their risk of heart attacks and strokes and no reduction in their death rate if they rigorously controlled their blood sugar levels.

[…]

Thus both studies failed to confirm a dearly held hypothesis that people with Type 2 diabetes could be protected from cardiovascular disease if they strictly controlled their blood sugar.

[…]

Still, said Dr. John Buse, president for medicine and science of the diabetes association, the blood sugar/cardiovascular disease hypothesis has failed for people with established Type 2 diabetes.

For these patients, “intensive management of A1C for cardiovascular risk probably isn’t worth it,” Dr. Buse said.

The two studies both sought to control blood sugars through intensive use of pharmaceuticals – with no control group to compare findings in those utilizing dietary and lifestyle interventions shown to improve blood glucose and HbA1C levels (carbohydrate restriction) with lower levels of medications or no medication.

The blanket statement that the trials ” failed to confirm a dearly held hypothesis that people with Type 2 diabetes could be protected from cardiovascular disease if they strictly controlled their blood sugar” leaves out one critical qualification – the sentence should end with “through intensive use of medication.”

More than 50% of Americans Have a Chronic Health Condition!

A sobering finding from a recent Gallop Poll – 51% of Americans suffer with chronic health conditions such as heart disease and diabetes. That’s more than half of us!

As noted in the Reuters article, Many Americans Stuggling in Life, Survey Finds, “Healthways President Ben Leedle said 51 percent of Americans are stuck in a cycle of chronic disease such as heart disease and diabetes, in part because of their poor choices. ‘Many are stressed, worried and overweight, all factors which lead to illness and, ultimately, lifelong health conditions,’ Leedle added.”

An alarming 66% of working Americans reported one or more chronic disease or recurring condition, and greater than 20% reported calling in sick at least one day and on average six days in the past month!

What the heck is going on?

We spend more on healthcare than any other nation in the world, have the highest percentage of a population vaccinated, and are unusually obsessed with our health, diets and a variety of health risk markers! Yet more than half the population suffers a chronic disease?

What do you think is happening? Leave your comments!

My Big Fat Diet – Now Available on DVD

In March of this year I posted about a low-carbohydrate diet study, conducted in a small village on Alert Bay in Canada, with those from the area participating in what would be a ground-breaking trial to see the effect of returning to a dietary composition which reflected more traditional ratios of fat, carbohydrate and protein without going back to an absolutely pure traditional diet based on only traditional foods.

As I noted in my post, the findings were “expected” – it was reported that subjects in the study, following the dietary approach:

Lost 10.1% of body weight
Shed 9.7% of their waist circumference
Improved their waist-to-hip ratios significantly
Triglycerides (TG) declined 19.9%
HDL rose 17.4%
TG/HDL ratio improved 30.2%
TC/HDL ratio improved 11.5%
Total Cholesterol (TC) and LDL had no significant change

What’s neat about this study is that they didn’t just participate and then have researchers follow-up and report the findings – they also filmed a documentary about the study while it was in progress.

That documentary is now available and you can purchase a copy here! (for the record, I have no vested interest in sales of the DVD)

Dogmatic Conclusions to Make Your Head Spin

One of the oft repeated concerns about a carbohydrate restricted, high-fat diet is long-term effects. With globalization and a wide-variety of foods available in even remote locations today, it’s increasingly difficult to find traditional populations whom may be ideally suited to assess the long-term effect of such a diet.

One such population does exist – the Masai of Africa – for whom meat, milk and blood are their daily dietary staples, a naturally low-carbohydrate diet that has been traditionally consumed for generations. They offer us a unique opportunity to assess how such a diet impacts the ‘health risk markers’ held dear in modern science and medicine.

Does their diet, high in fat, make them fat?

Does their diet, high in fat, make them hypertensive?

Does their diet, high in fat, lead to high cholesterol levels?

For decades many have assumed that a diet rich with dietary fat leads to obesity, high blood pressure and high cholesterol, which then is assumed to lead to heart disease and other chronic health problems.

In the June 3, 2008 issue of the British Journal of Sports Medicine a study investigating the Masai and their dietary habits and comparing them with rural and urban Bantu consuming different dietary practices is quite enlightening and tells us a story about how consuming dietary fat per se is not the underlying cause of obesity, high blood pressure or high cholesterol.

In the study published, Daily Energy Expenditure and Cardiovascular Risk in Masai, Rural and Urban Bantu Tanzanians, we learn that researchers investigated the dietary habits of three distinct populations within the same country – Tanzania – thus limiting confounding variables due to vastly different cultural conditions.

In total, the researchers investigated the health and health risk markers of 985 Tanzanian men and women – 130 Masai, 371 rural Bantu and 484 urban Bantu – with each group reporting very different dietary habits.

The Masai reported a high-fat, low-carbohydrate dietary pattern.

The rural Bantu reported a low-fat, high-carbohydrate dietary pattern.

The urban Bantu reported a high-fat, high-carbohydate dietary pattern, similar to a Western diet.

Which group to do think fared best?

BMI (average)

Masai = 20.7
Rural Bantu = 23.2
Urban Bantu = 27.4 (as a whole, the group was, on average, overweight)

Incidence of Obesity (BMI at or higher than 30)

Masai = 3%
Rural Bantu = 12%
Urban Bantu = 34%

Waist-Hip Ratio (lower is better)

Masai = 0.87
Rural Bantu = 0.89
Urban Bantu = 0.93

Blood Pressure

Masai = 118/71
Rural Bantu = 134/80
Urban Bantu = 134/82

Prevalence of Hypertention

Masai = 4%
Rural Bantu = 16%
Urban Bantu = 21%

Total Cholesterol

Masai = 3.89mmol/L (152mg/dl)
Rural Bantu = 3.60mmol/L (140mg/dl)
Urban Bantu = 4.50mmol/L (176mg/dl)

HDL (higher is better)

Masai = 1.08mmol/L (42mg/dl)
Rural Bantu = 0.91mmol/L (36mg/dl)
Urban Bantu = 1.08mmol/L (42mg/dl)

LDL

Masai = 2.09mmol/L (82mg/dl)
Rural Bantu = 2.13mmol/L (83mg/dl)
Urban Bantu = 2.69mmol/L (105mg/dl)

Triglycerides

Masai = 1.36mmol/L (121mg/dl)
Rural Bantu = 1.45mmol/L (129mg/dl)
Urban Bantu = 1.61mmol/L (143mg/dl)

Total Cholesterol/HDL Ratio (less than 4 is ‘ideal’)

Masai = 3.72
Rural Bantu = 4.38
Urban Bantu = 4.53

LDL/HDL Ratio (the lower the better)

Masai = 2.21
Rural Bantu = 2.46
Urban Bantu = 2.69

ApoB/ApoA-1 Ratio (measure of LDL particle ratios, lower is better)

Masai = 0.74
Rural Bantu = 0.83
Urban Bantu = 0.81

So, there you have the major findings. What did the researchers conclude?

No! It couldn’t possibly be their dietary habits, it must be that the “potentially atherogenic diet among the Masai was not reflected in serum lipids and was offset probably by very high energy expenditure levels and low body weight.”

Now their level of physical activity certainly may be contributing to their overall health, but it’s certainly not independent of their dietary habits. In fact, I would contend that while it’s ideal to be active, that is not the driving force in ‘health’ or lack thereof – it’s dietary habits that dominate our health outcomes, our level of activity may be important too, but activity in and of itself is no solution to a piss-poor diet.

We need, before activity, a proper diet to enable us to perform phyisical activity, not the other way around! So while the researchers here could not bring themselves to even consider that the habitual diet of the Masai – high-fat and low-carbohydrate – was the driving force in their good health and enabled high levels of activity, I’ll say it!

Here we have evidence that a high-fat, low-carbohydrate diet, consumed habitually does not lead to obesity, high blood pressure and dyslipidemia, and it may, in fact, lead to beneficial long-term health and increased levels of activity in those habitually eating such a diet.

2010 Dietary Guidelines Committee

From Nutrition & Metabolism Society:

As you probably know, the U.S. Department of Agriculture (USDA) shapes the contents of the food pyramid. They are currently in the process of developing plans for the 2010 Food Pyramid and selecting experts for the committee.

This panel should reasonably include scientists or nutritionists who have experience with diets low in carbohydrates and, understand their impact on health.

In the past, the USDA has not included such researchers on their panels.

We’re reaching out to you to ask for your help in communicating to the USDA the importance of including viewpoints like Dr.’s Feinman, Volek, Westman and Lustig on the Dietary Guidelines Advisory Committee. Your encouragement will help ensure that the Committee has a balanced view of diet and nutrition.

Following is a sample template letter to the USDA (Carole.Davis@cnpp.usda.gov). Please customize with your own personal story, (Be sure to cc: NMS info@nmsociety.org and your Congressional Represenative and Senators). The dead line for nominations is May 23 so please take the time to do this now.

Personal stories about results of lowering carbohydrates in your diet will send a powerful message to the USDA. Let them know you have valuable input and a voice that will be heard.

For a list of qualified candidates, please consider NMS Scientific Board Members.

Thank you.

——————–

Sample Letter

Carole.Davis@cnpp.usda.gov

Nutrition Promotion Staff Director
Co-Executive Secretary of the Dietary Guidelines Advisory Committee
Center for Nutrition Policy and Promotion
US Department of Agriculture
3101 Park Center Drive, Room 1034
Alexandria, VA 22302

Dear Ms. Davis:

I am writing you about the recent announcement about the establishment of the Dietary Guidelines Advisory Committee for the 2010 Food Pyramid. I understand that the selection process is currently underway to determine what voices will be part of the discussion about the framework for the American diet. Some aspects of the current food pyramid are not a reflection of the needs that most Americans like myself have in order to maintain health. I encourage you to ensure that researchers who have performed extensive studies on the benefits of adjusting variables in the diet, like Dr. ___________ be included on the panel.

I have many reasons for wanting to make sure that the panel includes experts on the science behind different kinds of diets, such as diets low in carbohydrates. [insert your own personal story – 1 or 2 paragraphs – about the results you have achieved by lowering the carbohydrates in your diet. Write about how these results have made you feel. What health effects have you seen?]

Facts about the science of low-carb diets are important to the discussion about the new food pyramid. I urge you to make sure the Dietary Guidelines Advisory Committee includes scientists who are well-informed about these issues.

Sincerely,
[Your name]

Cc: http://www.NMSociety.org
(your senator)
(your congress person)

Bragging Rights

Last week, on Friday, my husband was on the front page of our local newspaper, the Columbia Tribune!

In vitro treatment success rate soars at Columbia clinic

In vitro fertilization, once a long shot for couples unable to conceive naturally, is becoming a much better option thanks to new technology, but high costs still prevent some couples from pursuing the treatment.

During a recent interview, Gil Wilshire, endocrinologist at Mid Missouri Reproductive Medicine and Surgery Inc., practically jumped out of his seat when discussing the rate of IVF pregnancies, embryos that were successfully implanted.

“I can’t even believe I’m giving this to you,” he said, sliding a piece of paper with his office’s statistics across the desk. “Last month I did five transfers, and four got pregnant. … That’s incredible.”

Last year, Wilshire said, his office broke all internal records. It saw a 44 percent success rate for patients between the ages of 38 and 40 years old and a 67 percent success rate for patients ages 35 to 37. Patients older than 40 were successful 17 percent of the time. Those numbers are significantly higher than the most recent national rates, which are also on the rise. Mid Missouri Reproductive performed 56 total IVF cycles in 2007.

The Missouri Center for Reproductive Medicine and Fertility at Columbia Regional Hospital, the other large fertility clinic in town, had a slow year, with only two pregnancies out of nine IVF cycles. But the center has just completed a move into a $1.4 million renovated fertility clinic at Columbia Regional Hospital, and doctors say they’re expecting a big 2008 and 2009.

“We’ve been a two-site program for the last five or six years,” said Danny Schust, one of two endocrinologists at the program. Schust said the laboratory was previously housed at University Hospital and the clinic was at Columbia Regional. “It was disjointed. It really makes no sense,” he said. “So we’re excited to have it all together.”

There are other reasons for optimism. In vitro fertilization has switched from a simple numbers game, where doctors tried to overwhelm long odds with large numbers of sperm and eggs, to a more precise science.

“Back in the early ’90s, when I did my fellowship in reproductive medicine and endocrinology, a good success rate was 14 percent,” Wilshire said. “We were groping in the dark as a profession. We’d put a bunch of embryos up there and pray to God, hopefully the embryos would stick and you’d get a pregnancy in there.”

If a couple decides to undergo the costly IVF treatment, doctors first prescribe a drug – gonadotropin – that stimulates ovulation to cause the woman’s body to release multiple eggs. They remove eggs from the woman and place them in a petri dish protected in an incubator. The doctor then has two choices: pour sperm over the egg in hopes that one will make its way in or, in cases of men with low sperm counts, use a “micro manipulator machine” to inject a single healthy sperm into the egg.

Then it’s time for the fertilized egg to grow. One of the most exciting advances of recent years is the “medium” used to replicate the fluid of the womb. This medium – made up of amino acids, sugars and nutrients – has been perfected by scientists to replicate conditions in the womb.

Whereas 10 years ago doctors would have to implant the embryo in the womb after one or two days in the petri dish, they now can wait five days, until the embryo has divided into eight cells and is well on its way to becoming a fetus. “The real advances are in the IVF lab. I wish I could say the doctors are getting better, but I think it’s the embryologists who are getting better,” Schust said.

But the doctor’s skill comes next. After five days, he or she must remove one or two of the fertilized eggs and implant them near the top of the womb. Wilshire said when he began practicing, he would put in four or five embryos just to be sure one would take. Today, he says, he rarely puts in more than two.

Wilshire proudly wielded the “coaxial catheter,” a thin, rotating pipette used to do the implantation.

“I liken it to fly fishing,” he said. “When you’ve got crystal-clear water and you’ve got a big trout in the pool, if you even look in there or drop a stone, it scurries away – it’s very scared and skittish. However, if you’re a good fly fisherman, you’re way away and you cast just right, then the fly goes out and it goes … down real lightly like a natural fly, and the trout comes up and gets hooked.”

None of this is cheap, however. IVF cycles typically cost about $7,000 without medication. Once the medications are included, that figure can rise to $10,000 or more. In Missouri, group health insurance policies are not required to cover IVF, but a bill sponsored by Rep. Steve Hodges, D-East Prairie, would mandate that all policies covering more than 25 employees cover the treatment.

Hodges said he got the idea for legislation after hearing the story of a New Madrid couple who needed help from family members to pay for IVF.

“For people who want a child that badly – and the procedure is fairly taxing, not counting the expense and emotion involved – I just thought, ‘We spend lots of money trying to save lives, why not spend some money trying to create one?’ ” Hodges said. “I have a saying: ‘A good thing is always a good thing,’ and I think this is a good thing.”

Roman Gladiators: Diet Made Them Fat

An interesting article in News in Science, Ancient Worlds – Roman Gladiators Were Fat Vegetarians – gives insight that their diet, heavy with carbohydrate, made them fat.

“Tests performed on bits of bone taken from the skeletons of some 70 gladiators buried at Ephesus seem to prove that they ate mainly barley, beans and dried fruit,” said Dr Karl Grossschmidt, who took part in the study by the Austrian Archaeological Institute “This diet, which has been mentioned in the oral history, is rather sad but it gave the gladiators a lot of strength even if it made them fat,” said Grossschmidt who is a member of the University of Vienna’s Institute of Histology and Embryology.” [emphasis mine]

Under-the-Radar Petition at the FDA from American Dietetic Association and Others

Now that the pharmaceutical industry has its first FDA approved weight-loss drug available to the public, over-the-counter (OTC) no prescription needed Orlistat, it’s time to eliminate the competition in the marketplace – dietary supplements – used by many Americans to help with weight loss.

On the Regulations.gov website, an interesting petition exists that has had virtually no attention in the media – Treat Weight Loss Claims for Dietary Supplements as Disease Claims – filed as a citizen petition to the FDA by the American Dietetic Association, the Obesity Society, Shaping America’s Health and GlaxoSmithKline Consumer Healthcare.

The full document PDF is available here as well as on the page linked above.

The document is quite interesting and it’s obvious the petitioners do not want input from the public or an open comment period – they just want the FDA to take the action they request, no questions asked, no comments, no looking at anything other than what they’ve provided the FDA. Basically telling the FDA to just trust them!

The petition requests FDA to require manufacturers of weight loss supplements to obtain FDA review of their claims before the products can be sold, asserting such claims are “disease claims” as clearly indicated by the title page of the petition document – “Citizen Petition of the American Dietetic Association, The Obesity Society, Shaping America’s Health, and GlaxoSmithKline Consumer Healthcare requesting the Food and Drug Administration to determine that claims that dietary supplements promote, assist, or otherwise help in weight loss are disease claims under Section 403(R)(6) of the Federal Food, Drug and Cosmetic Act.”

We learn more in the section Action Requested, “In support of this action, petitions present extensive scientific evidence and consumer survey data that has been developed during the past decade. This new information conclusively establishes three critical facts. First, the condition of being overweight is a significant risk factor for serveral serious diseases, including diabetes, cardiovascular disease and cancer. Second, many Americans understand the health risks of being overweight and they rely on dietary supplements to lose weight. Third, there is little, if any, evidence, indicating that dietary supplements marketed for weight loss actually work. As a result of these three facts, many Americans are being thwarted in their efforts to lose weight, and reduce the risk of disease, by ineffective weight loss supplements.”

To support their postion, they assert that claims such as the above are “qualified health claims” that require authorization and approval from the FDA and state they believe “there is no credible evidence whatsoever to support any type of qualified health claim for a weight loss supplement…In the case of weight loss supplements, there is no credible evidence to indicate that supplement themselves assist in weight loss or, even if they do so, that there is a commensurate risk reduction of disease from the use of any such supplements.”

A qualified health claim is a claim authorized by the US Food and Drug Administration (FDA) that must be supported by credible scientific evidence regarding a relationship between a substance (specific food or food component) and a disease or health-related condition. Both of these elements — a substance and a disease — must be present in a health claim. An example of a qualified health claim is: “Calcium may reduce the risk of osteoporosis.”

The petitioners even go so far as to strongly suggest public input and comment is not necessary, they carefully take the position that overweight need not be redefined as a disease, but rather a risk factor for disease; thus providing the FDA an opportunity to act in their favor without notice or comment rulemaking.

“Finally, in this context, petitioners must emphasize that FDA is not required to engage in norice and comment rulemaking under the Administrative Procedures Act (APA), 5 USC 553, before implementing the actions requested in the petition. That is because the petitioners are not asking FDA to change its earlier interpretation of the way that two of the criteria in the structure/function rule apply to weight loss claims. Rather petitioners are requesting FDA to apply a particular provision in its existing regulations to weight loss claims in light of the substantial body of literature and consumer survey data developed during the past decade. An agency’s application of its regulations to particular factual scenarios certainly does not require notice and comment rulemaking under the APA. Moreover, to the extent that FDA concludes that granting this petion woudl require the agency to modify its earlier statements about weight loss claims in the preamble to the structure/function rule, such statements constitute “advisory opinions” that can be modified at any time following notice in the Federal Register.”

At least we find public comments are open online (even if nothing is found elsewhere online to hint this petition even exists)….the public comment and submission page is here.

Time to get to work!

The Solar Powered Plate

I feel a rant coming on today – Earth Day – when as if on cue, the media is hot and heavy with the message that the best thing any one of us can do to reduce our carbon footprint is to eat less meat. In newspapers, magazines and blogs we find all sorts of reasons behind the rush to banish meat from our diets:

Toronto Star: “Eat less meat. Raising cattle, sheep and pigs uses up resources.”

Sacramento Bee: “Another thing is, gosh, if you can reduce demand, get people to eat less meat, all those things would be great.”

The Day: “People should eat less meat. You would be healthier and so would the planet,” because of the tremendous resources used in raising and processing meat for consumption.”

The Guardian: “But there is a bigger reason for global hunger, which is attracting less attention only because it has been there for longer. While 100m tonnes of food will be diverted this year to feed cars, 760m tonnes will be snatched from the mouths of humans to feed animals – which could cover the global food deficit 14 times. If you care about hunger, eat less meat.”

The Guardian: “For both environmental and humanitarian reasons, beef is out. Pigs and chickens feed more efficiently, but unless they are free range you encounter another ethical issue: the monstrous conditions in which they are kept. I would like to encourage people to start eating tilapia instead of meat. This is a freshwater fish that can be raised entirely on vegetable matter and has the best conversion efficiency – about 1.6kg of feed for 1kg of meat – of any farmed animal. Until meat can be grown in flasks, this is about as close as we are likely to come to sustainable flesh-eating.”

PETA: “Mr. Gore likes to be thought of as an environmentalist steak-and-potatoes kind of guy, but there’s no such thing as a meat-eating environmentalist,” says PETA Vice President Bruce Friedrich. “He needs to confront the ‘inconvenient truth’ that meat production is the main culprit in global warming.”

I could continue with more quotes, but I think you get the point – we’re being told, repeatedly, we need to eat less meat!

With all the urgency in this message, the question begs – is eating meat really an environmental problem?

The answer really is a “yes” and “no” – meat from livestock is an excellent source of complete protein, vitamins, minerals and fatty acids essential to human health.

The big problem isn’t so much the meat, but the way we in the United States (and more and more countries around the world) raise livestock today – intensive feedlot operations which demand huge amounts of “inputs” to fatten cattle quickly.

The various reports on the global impact of raising livestock are based on factory farming practices which are indeed damaging to the environment. To really understand how, we need to look at how livestock in the US, and in other parts of the world, is now routinely raised for food and how the messages about the “inputs” is virtually ignored by the popular and politically correct message to eat less meat. All of these “inputs,” interestingly, are also required for growing the plant-based vegetarian/vegan diet being promoted as the way for us to save the plant….but those promoting that message don’t bother telling us that in their cries we must eat less meat.

Like I said, the problem isn’t the meat – it’s the method used to produce the meat. You see, cattle, pigs, turkeys and chickens are no longer pastured – that is allowed to graze in fields all day – instead, they’re raised in what has been rightly named “factory farms” [CAFO – Confined Animal Feeding Operations] where they’re raised in huge numbers – apparently the largest operations in the United States have tens of thousands of cattle in one facility at a time.

The practice of CAFO is fairly new, gaining ground in the US since the 1960’s and was/is seen as a way to produce food while controlling cost and a uniform standardized product output.

But to achieve the output desired requires some intense “inputs” – namely fossil fuel based fertilizers, chemical pesticides, diesel and fuel for transportation, energy for manufacturing ferilizers, pesticides and feeds, pharmaceuticals to maintain animal health (somewhat) while feeding a diet they are not designed to eat, supplements to provide vitamins, proteins and such not in the feed, energy and resources to house and maintain the animals from birth to slaughter and managing large volumes of waste that is unsuitable for use as fertilizer since the diet teh animal is raised on renders it toxic.

While the industry calls these practices “efficient” – they’re anything but, and I’d say are part of the problem we’re trying to solve.

The equation looks sort of like this:

Synthetic Fertilizer & GMO Patented Seeds [$] —-> Pesticides [$] —> Feed [$] —> Cows [$] —> Building [$] —> Electricity [$] —> Pharmaceuticals [$] —> Manure Lagoons [$] —> Transportation [$] —> Food

On the other hand, properly raised livestock is solar powered food, it’s equation looks like this:

Sun [free] —> Grass [free] —> Hay & Silage [$] —> Cow [$] —> Food & Organic Fertilizer

Funny, while the politically correct message these days is eat less meat, it truly should be eat more – from livestock raised properly – that is livestock that turns the energy of the sun into high quality food for human consumption rather than requiring intensive energy inputs as the means to an end.

This food – pastured meats – is food that truly is created from the sun to become a solar powered plate of delicious and nutritious quality food for us to enjoy, not only guilt-free, but that also is environmentally friendly too!

You see, what those repeating the message above fail to disclose is that livestock, especially cattle, are not naturally grain consumers – they eat mostly grass, ground covering legumes, and an assortment of weeds and other plants that are indigestible for humans.

These plants grow in abundance in rich soil, turning the energy of the sun into food for the cow – which in turn allows us to consume that same energy that’s not usually available to us when we consume the flesh of the animal.

Not only that, but grazing animals do more than turn the energy of the sun into food for us – they fertilize and replenish the soil upon which they graze, allowing rich soil to accumulate and grow plants rich with nutrients, which in turn squesters carbon in the soil and those plants sucking CO2 out of the air.

Farmers from long ago understood the relationship between their animals and their crops too – livestock did much of the necessary “work” for the health of the total farm – grazing in the fields, depositing manure to provide food to birds that followed along behind them (chickens, turkeys, etc.) and create rich soil deposits to optimize the grass and ground covering plants growth, and consuming silage from crops planted on the farm and hay baled throughout the warm months.

All this in a dynamic that allowed the farmer to not only have quality protein from the meat, but also healthy soil to grow nutrient-dense plant foods to provide for both his animals, his family and his community.

This dynamic is lost in factory farming of animals and in monoculture crop farming of plant-foods, where one crop dominates again and again, requiring the use of synthetic fertilizers, pesticides and now, even patented seeds year after year.

And rather than address this issue, we’re being told to eat less meat to save the planet.

We’re told that’s green and good and that it’s the way of the future; that it’s healthier for us and the environment; that we’ll all benefit if we just eat less meat.

Sorry, no can do – I’m simply not going to be part of growing an industry that will continue to require, in higher and higher quantity, synthetic fertilizers, fossil fuels, chemical pesticides, sterile patented seeds farmers need to buy from the industry year after year since storing seed is either useless or illegal whle still requiring huge amounts of energy to transport and process the resultant crops into foodstuff…!

I’m not going to enhance their profits while they destroy our health and the balance of nature with unnatural and intensive input requirements to grow their self-defined “healthy” food products.

Soyburgers? No thanks!

Soymilk? You’re kidding, right?

Quorn? Oh, don’t even go there!

Tofurky? What’s up with mock “meat” anyway?

This Earth Day my commitment is not to enhance the bottomline of ADM, Cargill or Monsanto, but to:

A) Support my local farmers commited to traditional farming practices that enhance the health of the planet and those eating from its bounty – those who pasture their animals and grow crops using organic methods

B) Grow some of our food this summer – tomatoes, lettuce, beans, cucumbers, carrots and more, in our garden

C) Try my best to create and eat foods that really are on a solar powered plate – local fruits, vegetables, nuts and seeds and yummy pastured meats, eggs and dairy!

When Good Intentions Have Unintended Consequences

Unlike adults, children – especially those under five – are quite unique in their requirements for calories and nutrients each day. That is because they’re on a trajectory of growth that requires significant calories, making it is next to impossible to estimate accurately their energy needs by any formula that applies to adults.

Yet this fact doesn’t stop the well-intentioned from taking the standard dietary recommendations for adults and simply downsizing portions, in the assumption that smaller portions of the same foods recommended for adults will translate to adequate nutrition for children.

Back in January 2007, I wrote about a study in Sweden that found children fed a diet low in fat were found to have a higher incidence of insulin resistance, significant nutritional deficiencies, and weighed more with higher BMI’s than children fed a diet higher in fat.

As I noted in that post, “In previous generations the focus was mainly on getting and providing enough food to meet these energy needs; today we’ve modified our view and extrapolated our notions about a “healthy diet” – carbohydrate-rich, low-fat – to our children. Not a day goes by that there isn’t an article or segment in the news that we need to feed our kids less fat and more “good” carbohydrates.”

Also in January of last year, I shared with readers a day in the life of my son by posting pictures of the foods he consumed throughout the day, along with how his menu stacked up for nutrients and calories, along with how his eating differed from the sample menu offered by the American Academy of Pediatrics (AAP) as an example of “healthy eating” for children.

In that post I noted, “the menu [from the AAP] fails to provide adequate intake of Vitamin E, Vitamin K, Copper, Selenium, Potassium and omega-3 fatty acids” for a toddler.

I also wrote, “We seriously need to start re-thinking our dietary recommendations for children; right now our dietary recommendations and policy are failing them because our phobias about dietary fats have seeped into their lives as we’ve modified their diet to limit fat and include an abundance of carbohydrate-rich foods that does not, at the end of the day, have the desired effect.”

The desired effect these days is prevention of childhood obesity and rather than truly look at how children are eating, the experts continue to downsize adult dietary recommendations and assume they’ll meet the requirements of children. The worst of the assumptions is that if parents feed their children a downsized adult diet, with a variety of foods while limiting dietary fats, their children will learn good eating habits and avoid obesity.

While I was away on vacation, I read the disturbing findings reported in the Observer – a survey of nursery preschools in the UK found that 70% are feeding children inadequate calories each day because they’re feeding them too many fruits and vegetables in an attempt to make sure they’re eating enough fiber!

As Sarah Almond, a pediatric dietitian, noted, “We expected the study to show nurseries were serving children food that was too high in calories, fat, saturated fat and salt, and low in vegetables and fruit. Instead, we found that the majority of nurseries had gone to the other extreme and appeared to be providing food that was too low in calories, fat and saturated fat and too high in fruit and vegetables.”

[…]

“Because a significant number of children attend nurseries from 7am until 7pm, the food and nutrition they receive there are key to their health,” said Almond. “Nurseries are applying requirements of healthy eating for school-age children and adults to the one-to-four age group, who have entirely different requirements.”

These findings speak volumes about the unintended consequences of good intentions that are based on dogma and assumptions rather than hard data. And when hard data points to the opposite of the assumptions and dogma, it’s ignored.

In our desire to prevent childhood obesity, we’re missing the forest for the trees and ignoring the critical requirement they have for both energy and nutrients to grow properly. It is easy to assume that a child under five doesn’t need a lot of calories, especially when we think about how many we need as adults. If we believe the average adult needs about 2000-calories a day, then that tiny little kid should only need a fraction of what we need since they are much shorter and weigh a lot less, right?

Wrong.

Check out the Energy Calculator online, created by the USDA/ARS Children’s Nutrition Research Center, designed to help parents and caregivers estimate calorie needs for children.

If you input the numbers for an average three year old boy (38″, 32-pounds and active 1-hour or more a day) you’ll learn he needs 1710-calories a day on average!

What do you feed a three-year old boy to meet his energy requirements and nutritional needs? I can tell you this – it’s not a low-fat diet!

Where’s Regina?

I know, I know, I’ve been remiss in my blogging duties!

For those wondering where I’ve been – I recently launched a new website for families with children, here in Missouri – Mid-Missouri Family. I’ve been a bit taken aback by the overwhelming response to its launch – a lot more visitors each day than I’d anticipated (a good thing) with many, many emails to answer each day, and subscriptions to the newsletter far exceeding my expectations (a great thing)!

And now, just as I’m getting into a routine for time to update that each day and write for my blog – I’m off on vacation through the 19th – so I’ll be back here again, posting to my blog, on April 21st (that is if I don’t blog while I’m on the road – just no promises that I will be able to).

Time for Critical Appraisal

Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal

Current nutritional approaches to metabolism syndrome and type 2 diabetes generally rely on reductions in dietary fat. The success of such approaches has been limited and therapy more generally relies on pharmacology. The argument is made that a re-evaluation of the role of carbohydrate restriction, the historical and intuitive approach to the problem, may provide an alternative and possibly superior dietary strategy. The rationale is based on the accepted idea that carbohydrate restriction improves glycemic control and reduces insulin fluctuations which are primary targets. Experiments are summarized showing that carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets and that substitution of fat for carbohydrate is generally beneficial for risk of cardiovascular disease. These positive effects of carbohydrate restriction do not require weight loss. Finally, the point is re-iterated that carbohydrate restriction improves all of the features of metabolic syndrome.

Anthony Accurso
Richard K Bernstein
Annika Dahlqvist
Boris Draznin
Richard D Feinman
Eugene J Fine
Amy Gleed
David B Jacobs
Gabriel Larson
Robert H Lustig
Anssi H Manninen
Samy I McFarlane
Katharine Morrison
Jorgen VESTI Nielsen
Uffe Ravnskov
Karl S Roth
Ricardo Silvestre
James R Sowers
Ralph Sundberg
Jeff S Volek
Eric C Westman
Richard J Wood
Jay Wortman
Mary C Vernon

Full-Text PDF

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You’ll note the above list includes two individuals that I’ve recently posted about, Dr. Annika Dahlqvist and Dr. Katharine Morrison, along with a number of individuals you all know from their books, published studies and commitment to the science of carbohydrate restriction.

They’re all members of the Nutrition & Metabolism Society, an organization committed to “providing research, information and education in the application of fundamental science to nutrition. The Society is particularly dedicated to the incorporation of biochemical metabolism to problems of obesity, diabetes and cardiovascular disease.”

If you haven’t done so, you can join today – membership helps NMS in the “promotion of scientific information in an environment where such information is not adequately supported by government and private health agencies. “

Gorillas Dying Prematurely

What happens when you feed this to a gorilla?

Ground corn, Soybean meal, Cracked wheat, Sucrose,Wheat germ meal,Animal fat (preserved with BHA, propyl gallate and citric acid), Dried whole egg, Dicalcium phosphate, Calcium carbonate, Iodized salt,Vegetable oil, Choline chloride, Stabilized ascorbic acid (source of Vitamin C), Ethoxyquin (a preservative), Ferrous sulfate, Zinc oxide, Copper chloride, Manganous oxide, Cobalt carbonate, Calcium iodate, Sodium selenite,Vitamin A supplement,Vitamin D3supplement,Vitamin E supplement, Thiamine (Vitamin B1), Niacin, Calcium pantothenate, Pyridoxine hydrochloride (Vitamin B6), Riboflavin (Vitamin B2), Folic acid, Biotin,Vitamin B12supplement.

Apparently they develop heart disease and die prematurely.

Maybe they need more soy, corn and wheat with less animal fat, eh?

Your Leg or the Bread?

While Dr. Annika Dahlqvist is challenging the conventional wisdom of diet and health in Sweden, so too is Dr. Katharine Morrison in the UK; a GP who “is one of a vocal minority who contend that the orthodox advice given to type one and type two diabetes patients is not only unhelpful but might be counterproductive.”

In today’s Herald, Are Diabetics Suffering for No Reason, provides readers with a look at the benefit experienced by those with diabetes who modify their diet to restrict carbohydrates.

John Gibson’s leg had been ulcerated, swollen and inflamed for weeks. “It looked like a damson from my toes to my knee,” the 61-year-old recalls. His specialist suggested it would have to be amputated. “He whipped out a camera and photographed it. I said, Is this going to be the last time you see it?’ and he said, It might be.'”

But when he next visited, Gibson explains as he sits at home in Mauchline, Ayrshire, the specialist was astonished to see that the leg had healed. “He asked me, Where’s the ulcer?'” The former army nurse explained that his diabetes was now being managed on a special low-carbohydrate diet, recommended by his GP. “The specialist told me, Oh, we don’t believe in that.'”

Truly amazing, isn’t it?

A man’s leg, saved from amputation….but that’s no reason to even consider a carbohydrate restricted diet if you have diabetes.

No siree, no can do, let’s not forget, “Diabetes UK continues to recommend that diabetic people follow the same balanced diet recommended for the rest of the population. Low in fat, sugar and salt, with plenty of fruit and vegetables, meals can contain some starchy foods such as bread, potatoes, cereals, pasta and rice.”

And who really wants to give up eating bread, pasta, rice, potatoes and cereal anyway?

“Hope Warshaw says many study subjects are unable to stick with Bernstein-style diets. “Diabetes lasts the rest of your life. You need to find an eating plan that you can follow for that long as well.”‘

I don’t know about you, but if I had to choose between my leg or the bread…..mmmm, thinking……thinking……

How about you?

Do They Serve Exclusively Grass-Fed Meat at the Funny Farm?

I’ll be waiting for the men in white jackets to take me away.

Seems I suffer this new eating disorder, orthodexia, characterized by shunning foods with “artificial ingredients, trans fats or high-fructose corn syrup.”

Oh, I also read labels and plan my menus (gasp!) for the week ahead; which according to Dr. Steve Bratman (who coined the name for the condition) is a sure sign I need help…. “If you get a thrill of pleasure from contemplating a healthy menu the day after tomorrow, something is wrong with your focus.”

What do you think? Is orthorexia a health concern or hype?