Thursday, March 28, 2019

Dr. Stephan Guyenet's references to the Joe Rogan Experience Debate with Gary Taubes

I was introduced to the principles of health by Dr. Stephan Guyenet who had a blog named WholeHealthSource (now, more than 10 years ago. He was a student at that time. The first article I read was about Vitamin K2. He is a researcher working on the Neurobiology of Obesity. He recently had a debate with Gary Taubes of Good Calories Bad Calories on the Joe Rogan Experience. I have read that book and it is pretty good. But Gary Taubes is married to the Insulin drives obesity theory. Obviously there would be a lot of contentions between the two. Stephan has posted an article which links to all the research papers he has on all the contentious issues raised during the debate.

TL;DR: Calorie is king, and brain is the regulator of fat, insulin has minimal effect on obesity, ease of getting tasty food and over indulgence is the basic problem.

Stephan has also shown several references where we can see that Gary Taubes is very willing to misuse data to forward his pet theories (Rigor section).

To quote regarding Low Carbohydrate diets.
For context, I am favorable toward low-carbohydrate diets, but the references below mostly reflect issues that Gary and I are likely to disagree on.

It is a huge article. Following are all the different subtitles of the sections in his article.

The brain

1. The brain regulates body fatness
2. The genetics of obesity point to the brain, not fat cells or insulin, as the primary determinant of body fatness
3. The brain regulates appetite
4. The determinants of appetite are complex and cannot be reduced to glucose and insulin
5. Lean people, and people with obesity, both “defend” their current level of body fatness against fat loss
6. Single-gene mutations that lead to obesity in humans act in the brain


7. People with obesity eat, and expend, more calories than lean people
8. Reducing the calorie intake of a person with obesity to that of a lean person causes weight loss
9. Calorie intake, not carbohydrate intake, is the main dietary determinant of body fat loss
10. Changes in body fatness as a result of diet depend primarily on calorie intake, not carbohydrate intake
11. Energy expenditure (metabolic rate) is scarcely affected by differences in carbohydrate and fat intake

Carbohydrate, sugar, and fat

12. Low-fat, high-carbohydrate diets cause weight loss, even without deliberate portion control
13. A low-calorie diet composed almost entirely of refined carbohydrate, including sugar, causes substantial weight loss
14. Dietary fat can be fattening in a variety of nonhuman species
15. Dietary fat can be fattening in humans
16. Fat and carbohydrate are equally fattening when overconsumed
17. Sugar intake has been declining for 20 years in the US and 50 years in the UK, while obesity and diabetes rates have risen
18. Carbohydrate, fat, and protein intake in the US over the last century
19. White flour intake was much higher in 1900 in the US than it is today
20. Sugar intake in the US, 1822-2016
21. Cultures with high intakes of sugar but otherwise healthy diets and lifestyles do not have obesity or diabetes
22. During the Cuban economic crisis, sugar intake rose, calorie intake declined, and obesity plummeted
23. Cultures with very high intakes of carbohydrate tend to be lean, even if the carbohydrate is white rice
24. In human randomized controlled trials, sugar is only fattening by virtue of its calories
25. In randomized controlled trials, low-carbohydrate and low-fat diets yield similar (unimpressive) long-term weight loss results
26. Meta-analyses of ketogenic diet studies
27. Adherence to ketogenic diets tends to be mediocre
28. The Virta Health study
29. Eating sugar does not impair weight loss on calorie-reduced diets


30. Weight loss greatly reduces the risk of developing type 2 (common) diabetes
31. Reducing fat intake, without reducing carbohydrate intake, causes weight loss and reduces type 2 (common) diabetes risk
32. Exercise substantially reduces the risk of developing type 2 (common) diabetes
33. Weight loss via a temporary very-low-calorie diet durably puts type 2 (common) diabetes into remission

Insulin and insulin resistance

34. Insulin resistance predicts a variety of age-related diseases
35. People with higher insulin levels don’t gain more weight over time than people with lower insulin levels
36. Weight loss increases insulin sensitivity, regardless of whether it’s achieved by a low-fat or low-carbohydrate diet
37. Insulin resistance is “an appropriate response to nutrient excess“
38. When fat cells “fill up” due to fat gain, energy spills over onto other tissues, causing insulin resistance
39. The impact of foods on blood glucose and insulin has little do with how filling they are
40. Insulin resistance is caused (in large part) by exceeding the unique storage capacity of your own fat tissue
41. Mendelian randomization studies on the impact of insulin level on body fatness
42. Of the three published studies funded by Taubes’s organization the Nutrition Science Initiative (NuSI), at least two, and possibly all three, refuted the carbohydrate-insulin hypothesis


43. Exercise tends to cause weight and fat loss in people with excess body fat
44. Exercise increases insulin sensitivity
45. Sedentary behavior causes insulin resistance

Food reward

46. Fat and carbohydrate both cause dopamine release and increase eating drive, particularly when combined
47. The most commonly/intensely craved foods combine carbohydrate and fat together, while foods that are high in sugar or fat alone are less commonly craved
48. We eat more food when it tastes better


49. Calling for more rigor in science does not necessarily make a person rigorous
50. Expert reviews of Taubes’s writing have uncovered extensive misuse of evidence
51. The Nutrition Science Initiative (NuSI), with Gary Taubes at its helm, attempted to interfere with the research that it funded once unfavorable results came in


52. The most fattening diet in animals and humans is human junk food, and its fattening effect cannot be explained by carbohydrate or fat alone
53. Obesity has a strong genetic component
54. Synthesis of fat from carbohydrate is negligible in humans eating typical Western diets
55. Partially suppressing the release of fat from fat cells (lipolysis) does not cause fat gain, hunger, or a slower metabolic rate
56. The fat tissue of people with obesity releases fat at a greater rate than that of lean people, not a slower rate

Monday, March 5, 2018

Klieber's Law and evolutions that made us human

Klieber's law says that the ratio between the masses of animals and their metabolic energy consumption are related by a power law. Specifically energy goes up by the power of 3/4 with mass. This means that an animal that is 16 times bigger than another animal will be able to use 8 times the energy of the other animal.

Note for the non-science people. The energy we consume is ordered energy which converts to disordered energy called heat, according to the law of conservation of energy. So as we use energy it converts to heat.

The law comes about because of the problem of transporting heat and oxygen and other nutrients through the body. So a body will not be able to dissipate more than that energy or transport enough oxygen, so the energy is limited. Since this law is related to heat dissipation, it applies to different classes of living organisms differently. It works as defined only for warm blooded animals (and birds), and there are slight deviations for warm blooded animals living in water. This a pretty fundamental law and the deviations are minor.

There are several kinds of tissues in the body. Normal or structural cells are the most frugal in their energy use. Special tissues have different energy requirements. The most expensive of them all are neurons or the brain cells. The other biggest energy sink is the digestive system. It basically separates humans and the rest.

The other constraint is food availability and success in feeding. Food can also be divided into several types. Meat provides a very important macro-nutrient, but is thermogenic so not a very efficient source of energy. Carbs are normally complex in nature, and require a lot of indirect digestion through the use of bacteria. There are some exceptions, fruits and honey which have sugars, which are easier to absorb directly. Fats is rare in nature, even the animals in nature have little fat, except females during gestation, or animals before entering hibernation.

The herbivores have the most complex digestive systems and the smallest brains, as they spend too much energy digesting the food. They actually don't even eat directly. They breed bacteria which feed on their food and they feed on the output of the bacteria. Lots of the produced bacteria get thrown out which is why it becomes very inefficient.

The obligate carnivores have the simplest of digestive systems, but they eat a lot of protein, which is very thermogenic. Almost 30% of the energy goes waste as heat. This is why they don't have much energy left to have a bigger brain.

Lastly are the omnivores. These are able to eat both animal and plant matter. But it depends on what type of food they eat. Note if protein is eaten separately it will be converted to glucose and produce lots of heat and if plants are eaten it will require lots of energy. Still they are midway and generally have a slight advantage in the brain department.

We should take a note of birds and sea mammals here. Birds are omnivores and eat seeds, insects, and in some cases large animals. Sea Mammals eat fish mostly, but they are in water which allows them to dissipate heat much more easily, which gives them a slight edge as per Klieber's law. Both can go higher on the scale to have a higher brain size. But birds cannot grow very big if they have to fly, and they also need to have large parts of brain dedicated to flying functions. Sea mammals are considered pretty intelligent. In fact Dolphin and Killer Whales are next to humans in intelligence.

So we have seen how an omnivore diet helps in supporting larger brain. Now coming to the specific case of Primates and evolution to human. The primate closest in intelligence to human is Chimpanzee, and is also closest to us in genetic distance. They are fruitarians and non-vegetarians. They actually hunt for other monkeys and animals for meat. The fruit is very easy to digest which allows less energy wasted on the gut bacteria, allowing brain to grow. And meat consumption allows for easy access to protein which is very low in fruits.

Proto-Humans also started off as tree dwellers eating fruit and meat. Then they developed the ability to break bones to get to the marrow part. The marrow is highly nutritious both in energy and nutrients. This was a critical development, and moved them to become scavengers, hunting for kills from the top predators. It also caused a jump in brain size, because of the extra energy from fat. They gave up living in trees and moved to grasslands.

Then about 1.8 million years ago, something changed. Proto-Humans (aka the homo-erectus) lost their gut. This is pretty significant, as it means that they stopped relying much on the highly fibrous plant matter. The most likely thing is that they learnt how to use fire to cook their food. Heat softens food and makes it more bio-available. This caused a very big change in the brain.

The last major change was around 200,000 years ago, when Homo Sapiens arose. The major change is likely that humans learnt how to obtain starches and sugars more easily. It could be the evolution of honeyguide which provided humans access to a lot of honey and simple sugars. Humans could have also started to selectively breed more starchy tubers and fruits.

What we learn from this evolutionary story, is that simpler foods are better for our brains, but it takes several generations for the brain to increase due to increase in energy. It also requires a lot of nutrients, unless the human body adapts to producing them from other more plentiful nutrients. In the short term the excess energy is only going to make us fat.

Friday, November 24, 2017

Paleolithic Principle and Diet

This is an explanation of the Paleolithic Principle and my expectations of the Paleolithic diet.

First off we should get rid of the myth that Paleolithic people led short brutish lives. This statement is a general misunderstanding of the concept of life expectancy at birth and due to the bones found of paleolithic people.

Paleolithic people generally had much better bones than the neolithic and present people. A life expectancy of 30 does not mean that people lived only till 30 years. This means that average of the age at death of people was 30 years. Lots of children died within a couple of years after birth, which reduced at higher ages, but still significant number of children did not live past 15 years of age. After that death due to diseases and accidents reduces significantly. It is common to find men/women of age 80 years in hunter gatherers.

Also menopause which starts after 45 years cannot evolve unless people are living beyond the age of 50 regularly. It is an adaptation to reduce resource competition by taking females out of the task of producing offsprings thereby reducing the population, and provide help to the younger females so that the young ones can be cared for better.

There are two phases in human development. Before migration from Africa, and after. The adaptation made before the migration are common to all humans. Adaptations made after are not.

It is easy to recognize that humans migrated from Africa because the genetic variation in Africa are much more than elsewhere. Also the reason why humans have the huge number of sweat glands and very little hairs. This is because humans evolved in a hot and dry environment.

The diet prior to migration would be called the paleolithic diet. The later changes are due to adoption of agriculture. Where humans started to grow grains and legumes and drying and storing them for lean periods. This period is marked by higher consumption of grains and legumes and adaptations based on these.

There are controversies regarding Paleolithic diet. Paleolithic period human remains obtained are high in 15N Nitrogen isotope. Since these are high in grasses rather than other types of plant food, and humans cannot consume grasses, it was assumed that humans ate a lot of meat of animals that were eating grasses. But recently it has been discovered that there are some tubers that are high in 15N, particularly the tiger nut. It is possible and makes more sense that humans consumed these type of tubers as a majority of their diets. In fact some of the old African tribes use these as their staple. 

Hunts are not always successful, and there are very few extinctions in Africa, so it is likely that humans evolved and became adept at hunting, while animals evolved in Africa to avoid getting hunted. When skilled humans moved out of Africa, they were a totally different beasts for the animals in the rest of the world and the animals could not adapt and were extincted.

So humans must not have obtained a regular supply of meat. Also fruits in Africa are huge. It is very much obvious that humans obtained a large part of their calories from high carb foods. As an aside note that all long living populations at present are high carb, Okinawans and Mediterraneans; Okinawans more than mediterraneans.

We also know that Africans have a much longer colon, which means that humans had a much higher consumption of fiber. The fruits and tuber consumption would provide them with the high fiber content.

There is another observation. There is a bird called honeyguide. It has evolved along with humans and can guide them to beehives. The present African tribes use the Honeyguides to obtain a lot of honey during season. This results in a very high sugar diet during the season. The tribals do not suffer any harmful effects of this high sugar diet.

Hunts succeeded rarely, so meat was not a big part of the diet, but smaller animals could be caught regularly. So it was a regular part of the diet, but not a staple.

Fat is very difficult to obtain in the wild. Most of the plant foods don't have much of it. And animals in the wild don't accumulate much fat except during specific seasons or pregnancy. Many tribesmen try to avoid killing females, and particularly pregnant or mothers. This can be seen in meat preferences to this day.

Humans have been cooking for at least a couple of hundred thousand years.

Tribal people are not particularly known for their cleanliness. And this means that they get a huge amount of bacteria in their bodies.

To summarize paleolithic diet was based on real and whole food.
It was high in carbs, fibers and simple sugars.
It contained regular meat consumption but was not a major part of calories.
It was low in fat.
Majority of calories came from tubers, followed by fruits, and seasonally honey.
Grains were very rare and legumes were never dried. Legumes were part of vegetables.

Now the paleolithic diet ideas cannot be directly used in modern times.

It is difficult to get good quality honey for most people. Refined foods must be avoided including refined sugar. Raw cane sugar maybe ok, in small quantities.

Our digestive system can no longer handle huge amounts of fiber. Still its a good idea to determine how much fiber we can handle, and aim for that.

Meat and other animal products are good to consume regularly.

Grains and dried legumes should be reduced in the diet. Dried legumes are probably ok after sprouting.

Wednesday, May 31, 2017

Weight loss theory and strategies

Weight loss requires calorie deficit. That is the thermodynamic principal.

Now this can be done via two ways, reducing intake and/or increasing expenditure. The better option is to use both together in various ways.

Both have their difficulties and pitfalls. And as you will realize below, you cannot have a sustainable weight loss without using both together.

Before we begin the most important part to understand is that the body has a fat set point, which it will defend. To force the body to lose weight you have to change your diet/exercise regime. And to have sustainable weight loss you have to have a sustainable strategy.

Lets take the less complex part, increasing expenditure. This will have a feedback in increasing hunger, which causes more intake, due to the fat set point. Also there is the case of adequate rest, and avoiding repetitive stress injuries. You also want to avoid overusing very few muscles. The exercise needs to be overall body, with adequate rest, and a healthy diet.

Now for reducing intake. This can be done two ways.

Destroy your digestive system so that it cannot absorb the energy. For some reason bariatric surgeons favor this route, possibly because it makes them more money. You can also have it destroyed by overusing antibiotics.

The other more prudent way is to eat less. This strategy is pretty complex because of several reasons.

First the body has a set point which it wants to defend. So attempting to eat less will increase your hunger and temptation to food. The strategy of fighting your basic hunger will be a failing strategy. So your strategy has to reduce your calories but while achieving satiation.

Second the body can control its expenditure, by releasing or holding body heat. Basically the body needs to burn calories for doing work as well as maintaining body heat. So it can reduce the expenditure by slowing metabolism by reducing body temperature. This is the starvation response, the thyroid hormones are down regulated and metabolic rate is reduced. This happens when the calorie intake is low too for too long.

Third the diet must provide enough micro-nutrients for the body's upkeep. Your body can supply the energy by burning the excess fat, but it has limited stores of micro-nutrients. So these must be part of your diet in adequate amounts. This actually implies that the diet should be low in carbs and fats, as both are plain calories which you want to reduce. It is best to consume whole natural foods.

Fourth the diet must be highly satiating. This is the most complex and subjective part of the diet. It depends on every persons personal tastes and gut flora. There are a few generic ideas that would help.

Protein is more exothermic so keeps your metabolic rate higher, and is not readily used for energy, which makes it more satiating. Strive for protein intake between 15%-30%. The exothermic part of protein limits its intake during tropical summers. In extreme winters protein intake can get a lot higher and will be helpful to deal with winters. The body on an average has the ability to digest 250 gms of protein, which depends on the excretion of nitrogen from the body.

Fibers are more filling and good for the gut flora. The ability to digest fiber depends on the gut flora and the type of fiber. Generally you want a good mix. Normal humans can absorb 100gms per day, but you need to have adequate gut flora for it. It might take some time to build enough gut flora.

There are some foods which are highly satiating. The foremost example is the potato. The potato hack is the fastest way of losing fat. It is difficult to consume more than 1200kcal from boiled and lightly seasoned potatoes, if no fat or other caloric additives are added.

Lastly there is fasting. There are several fasting protocols which are used. The best seems to be eating in a small window. For example 16 hour fasting and 8 hour eating window. Another variation is fast5, which is a 5 hour eating window. Some people also do alternate day eating. The fasting protocol does not limit calories within the eating window, so you are never under eating for too long. It is generally good to sleep on a more or less empty stomach. ie Almost never have a big dinner.

Wednesday, July 29, 2015

Heuristics for a healthy diet

I think food is the largest amount of chemicals that we ingest. So food can have the most effect on our health. Unfortunately, doing long term double blinded clinical trials on each and every food item is prohibitively expensive, so the mainstream ignores food as having much effect on health. So all the nutritional information that we receive is through epidemiological (aka observational) studies. Unfortunately, epidemiological are known to be done in the cheapest possible way, which results in lots of bad data. The reason why they are used is that it is easier to get whatever information you want from them. Great for getting grants which are profitable and vast possibilities of generating papers. Even if epidemiological studies are done with great care they should only be used to generate hypothesis, which need to be tested with mice studies and finally with long term double blinded clinical trials before finally accepting it as a truth.

The other problem with individuals is that the response of each person to these chemicals is highly individual. In the case of medicines, there is an entity that wants positive outcomes, and many researchers will do indulge in malpractices to get the expected outcome. So its a very problematic condition in the medical world. Even animal studies tailor their studies to get pre expected results with 2-3 years, so they start with special mice and use special diets.

It is a hard problem for the person trying to determine what is good for them and what is not. The best option is to do your own n=1 study, and use those results. Of-course with these studies sometimes you end up with local maxima, which is not anywhere the real maxima.

Now the above would seem to be an intractable problem. But then you can employ some heuristics to select experiments that should be done to reach a better outcome than random testing. For me that heuristic is the Palaeolithic Principle. Generally our bodies have evolved over time, and it has evolved under selection pressure created by environment as well as diet (due to food availability). The last time humans moved out of Africa (where our ancestors evolved from our immediate predecessors), was around 70,000years ago. The adaptations at this point will be common to all people, but adaptations after this point may or may not be universal. So foods at this point should be good for us. The only trouble is that all the foods that we use today are highly evolved (artificially selected by humans) from those times. So we don't have the same foods, but the classes of foods should be generally similar. Also we can observe what other primitive societies eat, to determine what would be good for us.

Humans have been cooking for at least 200,000 years ago, so cooked food is a required part of the diet.

What we do know is that all these primitive societies eat a lot of fiber and FODMAPS. Much much more than what we eat today. They eat anywhere around 150gms, while we barely reach 25gm per day. This is a very big difference. We do need to note here that there are African peoples who have evolved separately from us, that have slightly bigger colon, which allows them to digest even more fiber. The 150gm number is from Polynesians.

Another is that all of these societies eat meat, there are no vegan or even vegetarian societies. The actual amount varies a lot, from the Inuits (which eat mostly meat, and have a peculiar adaptation to high protein consumption for heat production) to the Polynesians that eat very little meat/fish.

The majority of fiber was obtained from root vegetables, not from fruits or above ground vegetables or leaves. In fact eating leaf is not that common in traditional societies. There maybe a problem with trying to increase fiber without a healthy gut flora, so it might be a good idea to supplement with some good probiotic, while increasing fiber and FODMAPS. Elixa is a very interesting probiotic.

The above is just an example of how you would explore this heuristic. The benefit is that you can also think of this heuristic for other parts of a lifestyle. Some examples below.

1) Exercise - Exercise in those times was basically hunting or gathering, or sometimes trying to save your life. They used to walk a lot, and at a fairly brisk speeds. Humans also are known to be able to hunt down deer just by outrunning them with their superior stamina. Look for persistence hunting. That would give you a clue what kind of exercises will be best for us.

2) Meal times - Humans had their biggest meal around sunset. We are talking about Africa only :-). They did not eat all the time. Breakfast would probably happen with leftovers and rest of the day it would be small snacks subject to availability.

3) Sleep - They would sleep not long after sunset, and wake up with sunrise.

4) Probiotics - Humans were not very clean they got dirt on all the foods they ate, and so got micro-organisms in their bodies all through their lives. Contrary to popular belief humans did not die that easily. The majority of deaths happened for children pre-puberty. If somebody reached adult hood they were likely to reach old age, barring accidents, or epidemics. The frequent reaching of old age was the reason why women have menopause. So the micro-organisms must have caused children to die but adults became resistant to most diseases and were able to live long lives. Also the healthful micro-organisms stayed in the gut and provided a lot of health benefits. The present population has very depleted gut flora, and this is possibly the major reason for some types of health problems, particularly related to auto-immune diseases. Also these may have a bearing on modern diseases of civilization, aka heart disease, diabetes and cancer. These are mostly non-existent in populations living traditional lives. It could be that the people who survived to adult hood were more resistant to these diseases as well.

If we try to tailor our lifestyle around such heuristics they will tend to work for us. You can then try to extend the framework to decide on what to do for adaptations that you might have due to your ancestors. The important part of ancestral diets is the way they combine or prepare a food. That method has a lot of impact on its healthfulness, as food tends to work best when they are not eaten in isolation, but in combinations. But be aware local cuisine of a society can change drastically within 50 years. So you have to be sure that the food items you are looking at are really old. In any case anything that has been there only been there less than 50 years is probably suspect.

For example wheat is traditionally cooked after fermenting it with yeast or yogurt. Also the wheat used to be freshly milled, and not to a very fine consistency. Then it was sieved to remove the husk. Lastly all societies eating wheat also ate milk (obviously raw in those days). The last is a pretty interesting observation. Populations that don't eat wheat, are mostly not able to digest milk (lactose intolerance). My expectation is that there is something in wheat that required raw milk, and that adaptation was forced, when people started eating wheat. Another factor is that only Europeans who eat a lot of wheat have the kind of the peculiar white skin. No other people have this feature. Not the Inuits that never get sun or the middle eastern people who do get a lot of sun. I think it has to do with the combined effect of the Vitamin D depletion capacity of whole wheat and lack of sun all year round.

To conclude everybody must assess their lifestyle and determine ways to improve on it. How to do it is a hard task, as modern science gives very confusing signals regarding diet. The only possibility is to use a framework that allows one to experiment on themselves and come out with possible results that would benefit them greatly.

Wednesday, April 3, 2013

Understanding Nutrient cycle and its consequences

The nutrient cycle is very important for the continuation of life in any area. The loss of nutrients causes Deserts. Currently we believe that we can add any nutrients that plants need and do not really need a cycle to help us grow plants. This is a myth, as the inability to grow plants in barren lands shows.

Plants grow in the soil, which provides it several nutrients, and the major nutrients it gets from the air, oxygen, carbon, hydrogen and nitrogen. The micronutrients like calcium, magnesium etc, are not present in the air, and need to be recycled. In the prehistoric times there was no transportation. So plants and animals used to live in a geographically isolated areas. This tended to keep the nutrients in a balance.

But technological revolution has brought many improvements in transportation technology, and we get food from the world transported to every where. This has major implications for nutrient cycle.

Another major issue is understanding the nutrient cycle loops between plants and animals. Plants create most of the nutrients required for animals. When the plant dies the nutrients must be shunted back into the soil, so that it is available for the next generation of plants. Ultimately the decomposition happens through bacteria. But animals speed up the process quite substantially.

Bacteria need moisture for them to thrive, and break down substances. Moisture is not a problem in the sea. But its very important on the land. Animals provide a place for the bacteria to live, and provide them with the  ideal breeding ground so that they can break down stuff much faster. Ultimately the plants need the nutrients the animal has absorbed from the plants. This is the reason plants thrive much better when they are grown together with animals.

Lets see what happens when we do not have animals where we grow plants. We need to put chemical fertilizers. These are only good to the point of our best understanding. Unfortunately, contrary to popular belief, scientists don't know all the nutrients that plants need. Also some of the nutrients, when created in factories are not nature identical but slightly different. This creates problem for the plants to utilize them.

Another big problem is that the major consumer of unrecycled nutrients is man. We do not feed the human waste back to the plants, because it is expensive, but we drain it out to the sea. We also drain out excess plant matter because we are not feeding them to the plants. This causes havoc in the sea, in the form of Algal blooms.

Wednesday, February 27, 2013

Diabetes: Why you should critically analyze your doctors advice

I wrote the following as a note in facebook. I think it gives a very good idea of why and what a diabetic must do. My understanding has evolved since then, but I only make small modifications to it as it is still not wrong.

A friends father passed away today. It was a case of complications due to Diabetes. It resulted in Heart Attack. His father did love meat, and he could have cured his disease if he could be convinced to not follow his doctors advice.

Diabetes is not an incurable disease, provided you understand why your doctor recommends the diet he does and why it is exactly the wrong kind of diet for Diabetes. Dr. Bernstein is a great example, of what can be done with patience and critical thinking.

Dr. Bernstein is a Type1 diabetes patient. He was diagnosed at 12 years of age. He discovered the cure for diabetes at the age of 35 when he got hold of a glucose meter. At that time he was suffering from ill health due to diabetes. When he discovered the cure, he stopped suffering and has been healthy since. He is now 76 years of age, and very active. He is still running his practice. In fact he is now at the age which is the average expected age for normal people. He wasn't a doctor to begin with, he became a doctor because he wanted to help other diabetes patients, and his cure was not accepted by other people. To be able to convince other people he studied to become a doctor.

Dr. Bernstein is living with this disease for the last 64 Years, of which the first 23 were without understanding and following his doctors advice. These 23 years were miserable. The next 41 years he has lived with his understanding and he is happy. How many people survive for 41 years with diabetes following their doctors advice? How many do it while enjoying life?

It is important to remember that Type1 diabetes is much worse than Type2. Type1 normally occurs due to an auto-immune condition, where the Beta cells in Pancreas have been killed. A Type1 is unable to produce sufficient insulin for signalling consumption of nutrients including glucose. A type1 diabetic is emanciated because he/she cannot store amino-acids to allow muscle growth, cannot store triglycerides to build fat storage, cannot store glycogen to allow heavy physical work. All in all they have a very difficult life. They need exogenous insulin to survive.

Type2 diabetes is a condition where the liver, muscles, fat cells have become resistant to insulin, and do not react to it. Some of it is due to the fact that muscles and liver are choc full of glucose and cannot accomodate anymore of it. Some of it is because the cells insulin receptors have been damaged. They are producing enough or maybe even a lot of insulin. That is not where the problem is. The solution given is metformin which acts like insulin but bypasses the resistance. This will work for some time. The other solution is exogenous insulin, which is like increasing the volume when you are going deaf. It works some time, and then you grow more resistant, just like growing more deaf with extra volume.

Most people are Type 2 Diabetics. Type1 normally happens to children, although the auto-immune attack can happen at any age, it is more likely to happen in children. If you got it at an old age, it is almost always going to be Type2. If Dr. Bernstein is still alive and healthy at a ripe old age of 76, even though he has Type1 diabetes, anybody with Type2 can do the same, more easily. You just need to understand the basics, and have the patience and resilience to avoid stuff that is bad for you.

Diabetes is one of the simpler diseases to understand. It is basically an inability to use glucose. The food we eat if it contains starch will convert to glucose in the body. The body normally reacts by storing the glucose as glycogen and converting the excess to fat and storing it as triglycerides in fat cells. A Type2 Diabetic person cannot store the glucose, because the cells do not see that there is glucose around. The liver does not see that there is glucose around. The result is that glucose stays high in the blood.

It is interesting to note that the ideal blood sugar level is 80mg/dl, and the max acceptable blood sugar level is 140mg/dl. Given that an average person has about 5ltrs of blood, these levels amount to 4gms and 7gms respectively. The difference between ideal and max is just 3gms, which is about a half teaspoon of sugar. So we do not want to eat anything that will provide this much sugar, at a fast rate. The recommendation of low glycemic dieting and eating multiple times a day arrives from this fact. But the real information is lost, that 3gms is the limit.

A healthy persons body will be able to get rid of 200gms of sugar in one hour, stored as glycogen. But this does not apply to a diabetic person. Typically, they are not even able to store 10gms in an hour. Given that even low glycemic foods do not have a peak that lasts for more than an hour, it is highly recommended to check with a glucose meter, when the peak occurs for each food, and take care to consume only the amount of carbs that will not cause a peak higher than 140mg/dl. This is time consuming, painful, but the only effective method of controlling diabetes.

An easy solution obviously is to not eat anything that will convert to glucose. This may sound easy to do but it has pitfalls here. If you do not eat carbs, the blood sugar level can drop to dangerous levels, because the liver does not see that there is too little glucose in the blood. It is the task of liver to supply glucose when it is running low. This makes it quite dangerous to not eat glucose.

The minimum daily requirement of glucose is about 50gms, provided atleast 100gms of protein is eaten everyday. A diet which provides these would be able to keep diabetes in check, without any bad effects. The carbs should be split into 4-6 meals and snacks, separated at equal intervals. At 5 meals it would be 10gms per meal. Another interesting thing to note is that the stomach delays emptying with protein or fat is present in the meal or snack. It does not do so unfortunately for carbs, as it cannot do any digestion for them. Protein and Fat need to be carefully split into smaller components before releasing which reduces the rate at which stomach empties.

A mixed snack/meal with a small amount of carbs with fat and proteins, eaten at regular intervals would be very helpful in keeping the blood sugar level constant the whole day. It would avoid precipituous falls and high peaks.

In the initial period the glycogen stores are full. This means that requirement of glucose will be much lower. This is the reason that Atkins diet called for a Initiation Phase where 20gms of Nett carbs (basically fiber) was only allowed. During this phase liver and muscle glycogen gets utilized. A side effect of this for diabetics is to increase insulin sensitivity. Also a side effect of a high fat low carb and moderate protein diet is that you lose appetite. This would mean that you will lose weight.

Another pitfall in switching to this diet is that any insulin or metformin must be stopped or reduced, as they would cause the blood sugar level to drop too much. This does require the experience of a doctor, who has worked with this kind of diet. Or the patient must take a lot of risks, just like Dr. Bernstein did. His books will help understand the problem, and provide a method to fix it. So read it carefully, if you can't find a helpful doctor.

The above still does not explain why fat will not be harmful even though everybody claims that the fats are the devils.

Firstly, carbs are the overriding problem here. Nobody says that you will die immediately if you eat a lot of fat. But a diabetic will die if he/she eats a lot of carbs.

Second if you have read the above carefully, you would have noticed that carbs can convert to fat, and it converts to saturated fat, a particular fat called Palmitic Acid. Everybody who calls fat bad, they call saturated fat super bad. And carbs do convert into saturated fats. So by that logic carbs are super bad. But rest assured our body is not trying to kill us by creating saturated fats. It creates saturated fats because it is very stable, and it has a high energy density, so that it can store lots of energy safely. So carbs are not a problem because the body neutralizes it as saturated fat. This does mean that Saturated fat is not a bad thing to eat. It is logical, but most people (including doctors) are not very strong in logic.

Glucose to fat conversion happens only in people that are gaining weight. This happens for people who are losing their insulin sensitivity. Normally Liver and muscle cells lose sensitivity first and fat cells last. So these people tend to gain weight, till the point that fat cells lose sensitivity. At which point they move into diabetic phase.

Thirdly protein can convert to glucose, but do so only when glucose is required, so exceeding the limits of proteins will not have a detrimental effect on glucose control. In fact there are some proteins that do not convert to glucose. Eating more of these would be helpful. These are lysine and leucine, and are found in BCAA mixes that body builders use to enhance performance. Still making protein a very large part of the diet will be problematic.

There are some other considerations but those are minor. Supplementing Magnesium and Chromium helps improve insulin sensitivity. Omega3 supplements (such as fish oil) are also very helpful. As also is avoiding any concentrated source of omega6. If an oil contains more than 10% Omega6 avoid it, or keep the consumption below a tea spoon per day of all such oils. The best oils are ghee, butter, coconut oil, olive oil, palm kernel oil, High Oleic Sunflower oil, and animal fats. There are some others which are much more expensive.

The bottom line is that Diabetes requires some sacrifice. If you equate Food with Living then unfortunately, there is no solution for you. You are bound to suffer, and you can only hope for a quick death in the form of a heart attack, rather than lose the kidneys and the be on dialysis for a long time. If you have diabetes, hopefully this article has provided you with some pointers, and a drive to analyze your situation critically.