Sunday, December 30, 2012

Et tu Insulin ?

When talking about diet plans and general health, the word "Insulin" gets used ALOT. People speak about it as if it is the very secret to life. There is NO question that Insulin is a critical part of our normal day to day functioning. But like everything else, its role must be kept in perspective.

Insulin is critical to our health because it is a key player in the control of our blood levels of sugar, or more specifically, a specific kind of sugar called glucose. There are actually lots of different sugars and  the word sugar itself is used to refer to a whole group of molecules that share certain characteristics. I will NOT get into the chemistry of sugar and covalent bonds and double helices and carbon nanobots and black holes and ...

In any case, Insulin exerts a great deal of control on the level of sugar in our blood. The key role of Insulin is to make it possible for our cells to "eat" the sugar that floats around in our blood. This is SO important that when Insulin does not function properly, people die.

There is a disease that is specifically related to problems with Insulin and it is called Diabetes Mellitus, but often just called Diabetes. There are basically two types of Diabetes. In one type, a person's body does not produce any Insulin. This is VERY serious and can cause a relatively fast decline in a person's health and lead to death. More frightening is that this kind of diabetes is (or actually used to be) more common in children. Before Insulin was produced as a medication that could be injected, these children suffered and died. It was horrible. Since the time that Insulin is available, these children can live long lives and have their own children AND grandchildren. It is nothing short of a medical miracle.

There is another type of Diabetes where the basic problem is that a person's body becomes resistant to Insulin. In other words, their bodies are producing Insulin but their own cells are not able to respond to the Insulin.

Think of it as a door on the top of each cell in your body. This door only opens when there is Insulin, and when it opens, it lets sugar into the cell. Now imagine that the door slowly gets jammed and becomes resistant to opening. This "Insulin resistance" is responsible for the development of a condition called  "the Metabolic Syndrome" and yes, it would make a great name for a movie. What happens is that in order to "push the door open", our bodies produce more and more Insulin. It is equivalent to more and more people pushing against a jammed door until it finally gives way. The problem with this, is that too much Insulin floating around has other side effects, like high cholesterol and high blood pressure. Eventually, no matter how much Insulin is produced, it can barely open the "door". More sugar stays in our blood and causes "hyperglycemia" which is latin for ... (I am Googling it) .. "too much sugar in our blood". This is what your doctor sees when they test your blood and say that you now have Diabetes. And now you can understand that the real problem is that your cells cannot get to the sugar and they become starved and sick. So, unless you find a way to fix this problem with Insulin, a person's health begins to quickly deteriorate.

There is one other effect of the Metabolic Syndrome that catches everybody's eyes - weight gain. It seems that, as luck would have it, our fat cells still manage to respond to Insulin even when there is Insulin resistance and they interpret all this extra Insulin as a signal to store energy, i.e. to sop up the extra sugar in our blood and to store it away for a rainy day.

IF this is the case, then the theory goes (read my last blog about "theories"), if you can overcome Insulin resistance, then your body's Insulin levels will go back down and your fat cells will stop being exposed to super high doses of Insulin and they will stop storing fat. In fact, they may start releasing the fat - which means LOSING WEIGHT !!

So, let's now take a BIG jump over to the low carb dieters and see why Insulin is talked about so much in this camp. The idea is that constantly EATING (or drinking) sugar constantly stimulates our bodies to make Insulin. This constant exposure to Insulin causes our cells to develop Insulin resistance and thus all the things I discussed above. So, IF we stop eating sugar, much less Insulin will get produced and we will never develop resistance. THAT is the theory.

Here's the problem. If we protect ourselves from developing Insulin resistance, then we can see that we will not tend to gain weight. But even if do not eat sugar, and even if Insulin is never over produced, why should this make us LOSE weight ?  More so, if we eat lots and lots of other foods without sugar (like meat and eggs and fish), how come we don't gain weight from all the calories in them (and yes, they have calories) ? Many in the low carb group make it sound as if we will shrink away to nothing if we simply never eat sugar, NO MATTER how much other food we eat.

It is in THIS point that there is SO much controversy. Some people argue that without stimulating Insulin, our bodies effectively ignore most of the non-sugar calories we eat. Others challenge this and say, that a calorie is a calorie. So NO MATTER what calories you eat, if you eat too much, you will gain weight. And believe it or not, for ALL of the research on this matter, there is still a huge difference of opinion about the real role of Insulin, sugar and weight gain.

MY perspective on the research is that there IS something very real to the argument that low carb is an effective way to lose weight and to even fix Insulin resistance and cure Metabolic syndrome. It is less important to argue WHY low carb diets work. It is MORE important to recognize that there is sufficient evidence to accept low carb dieting as an option for people with various health problems. And if so, then for people with Metabolic Syndrome, the option of starting a low carb diet should be discussed with their doctors. Will it magically fix everything ? There is no magic. But it may still be very helpful for at least some people struggling with their weight and other medical problems.

In my next entry, I will talk about the idea that low carb dieting actually DOES reduce your intake of calories even  though low carb dieters believe that they can eat as much as they want.

Thanks for listening

Saturday, December 29, 2012

In theory ...

Theories are wonderful things. They allow us to say a whole range of things and sound very professorial when we do it.

"The theory is that we are designed to eat low carbs because for 100,000's of years, our cavemen ancestors ate a primarily meat and fat diet".

This is one of the founding principles behind low carb diets, specifically one like the Paleo diet.

It makes sense - right ? Unfortunately, we do not have that many caves with people in them, AND we are fresh out of dinosaurs, so it is difficult to prove this theory. But repeat this theory often enough to people, and they will begin to recite it as doctrine.

Now, before anyone thinks I am about to trounce all low carb diets, let me make full disclosure. I personally follow a low carb diet. I actually believe, from my reading of the literature and my personal experience, that low carb diets are THE solution to many people's health problems. So, the purpose of this discussion is NOT to shoot down Paleo diets and their kin. It is to make clear what the danger is, in relying on unproveable theories.

So, let's go back to our caves, where the lean mean six-pack wielding cave men (and women?) are telling stories about the silly looking Tyrannosaurus Rex they saw earlier in the day. What can we really learn from their lifestyle ?

Well, for one, they did not have exercise bikes in these caves (or at least, we have not found any amongst the fossils). They also did not do Pilates as far as we can tell. And finally, we found no evidence to date of them squatting 1000 pounds and then flexing in their mirrors. So, for one, IF we want to learn something from the cavemen, it is that we were clearly designed and selected genetically NOT to formally exercise !!  Interestingly, no one ever mentions that. Now it is true that chasing down and killing those big dinosaurs required alot of running and shooting and jumping. If anything, we might be able to argue that high intensity physical activity (which is its own style of training) IS in our genes. But would someone, in either the low carb and hi carb camps, argue that we should NOT formally exercise because our great ancestors never did ?

What about the effect of such a diet on longevity? How healthy were the cavemen by the time they hit 50, 60 and more years of age? Well, as far as we can tell, until the modern era of medicine, people tended to die quite young (MUCH less than 60 years old). So, for all we know, a caveman diet might be great for us until we are 30 or 40, but becomes toxic to our bodies when we hit our midlife crisis (which back in cavemen days meant hanging out with the 20 year old cavegirls and riding around in a suped up cart on wheels). So, the theory sounds great. But when you think of all of the repercussions of being genetically selected out for living under caveman conditions, it actually makes you want to rethink trying to emulate their lifestyle. In other words, we would probably do better trying to break away from their habits and find a way to bend our genetics so that we will still be healthy when we are much older. THIS theory has as much validity as the one that says, "eat like cavemen".

Now, contrarily, I have heard speakers talk about the clear benefits of eating non-meat / non-dairy / non-fish / non-egg diets and how vegetarianism and veganism are, as their theory states, the way to counter all of the toxins that we eat on a regular basis. I have heard them describe various chemical reactions in our bodies that produce all kinds of nasty by-products when subjected to anything other than broccoli. To be clear, I think it is true that there are many benefits to eating lots of vegetables and fruits. And any healthy diet should include these items, in their most natural form (see my previous post). But meats and fish and eggs are not Satan's way of getting to our souls. One can eat a healthy diet and have great blood tests and great cardiovascular fitness while still eating a steak, salmon, eggs WITH the yolks, and a glass of milk. In fact, there are those who would benefit greatly from adding such foods to their diets to counteract their low Calcium, low Iron and low vitamins.

The way to know if a particular diet/lifestyle is better than another, is to formally compare them in a controlled study. Theories get disproved all the time when the actual experimentation is done. Many very smart people have had to retract their brilliant theories when the final data was analyzed and proved the exact opposite of the existing theory.

So be wary of theories. Be careful when a lecture on ANY topic spends 3/4 of an hour talking about the theory and then only mentions, in passing, a couple of studies with data that support this theory. When you have the winning horse, you do not need to describe all the reasons WHY it should win. You should be able to show a picture of it with the trophy, and then you can talk about anything else you want. In the same fashion, if someone wants to prove their theory about lifestyle and eating, let them start with all of the supporting research, THEN let them list the research that challenges their theory and THEN let them explain away these contrary data. THAT is an honest and professional way to address any topic.

Thanks for listening.

Friday, December 28, 2012

An obvious question is "why is there confusion about something so basic as proper nutrition" ? In the world of medicine, with so many technological advances, you would think that someone could once and for all do a study, analyze the data with lots of smart computers, and give a definite answer as to what is the best way to eat.

Think of it this way: when you go to the doctor with a sore throat and a fever, and the doctor says you have a "nasty throat", is there any question that you need antibiotics ?  if you break a bone in your foot - is there any question that you need a cast ?

Well, in fact, there is. As time goes on, we learn things in medicine that challenge previous "knowledge". The vast majority of people with a fever, sore throat and pus on their tonsils, do NOT need antibiotics, as the cause is a virus (which does not respond to antibiotics). And some bone fractures in the foot do not need a cast. More than that, sometimes you cast even when there is no fracture. When I went to medical school in the 80's, I was taught a lot of "facts". if I were to practice medicine today according to those same facts, I would occasionally be held liable for malpractice.

So medicine is in a constant state of learning. And when dealing with something as complex as diet and its effect on health, it is not surprising that there would still be such controversy.

But that does not help "John" or "Mary" who today, need to do something to help improve their health. That does not help them when they need to find a way to deal with their high blood pressure or diabetes.

Let me already jump to the end of my train of thought and share with you some simple conclusions about ALL diets, whether low carb, high carb, vegetarian, high animal protein and so forth. There are some common threads to all of these diets. And it is those threads that make up the fabric of a healthier eating style. Along with these conclusions about all diets, I also sneak in some of my personal recommendations.
  1. Reduce your intake of processed foods. Let me already be clear - this does not mean that you need to dress like Grizzly Adams and chew on organic free range tree bark. It means simply that when possible, always choose less processed foods. So, if you can eat a can of tuna instead of "out of the box tuna pancakes" then great. If you can have freshly made chicken (yes, even with the skin) instead of chicken nuggets (even when they are fortified with B12) then eat the plain chicken. When you can have a baked potato (with yes, its atmospheric glycemic index) instead of french fries or potato pancakes (with real potato flakes !!), choose the baked potato.

    Almost every diet requires that you reduce processed foods. So if you are low carb, you will skip the pizza because of its crust. If you are low fat, you will skip the pizza because of its cheese and oil. This is one of the reasons it is so hard to differentiate between many diets - because as unique as they may be, they still have such a basic tendency in common - which is to reduce your intake of many problematic foods.

    I feel comfortable saying that JUST this one basic principle would be transformative to a large number of people and would potentially curb their tendencies towards many diseases.
  2. Do not drink too many calories. if you have a choice between drinking orange juice and eating 2 fresh oranges (with a glass of water), then go for the regular oranges. Many juices may have added sugar and most often deny you many of the healthier benefits of fresh fruit or vegetables. And if you have a choice between drinking regular soft drinks versus diet drinks, yes, it is better to skip the sugar.

    One of the problems with drinking calories is that you don't really "feel" them. As such, you can drink a liter of regular sweetened cola without feeling full. Moreso, you can easily keep drinking such fluids until your calorie count approaches that of Michael Phelps on one of his heavy training days. It is just THAT easy to drink extra calories.

    Does this mean "don't drink milk". Or what about a glass of juice every morning with breakfast? is that so bad ? And then there is the issue of a glass of wine every day as being the magic potion to a long and healthy life (at least in France). So are ALL of these verbotten ?

    This brings us to our next basic principle.
  3. Don't think in absolutes. You get the impression from some diet plans that if, say, on a low carb diet, you take in ONE extra gram of carbs, you will explode in a fashion that would qualify you as a weapon of mass destruction. Contrarily, for those on low fat diets, you would sometimes think that you must live your life in a way that makes the Essenes look like the ultimate party animals - "no cake for you. No shtrudel. No home made apple pie. No No No".

    The key in all of this is not to get extreme. It is great if you have managed to stabilize your weight and get off your diabetic medication by sticking to a low carb diet. But if you do break down and once a year/month/week have a brownie, the world will not end. MOST people need to eat better and "cleaner". But they do NOT need super strict eating regimens to achieve their health goals. So, relax and enjoy life, at least once in a while.
  4. It actually is not about your weight. I realize that most people start a diet primarily to lose weight. Well, ok, the vast majority. Alright. EVERYBODY starts a diet to lose weight. And because of this, the word diet is immediately associated with hunger, misery, punishment, new shoes, and so on.

    But believe it or not, there really is such a thing as eating to improve one's health INDEPENDENT of weight. More so, a person could have quite a few "extra pounds" on their body  and still be fit and healthy with perfect blood sugar and low cholesterol.

    The point is that if someone switches from a poor quality, high calorie way of eating to a healthier way of eating, they will lose weight as a by product. And well before they hit some magical number on the scale, they will likely have already dramatically reduced their risk of heart disease, cancer, stroke and lots of other fun diseases.

    Contrarily, if your only focus is a number on the scale, then you will have a much greater risk of losing and then regaining weight. If the way you choose to lose weight is not sustainable (such as 500 calorie a day diets, or 3 hours a day of intensive aerobics), then once you lose the weight, you will revert to your "old habits" and watch your weight rise again.

    As hard as it is for so many people to accept, our natural state is NOT a six pack abdomen. Models and fitness professionals, whether female or male, live a very strict lifestyle which demands a great deal of physical activity and/or very controlled food intake. And yes, some of them (maybe most of them) have a genetic gift that lets them stay leaner than the "average bear". It is interesting to look at some of the great athletes of 20, 30 and more years ago, to see how they look when they are older. And there are those who once had the bodies of gods but who now look like they ate one of those gods. And that is called age and life.

    Give yourselves a break. Accept your bodies, strive for better health and THEN enjoy the extra prize of losing a few pounds in the process.
  5. There is a difference between someone who is 200 pounds overweight and someone who is 30 pounds overweight. I am always astounded at how the exact same principles of eating and exercise are touted for people who need to lose some weight versus those who are trapped within a morbidly obese body that even limits their ability to breath.

    When a person walks into a doctor's office with a 20 year history of trying to lose weight, who is already diabetic and after a heart attack, and is carrying 200 extra pounds on their body, does it seem reasonable that their treatment should be "walk 20 minutes a day and eat green leafy vegetables". Would these things help ? They might. But the likelihood that this is the "cure" is very small. And to attack such people with vicious and hateful comments, blaming them for being "too lazy or stupid" to lose weight is nothing short of EXTREME cruelty.

    Can you imagine screaming at a young, severely underweight girl because she refuses to eat? Can you imagine a doctor telling a person suffering from anorexia that she is "being silly"? Can you imagine it ever working to just tell such a person that she needs to eat more to be healthy? Yet when it comes to obesity, it is "clear" that the only problem is laziness and gluttony. Sometimes those people who claim to be the most tolerant of different view points, cultures and people in general, have NO tolerance or sympathy for the obese. Why is that ?

    So, for those who have a severe weight problem, you will most likely need professional help. Modern medicine has a number of options to help people with severe obesity. And it is NOT any sign of personal failure when you struggle with your own weight. And for those who do not have this issue, rather than pat yourselves on the back congratulating yourselves for clearly being superior human beings with amazing will power, take a Valium, put in between your teeth and stop talking.
  6. Question everything. Trust no one. Or as the greatest physician of all time, Dr Gregory House, has said, "Everybody lies".

    Whenever you flip on a youtube video and see an "expert" talking about any topic, you assume that they must know something. No one would speak authoritatively about a topic they were not experts at. And if such a presenter states that the "literature clearly shows ...", then he or she must be well read and really smart. How is it then that there are fundamental arguments over the same sets of data ?? How can two people quote the same research and come to opposite conclusions ?

    There are studies often quoted in the health world that are the "go to" study to prove a point. And yet, you will have authorities (what does that mean, you ask?) who challenge the conclusion of that very study. More than that, you will have people delve into the actual data collected for that study, re-analyze it, and come to very different conclusions.

    So how is anyone supposed to know who to trust and what to do? I have no easy answer. The march to knowledge is a slow one. And there are many points along the way that require one step back. We are getting better in the sense that more scrutiny is in place whenever anyone makes a grand claim. Still, even pure research can be tainted. Sometimes it is a matter of trial and error. So, if one treatment does not work, you try another. If one diet does not work for you, you try another. The key is to do things slowly and under supervision to really track success or failure. But it is not easy and again I say, I have no magic answers to make you feel safer.

    But consider this: we must be doing something right because people are living longer and not dying of simple infections, at least in those areas that have access to proper medical care. So, it is fair to say that overall, Penicillin is a good thing. But low carb versus low fat ? Still not clear.
  7. Give yourself time. If I told you that I lost 10 pounds in 3 months on my "new super eat anything before 12 and then only fat until 2 and then only fiber until three" diet, would you consider that a success or failure? I think most people would say "nice job" but under their breath would say "who notices 10 pounds when he needs to lose 70".

    On the other hand, let's do some simple math. If this same person CONTINUES to lose weight at the same rate of 10 pounds every 3 months, then in 1 year, they will lose 40 pounds and in 2 years, 80 pounds. Now in practice, weight loss usually stops at some point (sooner than you want). But you should never judge the success or failure of a new healthier life style based on the  weight you have lost in the first weeks. What you should be able to see very soon after starting a healthier lifestyle is improvements in your blood tests. You should see your blood sugar and cholesterol improve (if they needed improving) within the first month. The degree of improvement will depend on how high these were before you started, and how much of an effort you are making ("skipping desert" versus transforming your whole way of eating").

    But again, give it time. Do NOT be discouraged. Think "how will I feel and look" in a year, not in a month. 

This is not the complete list of all common threads, but I think it is a good start. It definitely helped me put things in perspective.

Thanks for listening

Thursday, December 27, 2012

Despite being quite the computer geek for decades, this is my first blog. I was waiting for a topic that was dear to me and that would get me to write. And I found it.


My recent experiences have led me to spend many the hour in front of my computer screen, looking for any and all information about "proper diet and exercise". I wanted to hear and read what was the present take on nutrition and weight loss. And what I discovered was a near chasm between different proponents of their unique diet plans. On one end, you have the low carb camp arguing that Insulin is the devil incarnate. And on the other end, you have the low fat group holding back their lunches whenever anyone suggests bacon and eggs for breakfast. And yes, there are other ends with other dietary variations leading to a very confusing polygon.

The strange thing is that I should be able to sort things out for myself, given my background. I am an MD from McGill University, which I completed following a degree in Physiology from the same school. Since graduating, I have continued to study (as all doctors must) and have even taken a special interest in the field of bariatrics, i.e. the medical specialty that deals with obesity. I also have been weight training (on and off, with some big OFFs) since 18. So I also have a good knowledge base when it comes to understanding the value of exercise, and more specifically, different kinds of exercise.

So why are things so confusing. Why do I read and see articles and videos, presented by very intelligent sounding professionals with lots of letters after their names, that are SO adamant that "their way" is the THE way. More importantly, each evangelist seems quite disparaging of the other diet camps. SO here you have 2 guys with PhDs who are arguing (well) the exact opposite points. If I am confused, then I do wonder how people without any formal health education, manage to "get it right".

My impression is that many do not "get it right". Instead, they move from diet to diet more quickly than James Bonds changes exotic locations. In the end, you have so many people who have made nothing short of heroic attempts to improve their health and yet find themselves having failed to achieve their goals. And when they seek medical advice on these issues, they far too often are inundated with simple platitudes, such as "just eat less", "peanuts will stop your hunger pangs", "no carbs after 8 PM", "eat low density foods and you will always be happy and full !!", and so on and so on.

What I hope to do is to share what I have learned over these last few months about all of these issues. My conclusions so far are actually quite simple and perhaps they will be helpful to some others out there.

Thanks for listening.