Tuesday, January 29, 2013

You say tomato (diet), I say...No.

Thanks to my not-so secret network of "crazy diet finders" I get to hear stories like this:
"Overheard at the diner: 'On day three of my diet I get to have two 10 ounce pounds of any kind of meat I want, and three cold tomatoes.'"  And apparently this diner repeated this info, more than once. 

First of all, if you use phrases like "two 10 ounce pounds" you are probably having trouble losing weight because a) you are bad at math, or b) you are consuming too much alcohol at one sitting, or c) all of the above.  Second of all, even though she was obviously trying to follow some form of a carb controlled and/or higher protein plan, I wasn't sure where the tomatoes were coming from.  So I decided to do a little digging, and here's a summary of what I found:

1) Most of the "tomato diet" plans I saw assumed that people were not eating enough vegetables, period, and that people were filling in the gaps with high calorie/low nutrition processed grains.  Basically, by adding sliced tomatoes to a meal, or making a homemade broth-based tomato soup to eat in between meals, people were filling up on lower calorie/higher nutrient dense foods, and that's what helped them lose weight.  All fine and good, and convenient to a certain extent I suppose, but I think I would want to start throwing tomatoes out the window after a day or two.  You should definitely let your meals overflow with non-starchy vegetables to fill up on all the fiber and water and get some good potassium, etc in the mean time, but you can certainly do that with more than just tomatoes.  (And making a large batch of some kind of vegetable soup for freezing is a great convenient way to fill out a meal or snack.)

2) A second interesting tidbit was a claim that tomatoes suppressed appetite.  I was able to trace this claim back to a small study done in the UK in 2009 where average weight women were fed a cream cheese sandwich either on carrot-enriched white bread or tomato-enriched white bread; apparently the women felt more "satisfied" after the tomato bread sandwiches.  Some of the speculation involved was that the lycopene in the tomatoes might suppress ghrelin (which normally stimulates the appetite). First of all, the author of the study said "we need more research;" second of all, I wonder how many tomatoes it took to enrich those bread slices with lycopene.  My experience with supplemental/enriched foods is that it usually takes a lot of one food to create a "therapeutic" level of a vitamin and/or mineral, so we might be looking at an impractical amount of tomatoes to eat or that we would actually have to "feed" a supplement manufacturer.  So once again, if you want to "round out" your meal with tomatoes and other vegetables (try using lettuce leaves instead of bread as a lower calorie/nutrient dense substitute), and possibly get a longer lasting feeling of fullness, but there may not be anything magic about the tomatoes.

3) Of course no crazy diet would be complete without some mention of "detoxification."  Go back and read this post if you are new to this blog or you just need a reminder that neither tomatoes nor anything else will improve your liver and/or kidney function and that "toxins" are the modern-day "evil spirits."

4) My favorite was probably one claim that tomatoes "activate your DNA" to help you shed fat.  First of all, our friend Orac over at Respectful Insolence has already talked about this particular level of junk science, and the part about Jesus activating his DNA was particularly intriguing.  All, I could say is, some of that DNA is junk for a reason and I probably don't want to activate it without knowing what the hell it's going to do.  But anyway, it looks like the people making this claim were looking at a small study done in obese rats in which a substance called 13-oxo-ODA was derived from tomato juice and it seemed to reduce the amount of triglycerides in the blood and reduce the fatty deposits.  This is interesting, but a) we can't extrapolate to humans although this is interesting, b) we don't if the substance acts the same while in it's tomato juice form, and c) there was no mention of weight loss, just that the triglycerides went down (which is a good thing, but there was no loss of body fat mentioned).

Take home message--you can use tomatoes and other non-starchy vegetables as a filler to increase satiety at meals and get more nutrition for less calories, but don't count on the tomatoes themselves to magically cause you to lose weight.

Monday, January 28, 2013

Can't see the forest for the trees.

Did I get some of you hooked on Ape Not Monkey last week?  Good, because I have another more informational site to look at, specifically this article on insulin that I came across when researching something else: Insulin....an Undeserved Bad Reputation. 

You've taken time to read the post, yes?  I like this post (and this website) for a variety of reasons; one, it's written in language that make science a little easy to understand.  Two, he backs up his info with links to articles.  Three, he's not pushing a particular diet on anyone, but trying to present the best that science has to offer.  But I also like the post because of how it reminded me about some of the pitfalls that I have when trying to help people be healthier (and I am pretty sure I am not the only health care person that falls into these holes either).

First of all, it reminded me that we as human beings can still tend to think of our body and it's functions and/or excretions as, at best, mysterious and unknowable, and, at worse, completely disgusting and bad.  I am not a philosopher, but I do know enough about the history of western medicine to know that the Greek concept of Dualism has had an impact on how we think the mind/body interact, and sometimes it has been to our detriment (philosophy friends, please correct me or add to that!).  In my opinion, it doesn't do anyone any good to remain ignorant of how your body works, particularly if you or a loved one has a life threatening condition, and it doesn't do you any good to see necessary parts of your body as bad.  Your body requires insulin to live, period.  You need to maintain a certain level of glucose in your body to live as well.    Think of your insulin levels as a river; necessary for carrying life sustaining substance and often beautiful and awe inspiring, but when it overflows the banks there can be trouble.   Seeing the river as evil and making attempts to remove it can result in dried out land, working with the river can help the area maintain its beauty and life.  Same thing with hormones like insulin, they are not bad by themselves, but we do need to know how to work with them.

Second of all, this alerted me to another cognitive error that a lot of health care providers and clinicians can fall into--that what Dr. Peter Palmieri calls "vertical line failure" in his excellent book Suffer the Children: Flaws, Foibles, Fallacies and the Grave Shortcomings of Pediatric Care (even if you don't have children, this book provides an excellent read for anyone interested in science-based medicine.  "Vertical line failure" means that you are assuming that all of your patients have a common condition.   And while reading this post I was alerted to where I fall into this very same problem--my specialty is diabetes, and I have this tendency to think that everyone has diabetes or some kind of insulin related problem, and so a lot of my dietary recommendations are based on that.  Now, don't get me wrong, the numbers that the American Diabetes Association released last year are scary: 18.8 million diagnosed with diabetes, 7.0 million people undiagnosed, and 79 million people estimated to have pre-diabetes--and for those people a carbohydrate controlled approach is likely the best way to control their blood glucose levels, lose weight, etc.  But sometimes the person who comes to see me doesn't have insulin resistance, and they might be able to lose weight and improve their health while including grains, etc.  I can't make that assumption that just because this person is overweight that she has the exact same cause as the next person, I need to take a detailed family history (if they know it!), find out what has worked for them in the past as far as weight loss, and look at their lab work (I very rarely get a chance to look at someone's insulin levels, but other people might get a chance to have their provider order this), find out what lifestyle habits affect their eating, etc, etc.  If I don't do that, I'm putting that person into a box they may not fit in.  And anyone who has been overweight has probably been told something "canned" by a doctor or dietitian--you need to become a vegetarian, or you need to stop being a vegetarian, or you need to eat an apple and drink water before every meal for satiety (yeah, one of my favorite eye-ball rolling moments when I read that in a chart).  And a lot of these people were not bad docs, but because they were human they had trouble getting past a particular cognitive error.  Oh, and those of you who are "evangelizing" on your weight loss plan?  I'm happy it worked for you, maybe you might help someone else, but try not to fall into this logical fallacy yourself.

And third, I think this is an excellent summary quote: "you should worry about whatever diet works the best for you in regards to satiety and sustainability."  In other words, does the food you are choosing help you feel full and satisfied so that you are less likely to overeat later?  (Some people can have 1-2 cookies and walk away, I can't).  And can you live with this type of program for as long as you need too, which might be the rest of your life?  Yes, I've had many people over the years try to "evangelize" me on why their particular choice of diet was so wonderful, only to say "but you can't stay on it."  Now, everybody needs a little encouragement to get "back on the wagon" if the've fallen off, but do you really want to stay on that up and down cycle?  Studies on whether or not you harm your health by weight cycling are mixed (link), but do you really want to go through buying new clothes, seeing your lab work fluctuate, maybe not feel so good, and have that feeling of never getting anywhere.   And even on the best of programs you might have moments of "I can't keep this up," but use that as a way to re-evaluate.  For example, I have know people who have lost weight on a program like medi-fast, but after a while they get bored with eating the same thing over and over again (or they never really liked the food in the first place).  Rather than just give up and go back to your former bad eating habits and weight gain, maybe you want to experiment with some new recipes so you can actually enjoy what you are doing?   Or maybe even think about whether or not what you were doing was actually good for you?  I was one of those people who enjoyed being almost vegan, but when I realized my GI system would no longer tolerate soy, legumes, etc I had to say "this no longer works for me, what can I do better?"

Take home message--don't stop trying to find a doc and/or a dietitian who is willing to individualize nutrition recomendations for you, and learn as much as you can about physiology from reliable sources.

Wednesday, January 23, 2013

Calorie Balance

The Skeptic community has some very talented people who use a variety of media to enlighten others, and one of my favorite websites that does "education through art"  is the web comic Ape not Monkey.  I was actually pondering how best to answer a charge about how it was "completely wrong" to say someone could eat [insert unhealthy food here] and still lose weight, when another friend pointed out to me that this comic was doing a series food labeling and diet.  I like what the author has done so far as linked above, and am looking forward to seeing the rest in his series.  It looks like he's already started on a rant about how many things impact our metabolism and how claiming foods have "negative calories" is, at best, a distortion of our complex metabolic processes. 

Anyway, the charge that no-one could lose weight eating "crummy" food, and related charges that I've been reading lately stating that "calories in/calories out" doesn't work, reminded me of this post that I had written commenting on Brian Dunning's post on Skeptoid (who did the research for the Ape not Monkey posts!) where Brian did just that--lost weight by controlling his calories.  He also linked to some other self experimenting people who had lost weight while eating twinkies, etc, and did acknowledge that what he was doing was anecdotal, but at the same time scored several points for the skeptic community.  I pointed out that none of are exempt from the First Law of Thermodynamics as well, but I also pointed out that some of us do benefit from using a few more behavioral attributes to stay on track.

So we have case studies that indicate people have lost weight, and kept it off, by merely controlling their calories, and then we have case studies of people who were not able to achieve their body weight until they followed a paticular kind of diet.  Then, of course, we also have more recent studies (not just observational) that indicate people following a low carb plan do actually seem to experience basal metabolic changes, and studies like the Body Weight Simulator that indicate that the very act of losing weight can change our metabolism in ways that we didn't necessarily expect.  So what is a Skeptic suppossed to do?

First of all, we need to ask what other health goals we are really trying to accomplish here, and by that I mean that not everybody is trying to "just" lose weight.  Most of the people I work with are trying to control their blood glucose and/or avoid Type 2 diabetes, lower their LDL and/or triglycerides, lower their blood pressure, prevent cardio vascular disease (or in the case of one of my new patients, prevent having stroke number 6!).  Oh yeah, and they want to lose weight too.  Granted, I work with a population known for the mulitiple medical problems, but I know they are not the only people out there with what we call "co-morbidities" or sometimes "weight-related illnesses."  So, for example, maybe are a person with diabetes and you are someone who actually makes a point of staying within your calorie limit every day.  You've been losing weight slowly, but your doc just told you that your bloodwork isn't looking so hot, so you decide to test your blood sugar more often, including before you eat after you eat.  You test your blood glucose before you eat and it's 115 mg/dL (which is not bad, could be better) and then you eat your little bowl of oatmeal, and about an hour later you test and you find you blood glucose is now 225 mg/dL! (I would love to see it less than 180, and that's still aiming for a higher goal than I want.)  You start testing at other meals and you still see higher readings than you want, but you were staying within your caloric limit and losing some weight!  So, you are probably meeting your goal of losing weight, but you certainly aren't meeting any blood glucose goals, and your related problems of blood pressure and triglycerides probably don't look so hot either.  This means that 1) you need to do some goal revision and add "bring my fasting blood glucose levels to 70-100, etc." and 2) realize that "what" you eat really is as important as "how much" you eat, especially for people with insulin resistant related problems (blood pressure, type 2 diabetes, prediabetes, high triglycerides, etc).

Second of all, while any weight loss is going to help someone who is morbidly obese, some people are worried about how much of their body weight is fat mass or lean body mass (muscle and all the other non-fat parts), a ratio that we usually call "body composition."  If you have achieved a weight that you want, but you still have a "spare tire" around your middle, chances are you've still got more body fat than what is healthy for you.  Or, most common in people who lose weight very quickly, the muscles in your arms and legs actually look shrunken, a condition we call muscle atrophy or wasting.  If you didn't lose your spare tire, you are all at a higher risk for diabetes, cardio vascular disease, etc, and if you lose muscle mass you might be more at risk for developing bone disorders later in life and you can still have more problems with insulin resistance.   I think that "losing excess body fat" is a more accurate description of what people really want to do, and most people would probably want to add "keep/build my lean body mass" at the same time.  "Change my body composition" would also be a fairly accurate phrase as well.  I do not like the term "lean out" because it sounds too much like an advertising gimmick, but that is my curmudgeon coming through.   Moral of the story here is that you probably want to preserve your lean body mass and lose extra fat, and the composition of your diet can make a difference as well as taking in less calories.  If you don't consume adequate protein (and a lot of my patients don't), you are more likely to lose muscle along with the fat.  If you don't do any kind of resistance training, you are more likely to lose muscle along with the excess fat.  If most of your calories are coming from carbohydrate, and you have a history of insulin resistance, chances are you are going to have trouble losing that spare tire because you are elevating your insulin levels, and the glucose that you do not "burn" for energy gets stored right there in your belly (you'll see something similar if you "save up" your calories so that you can have a six pack of beer every night).  Once again, I just simplified a very complex interplay of a variety of hormones, insulin is just one of those.  You can read a little more here.

Third, we do have to think about the way the basal metabolism does change when we reduce our calories.  At the risk of getting too anecdotal here, I have worked with people who had to lose a certain amount of weight just so they could have Gastric Bypass Surgery.  Yeah, it sounds weird, but we had some people that had so much extra abdominal fat that the surgeon could not perform the surgery, and a lot of them had addtional fat deposits in their liver which was also obstructing the surgeon, so losing weight would help remove the obstructions.  So, people would lose the required amount of weight, have the surgery, which for some was a life saving procedure, and then of course they would have to deal with the sneers, even from people in the medical profession, about how "well if you can just put less in your stomach now, why can't you do it forever?"  Well, my fellow skeptics, one of the reasons is that cutting the calories alone on average only helps people lose about 10% of their weight (Link).  Fine if you only wanted to lose from 205# to 185#, but if  you are 330# and you are now stuck at 300#, you probably still have some health problems going on and/or still being a little hard on your joints.  There was also a study done by the NIDDK that resulted in the creation of the Body Weight Simulator that shows the changes that your metabolism can go through when you reduce your calories.  So for some high risk individuals, having major surgery and inducing malabsorption is what that person and his/her physician has decided is the best course for them (and really, the sneering doesn't cause someone to lose weight).  Now, there is some evidence that people on carbohydrate controlled plans can actually alleviate some of the metabolic changes and go beyond that ten percent (Link), but then there are still those who have been overweight for so long that they still find themselves "stuck" at a higher body fat than they want (and my friend Georgene actually details her experience in her book).  Of course, your body fat percentage is not the only marker of your health either.  Some people do have extra and maintain excellent lipid profiles, blood glucose control, and blood pressure control, and they are (gasp!) even satisfied with how they look.

Fourth, losing body fat is not the hard part, keeping the weight off is.  That's why so many people are willing to brag about their latest diet, or "magic weight loss tool," when they first start, and then, in the words of Clemens at Ape not Monkey, "I hate it so much!"  So, you actually want to find a plan that you can stay with and not be hungry and yelling at people all the time.  I happen to prefer the carb controlled approach because by not elevating your insulin levels you can control your appetite better, but not every overweight person is insulin resistant and so that may not be the best approach for everybody.  And then there was a friend whose diabetes is currently controlled with Victoza and (mostly) diet, who asked me about going on insulin as every time she eats rice, etc her blood glucose goes way to high.  I tried to gently direct her to a more diet controlled approach, but, in her words "I want to be able to eat rice when I want too!" Not my way of approaching things, but as her main goal is to keep her blood glucose controlled AND still eat rice when she wants to, I can't fault her for that.  And then there is a related, but albeit more difficult to quantify, issue of "how I feel."  Some people, when they spend all day eating pop-tarts they just feel more tired (and if your blood glucose levels are swinging, you may not feel so hot).  Staying with your new plan is hard enough, why add more misery to your life by continuing to eat things that do seem to cause a noteable change in how you feel?

Fifth, I know some of you are whining about keeping track of your caloric intake, even if you've got a handy smart phone app for it.  I also saw someone complaining on the internet about how "our ancestors didn't count calories, so why should we?"  Well, even if you don't count calories (or exercise portion control, as I also call it), you are still going to be reading a bunch of labels for carb content and hidden whatever else you are trying to avoid, so you are still doing the same amount of work.  Also, true, those who limit themselves to protein/olive oil/vegetables (and are ok with that) don't really have much to think about, but some of the rest of us do actually want some of those indulgences (like wine!), so you better be keeping track of the calories and portions to make sure you are not indulging too much or too often.

In summary/take home message--both how much and what you eat are going to help you reach your health goals, it's not an either/or thing.  You need to ask yourself the following:
1) What kind of foods/quantities of foods will help me achieve my other health goals?
2)  Do I care about my body composition right now?
3)  Will I be content with just ten percent weight loss or do I need to try to go beyond that?
4)  Can I stay with some version of my diet for the rest of my life and, at the very least, be content with this?
5) Am I watching my portions of everything!

Tuesday, January 22, 2013

What about the carrots?

It's fun to have dinner with smart people and fun to follow up on those discussions on social networking sites, or even better, at the next dinner.  Those social networking sites are also great ways for those of us who don't get to attend a dinner meet-up to get the scope on what people discussed.  I noticed that I missed a hot topic of discussion on the nature of the so called "baby carrots."  Are they chopped up big carrots or specially bred little carrots?  How are they cleaned?   The answer might be different than you think.

Fortunately one doesn't have to look too far to clear up this one as snopes.com does a nice job of clearing that one up.  In summary, the consumption of carrots did lead to a product called "baby cut" carrots that were made from larger ones, but this actually led to the development of another type of carrot bred to be smaller, sweeter, brighter in color (apparently easier to market to kids too).  And yes, they are sometimes treated with chlorine to get rid of microbes that could cause a food-borne illness and rinsed; use of chlorine in this manner has found to be safe except on websites like mercola.com that are known for their anti-science ways.

One of the problems that I have encountered in my dealings with people with diabetes and others who are trying to decrease their carb intake is that they will avoid carrots because they are "too high in sugar."   And of course my (snarky) answer tends to be "compared to what?"

As always, we are talking about amounts here.  Let's say that you are a not-so-well controlled diabetic trying to clean up your eating habits, and right now your carb intake is about 15 grams per meal.  By using the internet resources available to you, as you should, you see that even a large carrot only has 5 net grams of carbohydrate per carrot (and ~31 calories), and you can get several carrot sticks out of that.  Heck, you could even eat 3 large carrots if you wanted to chew that much, and you will would still be within your limit.  I personally would rather much on those carrots than eat a piece of bread, for example, because I could "feel" like I'm eating more and get away with less.

There is a problem with the baby carrots, however, in that our perception of "enough" is skewed if we are not paying attention.  There is actually ~1 gram of carb per baby carrot, so you would only get about 15 at that meal (and that would be it for your carb intake).  Now, for those of you who sit and eat the whole bag of baby carrots (and you know who you are) you are going to get about 45 grams of carb at one sitting, which might be too much for you.  And then there was my patient who couldn't figure out why his blood glucose was so high when he was "eating" all these healthy vegetables via his brand new juicer.  Turns out he would put 2 POUNDS of carrots in the juicer, which would only produce about 16 oz of juice on his machine, and he would drink ALL 16 OUNCES at once.  That equals out to roughly about 60 grams of net carb per glass and ~372 calories (and that was along with his breakfast).

And then I have found that buying the carrots and chopping them myself is more economical, but that's just me.

Take home message--baby carrots and "baby cut" carrots can safely be worked to a carb controlled meal plan so you can get the fiber, potassium, and satisfying crunch.  If you have trouble with overconsumption and/or you want to save a little money, start cutting up your own carrots.

Be prepared for some Wineing.

We are in the post holiday season, and some people are not happy with their weight gain, so as a result they are hopefully paying attention to more of what they eat.   Some people,  however, are merely going by what they "hear" is bad for them and not necessarily taking the opportunity to look up what is actually in what they are drinking or eating.  The other day I saw a friend make a comment about all the "sugar" in wine, and as usual I knew I had to make a commentary.

*As an aside, not only am I skeptical of everything, but I really love a glass of wine, so you can be assurred that the research was done.

One of the comments I have heard besides wine having "a bunch of sugar" is that "wine has a ton of carbs," which is basically two different ways of saying the say thing.  Unfortunately, neither of those statements mean anything unless they are put in context.  What, exactly, is a "ton" of carbs?  And does wine actually have a ton of carbs?  To answer, you first have to figure out what your daily limit is (which I have talked about in item #7 in this post); so let's say that you are trying to keep it roughly about 50 grams per day because you are still trying to lose that little bit of extra weight/fat you have hanging around (so about 15ish grams per meal).  Second, you need to actually look up the carbohydrate content of wine, which is actually readily available on the internet (like here).  And then you have to pay attention to the serving size, so if you get a 4 ounce glass of dry red wine you will get----about 2.5 grams of carb (some less, some more like 3 grams)

Now, I personally cannot see how 2.5 grams equals a "ton" of carbs, particularly since most people who are eating carb controlled diets (particularly when they are eating out) will likely choose a steak (no carbs) and a salad without croutons (maybe 5ish carbs), so you know have about 7 or so carbs.  And even if you got a more standardized glass of 5 ounces, you are still only getting about 8-9 carbs for that meal.  So, once again, hardly a ton.  If you are consuming sweeter wines you will be getting about 5 or more grams of carb, so I suppose I could start to see why people start to use the undefinable term "ton of carbs."

Of course, if you go out drinking and have 2, 3, 4 glasses of wine the carbohydrate grams and the calories will eventually add up.  And since alcohol can stimulate the appetite, you might wind up giving in to having a "taste" or more of someone's french fries, and then take in more carb.  Or you lose track of what you are eating, period.  At that point, you have not thrown off your diet because of the wine itself, it was the AMOUNT that you consumed.

Now, if you are someone who is going through the less than 25 grams of carbohydrate per day phase because of poorly controlled blood glucose levels in Type 2 diabetes, etc you very likely will find it hard to work in one glass of wine, especially if you are trying to eat some vegetables during the day.  Of course there are other reasons that you are typically are not suppossed to consume alcohol during that phase.  If your blood glucose levels are high, you are already at risk for dehydration and probably do not want to complicate matters further by consuming alcohol.  Also, alcohol inhibits glucagon, a hormone that works in tandem with insulin to regulate your blood glucose levels, and anything that messes with the body's regulation of these hormones could result in more blood glucose swings.  (That was an extremely simple explanation of a complicated body process, read more here).  And I also think there is the often undervalued psychological effect too.  If you are making radical changes in your diet, and overconsumption of wine or any other alcohol has historically been one of your downfalls, staying away from something your body doesn't really need anyway for two weeks can give you 1) proof that you can survive without it, 2) a chance to see how  you feel without alcohol in your system, and 3) the feeling of starting off your new plan with a "fresh start."

Now, since my specialty is diabetes, I am going to point out some situations where a person with diabetes or pre-diabetes should not consume alcohol:
1) You are "cleaning up"  your diet as above.
2) You all ready have trouble with your kidney function.
3) You have fatty liver disease or any other known liver problems, such as Hepatitis C.
4) You already have known nerve damage that is causing you pain.  For some people they actually have more difficult to control pain when they consume alcohol.
5) You have a co-morbidity such as congestive heart failure, where alcohol can put even more pressure on your heart.
6) You are taking a medication that alcohol interferes with.
7) Your triglycerides are over 500--your risk of a nasty condition called pancreatitis is already way too high, and you don't want to push it.
7) You didn't drink to begin with.  (I still remember my poor little patient, who hated red wine, who was "ordered" to drink a glass of red wine by his cardiologist.  He dutifully choked it down nightly, only to see his HDL go up by a whole whopping one point and see his triglycerides increase).  Although there is some evidence showing that moderate consumption of red wine might have health benefits, there isn't really enough for non-drinkers to start.

Take home message--save the wine for after you have "cleaned up" your diet, but use the resources available to you to find out the carb/calorie content of what you are drinking and watch the amounts.

Thursday, January 17, 2013

Is that the good cholesterol or the bad cholesterol?

Last week I talked a little about some of the popular rumors about margarine in this post.  I thought I could move on from this topic, but as there no shortage of "I'm not a medical professional, but I play one on the internet" floating around on social networking sites, I decided that wasn't quite possible just yet.

One of my friends decided to make a comment about a doctor recommending that he eat more butter.  I try to stay out of things unless I am specifically paged, but then a comment was made about butter having "good cholesterol" and margarine having "bad cholesterol" and I knew I couldn't escape another opportunity to enlighten those who want to be enlightened.

Lets talk a little bit about what cholesterol is first.  Cholesterol is a waxy lipid that is part of the lining of every cell in the bodies of animals, both the two legged and the four legged kind.   Cholesterol is necessary for insulating our neurons (kind of like the insulation of a wire), it helps build and maintain the membranes of our cells, it helps us metabolize fat soluble vitamins, helps us produce bile (which helps us digest fat), and helps our body make the hormones needed for daily function.   In other words, this substance is suppossed to be present in a certain amount in a normal, functioning, healthy body. 

Most people think of cholesterol as something that there doctor checks levels of in their blood periodically, and that there are only two types--the suppossed "good" cholesterol (HDL) and the "bad" cholesterol (LDL).  Well, that's not exactly the case.  The acronym of HDL stands for High Density Lipoprotein and the LDL stands for Low Density Lipoprotein (and there is also a VLDL, Very Low Density Lipoprotein).  Now, if you take a look at those labels you will hopefully notice that lipoprotein is part of every label, but cholesterol is not.  That's because all those little labels are suppossed to signal a particular substance that has the JOB of carrying cholesterol.   So LDL and HDL aren't bad by themselves, they are just doing their job of carrying a vital body substance.

Now the problem seems to come when abnormalities develop in the LDL and VLDL and the amount might be indicative of later problems too.  Why do people develop abnormalities in their shuttles or have more of them.  Well, one reason seems to lie in our genetic history, some people for whatever reason tend to produce more smaller dense LDL.  The other reason lies in our diet, which is where things get a little messy, and I am going to do my best to summarize.

Since roughly the 1970's, although some might argue a little earlier, we in the medical community have argued that to lower the amount of LDL and VLDL cholesterol you needed to limit saturated fat and total fat intake (and watch your calories), which was essentially based on observational research done by Ancel Keys.  There were inklings that the research was flawed, but at the time that was the best advice we had.  Now, just because someone was concerned with their risk of heart disease didn't mean that they wanted to give up taste necessarily, so people starting using a lot more unsaturated oils and also filling in the gap with a lot of low nutrient carbohydrates.  (Anybody remember the favorite "diet" meal of the 1980's and 1990's consisting of a baked potato with low fat sour cream?)  None of that helped--as many people ignored that their low fat items often contained the same amount of calories, and if they weren't getting enough protein and fat they didn't feel full, and likely ate more.  All of these things together likely contributed to burgeoning waistlines, which in turn by itself increases LDL.  The increase in vegetable oils might contribute to an excessive intake of omega-6 fats, which might contribute to inflammation, and the body will start shuttling more cholesterol to "heal" the inflamed arteries (hence more LDL).  And the overconsumption of refined carbohydrates can lead to elevation insulin levels, also possibly triggering inflammation, and therefore, more LDL. 

Like I said, that was a summary, there is a whole lot more involved, but some of it gets on shaky ground as far as consipiracy theories about Big Pharma, etc.  But the moral of the story is that what a lot of people thought they were doing to lower their LDL levels backfired, and it also explains why people on low carb diets where able to improve their lipid profiles despite eating a lot of animal fat--they reduced their caloric intake, lessened their intake of omega-6, and they reduced their insulin levels.

But what about the people who went vegetarian or vegan and also claim lower weight, lower LDL, etc?  I think the explanation lies in the type of plans people follow when on they are on a controlled study, in other words, the study diets would have limited the caloric intake and helped with the weight.  They would have been low in fat, and quite possibly contained nuts and flax when fat was allowed, and they may have gotten a few more omega-3's and less omega-6's, and they still would have likely excluded the added sugars and the processed white bread, etc, meaning that they wouldn't raise insulin levels as much.   Now, when I was vegan, I like to think that I ate more like the "study diets" and I was able to keep my lipid profile in great shape and my weight under control for the most part (It didn't, however, take care of my GI problems, which is another story)  But we all know the people that cut out the animal foods only to pig out (that's a scientific term) on pasta and soy burgers and barely pick up a vegetable ever. 

So what can we agree on from a scientific standpoint so far?  Limit or avoid added sugars, limit or avoid refined starches, limit or avoid trans-fats, control your portions, consume animal protein that is as close to nature as possible, keep your animal fats as close to nature as possible (to get more omega-3s), limit or avoid processed vegetable oils, be careful about your alcohol intake, don't smoke, and control your portions.  Or as Michael Pollan said--"Eat food.  Not too much.  Mostly plants."

So, if you are still with me, let's go back to the butter having "good cholesterol" and margarine having "bad cholesterol."  First of all, margarine is not an animal product so it couldn't have cholesterol in it to begin with, nor does it contain low density lipoproteins either.  Second of all, dietary cholesterol does not raise the LDL, so the cholesterol (not lipoproteins) in butter does not affect you. Third, trans fat does raise LDL, but most margarines/spreads these days are trans-fat free.  Fourth, if you consume your butter on a pile of pasta/white rice/white bread (aka refined carbs), you are likely going to have trouble with your weight, LDL levels, and your triglycerides.

Take home message--The cholesterol found in food is not the same as the liproprotein carriers that are often misnamed as a type of "cholesterol."  And if you are using butter, watch what it's going on on what it's going along with.

Cholesterol and health

Tuesday, January 15, 2013

Put your pH strips away.

Just when you thought it was safe to go back to reading the tabloids (as if it ever was) I came across the "latest" diet craze according to the Daily Mail: These Female Celebrities Swear by the Alkaline Diet.

First of all, there is a reason that this tabloid is normally referred to as the "Daily Fail."  Second of all, it isn't new.  Third, it's more proof that most of don't know the basics of how our body systems work and work together.

The reasons why this is nonsense has already been adequately and succintly covered by Dr. Gabe Mirkin over at Quackwatch.  But let me highlight this paragraph right here:
"Dietary modification cannot change the acidity of any part of your body except your urine. Your bloodstream and organs control acidity in a very narrow range. Anything that changed acidity in your body would make you very sick and could even kill you. Promoters of these products claim that cancer cells cannot live in an alkaline environment and that is true, but neither can any of the other cells in your body."
In other words, your body is doing just fine on it's own as far as controlling pH levels is concerned; if it wasn't, you would be dead before you could whip up your batch of beetroot and walnut dip.

Now, is there still an advantage to getting rid of your high caloric soft drinks/coffee drinks/alcohol and other added sugars?  Of course, because you are reducing your calories, which will help with your weight,  and you are reducing your carbohydrate intake which will help those of us with insulin-resistant problems like diabetes and pre-diabetes (and the high blood pressure and cardio-vascular diseases that go along with that).  You also get to fill up on the nutrient dense, but still low calorie, items like vegetables and some fruits.   But, you will also likely be shorted on protein (as even beans are limited!), and I have written before about the pitfalls of raw diets.  And do people really think these celebrities prepare the food themselves?  Really?

Take home message--There are still good reasons to fill up your diet with fruit and vegetables and avoid processed/low nutrition foods, but changing your blood pH isn't one of them.

Monday, January 14, 2013

Honey, I love you but I just can't believe you.

My friends and readers are always worried that I am going to run out of material (or they like to watch my head explode), so the other day I got this:
honey and cinnamon cold remedy 1 teaspoon honey 14 teaspo - food

And with that picture were several paragraphs that essentially said honey cures everything.  If you are interested in the details, the full text is here on snopes.com.

First of all, if you look at the supermarket tabloid where this is published in 1995, you will notice that in that same publication you can read about AIDS cures being found in African vines and demons from hell killing people in church.  If that doesn't give you pause, I really do not know what to tell you.  However, I do know that sometimes you can find a shred of evidence mixed in outrageous claims, so I did go on an evidence hunt, starting with the honey anyway.

Naturally, there wasn't any evidence that supported any of those outrageous claims.   The only thing that I found that came close to having good evidence was the use of honey in wounds, usually in a product called Medihoney. (Link)  Emphasis on the MEDICAL GRADE honey, as in it's been pasteurized to make sure THERE ARE NO REMAINING YEAST/SPORES IN IT TO MAKE YOUR WOUND WORSE. (Yes, I am shouting because today I have been working with people who are that careless!)  And guess what, if your wound is already infected, you probably still need anti-biotics, but at least the medihoney can keep additional bacteria from getting in there and also dry out the wound.

One other thing that I will touch on is a question that I have received a lot over the years, and that is "Are 'natural sweeteners' like honey good for diabetics?"  Well, since you asked:
1) Natural does not mean it's better.  Arsenic is natural.
2) Honey contains carbohydrate, about 15-17 grams per Tablespoon.
3) People with type 2 diabetes have to control their carbohydrate intake when they eat (Average about 30 grams per meal, less if they attempting to lose a lot of weight and/or having out of control blood sugars).  People with Type 1 diabetes must compensate for any carb eaten with short acting insulin.
4) If you are capable of measuring out how much honey you are consuming, you could possibly work it in to your carbohydrate intake when you use it.
5) Since your eyes just glazed over when I mentioned the word "measure," you could also use your favorite sugar substitute and not worry about it.
6) You claim you can't use any of the sugar substitutes and you are wondering if you can use honey in moderation.  See point number 4--if you don't measure it at least once, you are likely getting too much.

Take home message--Honey will not magically cure anything.  If you use it, compensate elsewhere in your carb intake.

Wednesday, January 9, 2013

It makes no Sensa

The other day a Recreation Therapist co-worker was expressing dismay over the weight gain of one of her clients who has been known to eat large quantities of food in one sitting.  This unfortunate man has impaired decision making capabilities because of a brain injury, and even though his caregiver is trying to feed a healthy plan he still has trouble with overeating.   Caring for someone in this situation can be frustrating to say the least, and it can make one more vulnerable to the weight loss products that are advertised as helping people avoid overeating (particularly if they are labeled as "natural," etc).  This particular therapist had wanted to recommend Sensa as she thought it might help prevent this guy's tendency to overeat, but fortunately she was skeptical enough to ask me about it first.

Sensa, for those of you who don't know, is a "food sprinkle" made of  maltodextrin, tricalcium phosphate, silica, and flavors.  It is basically a strong smelling and the principle behind it is that the enhanced smell will work on the "satiety switch" in your brain and cause you to feel fuller, sooner.  The appeal of this product is also suppossed to come from it being "doctor designed" and he has apparently done research on this in which people lost weight. (Link)

Red flags?  Of course.  First of all, only one study was done and it was sponsored by HIS company.  Second of all, the study was not published in a peer reviewed journal.  Third, the study was only done for 6 months and there was no follow up to see if people were able to keep the weight off.  Fourth, there was only one very small study that indicated there might be something to sniffing peppermint and feeling full, but apparently the effect is short lived anyway. (Link)

Then there is the practical problem--not everyone stops eating when they are satisfied or full (especially when the food tastes good), so you still have to make that concious effort to stop eating when you are full.  (Behavior modification techniques for this will take up another blog post!)  And as this blogger said, you apparently feel like all of your food tastes like onion powder and/or crushed smarties depending on which Sensa product you use.  I think losing weight is hard enough work, do we really have to torture ourselves by eating food that tastes only of onion powder?  (I like onion powder, but not on everything).

So, no, I can't see any good reason that someone should spend the money on Sensa.  What I would do is take that money that you were going to spend on that product and take a cooking class that teaches you how to use herbs, spices, good fats, etc to actually help you enjoy what you are eating so you can actually stick with your plan.  Or just start experimenting with different spices using recipes from the internet.  Sure, you probably still have to limit your cheesecake consumption, but there's no reason that you can't eat well with what you have.

Take home message--Stay away from the Sensa, improve your cooking skills, and keep working on the behavior changes.

Tuesday, January 8, 2013

Psuedoscience Language

Typically whenever someone wants to promote their way of eating, food product, or herbal supplement there seem to be several common phrases that they use.  Here are a few of my favorite "claims" that need to go away.

1) Eating food "x" will stabilize your blood sugar.   I think a lot of people hear this and have this image that something they eat is going to either keep their blood glucose from going to high, or keep it from dropping later.  It's as though the eating of that food will somehow invoke the Blood Glucose Fairy who will wave her magic wand and "poof" all your blood glucose issues will resolve.   Sometimes this is used to dress up a claim that is downright false—one that I still hear is that eating protein with carbohydrate will somehow keep the carbohydrate from converting to blood glucose as fast.  That is incorrect, as only fat and fiber can slow down the emptying of your stomach and allow for a slower entrance into the small intestine and later into the blood stream.  If you have diabetes and you do not want your blood sugar to "spike" after a meal, then limit the amount of carbohydrate you eat at a meal period, and get a little help by eating some good fats and fiber along with that.  If you are pre-diabetic and/or feel like you have a blood glucose drop in between meals, you need to do the same thing to avoid over production of insulin resulting in a blood glucose drop later.  So, a better turn of phrase might be "you can avoid blood sugar and/or insulin spikes after a meal by limiting your consumption of "x" and by making sure you have adequate amounts of "y."

2) Eating food "x" will balance your hormones.  The last time I looked there were more than 60 different kinds of hormones, so I am wondering which one the particular food is supposed to "balance."  I suppose people who have hypothyroidism (aka "low thyroid hormones") or low testosterone or other "sex hormones" might be looking for a magic food to help the body produce more of something, but so far we do not have any good evidence that any one particular food or way of eating will do this.   I do get questions about certain foods, like soy, inhibiting thyroid function, but once again we don't have good human models for this (Link).  We do know that people with thyroid issues might have problems if they eat a lot of seaweed and get to much iodine, but that is pretty much the only good evidence we have.  Now, remember insulin is a hormone, and as I stated above, a person with insulin-resistant problems who eats too much carbohydrate will likely over produce insulin.  But avoiding carbohydrate doesn't "balance" it, it just keeps it from spiking.

3) Eating food "x" will boost your immunity (subtext of lymphatic system).    For those of you who are new to my blog, let me point you to my previous post that explains why boosting your immunity is a bad idea as it is normally understood.   Now, if you do find that you are engaging in a lifestyle behavior that causes yourself to be less than optimal, such as not getting enough sleep, it would be beneficial to correct it, but don’t try to overinflate that tire.

4) Eating food "x" will boost your metabolism.  Once again, I have covered this before.  Unless you’re exercising, and even then, you are probably not burning very many calories by doing whatever they wanted you to do or taking whatever you want to take.
5) Eating food "x" will strengthen your heart.  First of all there isn’t any evidence that particular foods or supplements will actually strengthen your heart muscles, particularly if you already have congestive heart failure or you have already had a heart attack.  You can, however, eat properly to lose weight to take the pressure off a weak heart, reduce your chance of inflammation, and alter your lipid profile, which are all wonderful things, but you are not strengthening the heart muscle.  You can improve your heart function by exercise, even after a cardiac event, but keep in mind that you are actually not “building” muscle in the heart.  If your heart muscle did actually get bigger, then you probably have another underlying serious condition.

Take home message--be very skeptical of anything that promises to "balance," "stabilize," or "strengthen" anything in your body.  You might not really be getting what you want.

Monday, January 7, 2013

Water in the morning?

During the morning social media workout I came across another meme gone wrong, and I knew I had today's material:
And they even numbered it for me, how kind of them to help me organize my blog.

#5) Once again, it looks like they are counting on people's ignorance when it comes to the inner workings of their own body.  A normal working digestive system is not a tube that food and/or water just flows through unimpeded, and most of us would find it fairly disgusting and unable to leave the bathroom if this were so.  Typically you are going to absorb most of the water you consume in the small intestine and very little actually goes into the large intestine (aka colon).  Now, if you are dehydrated this can cause constipation, in other words, this can interfere with the body's "normal" processes of elimination, but preventing constipation has nothing to do with what time of day you take in fluids.  I suppose some people might get a better start on their daily hydration by drinking a large glass of water in the morning, but don't expect any additional "cleansing" properties from this. (1, 2)

#4) I just pictured all the little cells in my marrow breathing a sigh of relief and saying "Oh good, she just drank water."  (Sorry, I was one of those kids that grew up on Schoolhouse Rock)  Of course, it's way more complicated than that.  Your bone marrow is making and breaking down red blood cells all day every day and it's going to do it whether or not you drink water in the morning.   My best guess is that this myth came from people being told to drink water before and after donating blood.  This is a good idea, not because the water will help you "build up" your red blood cells but  because 1) you might be a "harder stick" if you are dehydrated and 2) you may be more likely to experience a drop in blood pressure and get dizzy/faint if you are dehydrated.  That last one could be embarrasing and dangerous if you hit your head or pass out while driving later.  It is also why they tell you to not to drink alcohol after donating, so that you limit your chances of getting dehydrated.  Now, as far as building more muscle cells, you build muscle by doing weight bearing exercise (and making sure your protein intake is adequate, among other things).  Now, once again I suppose that this myth got twisted from dehydrated people getting fatigued sooner when they are exercising and their lack of exercise causes them not to build as much muscle, but then I really don't know what goes on in the mind of those who promote "woo-woo."

#3) I actually covered this before in a previous post that referenced a small study done in Germany that states you might burn an additional whopping 50 calories per day, which can be undone by eating half of a slice of bread.  Honestly, I have no idea where that 24%  came from.  By using one of the handy-dandy Basal Metabolic Rate (BMR--aka the calories you need daily to stay alive) calculators on the internet I know I need about 1400 calories per day to meet my basic needs (in theory), which means drinking cold water in the morning is suppossed to help me burn an extra ~335 calories per day?  Don't I wish.

#2)  Once again, we have some truth here.  People who are severely dehydrated can actually have skin that has a dry and shriveled appearance and doesn't "bounce back" when pinched.  But once again, this is when people have not been consuming enough fluids in general.  And we have the lovely use of the word "toxins" again, which is basically another way of saying "drinking water in the morning will cause the evil spirits to leave your body and your eyes will not be glowing red anymore."  So, if you are not drinking enough water that real waste products are building up in your blood stream and coming out through your skin, you are probably in kidney failure and need dialysis.

#1)  I plan in the near future to write a whole post about the use of the word "balances" and how it usually means absolutely nothing.   Yes, the lymphatic system is crucial for aiding the immune system and removing excess fluid and waste products from the body, and severe dehydration does impair the removal of wastes as above stated, but once again, if something is wrong with your lymphatic system drinking water isn't going to take care of it.  If your lymph glands are swollen because of an infection, you need to clear up the infection first.  If your lymphatic system has been damaged, then you will need compression garments and massage to help the lymphatic fluid drain properly.

Take home message--If drinking a large glass of water soon after waking help you meet your hydration goals, by all means do so.  But don't expect any other magic things to happen.   And enjoy this more sarcastic post from a science friendly site.

Saturday, January 5, 2013

The other secret of Paula Deen

Saturday mornings are usually reserved for listening to NPR around the SkepticRD household, particularly Wait, Wait, Don't Tell Me and This American Life.  The former was actually a rebroadcast and  the celebrity on the Not My Job segment featured TV food personality and now diabetes drug Victoza spokesperson Paula Deen.  Which reminds me of another article that popped up on my feed yesterday about how Paula is going to be discussing her weight loss again in a magazine next month.  And I also remembered what annoyed me about that article.

 First of all, I rarely take anything the Huffington Post posts seriously about nutrition or science because it has a a consistently poor evidence-based profile.  Second of all, they touted that the main reasons that she is losing weight is because she is making little changes and practicing moderation (as well as giving up her sweet tea).  And while I do say good for her, I think there is a very important thing they are leaving out, and that is that she is most likely taking and an advocate for a drug that is known to suppress the appetite.

Now, those of you have been reading this blog know that I am not anti-medicine when medicine is called for.  I would love nothing more than for people to control all of their chronic health conditions with diet and exercise alone whenever possible, but for a multitude of reasons not everyone can or chooses to do that, particularly when they are having an acute phase or exacerbation of the disease.  But I also think that we need to talk about those side effects.  As stated in the above linked article, many people experience nausea when they first start on the drug, which likely takes away the desire for donut cheeseburgers right there.  Even after the nausea passes many people are able to eat those smaller portions and stick with it because the drug helps them not want anymore.

Now, what do I see people complaining about when they try to lose weight?  It is the hunger that they experience when they just try to cut back.  It is the difficulty in not having the second helping of whatever that tasty food is.  It is watching other people eat something while you breathe in the aroma of that fresh-made bread or whatever.  It is also the humiliation that people experience when thin people sneer at them for their lack of impulse control.  There are people who overcome these things through behavior modification and eating foods in proper ratios to satisfy hunger, but there are others that do get help from medication (or weight loss surgery) and I certainly applaud them for doing what they need to do.

So Paula, please share how you have cut back.  But please do not withhold the evidence, OK?

Friday, January 4, 2013

What to do about a bad "Report Card."

While scrolling through today's newsfeed, I came across this blog article from MedPage Today about the use of something call surrogate endpoints: (Link).  In turn, this article had links to another excellent posting on what a surrogate endpoint is: Primer on Surrogate Endpoints.
For those of you who are still feeling a bit woozy after reading the medical jargon, let me use this metaphor: think about surrogate endpoints as kind of like the grading system that is used in schools.  Teachers/parents/children traditionally have used the grading system as an indicator of how the child is doing in skill now, but they also look at these grades as indicator of how well the child is going to do in their future academic career and there is always speculation about how they are going to do well in life.  But, those grades are just one indicator of success later.  Teachers and parents also look at the child's interpersonal skills, what kind of help/support they are getting in the home to achieve those grades, what kind of physical limitations they might have, what kind of learning difficulties they might have, etc to paint the whole picture.  People with diabetes and/or high cholesterol also get "report cards" that reflect their latest blood cholesterol and triglyceride levels, their Hemoglobin A1C test, and quite often their weight/BMI (seriously, several of the educators I've worked with call them report cards) as some sort of indicator of how they are doing with current disease control and speculation of future health and longevity.

And what I just mentioned was the positive side of the metaphor in an idealized school situation (I'm also thinking of what school was like more years ago than I'm admitting), let's look at the downside of the metaphor.  How many teachers/parents/children do we know that are so obsessed with getting a good grade in a particular subject or subjects that they actually neglect learning other life skills?  Or how many kids worked their behinds off to get a passable grade and were told they weren't working hard enough?  And how many kids to we know who didn't do well because of lack of parental support or poor nutrition?  And how many kids do you know who did well academically but didn't do well later in life for whatever reason?  The parallel that I am trying to draw here is that some people are so focused on getting that cholesterol down that they are willing to put up with medication side effects instead of focusing on diet.  I have seen so many people work to get their A1C down to goal but their docs tell them it's not good enough.  Or they have a doc that is unaware that BMI should not be used to judge individuals.  Or, they have limited funds and social support making achieving their health goals difficult.  In other words, because your health "report card" was off your are "told off" by your doc or somehow made to feel like a moral failure when that is only the tiniest part of the picture.  So what does a health conscious skeptic do?

1)  As I've said before, read the original research associated with the "medical breakthrough of the week" as much as you can.

2) Understand that your cholesterol levels, etc are just one indicator of your overall health.   While usually much more scientific than a crystal ball in judging future outcomes, they are not going to tell you "you will have a heart attack on such and such a date."

3) Find out what is really a good marker for your age group based on the available research.  For example, if I have a patient over 75  years of age and has cognitive deficits, their goal is usually to achieve an A1C of less than 8%.  We don't want their blood glucose levels to drop too low as they may not be able to communicate the problem and we are not worried about complications long term.  If they are 29 years of age and they want to have better odds at keeping their kidneys in good shape, we would set the goal of <6.5%.   Remember, the medical breakthrough of the week might not even apply to you!

4) Get a complete picture as much as possible.    Is your bad cholesterol high?  OK, find out about particle size and inflammatory markers (CRP levels).  Told you are too fat?   Remind your doc you lost a hundred pounds and you have kept it off for a year.

5)  If you are unhappy with what your doctor/diabetes educator/dietitian is telling you in regards to your indicators, something doesn't make sense, or you feel that a particular goal is not achievable, then you can politely tell him/her what the problem is.  For example, if you go for your physical and find out your "bad" cholesterol is high and your doc wants to put you on medicine right away, tell him/her that you want to come back in 3 months at the latest as you want more time to research the side effects/risks of that medicine and you want to improve your diet (and be specific!).  If your doc is not willing to work with you, find another doc.

Take home message—Surrogate endpoints are great for stimulating research to help find ways to help us live healthier and maybe longer.  Stop calling your labs a report card and look at the big picture.

Thursday, January 3, 2013

Margarine comes back

It's a new year, and it's also time to package up old myths as though they were new.  I saw another one come around on the Internet the other day about margarine.  There are a variety of versions of this myth and meme, but most of them go something like this:
1) Margarine was created to fatten turkeys but it killed them.  The mysterious creators of this product wanted money so they sold it to humans.   Alternatively, the origins of margarine are listed as part of the creation of soap or lubricant for WW II planes.  In all of them someone wanted money and sold it to the American public as part of a conspiracy.
2) Eating margarine increases heart disease because of a study done by Insert Prestigious Sounding University here.
3) Butter contains "many nutrients" but margarine doesn't (no nutrients  listed).
4) Butter tastes wonderful, margarine does not.
5) Butter has been around a long time, margarine less than one hundred years.
6) Contains trans fats, alters the cholesterol ratio in a non-favorable way, causes cancer, lowers breast milk quality, causes diabetes, decreases immunity, lowers the resale value on your home (just trying to see if you are paying attention!)
And then they usually hit you with the punchline.
7) Margarine is one molecule away from plastic!  Bugs won't eat it!  Put it in a time capsule and 100 years later it will still be there!
Now, is there any evidence to support those claims?  Let’s take a look at each one.
1)  Fortunately, one doesn’t have to look very far to find this has no basis in fact.  Back in 1869, a French chemist named Hippolyte Mège-Mouriès created a butter substitute for the lower classes and the military at the behest of Emperor Louis Napoleon III.   Now, I could see how some people might eventually twist this into the French upper class wanting to hurt the lower class, but usually you do want to give soldiers enough food so they can actually fight, so I don’t really see a conspiracy there.     If anyone has any information on how this story somehow evolved into “fattening turkeys” I would like to know.  Now, margarine did become used more often in the WW II era because food rationing limited the availability of animal fats, but once again I don’t really know how they got “airplane lubricant” out of that.  Maybe someone thought the taste was comparable, but I don’t want to know how they figured that out.
2) There is some twisted truth here, as apparently this “claim” comes from a study done in the 1980’s looking at trans-fats in general.  At that time, margarine contained a lot more trans fats that what we see today, and remember the study would have looked at other sources of trans fats besides margarine.  So, we can’t really rely on this claim given the different state of margarine today, and if someone refuses to use margarine but still smokes, eats excessive amounts of fast food (where trans fats are found) eats too many processed carbs, doesn’t exercise, has a family history of heart disease, etc you can still increase your heart disease risk.  Usually whenever someone makes a claim that one thing does another and ignores all the other factors you should be suspicious.  Now, once again, if you get a lot of omega-6 fats in your diet you might be setting yourself up for inflammation, would could also up your heart disease risk, but I’m also getting worried about your calorie intake at that point.
3) Well, butter does contain fat, but it really doesn’t contain a significant amount of vitamins and minerals, so this claim doesn’t hold water either.  Now, we do need to eat a certain amount of fat for cell membrane function, satiety, and to absorb certain vitamins, but we won’t actually get those from butter itself.
4)  Well this claim is up to the individual and I don't have a good record of who rates what higher on a hedonic scale.  Keep in mind though that margarine does have quite a following among Jewish people who keep the dietary laws of Kashrut which forbids mixing meat and dairy at the same meal.  Those of us who don’t tolerate dairy or who eschew animal products have also historically relied on margarine and other spreads, and since some of us can be quite loud in our request for alternatives it appears the taste and texture is an improvement over what the WW II generation had.  And of course we should never undervalue what good taste and texture does for helping someone stay on their new and improved diet.
5) No, see point number one.  Although they might be referring to the different incarnations that margarine has gone through, this is still an example of a logical fallacy called an Appeal to ancient Wisdom.  Older does not make it better.
6) Once again, there is a lot of twisting of a strand of truth here.  A high intake of trans fats does seem to be associated with an unfavorable lipid profile (in other words, raises LDL [bad] cholesterol and might lower HDL [good] cholesterol, a higher cancer risk, and more insulin resistance which can eventually lead to diabetes.  But, if today's margarine's don't have the trans fats, then we really cannot use this argument against margarine.   Once again, using too much vegetable oil can lead to an over consumption of omega-6, but that is not even part of the argument here.

7) And here is where the crazy people show their complete lack of chemistry.  Dan O'Brien over at Cracked.com said it the best: Saying something is "one molecule away" from plastic is like saying a farm is one letter away from a fart. Water is "one molecule away" from being explosive hydrogen gas. (Read the rest of this article here ). In other words, you can have chemically similar things that are still very different in reality.

Now, as fascinating as all this is, I am sure you are still wondering what to choose, and of course the answer is--it depends.  If you do not tolerate dairy like yours truly, make use of olive oil, coconut oil, palm oil, etc as often as you can.  Choose an omega-3 supplemented non-hydrogenated spread like the ones made by Earth Balance (they make a soy free one too!).  If you do tolerate dairy, choose a high quality, preferably grass fed butter and once again make use of the olive oil, etc so that you get a variety of fats.  And please watch what you are putting it on.  People who eat mostly protein and vegetables and season it with butter or a high quality spread are still going to have a lower calorie intake, and less cardio vascular risk than those who are eating large amounts of bread/pasta/rice/pastries/pie crust, etc. (and you know who you are!)

Take home message--Butter might be a better choice for those who tolerate dairy, but not for the reasons above.


Wednesday, January 2, 2013

Stop the Cleansing!

It's a New Year and people are ready for fresh starts.  I know I usually try to clean out my closets about this time and some people are also trying to clean up their diets in anticipation of a fresh start.  But what also comes along are several different kinds of programs that claim to "cleanse" your system after you have over indulged in holiday sweets or alcohol.  Are any of these things worth it?
I have written in a previous post that typically a lot of these programs are claiming to remove "toxins" from your system, and remember "toxin" is just a modern day word for "miasma" or "imbalanced humors." So, it is unlikely that you can be cleansed from something that doesn’t exist.  If you had in fact been poisoned, it is unlikely that drinking juices or taking the herbal product will help that.  I also wrote another post here about the problem with colon cleansing, which is also un-necessary and in no way evidence based.  The conclusion, of course, is that if you have been eating or drinking some things that are going against your health goals (like too many cookies), you can get closer to your goals by removing and/or greatly reducing the offending items and by making sure that you get an adequate amount of what you do need.  There is no magical item that will cleanse us of our perceived dietary sins, so to speak, but we can improve our health by eliminating certain items and by allowing our bodies normal metabolic processes to clear out the waste products.
But of course, I still get thrown articles like this (Clean your kidneys), which indicate that there is something accumulating in organs that can be eliminated by one simple natural thing!! (Notice how no one tries to sell you anything complicated).  The statement that got me was this one here: With time, the salt accumulates and this needs to undergo cleaning treatments and how are we going to overcome this?
To understand how ridiculous this statement is, let us talk a little bit about the anatomy of the kidney.   There is a more extensive and well done piece over here at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) here, but for now we will focus on the part of the kidney where the removal of waste actually takes place, in the nephrons.  Each kidney has a million nephrons, and each nephron contains a tiny little sieve called the glomerulus.  A normal functioning kidney will be able to gauge what needs to be filtered out into the urine and what needs to be reabsorbed, it's a delicate balance but our body has evolved to keep that whole process in check.  Sometimes, however, people have a chronic uncontrolled condition (like diabetes or hypertension) that put so much pressure on those delicate filters that they actually fall apart and become useless.  If enough of the nephrons fail, waste products and minerals build up in the body and the only way to remove them from the blood stream is by dialysis and/or kidney transplantation.  You can read more about that in the NIDDK piece, but it is not a process most people want to go through.
So, if your nephrons did actually accumulate salt in them like this article claims, you would need dialysis instead of a cilantro shake.  Fortunately, salt does not accumulate in the "filters" and therefore the need to add "cleansing agents" is not evidence based.  Now, some people with chronic kidney disease will experience swelling of the ankles/feet/hands when they take in too much sodium because their remaining nephrons cannot keep up with the demand.  Once again, the cilantro drink will not help you, but limiting your sodium intake in the future will prevent it from happening again (and some people even need medicine to help restore the balance).  And if you do have diabetes, hypertension, and/or are overweight, eating properly to control these conditions will help keep you nephrons in good working shape.
Oh, and one more thing, even if the cilantro did remove the excess sodium from the body, if you had too much of this you could develop a potentially dangerous condition called hyponatremia (definition) where the concentration of sodium in your blood becomes too low.  People with heart failure and chronic kidney disease who do have to take diuretics (aka "water pills") have to be monitored closely so that they don't have the delicate balance of sodium and water in their blood disrupted.  And any competitive athlete will tell you that they will usually have to consume an electrolyte solution during periods of intense training and competition (I've posted here about how that's likely not you).  So be careful of anything that claims to help you "lose" sodium because if it did work you might be in trouble.
Take home message—To keep your kidneys healthy stay hydrated and control chronic conditions like diabetes and hypertension, otherwise your body is doing fine on it's own.